Central executive training for ADHD

Singh, Gaye, Cole, Chan, & Kofler (2022) published “Central Executive Training for ADHD: Effects on academic achievement, productivity, and success in the classroom” in Neuropsychology. I was drawn to the article because Kofler has done extensive work is this field. His work is summarized as follows:

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.

In this study, they used Central executive training (CET), inhibitory control training (ICT), or behavioral parent training (BPT) on 108 8-13 year olds diagnosed with ADHD. Here are their findings:

CET was superior to BPT and ICT (d = 0.62–0.88) for improving masked teacher perceptions of academic success, impulse control, and academic productivity at 1–2 months posttreatment. At 2–4-month follow-up, CET (d = 0.76) and ICT (d = 0.54) were superior to BPT for improving objectively-tested academic achievement overall (reading comprehension, math problem-solving, language comprehension), and CET was superior to ICT (d = 0.56) for improving math problem-solving. The significant benefits of CET on academic success, academic productivity, reading comprehension, and math problem-solving replicated across both trials and were clinically significant as evidenced by low number needed to treat estimates (Needed to Treat; NNT = 3–7) and significantly higher proportions of individual cases demonstrating reliable improvements in academic success/productivity (33%–36% vs. 0%–18%) and achievement (38%–72% vs. 18%–54%) across outcomes (all p ≤ .01).  

Additional information from FSU explains that, “Central Executive Training (CET) is a 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’.” I have always been struck when parents insist that their children don’t exhibit ADHD symptoms under some circumstances. I’d like to see more research utilizing the CET protocol.