Brief Report: Pilot Study of a Novel Interactive Digital Treatment to Improve Cognitive Control in Children with Autism Spectrum Disorder and Co-occurring ADHD Symptoms
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The presence of attention deficit/hyperactivity disorder (ADHD) symptoms in children with autism spectrum disorder (ASD) is associated with worse cognitive control. Children with ASD and ADHD often respond poorly to medications, thus we need alternative treatments. We examined the feasibility, acceptability, and preliminary efficacy of Project Evo—a digital treatment. Nineteen children with ASD and co-occurring ADHD symptoms completed this app-based treatment that targets multi-tasking through gameplay versus a comparison educational treatment. Children had a high engagement with both treatments, and parents and children reported high acceptability. Within-group analyses suggest the multi-tasking but not the educational treatment may improve cognitive control. This multi-tasking treatment is feasible, acceptable, and possibly efficacious for cognitive control impairments in children with ASD and ADHD.
KeywordsNeurodevelopmental disorder Attention deficit/hyperactivity disorder Inhibition Executive function Go/No-Go Comorbidity
We would like to thank the youth and family members who gave their time and energy to participate in this study. The study was sponsored by Akili Interactive Labs (Akili). As part of the sponsored clinical study conducted with Children’s Hospital of Philadelphia.
Akili provided financial support in the form of salaries that was used for partial salary support for the first two authors (B.E.Y. and J.R.B.). All other authors (L.K., G.D., E.J.M., R.T.S., and L.S.) were advisors to Akili, and participated in the study design along with data interpretation, decision to publish, and preparation of the manuscript. R.T.S. holds stock options for consulting work to Akili Interactive Labs Inc., and is a member of the Scientific Advisory Board for Akili. G.D. is on the Scientific Advisory Boards of Janssen Research and Development, Akili Interactive Labs, Inc., LabCorp, and Roche Pharmaceutical Company, has received grant funding from Janssen Research and Development, L.L.C. and PerkinElmer, speaker fees from ViaCord, and receives royalties from Guilford Press and Oxford University Press. No additional salary support was provided for preparation of this manuscript. Akili participated in the study design, but did not participate in the data analysis, manuscript preparation, or decision to publish.
This study was sponsored by Akili Interactive Labs (Akili).
Compliance with Ethical Standards
Conflict of interest
Authors GD and RTS served as consultants to Akili Interactive Labs in the design of the study reported on here. Author RTS holds stock options for consulting work to Akili Interactive Labs Inc. Author GD is on the Scientific Advisory Boards of Janssen Research and Development, Akili Interactive Labs, Inc., LabCorp, and Roche Pharmaceutical Company, has received grant funding from Janssen Research and Development, L.L.C. and PerkinElmer, speaker fees from ViaCord, and receives royalties from Guilford Press and Oxford University Press. Author BEY and JRB received partial salary support from Akili to carry out the study reported on here. Akili participated in the design of the study, but did not participate in the data analysis and interpretation, manuscript preparation, or decision to publish.
All procedures performed in this study with human participants were in accordance with the ethical standards of the institutional research board committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This included obtaining informed parental consent and child assent for all participants.
