Faculty of Medicine Nursing and Health Sciences, Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia.
Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
J Child Adolesc Psychopharmacol. 2022 Jun;32(5):250-277. doi: 10.1089/cap.2022.0028.
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental conditions among school-age children. Early intervention and ongoing evaluation of treatment effectiveness are essential to minimize the life-long negative impact of ADHD. Neurocognitive functions have been reported to improve with pharmacological and cognitive training interventions for children with ADHD. We evaluated the value of measuring change in neurocognitive functions following ADHD interventions as a treatment outcome. We systematically reviewed randomized control trials of two distinctive types of ADHD interventions-pharmacological treatments and cognitive training-and summarized the changes in neurocognitive and clinical outcomes using a series of meta-analyses. Both pharmacological and cognitive training interventions showed positive effects on some aspects of neurocognitive functions. However, there were no significant correlations between changes in neurocognitive function (e.g., inhibition) and changes in ADHD behavioral symptoms (e.g., impulsive behavior). Although the associations between changes in neurocognitive function and clinical outcomes are not well studied, based on current findings, it is not suitable to use change in neurocognitive outcomes as a proxy for change in ADHD clinical symptom-based outcomes. There is, however, notable value in monitoring changes in neurocognitive function associated with ADHD interventions to achieve the following aims: (1) understanding full treatment effect on children with ADHD, (2) identifying ancillary indicators of subclinical changes, and (3) provision of objective and less biased measures of treatment effects. These findings are important evidence that changes in neurocognitive function could be a co-occurring objective indication that parallels the clinical effects of ADHD treatments.
注意缺陷多动障碍（ADHD）是学龄儿童中最常见的神经发育障碍之一。早期干预和持续评估治疗效果对于最大限度地减少 ADHD 的终身负面影响至关重要。已经有报道称，药物治疗和认知训练等干预措施可以改善 ADHD 儿童的神经认知功能。我们评估了衡量 ADHD 干预后神经认知功能变化作为治疗结果的价值。我们系统地回顾了两种不同类型的 ADHD 干预措施（药物治疗和认知训练）的随机对照试验，并使用一系列荟萃分析总结了神经认知和临床结果的变化。药物治疗和认知训练干预都显示出对神经认知功能某些方面的积极影响。然而，神经认知功能的变化（例如抑制）与 ADHD 行为症状的变化（例如冲动行为）之间没有显著相关性。虽然神经认知功能变化与临床结果之间的关联尚未得到充分研究，但根据目前的发现，不适合将神经认知结果的变化用作 ADHD 基于临床症状的结果变化的替代指标。然而，监测与 ADHD 干预相关的神经认知功能变化具有重要意义，目的如下：（1）了解 ADHD 儿童的全面治疗效果，（2）识别亚临床变化的辅助指标，（3）提供客观和较少偏见的治疗效果衡量指标。这些发现是重要的证据，表明神经认知功能的变化可能是与 ADHD 治疗的临床效果平行的伴随客观指标。
