Cognitive Remediation in ADHD Children : Comparison Between Three Therapeutic Strategies : Cognitive Remediation With a Virtual Classroom Software and Methylphenidate and Supportive Psychotherapy
Condition: ADHD
Study type: Interventional

Summary: 
      The Attention Deficit Disorder with or without Hyperactivity (ADHD) is one of the most
      frequently found disorder in children. It is characterized by a triad of symptoms involving
      attention deficit, hyperactivity and impulsivity and having an impact on the functioning of
      the subject especially in terms of learning.

      Currently, main interventions to treat ADHD in children are stimulant medication or
      supportive psychotherapy. Data from recent studies highlight the use of stimulant drugs
      (amphetamine derivatives such as methylphenidate) to treat the core symptoms of ADHD
      children. These drugs are generally effective but their nature (psychostimulants) and adverse
      effects they cause (appetite suppression, sleep disturbances, headaches, motor tics,
      abdominal pain, irritability, nausea and fatigue) encourage the development of new
      therapeutic approaches. The use of supportive psychotherapy alone would have limited effect
      on symptoms of children with ADHD. Our aim is to test the use a cognitive remediation program
      using a virtual classroom in children suffering from ADHD.
    

Detailed description: 
      Virtual reality offers the possibility to develop environments approaching situations of
      daily life that can be used to target evaluation but also for therapeutic purposes. As the
      school classroom is a daily life situation for children, Rizzo team has developed a virtual
      classroom software (Rizzo et al., 2006). This virtual classroom is a tool for the diagnosis
      of ADHD based on the exploration of attention deficit (distractibility, sustained attention
      ...), impulsivity and hyperactivity. On the other hand, the playfulness of the application
      helps the child to "forget" quickly that he is placed in a test situation.

      In the virtual classroom, the requested task is a letter detection task. The subject had to
      click on the mouse only when he sees the letter "K" preceded by the letter "A" appearing. The
      child had to perform this task, while the disruptive elements are distracting. These may be
      auditory (the bell ringing), visual (a paper airplane flying in the class) or visual and
      auditory distractors (the sound of the teacher who is moving).

      Cognitive remediation using virtual reality is an innovative approach in the care of
      children. We want to examine whether a cognitive remediation program based on the virtual
      classroom software can be a therapeutic tool for children suffering from ADHD.

      In our study, cognitive remediation will be accomplished through cognitive intervention such
      as a "training" of attentional and executive functions (such as planning, working memory,
      selective attention, ...). The cognitive remediation sessions will include the execution of
      the virtual classroom protocol, a stage of metacognition and again the virtual classroom
      assessment. Our remediation program will include 12 sessions (twice a week for 6 to 8
      consecutive weeks), lasting 30 minutes each. The effects of cognitive remediation will be
      compared to the effects of two other major interventions usually proposed: drug treatment
      with methylphenidate and supportive psychotherapy. 60 ADHD children aged 7 to 11 years will
      participate in our study, 20 in each treatment group (drug treatment vs. cognitive
      remediation vs. supportive psychotherapy).

      We expect that cognitive remediation and drug treatment improve attentional abilities of
      children with ADHD.
    

Intervention name(s): Methylphenidate; cognitive remediation; supportive psychotherapy; neuropsychological tests
Intervention type(s): Drug; Device; Behavioral; Other
Intervention description(s): Patient will take treatment during two months; Patient will have 12 sessions during 6 to 8 weeks; Patients will have 12 sessions during 6 to 8 weeks; neuropsychological tests will assess attentional and executive performance
Intervention MeSH terms: Methylphenidate
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: ADHD; children; cognitive remediation; virtual reality