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Metacognitive executive function training for young children with ADHD: a proof-of-concept study

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ADHD Attention Deficit and Hyperactivity Disorders

Abstract

Executive functions (EF) are impaired in children with attention-deficit/hyperactivity disorder (ADHD). It may be especially critical for interventions to target EF in early childhood given the developmental progression of EF deficits that may contribute to later functional impairments. This proof-of-concept study examined the initial efficacy of an intervention program on EF and ADHD. We also examined child performance on three neurocognitive tasks assessing cognitive flexibility, auditory/visual attention, and sustained/selective attention. Children with ADHD (ages 3–7) and their parents were randomized to receive an intervention targeting metacognitive EF deficits (n = 13) or to a waitlist control condition (n = 12). Linear model analysis of covariance compared groups on parent EF ratings, blinded clinician ratings of ADHD symptoms and improvement, and child performance on neurocognitive measures. Children who received the intervention significantly improved on parent ratings of attention shifting and emotion regulation in addition to clinician ratings of inattention. Moderate effect sizes showed additional intervention effects on parent ratings of inhibition, memory, and planning, and clinician ratings of hyperactivity/impulsivity and overall improvement. Small effect sizes were observed for improvement on child neurocognitive measures. Although replication with a larger sample and an active control group is needed, EF training with a metacognitive focus is a potentially promising intervention for young children with ADHD.

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Acknowledgments

We gratefully thank the interventionists, Peter Stavinoha, Jarrette Moore, Laure Ames, Tabatha Melton, Amanda Gray, Aleksandra Foxwell, Jeanne Rintelmann, Jessica Castrejana, Stephanie Weatherford, Gina Bolanos, and Amanda Moates, and data manager, Conrad Barnes. We thank Scott Klein and Helen Neville for their permission to utilize and modify the EF training program described in this study, and Joyce Pickering for providing space in which to administer the intervention. Dr. Tamm receives research Grant funding from NIH/NIMH & NICHD. This study was a collaborative effort of the Center for Advanced ADHD Research, Treatment, and Education (CAARTE). We are grateful to the Sparrow Foundation for funding this research and the CAARTE collaboration.

Conflict of interest

Dr. Tamm and Dr. Nakonezny report no biomedical financial interests or potential conflicts of interest.

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Authors and Affiliations

  1. Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 10006, Cincinnati, OH, 45229, USA

    Leanne Tamm

  2. University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-8828, USA

    Paul A. Nakonezny

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  1. Leanne Tamm
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  2. Paul A. Nakonezny
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Correspondence to Leanne Tamm.

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Tamm, L., Nakonezny, P.A. Metacognitive executive function training for young children with ADHD: a proof-of-concept study. ADHD Atten Def Hyp Disord 7, 183–190 (2015). https://doi.org/10.1007/s12402-014-0162-x

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