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Cited by 52Attention Deficit Hyperactivity DisorderDevelopmental and Educational NeuropsychologyEarly Childhood Education and Development

Do cognitive interventions for preschoolers improve executive functions and reduce ADHD and externalizing symptoms? A meta-analysis of randomized controlled trials

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Pauli-Pott, Ursula, Mann, Christopher, Becker, Katja·2021·European Child & Adolescent Psychiatry
DOI 10.1007/s00787-020-01627-zPMC PMC8505290
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Abstract

Many interventions targeting executive function (EF) development in the preschool period, where malleability might be particularly high, have been created and evaluated. We conducted a meta-analysis of randomized controlled trials (RCTs) on the effects of these interventions on (a) EFs in preschool children from the general population as well as preschool children with (symptoms of) attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), and (b) ADHD and ODD symptoms in preschool children with ADHD/ODD (symptoms). Literature search yielded 35 RCTs. Risk of bias of the individual studies was assessed. A random-effects model was used. Moderator effects were tested using mixed model analyses. The overall effects on EFs were: d = 0.46 (95% CI 0.30–0.61) for working memory (WM), d = 0.30 (95% CI 0.21–0.38) for inhibitory control (IC), d = 0.33 (95% CI − 0.04 to 0.71) for reward-related IC, and d = 0.47 (95% CI 0.28–0.66) for flexibility. In children with ADHD/ODD, mean effects were d = 0.64 (95% CI 0.31–0.96) for WM and d = 0.46 (95% CI 0.07–0.84) for IC. Studies on reward-related IC and FL were lacking. Effects on ODD and ADHD symptoms were d = 0.40 (95% CI − 0.23 to 1.03) and d = 0.28 (95% CI − 0.08 to 0.64), respectively. Interventions targeting multiple EFs and using interpersonal cognitive scaffolding approaches showed large and statistically significant effects on ADHD and ODD symptoms. In preschool children of the general population and in those with ADHD/ODD (symptoms), interventions led to an improvement of EF performance. In children with ADHD and ODD, cognitive scaffolding interventions were most effective in terms of reducing ADHD and ODD symptoms. However, more well-controlled studies need to be conducted before any firm conclusions can be drawn.

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  • Cognitive training in preschoolers with ADHD leads to moderate improvement in working memory and small-to-moderate improvement in inhibitory control.

    “A meta-analysis of randomized controlled trials (RCTs) with preschoolers found that cognitive training led to moderate improvement in working memory (23 studies, over 2,000 participants) and small-to-moderate improvement in inhibitory control (26 studies, over 2,200 participants) (Pauli-Pott et al., 2020).”

    From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Pauli-Pott et al., 2020

    Table 3 (Results > Working memory; page not provided) reports improvement in working memory across 23 studies (d = 0.46) and in cool inhibitory control across 26 studies (d = 0.30), supporting the stated effect sizes. The ADHD/ODD subgroup results come from only five and four studies, respectively, so the 23- and 26-study findings should not be presented as findings specifically for preschoolers with ADHD. The cited Results passages do not establish the stated participant totals of over 2,000 and over 2,200. (LLM, conf=0.86)

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Cited by

Sorted by citations

Authors
Pauli-Pott, U., Mann, C., & Becker, K.
Affiliations
Philipps University of Marburg (DE)
ORCID
Becker, Katja
Venue
European Child & Adolescent Psychiatry
Publisher
Springer Science and Business Media LLC
Published
2020-09-05
Volume
30
Issue
10
Pages
1503-1521
ISSN
  • 1018-8827 (ISSN-L)
  • 1435-165X
DOI
10.1007/s00787-020-01627-z
PMC
PMC8505290
OpenAlex
W3083597740
Cited by
52
References
14
Citations by year
2026: 10 · 2025: 4 · 2024: 13 · 2023: 14 · 2022: 8 · 2021: 2 · 2020: 1
FWCI
1.02
Type
journal article
Language
en
Open access
Licence
Locations
  • European Child & Adolescent Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by)
Funders
Philipps-Universität Marburg (Forschungsförderfond)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
  • Social Sciences › Education › Early Childhood Education and Development
Keywords
cognitive intervention, executive function, preschool children, attention deficit hyperactivity disorder, oppositional defiant disorder, externalizing problems, working memory, inhibitory control, cognitive flexibility, cognitive scaffolding, early intervention
MeSH terms
Attention Deficit Disorder with Hyperactivity, Child, Preschool, Cognition, Humans, Randomized Controlled Trials as Topic, Attention Deficit and Disruptive Behavior Disorders, Executive Function

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