Development of a Multi-faceted Cognitive Training Program for Children With Attention Deficit Hyperactivity Disorder (ADHD)

After decades of Attention Deficit Hyperactivity Disorder (ADHD) intervention research, only
two intervention approaches (i.e., psychopharmacology, behavioral treatment) have a
"well-established" evidence-base supporting their efficacy for children with ADHD. Both of
these interventions have inherent limitations. Recently multiple studies have demonstrated
that cognitive training may improve neuropsychological and behavioral functioning in
children with ADHD. The magnitude of treatment effects for cognitive training has been
comparable to treatment effects for behavioral treatment for ADHD (i.e., small to moderate
effect sizes). A limitation of existing cognitive training programs that may limit their
efficacy is that each has employed a unifaceted approach. Each intervention program has
targeted a single cognitive domain (e.g., working memory). This is problematic since as a
group, children with ADHD have multiple areas of cognitive deficit (i.e., working memory,
attention, response inhibition, delay aversion, intra-individual variability) and thus a
unifaceted intervention does not address the multifaceted array of cognitive dysfunction in
children with ADHD. Also, because individuals with ADHD each have unique patterns of
cognitive deficits, a unifaceted cognitive training approach may target areas which are
non-deficient and miss areas of significant deficit in individual patients depending on
their ideographic cognitive profile. The primary goal of the proposed research is to develop
and test a multifaceted cognitive training intervention that addresses a comprehensive array
of ADHD-related cognitive deficits thereby ensuring that children's unique areas of
cognitive deficit are targeted. During Phase I (R21 grant), software and a manual will be
developed consisting of four training tasks targeting response inhibition, verbal working
memory, attention, and delay aversion. Each task will possess advancing levels of
difficulty. On each task, children will receive feedback on performance accuracy as well as
on intra-individual variability in reaction times. The software will be pilot tested in
Phase I to determine performance thresholds and intervention duration. Also, focus groups
will be conducted to obtain patient perceptions of each task's difficulty and interest
level. In Phase II (R33 grant), a preliminary randomized clinical trial will be conducted in
order to obtain initial estimates of treatment efficacy. Pre-, post-, and follow up outcomes
will be collected on a wide range of neuropsychological, behavioral, and academic measures.
Effect size estimates across outcomes will be used to guide sample size determinations for
future clinical trials of multifaceted cognitive training.