Non-pharmacological treatment of Attention Deficit Disorder with or without Hyperactivity (ADHD). Overview and report of the first international symposium on the non-pharmacological management of ADHD.

Attention Deficit Disorder with or without Hyperactivity (ADHD is a neurodevelopmental disorder which affects the day-to-day functioning of children and adults with this condition. Pharmacological treatment can reduce the symptoms associated with ADHD, but it has some limitations. The objective of this symposium is to determine the effects of non-pharmacological approaches on ADHD symptoms. Results indicate that the following intervention are promising approaches: cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), yoga, cognitive and metacognitive intervention, neurofeedback and parental training programs. Current research advocates multimodal approaches in conjunction with school or work accommodations integrating innovative technologies.

Effect of Treating Anxiety Disorders on Cognitive Deficits and Behaviors Associated with Attention Deficit Hyperactivity Disorder: A Preliminary Study.

Twenty-five percent of children with ADHD also have an anxiety disorder (AD). As per Quay and in light of Barkley's model, anxiety may have a protective effect on cognitive deficits and behaviors associated with ADHD. This study aimed to evaluate the effect of treating AD on cognitive deficits and behaviors associated with ADHD in children with both disorders. Twenty-four children with ADHD and AD were divided into two groups: treatment for AD, and wait list. Participants were assessed at pre-treatment, post-treatment, and 6-month follow-up with the ADIS-C, the CBCL, and neuropsychological measures. The results revealed a significant improvement in automatic response inhibition and flexibility, and a decrease in inattention/hyperactivity behaviors following the treatment for AD. No significant differences were observed in motor response inhibition, working memory, or attention deficits. The results do not seem to support Quay's hypothesis: treating AD did not exacerbate cognitive deficits and behaviors associated with ADHD in our sample.

The role of the executive functions in school achievement at the end of Grade 1.

The aim of this study was to determine the role of executive functions (EFs) in early school achievement when a variety of potential confounding factors were controlled. Measures of EF (inhibition, flexibility, and working memory) and school readiness were administered to a sample of 85 kindergartners (39 boys and 46 girls, 5-6years old). School achievement was then assessed at the end of Grade 1. Results show math and reading/writing skills at the end of Grade 1 to be associated with kindergarten EFs. Only working memory contributed uniquely to the variance in school achievement after all covariates (preacademic abilities, affective variables, and family variables) were controlled and, even then, only with respect to math skills. On the other hand, working memory and inhibition had an indirect effect on reading/writing skills via anger-aggression. EF implication in school achievement is discussed in terms of task demands and child age.

Meta-Analysis of Sex Differences in ADHD Symptoms and Associated Cognitive Deficits.

Objective: A meta-analysis was carried out to determine whether there are sex differences among children and adolescents with ADHD on the primary symptoms of ADHD and on executive and attentional functioning. Method: Studies published from 1997 to 2017 comparing boys and girls with a valid ADHD diagnosis were retained. Results: The meta-analysis found boys with ADHD to be more hyperactive than girls with ADHD and boys to have more difficulties in terms of motor response inhibition and cognitive flexibility. Results also confirm that youths with ADHD have more executive deficits than non-ADHD peers have, but there is no sex difference in this regard. Conclusion: Results show that there are sex differences in the behavioral expression of the difficulties related to ADHD. This highlights the importance of pursuing research to refine the profile of girls with ADHD and to develop diagnostic criteria adapted to each sex.

Working Memory Training for Adults With ADHD.

Objective: The aim of this study was to examine the effects of Cogmed training on working memory in adults with ADHD, including the generalization of effects to nonverbal reasoning, executive function in daily life, and ADHD symptoms. Method: Adults of ages 18 to 63 with ADHD were randomly assigned to an experimental group that received the working memory training or to a placebo group that received a low-intensity comparison version of the training. Results: participants in the experimental group showed greater improvement in verbal and visuospatial working memory capacity. Effects persisted 6 months after intervention completion. However, effects did not generalize elsewhere. Conclusion: The results challenge the claims made by Cogmed to the effect that the program is effective in treating attention problems and improving performance in daily life over the long term in adults with ADHD.

