Researchers: Michel Bader

Training program used in research: Cogmed RM and Cogmed QM

Status: Ongoing

Overview
Neuroimaging studies have begun to document both structural and functional pathological changes in fronto-subcortical-cerebellar circuits in ADHD patients, but the utility of the findings are limited for purposes of diagnosis. However, it is possible that a better and more precise knowledge about the pathophysiology of ADHD and its relationship to therapeutic intervention will lead to improved diagnostic and treatment strategies. Thus, the intent of this ongoing Cogmed training study is to: a) better understand the anatomical substrates of working memory (WM) and executive function (EF) deficits in patients suffering from ADHD and b) delineate the effects of cognitive remediation (ie., Cogmed RM and Cogmed QM) on ADHD symptoms.

To investigate whether and to what extend Cogmed improved ADHD symptoms, researchers are currently conducting a randomized, double-blinded, study comparing 30 adolescents and 30 adults with ADHD who undergo adaptive-training compared to a age, sex, and socioeconomic status matched placebo control group. In order to evaluate the efficacy of Cogmed, researchers will look at changes in inattention and hyperactivity subscale scores on the ADHD-RS scale for adolescents, the Conner’s Adult ADHD-RS scale for adults and the Clinical Global Scale Impression Scale for both groups. The impact of Cogmed on cerebral brain activity will also be examined using fMRI so to quantify performance of EFs before and after Cogmed and to delineate the impact of Cogmed on brain function. Researchers will further compare the specific characteristics of individuals who respond positively to Cogmed with those who are less responsive to the intervention; assessing whether individuals who improve the most in EF (including WM) have different DSM-IV classifications. The intended analysis will hopefully reveal whether positive responders to Cogmed have different outcomes in terms of school and family adaption.

Results
The results of this study will provide new information about the magnitude of EF deficits in ADHD patients as well as, an objective measure of the effect of Cogmed on these EF deficits. Further, this work will help in defining the best target population for Cogmed intervention programs and assist in determining whether Cogmed should be used complementary to drug-based treatment in ADHD. With new insight into the neural correlates underlying Cogmed training in adolescents and adults with ADHD and evidence of the efficacy of Cogmed training in improving EF, it may also be possible to find novel treatment approaches for ADHD.

In the social and familial sphere, this study may increase awareness among French-speaking Swiss parents and adults of the significant impairments caused by ADHD and the need to recognize potential in psychostimulant and cognitive interventions for relieving ADHD symptoms. With a better understanding of the EF deficits that accompany ADHD, it may be possible to identify high risk individuals and to intervene prior to their experiencing poor academic and professional outcomes.