Marcelle Enitan T, Ho Erica J, Kaplan Michelle S, Adler Lenard A, Castellanos F Xavier, Milham Michael P
Department of Psychology, University of California, Berkeley, Berkeley, CA, United States.
Center for the Developing Brain, Child Mind Institute, New York, NY, United States.
Front Psychiatry. 2018 Aug 28;9:388. doi: 10.3389/fpsyt.2018.00388. eCollection 2018.
Cogmed Working Memory Training (CWMT), an online cognitive training program developed for children, is an increasingly popular non-pharmacological intervention for ADHD amongst all ages, despite limited supporting evidence. The initial objective of the present work was to examine the short- and long-term impacts of CWMT on brain function in adults with ADHD. However, during the conduct of our study, we experienced multiple levels of failures in recruitment and retention that signaled potential concerns about the suitability of CWMT for adults with ADHD. This perspective piece aims to describe the difficulties we encountered in the context of studies examining the efficacy of CWMT in comparable populations. We trace these difficulties to the limited tolerability of the current CWMT structure for adults with ADHD, and review similar limitations in the literature. We suggest that efficacy of CWMT in children may be due in large part to close monitoring and scaffolding provided by clinicians and caregivers. For CWMT to have viability for widespread use in adults, greater support and structure will be needed for users to improve the likelihood of adherence. We discuss implications and considerations for future efforts in both research and clinical practice.
考格麦德工作记忆训练(CWMT)是一款为儿童开发的在线认知训练项目,尽管支持证据有限,但它在各年龄段的注意力缺陷多动障碍(ADHD)患者中已成为越来越受欢迎的非药物干预手段。本研究最初的目的是考察CWMT对患有ADHD的成年人脑功能的短期和长期影响。然而,在我们开展研究的过程中,我们在招募和留住受试者方面遭遇了多重失败,这表明CWMT对于患有ADHD的成年人的适用性可能存在潜在问题。这篇观点文章旨在描述我们在研究CWMT在类似人群中的疗效时所遇到的困难。我们将这些困难归因于当前CWMT结构对患有ADHD的成年人的耐受性有限,并回顾了文献中类似的局限性。我们认为,CWMT在儿童中的疗效很大程度上可能归因于临床医生和护理人员提供的密切监测和支持。为使CWMT在成年人中能够广泛应用,需要为用户提供更多支持和框架,以提高其坚持使用的可能性。我们讨论了对未来研究和临床实践工作的启示和考量。