Data_Sheet_2_Which Factor Is More Relevant to the Effectiveness of the Cognitive Intervention? A Meta-Analysis of Randomized Controlled Trials of Cognitive Training on Symptoms and Executive Function Behaviors of Children With Attention Deficit Hyperactivity Disorder.doc

Objective: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by developmentally inappropriate inattention, hyperactivity, and impulsivity. Multiple cognitive training appeared to be more effective than working memory training, but the evidence remains insufficient, particularly for the subgroup symptoms and executive function behaviors at home. Further analysis of the impact of factors on the effectiveness would facilitate the development of cognitive training.
Methods: We searched PubMed, Cochrane Library, Psyche, Embase, Chinese Biomedical Literature Database, CNKI, and Weifang Database, and included randomized controlled trials (RCTs) of children with ADHD undergoing cognitive intervention. Metaanalysis and univariate metaregression were performed by STATE. The risk of bias was assessed with the Cochrane risk of bias tool 2.0 by the two investigators separately. This study was registered with INPLASY, number INPLASY202140065.
Results: We included 17 RCTs in the systematic review, with a combined 1,075 participants. For metaanalyses of both subgroups of ADHD symptoms and the executive function behaviors, the test of published bias failed to reach the p < 0.05 level. When all of the training are considered together, cognitive training can improve the presentation of inattention symptoms [SMD = −0.390, 95%CI (−0.675, −0.104)] and executive function behaviors (SMD = −0.319, 95%CI (−0.527, −0.111)]. In the subgroup analysis, the effects of working memory training on both presentations were not statistically significant. In contrast, the multiple cognitive training had significant effects on the presentation of inattention symptoms [SMD = −0.507, 95% CI (−0.722, −0.292)], hyperactivity/impulsivity [SMD = −0.305, 95% CI (−0.518, −0.09)], and the executive function behaviors [SMD = −0.499, 95%CI (−0.707, −0.290)]. In addition, metaregression analysis showed that only training frequency did significantly impact the symptoms of ADHD and the executive function behaviors.
Conclusion: This study showed that improvements in symptoms and executive function behaviors were related to the domains of cognitive intervention. The findings suggest that multiple domains of cognitive training and moderate training frequency may have wider clinical benefits. All the above results highlight further research in refining the executive functions of children with ADHD and developing individually tailored cognitive intervention on homes based for children with vulnerable executive functions.
Systematic Review Registration: [http://inplasy.com/], [INPLASY202140065].

研究目标：注意缺陷多动障碍（Attention deficit hyperactivity disorder, ADHD）是一种神经发育障碍，以发育不相称的注意力不集中、多动及冲动为核心特征。现有研究提示多领域认知训练的效果优于单一工作记忆训练，但相关证据仍不充分，尤其针对居家环境下的亚型症状与执行功能行为表现。进一步分析各类因素对训练效果的影响，将有助于推动认知训练方案的优化与发展。
研究方法：本研究检索了PubMed、Cochrane图书馆、Psyche、Embase、中国生物医学文献数据库、中国知网（CNKI）及潍坊数据库，纳入针对注意缺陷多动障碍儿童实施认知干预的随机对照试验（randomized controlled trials, RCTs）。采用STATA软件完成荟萃分析与单变量元回归分析。由两名研究者独立使用Cochrane偏倚风险评估工具2.0（Cochrane risk of bias tool 2.0）进行偏倚风险评价。本研究已在INPLASY平台注册，注册号为INPLASY202140065。
研究结果：本系统评价共纳入17项随机对照试验，累计纳入1075名受试者。针对注意缺陷多动障碍症状亚型与执行功能行为的荟萃分析均显示，发表偏倚检验未达到p<0.05的显著性水平。将所有训练类型合并分析时，认知训练可显著改善注意力不集中症状[标准化均数差（Standardized Mean Difference, SMD）=-0.390，95%置信区间（95% Confidence Interval, 95%CI）(-0.675, -0.104)]与执行功能行为[SMD=-0.319，95%CI(-0.527, -0.111)]。亚组分析显示，工作记忆训练对上述两项指标的改善效果均无统计学意义。与之相对，多领域认知训练可显著改善注意力不集中症状[SMD=-0.507，95%CI(-0.722, -0.292)]、多动/冲动症状[SMD=-0.305，95%CI(-0.518, -0.09)]及执行功能行为[SMD=-0.499，95%CI(-0.707, -0.290)]。此外，元回归分析结果显示，仅训练频率对注意缺陷多动障碍症状与执行功能行为存在显著影响。
研究结论：本研究结果显示，症状与执行功能行为的改善程度与认知干预的领域密切相关。研究结果提示，多领域认知训练与适度的训练频率或可带来更广泛的临床获益。上述所有结果均表明，未来仍需进一步优化针对注意缺陷多动障碍儿童的执行功能训练方案，并为执行功能受损的儿童开发基于居家场景的个体化认知干预措施。
系统评价注册信息：[http://inplasy.com/], [INPLASY202140065]。