Chen Shuxian, Yu Jinglong, Zhang Qiang, Zhang Jin, Zhang Ying, Wang Junhong
Foshan Hospital of Traditional Chinese Medicine, Foshan, China.
Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Front Psychol. 2022 Jan 13;12:810298. doi: 10.3389/fpsyg.2021.810298. eCollection 2021.
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by developmentally inappropriate inattention, hyperactivity, and impulsivity. Multiple cognitive training appeared to be more effective than working memory training, but the evidence remains insufficient, particularly for the subgroup symptoms and executive function behaviors at home. Further analysis of the impact of factors on the effectiveness would facilitate the development of cognitive training. We searched PubMed, Cochrane Library, Psyche, Embase, Chinese Biomedical Literature Database, CNKI, and Weifang Database, and included randomized controlled trials (RCTs) of children with ADHD undergoing cognitive intervention. Metaanalysis and univariate metaregression were performed by STATE. The risk of bias was assessed with the Cochrane risk of bias tool 2.0 by the two investigators separately. This study was registered with INPLASY, number INPLASY202140065. We included 17 RCTs in the systematic review, with a combined 1,075 participants. For metaanalyses of both subgroups of ADHD symptoms and the executive function behaviors, the test of published bias failed to reach the < 0.05 level. When all of the training are considered together, cognitive training can improve the presentation of inattention symptoms [SMD = -0.390, 95%CI (-0.675, -0.104)] and executive function behaviors (SMD = -0.319, 95%CI (-0.527, -0.111)]. In the subgroup analysis, the effects of working memory training on both presentations were not statistically significant. In contrast, the multiple cognitive training had significant effects on the presentation of inattention symptoms [SMD = -0.507, 95% CI (-0.722, -0.292)], hyperactivity/impulsivity [SMD = -0.305, 95% CI (-0.518, -0.09)], and the executive function behaviors [SMD = -0.499, 95%CI (-0.707, -0.290)]. In addition, metaregression analysis showed that only training frequency did significantly impact the symptoms of ADHD and the executive function behaviors. This study showed that improvements in symptoms and executive function behaviors were related to the domains of cognitive intervention. The findings suggest that multiple domains of cognitive training and moderate training frequency may have wider clinical benefits. All the above results highlight further research in refining the executive functions of children with ADHD and developing individually tailored cognitive intervention on homes based for children with vulnerable executive functions. [http://inplasy.com/], [INPLASY202140065].
注意缺陷多动障碍（ADHD）是一种神经发育障碍，其特征为注意力不集中、多动和冲动等发育上不适当的表现。多项认知训练似乎比工作记忆训练更有效，但证据仍然不足，尤其是对于在家中的亚组症状和执行功能行为。进一步分析影响有效性的因素将有助于认知训练的发展。我们检索了PubMed、Cochrane图书馆、Psyche、Embase、中国生物医学文献数据库、知网和潍坊数据库，并纳入了接受认知干预的ADHD儿童的随机对照试验（RCT）。使用STATE进行荟萃分析和单变量元回归。两位研究者分别使用Cochrane偏倚风险工具2.0评估偏倚风险。本研究已在INPLASY注册，编号为INPLASY202140065。我们在系统评价中纳入了17项RCT，共有1075名参与者。对于ADHD症状亚组和执行功能行为的荟萃分析，发表偏倚检验未达到<0.05水平。当将所有训练综合考虑时，可以改善注意力不集中症状的表现[标准化均数差（SMD）=-0.390，95%置信区间（CI）（-0.675，-0.104）]和执行功能行为（SMD=-0.319，95%CI（-0.527，-0.111）]。在亚组分析中，工作记忆训练对这两种表现的影响均无统计学意义。相比之下，多项认知训练对注意力不集中症状的表现[SMD=-0.507，95%CI（-0.722，-0.292）]、多动/冲动[SMD=-0.305，95%CI（-0.518，-0.09）]和执行功能行为[SMD=-0.499，95%CI（-0.707，-0.290）]有显著影响。此外，元回归分析表明，只有训练频率对ADHD症状和执行功能行为有显著影响。本研究表明，症状和执行功能行为的改善与认知干预领域有关。研究结果表明，多个认知训练领域和适度的训练频率可能具有更广泛的临床益处。上述所有结果突出了进一步研究以改善ADHD儿童的执行功能，并为执行功能较弱的儿童开发基于家庭的个性化认知干预措施。[http://inplasy.com/]，[INPLASY202140065]
