Grandjean A, Suarez I, Miquée A, Da Fonseca D, Casini L
Laboratoire de neurosciences cognitives, FR 3C, Aix-Marseille Université, CNRS, Marseille, France.
Service de Psychiatrie infanto-juvénile, Hôpital Salvator, Marseille, France.
Encephale. 2022 Apr;48(2):148-154. doi: 10.1016/j.encep.2021.02.009. Epub 2021 May 13.
MPH is the more often prescribed stimulant for Attention Deficit Hyperactivity Disorder (ADHD), but it has been estimated that 30% of patients do not adequately respond or cannot tolerate it. Therefore, some other therapies are needed, such as cognitive behavioral therapy. Cognitive behavioral therapy is an intervention proposed over several sessions and aimed at modifying behavior by teaching different techniques that participants can re-use to control their symptoms. In our Institute, we used a program centered on attentional and metacognitive functions. It consists of a series of workshops performed in group at the rate of one workshop of 90minutes per week for 12 weeks. Positive effects on the behavior of adolescents with ADHD have been reported by parents and educators, but the effects of the program on specific cognitive processes have never been precisely investigated.
In the present study, we evaluated the impact of the program on impulsive control in adolescents with ADHD who are known to present impaired impulsive control. Impulsive control is required each time there is a conflict between an inappropriate prepotent action and a goal-directed action. At an experimental level, impulsive control can be studied with conflict tasks, such as the Simon reaction time task. Interpreted within the theoretical framework of the so-called « Dual-process activation suppression » (DPAS) model, this task is a powerful conceptual and experimental tool to separately investigate the activation and inhibition of impulsive actions, which is almost never done in studies about impulsive control. Twenty adolescents followed the program and were tested before and at the end of the program by using dynamic analyses of performance associated with DPAS model.
The results have shown an improvement of the impulsive control after three months of cognitive behavioral therapy, and this improvement was due to both a decrease of the propensity to trigger impulsive actions and an improvement of inhibitory processes efficiency.
This program could be a relevant alternative to the stimulant medication, more particularly when parents are reluctant with medication or when the adolescent suffers from important side effects.
甲基苯丙胺是治疗注意力缺陷多动障碍（ADHD）时更常开具的兴奋剂，但据估计，30%的患者反应不佳或无法耐受。因此，需要一些其他疗法，如认知行为疗法。认知行为疗法是一种经过多个疗程的干预措施，旨在通过教授参与者可重复使用的不同技巧来改变行为，以控制症状。在我们研究所，我们使用了一个以注意力和元认知功能为中心的项目。该项目由一系列小组工作坊组成，每周进行一次90分钟的工作坊，共持续12周。家长和教育工作者报告称该项目对患有ADHD的青少年的行为有积极影响，但该项目对特定认知过程的影响从未得到精确研究。
在本研究中，我们评估了该项目对已知存在冲动控制受损的ADHD青少年冲动控制的影响。每当不适当的优势动作与目标导向动作之间存在冲突时，就需要冲动控制。在实验层面，可以通过冲突任务，如西蒙反应时任务来研究冲动控制。在所谓的“双过程激活抑制”（DPAS）模型的理论框架内进行解释，该任务是一个强大的概念和实验工具，可分别研究冲动动作的激活和抑制，而这在关于冲动控制的研究中几乎从未进行过。20名青少年参与了该项目，并在项目开始前和结束时通过使用与DPAS模型相关的表现动态分析进行测试。
结果显示，经过三个月的认知行为疗法后，冲动控制得到改善，这种改善归因于触发冲动动作倾向的降低以及抑制过程效率的提高。
该项目可能是兴奋剂药物的一个相关替代方案，特别是当家长不愿让孩子用药或青少年出现严重副作用时。
