Effect of Working Memory Training on ADHD Brain Function
Condition: Attention-Deficit/Hyperactivity Disorder (Combined-subtype)
MeSH terms: Hyperkinesis; Attention Deficit Disorder with Hyperactivity
Study type: Interventional
Phase: Phase 3

Summary: 
      There is evidence both that computer-administered cognitive training can improve ADHD working
      memory deficits and that this type of training in non-ADHD enhances normal working memory
      ability by altering brain activity in prefrontal cortex and the parietal lobe. However, no
      study has characterized brain activity changes following working memory training in ADHD to
      understand what neural changes occur when cognitive deficits are remedied. This R21
      exploratory study will examine the neural basis of cognitive training treatment gains in
      working memory, ADHD symptoms, and various other executive abilities. We will test the
      hypothesis that working memory training increases frontoparietal brain activation and examine
      other regions to see if there is any evidence for "neural compensation" (i.e., engagement of
      brain regions after training that are not normally recruited for task performance).
    

Detailed description: 
      There is evidence both that computer-administered cognitive training can improve ADHD working
      memory deficits and that this type of training in non-ADHD enhances normal working memory
      ability by altering brain activity in prefrontal cortex and the parietal lobe. However, no
      study has characterized brain activity changes following working memory training in ADHD to
      understand what neural changes occur when cognitive deficits are remedied. This R21
      exploratory study will examine the neural basis of cognitive training treatment gains in
      working memory, ADHD symptoms, and various other executive abilities. The study will compare
      n=21 ADHD adolescents with evidence for baseline deficits in working memory (i.e., <1.5 SD
      below normative ratings at baseline) before and after working memory training. Participants
      will undergo baseline neuropsychological and fMRI imaging with verbal and visuospatial
      Sternberg fMRI working memory tasks, 5 weeks of daily computerized working memory training,
      and then endpoint fMRI and cognitive evaluation of neural and behavioral changes. Training
      will utilize commercially-available Cogmed software (http://www.cogmed.com) as it has a
      well-developed set of computerized tools, with numerous practical advantages for this study.
      Our analyses will identify which brain regions in ADHD adolescents are affected by working
      memory treatment and characterize patterns of activation change between baseline and
      endpoint. We will examine post-treatment differences in the extent of activation and
      functional connectivity among activated brain regions to test hypotheses about possible
      neural mechanisms underlying treatment gains. Finally, we will conduct a series of analyses
      to determine what changes in brain function underlie a generalized effect of working memory
      training on ADHD symptoms and other 'executive' abilities. By identifying the neural
      correlates any such effect, this study could yield invaluable information about what the
      neural targets of any effective ADHD treatment must be. The key accomplishment of this
      exploratory study will be to characterize the neural basis of treatment gains in ADHD by
      testing theoretically-guided hypotheses about possible neuroplastic changes. The results will
      support larger, future studies aimed at better understanding the neural basis of this
      alternative treatment for ADHD, identifying biological or genetic factors that might denote
      the presence of a remediable working memory deficit, and ultimately achieving a better
      understanding of the etiology of ADHD working memory deficits.
    

Intervention name(s): Working memory training; Functional magnetic resonance imaging (fMRI)
Intervention type(s): Behavioral; Device
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: ADHD, hyperactivity, inattention, working memory