Proof-of-concept study of an at-home, engaging, digital intervention for pediatric ADHD

Naomi O Davis, Jeffrey Bower, Scott H Kollins, Naomi O Davis, Jeffrey Bower, Scott H Kollins

Abstract

Objective: Pharmacological and behavioral therapies have limited impact on the distinct neurocognitive impairments associated with ADHD, and existing cognitive training programs have shown limited efficacy. This proof-of-concept study assessed treatment acceptability and explored outcomes for a novel digital treatment targeting cognitive processes implicated in ADHD.

Method: Participants included 40 children with ADHD and 40 children without ADHD. Following psychiatric screening, ADHD ratings, and baseline neuropsychological measures, participants completed 28-days of at-home treatment. Neuropsychological assessment was repeated at end-of-study along with treatment satisfaction measures.

Results: Eighty-four percent of treatment sessions were completed and ratings showed strong intervention appeal. Significant improvements were observed on a computerized attention task for the ADHD group and a highly impaired ADHD High Severity subgroup. There was no change for the non-ADHD group. Spatial working memory also improved for the ADHD group and the ADHD High Severity subgroup.

Conclusion: Findings provide preliminary support that this treatment may improve attention, working memory, and inhibition in children with ADHD. Future research requires larger-scale randomized controlled trials that also evaluate treatment impact on functional impairments.

Trial registration: ClinicalTrials.gov NCT01943539.

Conflict of interest statement

Competing Interests: Jeffrey Bower is an employee of Akili Interactive Labs. Scott Kollins is an advisor to Akili. Naomi Davis is a Principal Investigator for another Akili study. In the past 2 years Dr. Davis has received research support and/or consulting fees from Akili Interactive Labs and Rhodes Pharmaceuticals. Dr. Kollins has received research support and/or consulting fees from the following commercial sources in the last 2 years: Purdue Canada, Akili Interactive Labs, Alcobra, Bose, Jazz, Ironshore, Medgenics. Sunovion, Rhodes, Shire, SK Life Sciences, KemPharm, and NLS Pharma. This commercial affiliation does not alter our adherence to PLOS ONE policies regarding sharing data and materials.

Figures

Fig 1. CONSORT flow diagram.
Fig 1. CONSORT flow diagram.
Fig 2. Study design and participant flow.
Fig 2. Study design and participant flow.
*All participants drop outs were due to noncompliance with the intervention.
Fig 3. Performance on the TOVA API…
Fig 3. Performance on the TOVA API pre- and post-intervention for the ADHD group and the non-ADHD group.
Note: Error bars represent standard error of the mean (*p

Fig 4. Performance on the TOVA API…

Fig 4. Performance on the TOVA API pre- and post-intervention for the ADHD High Severity…

Fig 4. Performance on the TOVA API pre- and post-intervention for the ADHD High Severity subgroup and the non-ADHD group.
Note: Error bars represent standard error of the mean (*p

Fig 5. Performance on the spatial working…

Fig 5. Performance on the spatial working memory task pre- and post-intervention for the ADHD…

Fig 5. Performance on the spatial working memory task pre- and post-intervention for the ADHD group and the non-ADHD group.
Note. Scores represent mean time to last response with 4 boxes. Error bars represent standard error of the mean. (** p

Fig 6. Performance on the spatial working…

Fig 6. Performance on the spatial working memory task pre- and post-intervention for the ADHD…

Fig 6. Performance on the spatial working memory task pre- and post-intervention for the ADHD High Severity subgroup and the non-ADHD group.
Note. Scores represent mean time to last response with 4 boxes. Error bars represent standard error of the mean. (** p

Fig 7. Example of a Project: Evo…

Fig 7. Example of a Project: Evo task.

