数字化靶向认知训练对多动症儿童药物治疗的促进作用：一项随机对照试验。
The promoting effects of digital targeted cognitive training in medication treatment for children with ADHD: a randomized controlled trial.
作者信息
Dang Chen, Zhu Yu, Luo Xiangsheng, Liu Lu, Feng Yuan, Wu Guisen, Zhong Shaogen, Wang Xin, Zhang Jianzhao, Zhu Yike, Liu Siqi, Liu Ziqi, Qin Li, Ma Xiaohui, Wang Yufeng, Wang Xiaoyi, Yang Jian, Wang Changming, Sun Li
机构信息
Peking University Sixth Hospital, Peking University Institute of Mental Health, Beijing, China.
NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
出版信息
BMC Med. 2025 Jul 1;23(1):371. doi: 10.1186/s12916-025-04192-x.
BACKGROUND
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder often managed with medication. Improving cognitive functions alongside medication treatment is crucial for better outcomes. This study mainly aimed to investigate the therapeutic effects of combining digitally targeted cognitive training with medication compared to medication monotherapy on ADHD core symptoms. We hypothesized that targeted cognitive training could enhance treatment efficacy when combined with medication.
METHODS
This was a randomized parallel-group controlled trial. A total of 124 children with ADHD were randomly allocated to two groups: 64 received medication treatment alone (M), including atomoxetine (ATX) and methylphenidate (MPH); 60 received targeted cognitive training combined with medication (TCT + M), including TCT + ATX and TCT + MPH. Both groups received 8 weeks of treatment. The primary outcome was the changes in ADHD core symptoms measured by the ADHD Rating Scale (ADHD-RS). The secondary outcomes were parent-reported ecological executive functions, social functions, and laboratory cognitive functions.
RESULTS
Main results: When compared with M treatment, the TCT + M treatment did not show significant greater improvements in ADHD core symptoms, ecological executive functions, social functions, or laboratory cognitive functions. Post-hoc exploratory analysis results: (1) In patients who received ATX treatment, TCT + ATX led to greater improvement in ADHD-RS total, inattention, and hyperactivity/impulsivity symptoms. Similar between-group differences were observed in ecological executive functions, and the improvements were significantly correlated with changes of ADHD core symptoms. (2) In patients who received MPH treatment, no significant differences in the improvement of primary or secondary outcomes were observed between MPH monotherapy and TCT + MPH groups.
CONCLUSIONS
These findings demonstrated that, in comparison to medication monotherapy, the TCT + M treatment did not lead to more improvements in the core symptoms of ADHD, nor did it show superiority in other secondary outcomes. Specifically in children treated with atomoxetine, there's a potential promoting effect of targeted cognitive training on medication treatment in terms of the alleviation of ADHD core symptoms.
TRIAL REGISTRATION
This study was pre-registered with the Chinese Clinical Trial Registry under the identifier ChiCTR2100043525.
背景
注意缺陷多动障碍（ADHD）是一种常见的神经发育障碍，通常采用药物治疗。在药物治疗的同时改善认知功能对于获得更好的治疗效果至关重要。本研究主要旨在探讨与药物单一疗法相比，数字靶向认知训练联合药物治疗对ADHD核心症状的治疗效果。我们假设靶向认知训练与药物联合使用时可提高治疗效果。
方法
这是一项随机平行组对照试验。总共124名ADHD儿童被随机分为两组：64名仅接受药物治疗（M组），包括托莫西汀（ATX）和哌甲酯（MPH）；60名接受靶向认知训练联合药物治疗（TCT+M组），包括TCT+ATX和TCT+MPH。两组均接受8周的治疗。主要结局是通过ADHD评定量表（ADHD-RS）测量的ADHD核心症状的变化。次要结局是家长报告的生态执行功能、社会功能和实验室认知功能。
结果
主要结果：与M组治疗相比，TCT+M组治疗在ADHD核心症状、生态执行功能、社会功能或实验室认知功能方面没有显示出显著更大的改善。事后探索性分析结果：（1）在接受ATX治疗的患者中，TCT+ATX在ADHD-RS总分、注意力不集中和多动/冲动症状方面有更大改善。在生态执行功能方面观察到类似的组间差异，且改善与ADHD核心症状的变化显著相关。（2）在接受MPH治疗的患者中，MPH单一疗法组和TCT+MPH组在主要或次要结局改善方面未观察到显著差异。
结论
这些研究结果表明，与药物单一疗法相比，TCT+M组治疗在ADHD核心症状方面没有带来更多改善，在其他次要结局方面也未显示出优势。特别是在接受托莫西汀治疗的儿童中，靶向认知训练在减轻ADHD核心症状方面对药物治疗有潜在促进作用。
试验注册
本研究已在中国临床试验注册中心预注册，注册号为ChiCTR2100043525。
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