- Anguera, J. A., Brandes-Aitken, A. N., Antovich, A. D., Rolle, C. E., Desai, S. S., & Marco, E. J. (2017a). A pilot study to determine the feasibility of enhancing cognitive abilities in children with sensory processing dysfunction. PLoS ONE, 12(4), e0172616. https://doi.org/10.1371/journal.pone.0172616.CrossRefPubMedPubMedCentralGoogle Scholar
- Anguera, J. A., Gunning, F. M., & Areán, P. A. (2017b). Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof-of-concept randomized trial. Depression and Anxiety, 34(6), 508–517. https://doi.org/10.1002/da.22588.CrossRefPubMedPubMedCentralGoogle Scholar
- Cambridge Cognition. (1996). CANTAB. Cambridge: Cambridge Cognition Ltd.Google Scholar
- Clapp, W. C., Rubens, M. T., Sabharwal, J., & Gazzaley, A. (2011). Deficit in switching between functional brain networks underlies the impact of multitasking on working memory in older adults. Proceedings of the National Academy of Sciences, 108(17), 7212–7217. https://doi.org/10.1073/pnas.1015297108.CrossRefGoogle Scholar
- Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum Associates.Google Scholar
- Corbett, B. A., Constantine, L. J., Hendren, R., Rocke, D., & Ozonoff, S. (2009). Examining executive functioning in children with autism spectrum disorder, attention deficit hyperactivity disorder and typical development. Psychiatry Research, 166(2–3), 210–222. https://doi.org/10.1016/j.psychres.2008.02.005.CrossRefPubMedPubMedCentralGoogle Scholar
- de Vries, M., Prins, P. J. M., Schmand, B. A., & Geurts, H. M. (2015). Working memory and cognitive flexibility-training for children with an autism spectrum disorder: A randomized controlled trial. Journal of Child Psychology and Psychiatry, 56(5), 566–576. https://doi.org/10.1111/jcpp.12324.CrossRefPubMedGoogle Scholar
- DuPaul, G. J., Power, T. J., Anastopoulos, A. D., & Reid, R. (1998). ADHD Rating Scale-IV: Checklists, norms, and clinical interpretation. New York: Guilford Press.Google Scholar
- Elliott, C. D. (2007). Differential Ability Scales-II (DAS-II). San Antonio: Pearson Assessments.Google Scholar
- Geurts, H. M., Verté, S., Oosterlaan, J., Roeyers, H., & Sergeant, J. A. (2004). How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism? Journal of Child Psychology and Psychiatry, 45(4), 836–854. https://doi.org/10.1111/j.1469-7610.2004.00276.x.CrossRefPubMedGoogle Scholar
- Gioia, G. A., Isquith, P. K., Guy, S., & Kenworthy, L. (2015). Behavior Rating Inventory of Executive Function, second edition (BRIEF-2). Odessa: Psychological Assessment Resources.Google Scholar
- Greenberg, L. M. (1996). Test of variables of attention. Los Alamitos: University Attention Disorder Inc.Google Scholar
- Gresham, F., & Elliott, S. N. (2008). Social Skills Improvement System (SSIS) Rating Scales. Lutz: Psychological Assessment Resources.Google Scholar
- Johnson, K. A., Robertson, I. H., Kelly, S. P., Silk, T. J., Barry, E., Dáibhis, A., et al. (2007). Dissociation in performance of children with ADHD and high-functioning autism on a task of sustained attention. Neuropsychologia, 45(10), 2234–2245. https://doi.org/10.1016/j.neuropsychologia.2007.02.019.CrossRefPubMedPubMedCentralGoogle Scholar
- Karalunas, S. L., Hawkey, E., Gustafsson, H., Miller, M., Langhorst, M., Cordova, M., et al. (2018). Overlapping and distinct cognitive impairments in attention-deficit/hyperactivity and autism spectrum disorder without intellectual disability. Journal of Abnormal Child Psychology. https://doi.org/10.1007/s10802-017-0394-2.CrossRefPubMedGoogle Scholar
- Klingberg, T., Fernell, E., Olesen, P. J., Johnson, M., Gustafsson, P., Dahlström, K., et al. (2005). Computerized training of working memory in children with ADHD—A randomized, controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 44(2), 177–186. https://doi.org/10.1097/00004583-200502000-00010.CrossRefPubMedGoogle Scholar
