Abstract
Cogmed Working Memory Training (CWMT), an online cognitive training program developed for children, is an increasingly popular non-pharmacological intervention for ADHD amongst all ages, despite limited supporting evidence. The initial objective of the present work was to examine the short- and long-term impacts of CWMT on brain function in adults with ADHD. However, during the conduct of our study, we experienced multiple levels of failures in recruitment and retention that signaled potential concerns about the suitability of CWMT for adults with ADHD. This perspective piece aims to describe the difficulties we encountered in the context of studies examining the efficacy of CWMT in comparable populations. We trace these difficulties to the limited tolerability of the current CWMT structure for adults with ADHD, and review similar limitations in the literature. We suggest that efficacy of CWMT in children may be due in large part to close monitoring and scaffolding provided by clinicians and caregivers. For CWMT to have viability for widespread use in adults, greater support and structure will be needed for users to improve the likelihood of adherence. We discuss implications and considerations for future efforts in both research and clinical practice.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children, characterized by impairing levels of inattention and/or hyperactivityimpulsivity
We focus on the acceptability and practicality of the intervention, defined by Bowen et al [28] as the extent to which a program is deemed suitable, satisfying, or attractive to participants, and the ability of participants to carry out program activities
Participants were recruited through local newspapers, internetbased advertising, college and university learning centers, and ADHD support groups
Summary
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children, characterized by impairing levels of inattention and/or hyperactivityimpulsivity. Longitudinal studies have found that impairing ADHD symptoms persist into adulthood in up to 65% of cases [1, 2]. Individuals with ADHD experience difficulties in occupational, social, and academic functioning [3,4,5]. Individuals with ADHD exhibit higher rates of substance abuse, motor vehicle accidents, accidental injury to self, nonsuicidal self-injury, and suicide [6]. When treating adults with ADHD, clinicians commonly encounter additional obstacles relating to adherence and efficacy. Stimulants, which are among the most effective treatments for ADHD in children, have been suggested to be less efficacious in adults [7, 8], with 20–50%
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