Design Fluency in Children with ADHD and Comorbid Disorders.

BACKGROUND: Attention deficit/hyperactivity disorder (ADHD) is often associated with frontal executive impairment in children. Oppositional defiant disorder (ODD) and anxiety disorders (AD) frequently accompany ADHD, but the impact of these comorbid disorders on cognition remains elusive. The five-point test (FPT), a design fluency task, has been shown to be sensitive to neurological damage, specifically to frontal lobe lesions in patients with brain injuries. The purpose of this study was to compare the performances of neurotypical children with that of children with ADHD, ADHD-ODD, and ADHD-AD on the FPT in order to examine whether these groups could be distinguished from one another based on their cognitive profile. METHODS: A total of 111 children aged 8 to 11 years old participated in the study. Six measures from the FPT were used to characterize their performance. RESULTS: Statistically significant differences between groups were observed for five of the six FPT measures. Essentially, children with ADHD-ODD made more repeated designs than the three other groups (control p > 0.001, ADHD p = 0.008, ADHD-AD p = 0.008), while children with ADHD-AD produced fewer total and correct designs than the control and ADHD groups (p = 0.009). CONCLUSIONS: This suggests that comorbidities have an additive impact on the cognitive profile of children with ADHD. Design fluency may be a sensitive measure for capturing the subtle cognitive deficits that are likely to be involved in these disorders.

The Impact of a Motor-Cognitive Remediation Program on Attentional Functions of Preschoolers With ADHD Symptoms.

OBJECTIVE: The purpose of this study was to measure the impact of the motor-cognitive remediation program (MCRP) that uses sensorimotor and visual-motor imagery techniques on attentional functions in preschoolers with ADHD symptoms. METHOD: A total of 15 high-risk preschoolers were selected based on high ADHD symptoms. An experimental group participated in the MCRP and was compared with a control group. The MCRP consisted of 30 activities, 3 times a week, during 12 weeks. RESULTS: Children in the experimental group improved significantly for orienting (selective attention) and executive control (inhibition, stopping, and engaging mental operations) compared with the control group. CONCLUSION: These results are a first step to support the postulate that training specific attentional functions by sensorimotor activities and visual-motor imagery has an impact on the cognitive network of attention. This study suggests the potential value of MCRP addressed to preschoolers with ADHD symptoms.

Executive functions in kindergarteners with high levels of disruptive behaviours.

Executive function (EF) deficits have yet to be demonstrated convincingly in children with disruptive behaviour disorders (DBD), as only a few studies have reported these. The presence of EF weaknesses in children with DBD has often been contested on account of the high comorbidity between DBD and attention-deficit/hyperactivity disorder (ADHD) and of methodological shortcomings regarding EF measures. Against this background, the link between EF and disruptive behaviours in kindergarteners was investigated using a carefully selected battery of EF measures. Three groups of kindergarteners were compared: (1) a group combining high levels of disruptive behaviours and ADHD symptoms (COMB); (2) a group presenting high levels of disruptive/aggressive behaviours and low levels of ADHD symptoms (AGG); and (3) a normative group (NOR). Children in the COMB and AGG groups presented weaker inhibition capacities compared with normative peers. Also, only the COMB group showed weaker working memory capacities compared with the NOR group. Results support the idea that preschool children with DBD have weaker inhibition capacities and that this weakness could be common to both ADHD and DBD.

A physical activity program improves behavior and cognitive functions in children with ADHD: an exploratory study.

OBJECTIVE: The objective of this study is to explore the effects of a moderate- to high-intensity physical activity program on fitness, cognitive functions, and ADHD-related behavior in children with ADHD. METHOD: Fitness level, motor skills, behaviors, and cognitive functions are assessed by standardized tests before and after a 10-week training or control period. RESULTS: Findings show that participation in a physical activity program improves muscular capacities, motor skills, behavior reports by parents and teachers, and level of information processing. CONCLUSION: A structured physical activity program may have clinical relevance in the functional adaptation of children with ADHD. This supports the need for further research in the area of physical activity with this population.