Fig 7. Example of a Project: Evo task.
All figures (7)
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Cited by
References
    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed Washington, DC: Author; 2013.
    1. Friedman LA, Rapoport JL. Brain development in ADHD. Current Opinion in Neurobiology. 2015;30:106–11. Epub 2014/12/17. doi: 10.1016/j.conb.2014.11.007 - DOI - PubMed
    1. Konrad K, Eickhoff SB. Is the ADHD brain wired differently? A review on structural and functional connectivity in attention deficit hyperactivity disorder. Human Brain Mapping. 2010;31(6):904–16. Epub 2010/05/25. doi: 10.1002/hbm.21058 - DOI - PMC - PubMed
    1. Volkow ND, Wang GJ, Kollins SH, Wigal TL, Newcorn JH, Telang F, et al. Evaluating dopamine reward pathway in ADHD: clinical implications. JAMA. 2009;302(10):1084–91. Epub 2009/09/10. doi: 10.1001/jama.2009.1308 - DOI - PMC - PubMed
    1. de Zeeuw P, Weusten J, van Dijk S, van Belle J, Durston S. Deficits in cognitive control, timing and reward sensitivity appear to be dissociable in ADHD. PLoS One. 2012;7(12):e51416 Epub 2012/12/14. doi: 10.1371/journal.pone.0051416 - DOI - PMC - PubMed
Show all 47 references
Publication types
Associated data
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Grant support
This study was funded by Akili Interactive Labs. As part of the sponsored clinical study conducted with Duke University, Akili provided financial support in the form of salaries that was used for partial salary support for two authors [SHK, NOD]. Akili also participated in study design, data analysis, decision to publish, and preparation of the manuscript, and Akili is employer for the third author [JB] who worked in this capacity. These contributions are articulated in the 'author contributions' section. No salary support was provided for preparation of this manuscript.
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Fig 4. Performance on the TOVA API…
Fig 4. Performance on the TOVA API pre- and post-intervention for the ADHD High Severity subgroup and the non-ADHD group.
Note: Error bars represent standard error of the mean (*p

Fig 5. Performance on the spatial working…

Fig 5. Performance on the spatial working memory task pre- and post-intervention for the ADHD…

Fig 5. Performance on the spatial working memory task pre- and post-intervention for the ADHD group and the non-ADHD group.
Note. Scores represent mean time to last response with 4 boxes. Error bars represent standard error of the mean. (** p

Fig 6. Performance on the spatial working…

Fig 6. Performance on the spatial working memory task pre- and post-intervention for the ADHD…

Fig 6. Performance on the spatial working memory task pre- and post-intervention for the ADHD High Severity subgroup and the non-ADHD group.
Note. Scores represent mean time to last response with 4 boxes. Error bars represent standard error of the mean. (** p

Fig 7. Example of a Project: Evo…

Fig 7. Example of a Project: Evo task.

Fig 7. Example of a Project: Evo task.
All figures (7)
Similar articles
Cited by
References
    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed Washington, DC: Author; 2013.
    1. Friedman LA, Rapoport JL. Brain development in ADHD. Current Opinion in Neurobiology. 2015;30:106–11. Epub 2014/12/17. doi: 10.1016/j.conb.2014.11.007 - DOI - PubMed
    1. Konrad K, Eickhoff SB. Is the ADHD brain wired differently? A review on structural and functional connectivity in attention deficit hyperactivity disorder. Human Brain Mapping. 2010;31(6):904–16. Epub 2010/05/25. doi: 10.1002/hbm.21058 - DOI - PMC - PubMed
    1. Volkow ND, Wang GJ, Kollins SH, Wigal TL, Newcorn JH, Telang F, et al. Evaluating dopamine reward pathway in ADHD: clinical implications. JAMA. 2009;302(10):1084–91. Epub 2009/09/10. doi: 10.1001/jama.2009.1308 - DOI - PMC - PubMed
    1. de Zeeuw P, Weusten J, van Dijk S, van Belle J, Durston S. Deficits in cognitive control, timing and reward sensitivity appear to be dissociable in ADHD. PLoS One. 2012;7(12):e51416 Epub 2012/12/14. doi: 10.1371/journal.pone.0051416 - DOI - PMC - PubMed
Show all 47 references
Publication types
Associated data
Related information
Grant support
This study was funded by Akili Interactive Labs. As part of the sponsored clinical study conducted with Duke University, Akili provided financial support in the form of salaries that was used for partial salary support for two authors [SHK, NOD]. Akili also participated in study design, data analysis, decision to publish, and preparation of the manuscript, and Akili is employer for the third author [JB] who worked in this capacity. These contributions are articulated in the 'author contributions' section. No salary support was provided for preparation of this manuscript.
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Follow NCBI
Fig 5. Performance on the spatial working…
Fig 5. Performance on the spatial working memory task pre- and post-intervention for the ADHD group and the non-ADHD group.
Note. Scores represent mean time to last response with 4 boxes. Error bars represent standard error of the mean. (** p

