Computerized Training Improves Symptoms of ADHD

Written by Tatjana Djakovic, Staff Writer. Computer training improved several measures of the working memory and may reduce ADHD.   

Attention-deficit/hyperactivity disorder (ADHD) affects up to 1 in 20 children in the United States and is characterized by lack of concentration, hyperactivity and impulsivity which have serious implications in both social and academic aspects (1). In fact, ADHD children are more likely to have learning disabilities, repeated grades, the need for academic tutoring, and a lot of these problems persist into adulthood. (2)

Impairments in working memory (brain function necessary for staying focused), response inhibition (ability to prioritize actions), and temporal processing (rate at which we can process information), have been suggested to play an important role in ADHD (3).

Previous research has indicated that improvements in working memory will reduce symptoms of ADHD.  In one study, young healthy adults received a brain scan while performing a task that involved the use of their working memory. It was found that working memory improved with training. It resulted in increased brain activity in regions of the brain that were implicated in ADHD (4).

The current randomized, controlled, double-blind study consisted of 53 children with ADHD aged 7 to 12 years that were not taking medication.  The purpose of the study was to investigate whether training of the working memory task during a 5 week period would improve working memory and reduce ADHD symptoms (5).

The training was a computerized program that was provided on a CD. It was used by the child on a personal computer, either at home or school. Participants were randomly assigned to use either the treatment computer program for training working memory or a comparison program.  The training automatically and continuously adapted the difficulty level to the performance of the child, to optimize the training effect. The children performed 90 working memory trials on each day of training. Total time depended on the level and time between trials.  Medium total training time (excluding breaks) was about 40 minutes (5).

The outcomes were measured using the following tasks:

• Span-board task- was used to measure visual perception of the spatial relationships of objects. In this task the children were presented with a series of stimuli, usually letters, words, digits, shapes and were required to recall those stimuli in the same or reverse order as they were presented.
• Digit-span task- was used to measure verbal working memory by showing the children visual inputs which are recorded in the short-term verbal store and are recalled when necessary.
• Stroop interference task- was used to measure response inhibition. The children were presented with words describing colors printed with ink in a color that was incongruent with the word, such as “green” printed in yellow ink and asked to name the color of the ink for each word (5).

There were significant improvements in the different aspects of working memory, especially the span board task.  In addition, there were important effects for secondary outcome tasks measuring verbal working memory, response inhibition and complex reasoning.

The researchers also measured parent and teacher ratings to see if there were any reductions in symptoms of inattention and hyperactivity/impulsivity using Conners Rating Scale. The parent rating scale showed a significant decrease for parent rating of hyperactivity symptoms (p=0.002) at follow-up  3 months later. The study shows that working memory can be improved by computerized training in children with ADHD, which can then reduce the symptoms of ADHD, such as hyperactivity and lack of concentration (5).

Source: Klingberg, Torkel, et al. “Computerized training of working memory in children with ADHD-a randomized, controlled trial.” Journal of the American Academy of Child & Adolescent Psychiatry 44.2 (2005): 177-186.

© 2005 The American Academy of Child and Adolescent Psychiatry Published by Elsevier Inc. All rights reserved.

Posted July 10, 2013.

References:

1. Pellow, Janice, E. M. Solomon, and C. N. Barnard. “Complementary and alternative medical therapies for children with attention-deficit/hyperactivity disorder (ADHD).” Altern Med Rev 16.4 (2011): 323-337.
2. Faraone, Stephen V., et al. “Intellectual performance and school failure in children with attention deficit hyperactivity disorder and in their siblings.” Journal of abnormal psychology 102.4 (1993): 616.
3. Rapport MD, et al., Upgrading the science and technology of assessment and diagnosis: laboratory and clinic-based assessment of children with ADHD. J Clin Child Psych. 29: 555-568.
4. Olesen P, et al., Increased prefrontal and parietal brain activity after training of working memory. (2004). Nat Neurosci  7:75-79.
5. Westerberg, H., et al. “Computerized working memory training after stroke-A pilot study.” Brain Injury 21.1 (2007): 21-29.