Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Calambrone, Pisa, Italy.
Tuscan Programme of Neuroscience, University of Florence, Pisa and Siena, Italy.
Neuropsychol Rev. 2024 Mar;34(1):98-133. doi: 10.1007/s11065-022-09574-z. Epub 2023 Jan 12.
Executive Functions are a set of interrelated, top-down processes essential for adaptive goal-directed behaviour, frequently impaired across different neurodevelopmental disorders with variable degrees of severity. Many executive-function-training studies in children with neurodevelopmental disorders have focused on near effects, investigating post-treatment improvements on directly trained processes, while enhancements of skills not directly trained, defined as far effects, are less considered, albeit these could be extremely relevant for reducing the negative impact of a disorder's core symptomatology. This systematic review and metanalysis aims to investigate the far effect outcomes after EF training in children with different types of neurodevelopmental disorders. 17 studies met the inclusion criteria for the systematic review, while 15 studies were selected in the metanalysis. An overall statistically significant effect size was found in the majority of far effect outcome measures considered in the studies. In particular, trainings on executive functions determine significant far effects on daily life functioning (0.46, 95% CI: [0.05-0.87]) and clinical symptoms (0.33, 95% CI: [0.15-0.51]). Despite a high variability of the results, intensity, frequency and the laboratory/life contexts dimension seem to be the most influential variables in determining far effects. This systematic review and metanalysis highlights the need to measure far effects of executive function training in neurodevelopmental disorders, selecting treatments not only on directly targeted processes, but also according to far impacts on the functional weakness of the disorder.
执行功能是一组相互关联的自上而下的过程，对于适应性目标导向行为至关重要，在不同的神经发育障碍中普遍存在，严重程度不同。许多针对神经发育障碍儿童的执行功能训练研究都集中在近因效应上，即研究治疗后对直接训练过程的改善，而对技能的增强则较少考虑，这些技能没有直接训练，定义为远因效应，尽管这些对减轻障碍核心症状学的负面影响可能非常重要。本系统评价和荟萃分析旨在研究不同类型神经发育障碍儿童接受执行功能训练后的远因效应结果。17 项研究符合系统评价的纳入标准，而 15 项研究被纳入荟萃分析。在研究中考虑的大多数远因效应测量中，发现了总体上具有统计学意义的效应量。特别是，针对执行功能的训练对日常生活功能（0.46，95%CI：[0.05-0.87]）和临床症状（0.33，95%CI：[0.15-0.51]）有显著的远因效应。尽管结果存在高度变异性，但强度、频率和实验室/生活环境维度似乎是决定远因效应的最具影响力的变量。本系统评价和荟萃分析强调需要测量神经发育障碍中执行功能训练的远因效应，选择治疗方法不仅要针对直接靶向的过程，还要根据对障碍功能弱点的远因影响来选择。
