Overview

This trial is active, not recruiting.

Condition attention deficit hyperactivity disorder
Treatment multifaceted cognitive training
Phase phase 2/phase 3
Sponsor Children's Hospital Medical Center, Cincinnati
Collaborator National Institute of Mental Health (NIMH)
Start date April 2011
End date December 2013
Trial size 40 participants
Trial identifier NCT01352468, R21MH085842, R33MH085842

Summary

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.

United States No locations recruiting
Other Countries No locations recruiting

Study Design

Allocation randomized
Endpoint classification efficacy study
Intervention model parallel assignment
Masking double blind (subject, caregiver, outcomes assessor)
Primary purpose treatment
Arm
(Experimental)
Cognitive Training with 4 different tasks each of which gets progressively more difficult as children obtain proficiency.
multifaceted cognitive training
Four computerized training tasks
(Sham Comparator)
Cognitive Training with 4 different tasks which does not get progressively more difficult throughout training
multifaceted cognitive training
Four computerized training tasks

Primary Outcomes

Measure
ADHD ratings
time frame: 8 weeks

Secondary Outcomes

Measure
Academic performance
time frame: 8 weeks
Stop Signal Reaction Time
time frame: 8 weeks
Reaction time variability on go/no-go task
time frame: 8 weeks
Total score on Total Score on K-KEFS Color-Word Interference Test
time frame: 8 weeks
TEA-Ch Sky Search Score
time frame: 8 weeks
TEA-CH Sky Search Dual Task Score
time frame: 8 weeks
Reaction Time variability on Child Attentional Network Task
time frame: 8 weeks
Working Memory Test Block Recall Score
time frame: 8 weeks
Reaction Time variability on Choice Discrimination Task
time frame: 8 weeks
Total score on Weschler Intelligence Scale for Children Digit Span task
time frame: 8 weeks
Raven's Progressive Matrices Total Score
time frame: 8 weeks
AIMSWEB math score
time frame: 8 weeks
AIMSWEB reading score
time frame: 8 weeks

Eligibility Criteria

Male or female participants from 7 years up to 12 years old.

Inclusion Criteria: - Consent: The family must provide signature of informed consent by parents or legal guardians. - Age at time of Screening: 7 to 12 years of age, inclusive. - Gender: includes male and female children. - ADHD Diagnostic Status: ADHD patients must meet DSM-IV criteria for ADHD-PIT or ADHD-CT subtype. Section D.4 below describes in detail the diagnostic process for arriving at diagnosis. - Cognitive Functioning: IQ of greater than 80 as estimated by the Wechsler Intelligence Scale for Children Fourth Edition. - Learning Disability: Children must score 75 or above on two of the Wechsler Individual Achievement Test (WIAT) subtests (Reading & Numerical Operations). - School: Children must be enrolled in a school setting from which teacher ratings can be obtained. - History of Psychiatric Medications: Children may be taking psychiatric medications. However, they must present with significant ADHD inattention symptoms while on medication in order to be included in the study. We will ask that children on ADHD medications to refrain from altering the dosage for 10 weeks from study enrollment to after the immediate post-intervention follow-up. In order to screen for possible medication adjustments, all parents will be asked during the initial phone screen if their child is on an ADHD medication and if they anticipate a change in that medication dosage. If they answer that they anticipate a dosage change, they will be excluded from the study. Exclusion Criteria: - Understanding Level. The patient and parent cannot understand or follow instructions given in the study. - Exclusionary Psychiatric Conditions: Children who meet diagnostic criteria on the K-SADS for OCD, any psychotic disorder, major depressive disorder or bipolar disorder will be excluded from participation. - Developmental Disabilities. Patients will be excluded if they are deemed to be significantly developmentally delayed or have a pervasive developmental disorder. Developmental delay will be operationally defined as an IQ score below 80. Children scoring 80 or above will be included. A semi-structured interview, the CAARTE, will be used to screen for autism.

Additional Information

Official title Development of a Multi-faceted Cognitive Training Program for Children With ADHD
Principal investigator Jeffery N Epstein, Ph.D.
Trial information was received from ClinicalTrials.gov and was last updated in December 2015.
Information provided to ClinicalTrials.gov by Children's Hospital Medical Center, Cincinnati.