Programme de Remédiation cognitive NEAR (Neuropsychological Educational Approach to Cognitive Remediation) chez des adolescents présentant un Trouble Déficit de l’Attention/Hyperactivité et/ou un Trouble du spectre Autistique

Abstract

ObjectivesCognitive Remediation is a therapeutic approach based on the notion of brain plasticity. It aims to improve certain cognitive function deficits through the repetition of specific exercises and to promote the metacognitive dimension (the awareness and reflection of an individual on his cognitions, his behaviors and the strategies he uses to solve a problem). Several programs have already been validated in adult patients with schizophrenia and have shown improvements in cognitive performance and functioning. Some of the programs were later applied to other pathologies such as anorexia nervosa or autism spectrum disorders (ASD). Remedial programs have also been developed for children and adolescents because the early symptomatic expression of certain disorders such as Attention Deficit Hyperactivity Disorder (ADHD) or ASD makes one suspect a neurodevelopmental origin and all have in common an alteration of the executive functions. There are programs of cognitive stimulation or cognitive training, particularly in the context of ADHD. Although the results do show benefits in terms of visual and verbal working memory, the effects of cognitive training seem to be difficult to generalize to other everyday learning and have only limited effects on the symptoms. The objective of this study is to assess the feasibility and acceptability of the Neuropsychological Educational Approach to Cognitive Remediation for Adolescents (NEAR). Patients or materials and methodsThe Department of Child and adolescent Psychopathology of the Sainte-Anne Hospital (Paris), part of the reference center for remediation and psychosocial rehabilitation (C3RP), used NEAR, originally developed for adult schizophrenic patients, with four preadolescents and adolescents aged 11 to 15 years with either ADHD or ASD. The IQ ranged from 80 to 112 and none was under medication. This method combines cognitive exercises and Cognitive-Behavioral Therapy groups. The interest is in working simultaneously on cognitive functions such as memory, executive functions, attention, visuospatial abilities and the metacognitive dimension by building “bridges” between what has been worked on in the sessions and examples from daily life. One of the main focuses in the NEAR method is the principle of encouraging intrinsic motivation. The method also aims to restore confidence in the ability to acquire skills, to overcome certain failures regularly encountered by these adolescents in their schooling and to encourage the generalization and transfer of learning to other situations or contexts from daily life. ResultsThe first observations show that this program is applicable and adapted to preadolescents and adolescents as well as to the pathologies targeted in this group. The participants reported improvement in memory. They also emphasized the benefits in attention and planning. Moreover, the adolescents report that the majority of learning has been transferable to the school environment. The commonest example was the use of techniques to improve their memory such as making a list, verbalizing (stating either aloud or mentally the subject matter of a course) or organizing information. Others have used attentional strategies learned during the group such as condensing information, pausing, using verbalization, or reducing sensory distractors. Another positive aspect of the group reported by all teenagers was the pleasure of seeing each other again every week, the perceived support and the development of self-help skills. ConclusionCognitive Remediation is now an additional therapeutic tool, which can empower other therapeutic approaches with no significant side effects. The development and evaluation of programs targeting a wider range of neuropsychological deficits than the NEAR program seems to us to be a future direction because children do not all have the same neuropsychological profile and they are often affected by several neuropsychological deficits. The first application of this program in adolescents is taking place within the Department of Child and Adolescent Psychiatry of the Sainte-Anne Hospital Centre. Neuropsychological and functional evaluations on a larger sample are underway.