Central Executive Training for ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a complex, chronic, and potentially debilitating disorder of brain, behavior, and development that affects approximately 5.4% of school-aged children at an annual U.S. cost of illness of over $42 billion. Medication and behavioral treatment are effective for reducing symptoms, but they are considered maintenance therapies because their benefits disappear within minutes to hours after treatment is stopped. Clearly, novel treatments are needed.

Central Executive Training (CET) is a novel, evidence-informed, computerized training protocol developed based on recent advancements in clinical and neuropsychological science. It differs fundamentally from existing, capacity-based “working memory training” programs. Each of CET’s 9 training games implement advanced algorithms to adapt based on the child’s performance and build capabilities across three, empirically-identified functions of the midlateral prefrontal cortex. These 3 functions involve dual-processing, continuous updating, and temporal ordering, and are collectively known as the brain’s ‘central executive.’

Central executive abilities are targeted in CET based on fMRI evidence of significant cortical underdevelopment in these areas in children with ADHD. Importantly, our previous work has shown that hyperactivity and inattentive symptoms are most pronounced in children with ADHD when they are engaged in activities that challenge their underdeveloped central executive abilities. In fact, several studies have found that children with ADHD do not show attention deficits or hyperactivity during conditions with minimal central executive demands.

Our preliminary data show that CET is superior to the current gold standard psychosocial treatment (behavioral parent training) for improving working memory in children with ADHD. Our data also show that CET is superior to the gold standard for reducing hyperactivity symptoms measured using high-precision actigraphs that sample children’s movement 16 times per second. CET was equivalent to the current gold standard for reducing ADHD symptoms based on parent report. A randomized clinical trial of CET is underway.

More on the NIH Award and a radio interview of Dr. Kofler.