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A Randomized Controlled Trial of Central Executive Training (CET) Versus Inhibitory Control Training (ICT) for ADHD

Authors
  • Kofler, Michael J.1
  • Wells, Erica L.1
  • Singh, Leah J.1
  • Soto, Elia F.1
  • Irwin, Lauren N.1
  • Groves, Nicole B.1
  • Chan, Elizabeth S.M.1
  • Miller, Caroline E.1
  • Richmond, Kijana P.1
  • Schatschneider, Christopher1
  • Lonigan, Christopher J.1
  • 1 Florida State University, Department of Psychology
Type
Published Article
Journal
Journal of Consulting and Clinical Psychology
Publisher
American Psychological Association
Publication Date
Aug 01, 2020
Volume
88
Issue
8
Pages
738–756
Identifiers
DOI: 10.1037/ccp0000550
PMID: 32700955
PMCID: PMC7384295
Source
PubMed Central
Keywords
License
Unknown

Abstract

Objective Executive function deficits are well-established in ADHD. Unfortunately, replicated evidence indicates that executive function training for ADHD has been largely unsuccessful. We hypothesized that this may reflect insufficient targeting, such that extant protocols do not sufficiently and specifically target the neurocognitive systems associated with phenotypic ADHD behaviors/impairments. Method Children with ADHD ages 8–12 ( M =10.41, SD =1.46; 12 girls; 74% Caucasian/Non-Hispanic) were randomized with allocation concealment to either central executive training (CET; n =25) or newly-developed inhibitory control training (ICT; n =29). Detailed data analytic plans were preregistered. Results Both treatments were feasible/acceptable based on training duration, child-reported ease of use, and parent-reported high satisfaction. CET was superior to ICT for improving its primary intervention targets: phonological and visuospatial working memory ( d =0.70–0.84). CET was also superior to ICT for improving go/no-go ( d =0.84) but not stop-signal inhibition. Mechanisms of change analyses indicated that CET-related working memory improvements produced significant reductions in the primary clinical endpoints (objectively-assessed hyperactivity) during working memory and inhibition testing (indirect effects: β ≥−.11; 95%CIs exclude 0.0). CET was also superior to ICT on 3 of 4 secondary clinical endpoints (blinded teacher-rated ADHD symptoms; d =0.46–0.70 vs. 0.16–0.42) and 2 of 4 feasibility/acceptability clinical endpoints (parent-reported ADHD symptoms; d =0.96–1.42 vs. 0.45–0.65). CET-related gains were maintained at 2–4 month follow-up; ICT-related gains were maintained for attention problems but not hyperactivity/impulsivity per parent report. Conclusions Results support the use of CET for treating executive function deficits and targeting ADHD behavioral symptoms in children with ADHD. Findings for ICT were mixed at best and indicate the need for continued development/study.

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