一项针对患有注意力缺陷多动障碍（ADHD）的学龄儿童进行的Cogmed工作记忆训练随机临床试验：在多样化样本中采用对照条件的重复研究。
A randomized clinical trial of Cogmed Working Memory Training in school-age children with ADHD: a replication in a diverse sample using a control condition.
作者信息
Chacko A, Bedard A C, Marks D J, Feirsen N, Uderman J Z, Chimiklis A, Rajwan E, Cornwell M, Anderson L, Zwilling A, Ramon M
机构信息
Department of Psychology, Queens College, City University of New York, Flushing, NY, USA; Department of Psychology, The Graduate School and University Center, New York, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; New York University Langone Medical Center Child Study Center, New York, NY, USA.
出版信息
J Child Psychol Psychiatry. 2014 Mar;55(3):247-55. doi: 10.1111/jcpp.12146. Epub 2013 Oct 7.
BACKGROUND
Cogmed Working Memory Training (CWMT) has received considerable attention as a promising intervention for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) in children. At the same time, methodological weaknesses in previous clinical trials call into question reported efficacy of CWMT. In particular, lack of equivalence in key aspects of CWMT (i.e., contingent reinforcement, time-on-task with computer training, parent-child interactions, supportive coaching) between CWMT and placebo versions of CWMT used in previous trials may account for the beneficial outcomes favoring CWMT.
METHODS
Eighty-five 7- to 11-year old school-age children with ADHD (66 male; 78%) were randomized to either standard CWMT (CWMT Active) or a well-controlled CWMT placebo condition (CWMT Placebo) and evaluated before and 3 weeks after treatment. Dependent measures included parent and teacher ratings of ADHD symptoms; objective measures of attention, activity level, and impulsivity; and psychometric indices of working memory and academic achievement (Clinical trial title: Combined cognitive remediation and behavioral intervention for the treatment of Attention-Deficit/Hyperactivity Disorder; http://clinicaltrials.gov/ct2/show/NCT01137318).
RESULTS
CWMT Active participants demonstrated significantly greater improvements in verbal and nonverbal working memory storage, but evidenced no discernible gains in working memory storage plus processing/manipulation. In addition, no treatment group differences were observed for any other outcome measures.
CONCLUSIONS
When a more rigorous comparison condition is utilized, CWMT demonstrates effects on certain aspects of working memory in children with ADHD; however, CWMT does not appear to foster treatment generalization to other domains of functioning. As such, CWMT should not be considered a viable treatment for children with ADHD.
背景
考格麦德工作记忆训练（CWMT）作为一种有前景的干预方法，用于治疗儿童注意力缺陷多动障碍（ADHD），已受到广泛关注。与此同时，以往临床试验中的方法学缺陷使CWMT所报道的疗效受到质疑。特别是，以往试验中使用的CWMT与CWMT安慰剂版本在关键方面（即偶然强化、计算机训练的任务时间、亲子互动、支持性辅导）缺乏等效性，这可能是导致CWMT出现有益结果的原因。
方法
85名7至11岁患有ADHD的学龄儿童（66名男性，占78%）被随机分为标准CWMT组（CWMT活性组）或严格对照的CWMT安慰剂组（CWMT安慰剂组），并在治疗前和治疗3周后进行评估。相关测量指标包括家长和教师对ADHD症状的评分；注意力、活动水平和冲动性的客观测量；以及工作记忆和学业成绩的心理测量指标（临床试验标题：联合认知康复和行为干预治疗注意力缺陷多动障碍；http://clinicaltrials.gov/ct2/show/NCT01137318）。
结果
CWMT活性组参与者在言语和非言语工作记忆存储方面有显著更大的改善，但在工作记忆存储加处理/操作方面没有明显提高。此外，在任何其他测量指标上均未观察到治疗组之间的差异。
结论
当采用更严格的对照条件时，CWMT对患有ADHD儿童的某些工作记忆方面有影响；然而，CWMT似乎并未促进治疗效果推广到其他功能领域。因此，CWMT不应被视为治疗ADHD儿童的可行方法。
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