| Part One: The Executive Function and ADHD Symptoms Efficacy of Computerized Executive Function Training-A Controlled Clinical ResearchObjectives: To compare the efficacy of computerized executive function training(EFTS),medication intervention and the combined EFTS and medication intervention.Methods: Participants were selected in the pediatric department of Shanghai mental health center and met the diagnostic criteria for Attention deficit hyperactivity disorder(ADHD)in Diagnostic and statistical manual of mental disorders(5th ed)(DSM-5)from May,2018 to January,2020.One hundred and four patients with ADHD were randomly divided into computerized executive function training(EFTS)group,combined EFTS and medication intervention group and medication intervention group for eight weeks.The three groups were assessed at baseline and week 8.The assessment included demographic information,Swanson,Nolan,and Pelham,version IV scale(SNAP-IV),Strengths and Difficulties Questionnaire(SDQ),Wechsler Intelligence Scale for Children-Fourth Edition(WISC-IV),Stroop Color Word Association test(SCWT),Wisconsin Card Sorting Test(WCST),Digital-span,Coding tests of WISC-IV,Behavior Rating Inventory of Executive Function Parent form(BRIEFP),Weiss Functional Impairment Scale-Parent form(WFIRS-P)and PiersHarris Children’s Self-consciousness Scale(PHCSS).Results: Repeated measurement variance analysis of the three groups showed:a.The scores of attention deficit,hyperactivity of SNAP-IV and emotional symptoms,conduct problems and difficulty total scores of SDQ,significantly decreased after eight-week treatment in three groups(P<0.05).However,there was no significant difference between the three groups(P>0.05).The score of SNAP-IV oppositional defiance was significantly different between the groups,and the score of the EFTS group decreased significantly after treatment compared with that of the medication intervention group(P<0.05).b.The correct number in Stroop test A and B increased,the number of errors in test A and the time in test B decreased after treatment in the three groups(P<0.05).The obverse digital-span breadth and scores,The reverse digital-span breadth,coding scores of WISC-IV was increased significantly(P<0.05).The number of persistent errors in WCST decreased significantly(P<0.05).The level of conceptualization,number of classification completion and number of continuous responses all increased significantly(P<0.01),there was no statistically significant difference between the three groups(P>0.05).After eight weeks,patients in three groups with ADHD had significant interaction effect in the number of errors and correction in Stroop test B,the inverted digital span score(P<0.05).Simple effect analysis of error number of test B showed that there was no significant difference between the medication intervention group before and after treatment(P>0.05),while the difference between the combined EFTS and medication intervention group and computerized executive function training(EFTS)group was statistically significant(P<0.05;P < 0.01).The simple effect analysis of the correction number in test B showed that the difference between the computerized executive function training(EFTS)group before and after treatment was not statistically significant(P>0.05),while the difference between the other two groups was statistically significant(P<0.05).The simple effect analysis of the inverted number digital span score in the three groups showed that the difference between the the combined EFTS and medication intervention was statistically significant(P<0.01),while the difference between the other two groups was not statistically significant(P>0.05).c.the differences of BRIEF-P emotional control,organization and monitoring factors,behavior management index,metacognitive index and total score before and after treatment were significant(P<0.01),and the differences of priming factors were statistically significant(P<0.05),but there was no statistically significant difference between the three groups(P>0.05).Before and after treatment,the inhibitory factors were different between the groups.The decreasing trend of the combined EFTS and medication intervention group was greater than that of the computerized executive function training(EFTS)group(P<0.05),and the decreasing trend of the computerized executive function training(EFTS)group was greater than that of the medication intervention group(P<0.05).d.There was an inter-group difference in WFIRS-P risk factors,and there was a significant difference in the trend of change in the time*group(P<0.01).The difference in the medication intervention group before and after treatment was very statistically significant(P<0.01),and the risk activity score increased after treatment,but there was no statistically significant difference in the other two groups(P>0.05).The total score of WFIRS-P decreased in all three groups,and the total score of the medication intervention group decreased more significantly.There were differences in WFIRS-P learning and school factor,the differences between computerized executive function training and medication intervention group were statistically significant(P<0.05),and the differences between the computerized executive function training group and the combined EFTS and medication intervention group were statistically significant(P<0.05).The differences of family,life skills and self-concept factors before and after treatment were statistically significant(P<0.05),the differences between groups were not statistically significant(P>0.05).e.the PHCSS behavior,social group,happiness and satisfaction,and the total score of the three groups all improved,and the difference before and after treatment was statistically significant(P<0.05),while the difference between the groups was not statistically significant(P>0.05).Conclusions: The core symptoms were reduced in all groups,and the improvement effect of EFTS training on oppositional defiance was better than medication intervention.EFTS can improve the executive function defects in a variety of areas,and some of them are better than the drug treatment group.The combined EFTS and medication intervention group had better effect on the inverted number score and the BRIEF-P inhibitory factor score.Children’s social function and self-awareness were improved by EFTS.The combined EFTS and medication intervention group had better effect on WFIRS-P learning and school factor score,the Patients’ risk factors may be increased in medication group.Part Two: The Efficacy of Computerized Executive Function for Patients with ADHD at Different FrequencyObjectives: In a preliminary study of children with attention deficit hyperactivity disorder(ADHD),to examine the difference in efficacy of low-frequency and high-frequency computerized executive function training and the feasibility and effectiveness of low-frequency computerized executive function training.Methods:Fifty eight patients with ADHD aged 6-12 years were divided into low-frequency training group(once a week)and high-frequency training group(three times a week).Conners parent symptom questionnaire(PSQ).The executive functions of digital-span,coding and symbol-search tests of WISC-IV,Stroop color-word test,Wisconsin Card Sorting Test(WCST)were applied for patients with ADHD.Results: The low-frequency computerized training was feasible and the adherence was high.The results before and after the intervention showed that the ADHD symptoms reported by the parents of the children were improved after the intervention,and the differences in PSQ character factor score and learning problem factor score were statistically significant(p<0.05).And there were significant differences in the in main domains of executive function(EF)tests after the training of low-frequency executive function.The difference in the correct number in test B of Stroop test after the training was highly statistically significant(P<0.001),and the difference in the number of WCST persistent errors was statistically significant(P<0.01).There was a statistically significant difference of the digital-span scores,coding scores of WISC-IV(P<0.01)and symbol-search scores of WISC-IV(P<0.05).The difference in WCST classification completion number was statistically significant(P<0.05),the difference in conceptual level scores of WCST was statistically significant(P<0.01),and the difference in sustained response scores was highly statistically significant(P<0.001).There were significant differences in the indicators of executive function and core symptoms in the high-frequency group after training.The results of repeated measures anova showed that except for the number of errors in Test A and B,there was no statistically significant difference in efficacy between the two groups(P>0.05).Conclusions:Computerized executive function training with different intervention frequency can improve the executive function and symptoms of ADHD children,and low-frequency training is feasible and effective. |