Fig 6. Performance on the spatial working…

Fig 6. Performance on the spatial working memory task pre- and post-intervention for the ADHD…

Fig 6. Performance on the spatial working memory task pre- and post-intervention for the ADHD High Severity subgroup and the non-ADHD group.
Note. Scores represent mean time to last response with 4 boxes. Error bars represent standard error of the mean. (** p

Fig 7. Example of a Project: Evo…

Fig 7. Example of a Project: Evo task.

Fig 7. Example of a Project: Evo task.
All figures (7)
Similar articles
Cited by
References
    1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed Washington, DC: Author; 2013.
    1. Friedman LA, Rapoport JL. Brain development in ADHD. Current Opinion in Neurobiology. 2015;30:106–11. Epub 2014/12/17. doi: 10.1016/j.conb.2014.11.007 - DOI - PubMed
    1. Konrad K, Eickhoff SB. Is the ADHD brain wired differently? A review on structural and functional connectivity in attention deficit hyperactivity disorder. Human Brain Mapping. 2010;31(6):904–16. Epub 2010/05/25. doi: 10.1002/hbm.21058 - DOI - PMC - PubMed
    1. Volkow ND, Wang GJ, Kollins SH, Wigal TL, Newcorn JH, Telang F, et al. Evaluating dopamine reward pathway in ADHD: clinical implications. JAMA. 2009;302(10):1084–91. Epub 2009/09/10. doi: 10.1001/jama.2009.1308 - DOI - PMC - PubMed
    1. de Zeeuw P, Weusten J, van Dijk S, van Belle J, Durston S. Deficits in cognitive control, timing and reward sensitivity appear to be dissociable in ADHD. PLoS One. 2012;7(12):e51416 Epub 2012/12/14. doi: 10.1371/journal.pone.0051416 - DOI - PMC - PubMed
Show all 47 references
Publication types
Associated data
Related information
Grant support
This study was funded by Akili Interactive Labs. As part of the sponsored clinical study conducted with Duke University, Akili provided financial support in the form of salaries that was used for partial salary support for two authors [SHK, NOD]. Akili also participated in study design, data analysis, decision to publish, and preparation of the manuscript, and Akili is employer for the third author [JB] who worked in this capacity. These contributions are articulated in the 'author contributions' section. No salary support was provided for preparation of this manuscript.
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Fig 6. Performance on the spatial working…
Fig 6. Performance on the spatial working memory task pre- and post-intervention for the ADHD High Severity subgroup and the non-ADHD group.
Note. Scores represent mean time to last response with 4 boxes. Error bars represent standard error of the mean. (** p

Fig 7. Example of a Project: Evo…

Fig 7. Example of a Project: Evo task.

Fig 7. Example of a Project: Evo task.
All figures (7)
Fig 7. Example of a Project: Evo…
Fig 7. Example of a Project: Evo task.

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    1. Volkow ND, Wang GJ, Kollins SH, Wigal TL, Newcorn JH, Telang F, et al. Evaluating dopamine reward pathway in ADHD: clinical implications. JAMA. 2009;302(10):1084–91. Epub 2009/09/10. doi:
    1. de Zeeuw P, Weusten J, van Dijk S, van Belle J, Durston S. Deficits in cognitive control, timing and reward sensitivity appear to be dissociable in ADHD. PLoS One. 2012;7(12):e51416 Epub 2012/12/14. doi:
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