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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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Abstract

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.

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References

  • American Psychiatric Association, & DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington: American Psychiatric Association.

    Book  Google Scholar 

  • Anguera, J. A., Boccanfuso, J., Rintoul, J. L., Al-Hashimi, O., Faraji, F., Janowich, J., et al. (2013). Video game training enhances cognitive control in older adults. Nature, 501(7465), 97–101. https://doi.org/10.1038/nature12486.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Botvinick, M. M., Braver, T. S., Barch, D. M., Carter, C. S., & Cohen, J. D. (2001). Conflict monitoring and cognitive control. Psychological Review, 108(3), 624–652.

    Article  PubMed  Google 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.

    Article  Google Scholar 

  • Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum Associates.

  • 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Davis, N. O., Bower, J., & Kollins, S. H. (2018). Proof-of-concept study of an at-home, engaging, digital intervention for pediatric ADHD. PLoS ONE, 13(1), e0189749. https://doi.org/10.1371/journal.pone.0189749.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google 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 

  • Gazzaley, A., Cooney, J. W., Rissman, J., & D’Esposito, M. (2005). Top-down suppression deficit underlies working memory impairment in normal aging. Nature neuroscience, 8(10), 1298–1300. https://doi.org/10.1038/nn1543.

    Article  PubMed  Google Scholar 

  • Geurts, H. M., van den Bergh, S. F. W. M., & Ruzzano, L. (2014). Prepotent response inhibition and interference control in autism spectrum disorders: Two meta-analyses. Autism Research, 7(4), 407–420. https://doi.org/10.1002/aur.1369.

    Article  PubMed  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.

    Article  PubMed  Google Scholar 

  • Gilotty, L., Kenworthy, L., Sirian, L., Black, D. O., & Wagner, A. E. (2002). Adaptive skills and executive function in autism spectrum disorders. Child Neuropsychology, 8(4), 241–248.

    Article  PubMed  Google 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 

  • Hedges, L. V. (1981). Distribution theory for Glass’s estimator of effect size and related estimators. Journal of Educational Statistics, 6(2), 107–128. https://doi.org/10.3102/10769986006002107.

    Article  Google Scholar 

  • Hill, E. L. (2004). Evaluating the theory of executive dysfunction in autism. Developmental Review, 24(2), 189–233.

    Article  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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jones, R. M., Caroline, C., Hamo, A., & Lord, C. (2017). Placebo-like response in absence of treatment in children with Autism. Autism Research, 10(9), 1567–1572. https://doi.org/10.1002/aur.1798.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kenworthy, L., Yerys, B. E., Anthony, L. G., & Wallace, G. L. (2008). Understanding executive control in autism spectrum disorders in the lab and in the real world. Neuropsychology Review, 18(4), 320–338. https://doi.org/10.1007/s11065-008-9077-7.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google Scholar 

  • Kraemer, H. C., Mintz, J., Noda, A., Tinklenberg, J., & Yesavage, J. A. (2006). Caution regarding the use of pilot studies to guide power calculations for study proposals. Archives of General Psychiatry, 63(5), 484–489. https://doi.org/10.1001/archpsyc.63.5.484.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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 

  • O’Hearn, K., Asato, M., Ordaz, S., & Luna, B. (2008). Neurodevelopment and executive function in autism. Development and Psychopathology, 20(4), 1103–1132. https://doi.org/10.1017/S0954579408000527.

    Article  PubMed  Google Scholar 

  • Pennington, B. F., & Ozonoff, S. (1996). Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry, 37(1), 51–87.

    Article  PubMed  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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rao, P., & Landa, R. J. (2014). Association between severity of behavioral phenotype and comorbid attention deficit hyperactivity disorder symptoms in children with autism spectrum disorders. Autism, 18(3), 272–280.

    Article  PubMed  Google Scholar 

  • Research Units on Pediatric Psychopharmacology (RUPP). (2005). Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Archives of General Psychiatry, 62(11), 1266–1274. https://doi.org/10.1001/archpsyc.62.11.1266.

    Article  Google 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.

    Article  PubMed  Google Scholar 

  • Rutter, M., Bailey, A., & Lord, C. (2003). Social Communication Questionnaire (SCQ). Los Angeles: Westerm Psychological Services.

    Google Scholar 

  • Scahill, L., McCracken, J. T., Rockhill, C., Shah, B., Politte, L., Sanders, R., et al. (2015). Extended-release guanfacine for hyperactivity in children with autism spectrum disorder. American Journal of Psychiatry, 172, 1197–1206.

    Article  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.

    Article  PubMed  Google Scholar 

  • Sinzig, J., Bruning, N., Morsch, D., & Lehmkuhl, G. (2008a). Attention profiles in autistic children with and without comorbid hyperactivity and attention problems. Acta Neuropsychiatrica, 20(4), 207–215. https://doi.org/10.1111/j.1601-5215.2008.00292.x.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

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.

Funding

This study was sponsored by Akili Interactive Labs (Akili).

Author information

Authors and Affiliations

  1. Center for Autism Research, Children’s Hospital of Philadelphia, 2716 South Street, 5th floor, Philadelphia, PA, 19146, USA

    Benjamin E. Yerys, Jennifer R. Bertollo & Robert T. Schultz

  2. Department of Psychiatry and Pediatrics, Perelman School of Medicine – University of Pennsylvania, Philadelphia, PA, USA

    Benjamin E. Yerys & Robert T. Schultz

  3. Center for Autism Spectrum Disorders and Division of Neuropsychology, Children’s National Health System, Washington, DC, USA

    Lauren Kenworthy

  4. Departments of Pediatrics, Neurology, Psychiatry, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA

    Lauren Kenworthy

  5. Department of Psychiatry and Behavioral Sciences, School of Medicine – Duke University, Durham, NC, USA

    Geraldine Dawson & Linmarie Sikich

  6. Department of Neurology, University of California – San Francisco School of Medicine, San Francisco, CA, USA

    Elysa J. Marco

  7. Duke Clinical Research Institute, School of Medicine – Duke University, Durham, NC, USA

    Robert T. Schultz & Linmarie Sikich

Authors
  1. Benjamin E. Yerys
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  2. Jennifer R. Bertollo
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  3. Lauren Kenworthy
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  4. Geraldine Dawson
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  7. Linmarie Sikich
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Contributions

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.

Corresponding author

Correspondence to Benjamin E. Yerys.

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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.

Ethical Approval

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.

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Yerys, B.E., Bertollo, J.R., Kenworthy, L. et al. 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. J Autism Dev Disord 49, 1727–1737 (2019). https://doi.org/10.1007/s10803-018-3856-7

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