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Computerized Cognitive Interventions for Adults With ADHD: A Systematic Review and Meta-Analysis
Luleå University of Technology, Department of Health, Education and Technology, Health, Medicine and Rehabilitation.ORCID iD: 0000-0003-1717-240x
Luleå University of Technology, Department of Health, Education and Technology, Health, Medicine and Rehabilitation.ORCID iD: 0000-0003-4813-0309
Luleå University of Technology, Department of Health, Education and Technology, Health, Medicine and Rehabilitation.ORCID iD: 0000-0003-2511-1631
Luleå University of Technology, Department of Health, Education and Technology, Health, Medicine and Rehabilitation.ORCID iD: 0000-0002-2709-9966
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2023 (English)In: Neuropsychology, ISSN 0894-4105, E-ISSN 1931-1559, Vol. 37, no 5, p. 519-530Article, review/survey (Refereed) Published
Abstract [en]

Objective: Treatments for adults with attention-deficit hyperactivity disorder (ADHD) are understudied, compared to children and adolescents with the same condition. In this systematic review and random-effects meta-analysis, we aim to evaluate the outcomes of computerized cognitive training (CCT) interventions in randomized controlled trials (RCTs) including adults with ADHD.

Method: Cognitive outcomes and ADHD symptom severity were analyzed separately. In addition, the Cattell–Horn–Carroll (CHC) theory of cognitive abilities was used to categorize outcome variables into subdomains, which were analyzed separately in a subsequent analysis.

Results: The results revealed a small positive change in overall cognitive functioning, a measure of all cognitive outcomes in each study, for individuals who took part in CCT compared to controls (k = 9, Hedge’s g = 0.235, 95% CI [0.002, 0.467], p = 0.048, τ2 = 0.000, I2 = 0.000). However, neither symptom severity nor specific cognitive outcomes (executive functioning, cognitive speed, or working memory) showed a significant improvement.

Conclusions: We analyzed the risk of bias in the chosen studies and discuss the findings in terms of effect size. It is concluded that CCT has a small positive effect in adults with ADHD. Due to the lack of heterogeneity in intervention designs across the included studies, increased heterogeneity in future studies could help inform clinicians about the aspects of CCT, such as training type and length, that are most beneficial for this group.

Place, publisher, year, edition, pages
American Psychological Association (APA), 2023. Vol. 37, no 5, p. 519-530
Keywords [en]
attention-deficit hyperactivity disorder, computerized cognitive training, meta-analysis, systematic review, executive functions
National Category
Psychiatry
Research subject
Psychology
Identifiers
URN: urn:nbn:se:ltu:diva-96327DOI: 10.1037/neu0000890ISI: 000946153700001PubMedID: 36892894Scopus ID: 2-s2.0-85150836585OAI: oai:DiVA.org:ltu-96327DiVA, id: diva2:1749316
Funder
VinnovaKnut and Alice Wallenberg Foundation, KAW 2014.0205
Note

Validerad;2023;Nivå 2;2023-07-06 (sofila);

Available from: 2023-04-06 Created: 2023-04-06 Last updated: 2024-04-09Bibliographically approved
In thesis
1. Exploring the Hidden Dimensions of Distraction in Adults with Atypical Attention
Open this publication in new window or tab >>Exploring the Hidden Dimensions of Distraction in Adults with Atypical Attention
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Inattention and proclivity for distraction are symptoms of adult ADHD that hamper productivity in study and work environments. The topic of this dissertation is mechanisms of distraction and facilitation of attention in ADHD. This thesis includes three studies. The following overarching questions are addressed in each study respectively: (1) Is computerized cognitive training (CCT) an intervention which improves overall cognitive outcomes in adults with ADHD, (2) Are there differences depending on ADHD symptom severity and distraction in auditory or vibro-tactile sensory modalities, and (3) Is background white noise a shield from distraction for those with ADHD during a short-term memory task?

Study I is a systematic review and meta-analysis of CCT interventions for adults with ADHD, following a pre- post-test design for randomized controlled trials. Nine intervention studies are included in the systematic review, with the resulting meta-analysis for overall cognitive outcomes showing a very small benefit of the CCT intervention. Study I also included sub-analyses of three outcome categories according to the Cattell-Horn-Carol framework of cognition: cognitive speed, executive functions, and short-term memory. None of these individual meta-analyses resulted in significant improvements. 

Participants took part in a cross-modal visual oddball task with auditory and vibro-tactile distractors in Study II. Forty-five participants were divided into two groups for the analysis: one group with low ADHD symptoms and one group with high ADHD symptoms. Findings did not show a relationship between ADHD symptom status and distraction in either auditory or vibro-tactile modality, despite both groups showing the expected slowed reactions on deviant trials. A sensitivity analysis showed that the high symptom group exhibited 0.5 % more missed trials compared to the low symptom group, possibly due to mind wandering in this non-forced-choice task.

For Study III, serial recall data was collected from sixty-six individuals with ADHD and sixty-six healthy control participants, who were tested with white background noise and no background noise conditions. The results showed that participants with ADHD were more likely to get distracted by auditory omission deviants in continuous background white noise, whereas healthy controls were more likely to get distracted by auditory addition deviants in the condition without background noise. Also, the individuals with ADHD on average did not exhibit a typical primacy effect across serial recall items. Overall, the results of the three studies in this dissertation point to some areas for improvement for adults with ADHD where targeted behavioral interventions might be useful in the future.

Place, publisher, year, edition, pages
Luleå: Luleå University of Technology, 2023
Series
Doctoral thesis / Luleå University of Technology 1 jan 1997 → …, ISSN 1402-1544
Keywords
attention, distraction, ADHD, cognition
National Category
Psychology (excluding Applied Psychology)
Research subject
Psychology
Identifiers
urn:nbn:se:ltu:diva-101691 (URN)978-91-8048-408-4 (ISBN)978-91-8048-409-1 (ISBN)
Public defence
2023-12-15, E632, Luleå tekniska universitet, Luleå, 13:00 (English)
Opponent
Supervisors
Available from: 2023-10-18 Created: 2023-10-17 Last updated: 2023-11-24Bibliographically approved

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Elbe, PiaBäcklund, ChristianVega-Mendoza, MarianaSörman, DanielLjungberg, Jessica Körning

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