- Lai, C. L. E., Lau, Z., Lui, S. S. Y., Lok, E., Tam, V., Chan, Q., et al. (2017). Meta-analysis of neuropsychological measures of executive functioning in children and adolescents with high-functioning autism spectrum disorder. Autism Research, 10(5), 911–939. https://doi.org/10.1002/aur.1723.CrossRefPubMedGoogle Scholar
- Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. (2012). Autism Diagnostic Observation Schedule, second edition (ADOS-2) manual (part I): Modules 1–4. Torrance: Western Psychological Services.Google Scholar
- Pugliese, C. E., Anthony, L., Strang, J. F., Dudley, K., Wallace, G. L., & Kenworthy, L. (2015). Increasing adaptive behavior skill deficits from childhood to adolescence in autism spectrum disorder: Role of executive function. Journal of Autism and Developmental Disorders, 45(6), 1579–1587. https://doi.org/10.1007/s10803-014-2309-1.CrossRefPubMedPubMedCentralGoogle Scholar
- Pugliese, C. E., Anthony, L. G., Strang, J. F., Dudley, K., Wallace, G. L., Naiman, D. Q., et al. (2016). Longitudinal examination of adaptive behavior in autism spectrum disorders: Influence of executive function. Journal of Autism and Developmental Disorders, 46(2), 467–477. https://doi.org/10.1007/s10803-015-2584-5.CrossRefPubMedPubMedCentralGoogle Scholar
- Russo, N., Flanagan, T., Iarocci, G., Berringer, D., Zelazo, P. D., & Burack, J. A. (2007). Deconstructing executive deficits among persons with autism: Implications for cognitive neuroscience. Brain and Cognition, 65(1), 77–86. https://doi.org/10.1016/j.bandc.2006.04.007.CrossRefPubMedGoogle Scholar
- Rutter, M., Bailey, A., & Lord, C. (2003). Social Communication Questionnaire (SCQ). Los Angeles: Westerm Psychological Services.Google Scholar
- Sikora, D. M., Vora, P., Coury, D. L., & Rosenberg, D. (2012). Attention-deficit/hyperactivity disorder symptoms, adaptive functioning, and quality of life in children with autism spectrum disorder. Pediatrics, 130(Suppl 2), S91–S97. https://doi.org/10.1542/peds.2012-0900G.CrossRefPubMedGoogle Scholar
- Sinzig, J., Morsch, D., Bruning, N., Schmidt, M. H., & Lehmkuhl, G. (2008b). Inhibition, flexibility, working memory and planning in autism spectrum disorders with and without comorbid ADHD-symptoms. Child and Adolescent Psychiatry and Mental Health, 2(1), 4. https://doi.org/10.1186/1753-2000-2-4.CrossRefPubMedPubMedCentralGoogle Scholar
- Wallace, G. L., Kenworthy, L., Pugliese, C. E., Popal, H. S., White, E. I., Brodsky, E., et al. (2016a). Real-world executive functions in adults with autism spectrum disorder: Profiles of impairment and associations with adaptive functioning and co-morbid anxiety and depression. Journal of Autism and Developmental Disorders, 46(3), 1071–1083. https://doi.org/10.1007/s10803-015-2655-7.CrossRefPubMedPubMedCentralGoogle Scholar
- Wallace, G. L., Yerys, B. E., Peng, C., Dlugi, E., Anthony, L. G., & Kenworthy, L. (2016b). Assessment and treatment of executive function impairments in autism spectrum disorder: An update. In International review of research in developmental disabilities (Vol. 51, pp. 85–122). San Diego: Elsevier.Google Scholar
- Yerys, B. E., Kenworthy, L., Jankowski, K. F., Strang, J., & Wallace, G. L. (2013). Separate components of emotional Go/No-Go performance relate to autism versus attention symptoms in children with autism. Neuropsychology, 27(5), 537–545. https://doi.org/10.1037/a0033615.CrossRefPubMedPubMedCentralGoogle Scholar
- Yerys, B. E., Wallace, G. L., Sokoloff, J. L., Shook, D. A., James, J. D., & Kenworthy, L. (2009). Attention deficit/hyperactivity disorder symptoms moderate cognition and behavior in children with autism spectrum disorders. Autism Research, 2(6), 322–333. https://doi.org/10.1002/aur.103.CrossRefPubMedPubMedCentralGoogle Scholar