Digital cognitive training improves quality of life for adults with ADHD

A randomized controlled trial examining the effects of a digital cognitive training app called NeuroNation MED showed that the program may improve psychological quality of life for adults with ADHD. Compared to a group receiving standard treatment, the app users did not show better performance on objective cognitive tests. However, they did tend to report feeling that their own cognitive functioning had improved. The paper was published in the Journal of Psychiatric Research.

Attention-deficit/hyperactivity disorder, or ADHD, is a neurodevelopmental condition. This means it is tied to differences in how the brain grows and develops. It is characterized by persistent difficulties with attention, impulse control, and activity regulation. People with ADHD tend to struggle to stay focused, organize tasks, and manage time.

They may also find it hard to remember obligations or complete work that requires sustained mental effort. Some individuals also experience hyperactivity, such as restlessness, excessive talking, or a constant need for movement. Impulse control difficulties can appear as interrupting others, making hasty decisions, or acting before considering the consequences.

Symptoms usually begin in childhood, but they may continue into adolescence and adulthood. ADHD can negatively affect performance in school, work, relationships, finances, and everyday routines. It is most often diagnosed when a child starts school and their behaviors come into conflict with classroom rules.

Study author Moritz Bergmann and his colleagues evaluated the effects of an adaptive digital training program called NeuroNation MED on ADHD-related cognitive challenges. The app-based program targets executive functions, which are a set of mental skills that help people plan, focus attention, and juggle multiple tasks. Specifically, the training focuses on working memory, processing speed, and the ability to control attention.

The app contains 23 exercises that adapt dynamically to individual performance. It specifically addresses areas where people with ADHD often struggle, such as attentional flexibility, which is the ability to shift focus between different tasks, and response inhibition, which is the ability to suppress impulsive actions. The app also includes game-like elements such as progress indicators, milestones, and rewards to keep users engaged.

The researchers recruited 77 adults between 18 and 60 years of age who had a clinical diagnosis of ADHD. The participants came from an outpatient clinic at the University Hospital Bonn in Germany. Individuals who had diagnoses of certain other mental health conditions were excluded. During the study, participants were permitted to continue taking their existing ADHD medication, but they were asked to skip their medication on testing days.

At the start of the study, participants were randomly divided into two groups. One group completed cognitive training using the NeuroNation MED app for 12 weeks. The other group continued their standard treatment as usual during that same timeframe. After this initial period, the standard treatment group crossed over and received access to the app.

Training began with a 15-minute baseline assessment within the app. The results were used to create a customized training profile that determined the starting difficulty and the specific mental skills to emphasize. Each subsequent training session consisted of a sequence of several short exercises, with each task lasting a few minutes.

The exercises were repeated across sessions but appeared in varying combinations. A built-in algorithm continuously adjusted the difficulty based on the participant’s performance. Participants were instructed to complete three training sessions per week over the 12-week period. Each session lasted approximately 30 to 40 minutes.

Before and after the 12-week period, participants completed a series of mental tests that lasted about two hours. The researchers scheduled a third follow-up test 12 weeks after the cognitive training ended. However, the drop-out rate for this final assessment was very high. This left the researchers with too little data to analyze the long-term effects of the training.

The two-hour assessments included a variety of objective cognitive tests to measure actual brain performance. The participants also filled out questionnaires to gauge their subjective quality of life, daily functional impairments, and symptoms of depression. Other surveys asked the participants to rate their own ADHD symptoms and perceived cognitive abilities.

Over the course of the study, 14 participants dropped out after the initial assessment. Three more individuals were excluded from the final analysis because they changed their medication routines during the trial. This left a final group of 60 participants for the initial comparison.

The scientists found that the cognitive training app produced an improvement in psychological quality of life compared to standard treatment. There were no differences between the two groups in their performance on the objective cognitive tests. Despite this lack of measurable change, participants in the training group tended to report that their memory, attention, and language skills had improved. They simply felt that their brains were working better.

The authors noted that the program demonstrated promising effects on perceived cognition and psychological well-being. However, they pointed out that objective cognitive improvements were not observed. They explained that this discrepancy highlights the importance of considering both perceived and measured outcomes in ADHD treatments.

The study explores the effectiveness of a digital training program for improving ADHD-related cognitive issues. However, the app group started the study with a somewhat lower subjective quality of life than the control group. Although this initial difference was not statistically significant, it was moderate in size. This suggests that some of the apparent improvement might reflect a natural return to average levels rather than an effect of the training itself.

It is also important to note that the reported cognitive improvements were not detected on objective tests. Instead, the gains were seen entirely on self-report assessments. This leaves room for reporting bias, which happens when participants feel or claim they are doing better simply because they are receiving a new treatment. Additionally, the study was supported by Synaptikon GmbH, the developer of the NeuroNation MED application.

The study, “Effects of a novel individualized digital cognitive training on ADHD characteristics, quality of life, and cognitive functioning in adults with ADHD: A randomized controlled trial,” was authored by Moritz Bergmann, Julia Schröfel, Laura Zimmermann, Anke Fastenau, Sara Pafel, Peter Sauermann, Jana Fecht, Alexandra Philipsen, and Silke Lux.