title: Executive Function Training for Children with Attention Deficit Hyperactivity Disorder.
abstract: BACKGROUND
  Accumulating evidence indicates that attention deficit hyperactivity disorder (ADHD) is associated with core deficits in executive function (EF) which predicts poorer academic and occupational functioning. This makes early intervention targeting EF impairments important to prevent long-term negative outcomes. Cognitive training is a potential ADHD treatment target. The present study aimed to explore the efficacy, feasibility, and acceptability of a cognitive training program (targeting child's multiple EF components and involving parent support in daily life), as a nonpharmacological intervention for children with ADHD.
  
  
  METHODS
  Forty-four school -age children with ADHD and their parents participated in 12 sessions of EF training (last for 12 weeks) and 88 health controls (HC) were also recruited. Training effects were explored using both neuropsychological tests (Stroop color-word test, Rey-Osterrieth complex figure test, trail making test, tower of Hanoi, and false-belief task) and reports of daily life (ADHD rating scale-IV, Conners' parent rating scale, and behavior rating inventory of executive function [BRIEF]) by analysis of paired sample t-test and Wilcoxon signed-rank test. The differences on EF performances between children with ADHD after training and HC were explored using multivariate analysis.
  
  
  RESULTS
  The results (before vs. after EF training) showed that after intervention, the children with ADHD presented better performances of EF both in neuropsychological tests (word interference of Stroop: 36.1 ± 14.6 vs. 27.1 ± 11.1, t = 4.731, P < 0.001; shift time of TMT: 194.9 ± 115.4 vs. 124.8 ± 72.4, Z = -4.639, P < 0.001; false-belief task: χ2 = 6.932, P = 0.008) and reports of daily life (global executive composite of BRIEF: 148.9 ± 17.5 vs. 127.8 ± 17.5, t = 6.433, P < 0.001). The performances on EF tasks for children with ADHD after EF training could match with the level of HC children. The ADHD symptoms (ADHD rating scale total score: 32.4 ± 8.9 vs. 22.9 ± 8.2, t = 6.331, P < 0.001) and behavioral problems of the children as reported by parents also reduced significantly after the intervention. Participants reported that the EF training program was feasible to administer and acceptable.
  
  
  CONCLUSIONS
  The EF training program was feasible and acceptable to children with ADHD and parents. Although replication with a larger sample and an active control group are needed, EF training program with multiple EF focus and parent involving in real-life activities could be a potentially promising intervention associated with significant EF (near transfer) and ADHD symptoms improvement (far transfer).
authors.affiliation: Department of Medical Psychology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Lan
authors.initials: L
authors.lastname: Shuai
authors.affiliation: Division of Psychiatry and Applied Psychology School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.
authors.forename: David
authors.initials: D
authors.lastname: Daley
authors.affiliation: Department of Child Psychiatry Research, Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China.
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Wang
authors.affiliation: Department of Medical Psychology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092; Department of Developmental Behavioral and Child Healthcare, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Jin-Song
authors.initials: JS
authors.lastname: Zhang
authors.affiliation: Department of Developmental Behavioral and Child Healthcare, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Yan-Ting
authors.initials: YT
authors.lastname: Kong
authors.affiliation: Department of Developmental Behavioral and Child Healthcare, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Tan
authors.affiliation: Department of Children's Psychiatry, Robusprout Children's Clinic, Beijing 100022, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Ji
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000503:physiopathology*; D002648:Child; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests