Does training working memory or inhibitory control produce far-transfer improvements in set shifting for children with ADHD? A randomized controlled trial
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Children with ADHD show impairments in set shifting task performance. However, the limited available evidence suggests that directly training shifting may not improve shifting performance in this population. We hypothesized that this incongruence may be because impairments exhibited by children with ADHD during shifting tasks are due to deficits in other executive functions, as shifting tasks also engage children’s working memory and/or inhibitory control abilities. This randomized controlled trial examined the extent to which neurocognitive training of working memory vs. inhibitory control can produce downstream (far-transfer) improvements in set shifting task performance. Children with ADHD ages 8–12 (M = 10.41, SD = 1.46; 12 girls; 74% White/Non-Hispanic) were randomized to either central executive training (CET; n = 25) or inhibitory control training (ICT; n = 29), two next-generation digital therapeutics previously shown to improve their intended neurocognitive targets. Two criterion set shifting tests were administered at pre- and post-treatment. Results indicated that ICT was superior to CET for improving shifting accuracy (treatmentxtime: p = .03, BF10 = 3.01, η2 = .09, d = 0.63). ICT was also superior to CET for improving shifting speed, albeit on only one of the two outcome tasks (p = .02, BF10 = 4.53, η2 = .08, d = 0.59). CET did not produce improvements in shifting speed or accuracy on either task (p > .52, BF01 > 2.62), but showed evidence for more general (non-shifting-specific) improvement in response times on one of the outcome tasks (shift trials, d = 0.70; non-shift trials, d = 0.68). Taken together, these findings confirm that inhibitory control is important for successful performance on shifting tests, and suggest that training inhibitory control may reflect a method for improving set shifting difficulties in children with ADHD.
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The pattern of results is also broadly consistent with a recent RCT indicating that training working memory may produce general improvements on both inhibition and choice-response tasks for children with ADHD.
“It is also broadly consistent with a recent RCT indicating that training working memory may produce general improvements on both inhibition and choice-response tasks for children with ADHD (29, 115).”
From Working memory and inhibitory control deficits in children with ADHD: an experimental evaluation of competing model predictions (2024) · cites this paper as [115]
The current findings are consistent with evidence from the cognitive literature and prior ADHD experimental work implicating working memory capacity as a core, underlying mechanism that broadly affects performance across a variety of neurocognitive tasks.
“Overall, the current findings are consistent with evidence from the cognitive literature and prior ADHD experimental work implicating working memory capacity as a core, underlying mechanism that broadly affects performance across a variety of neurocognitive tasks (e.g., 85, 115).”
From Working memory and inhibitory control deficits in children with ADHD: an experimental evaluation of competing model predictions (2024) · cites this paper as [115]
Working memory appears to affect response speeds more similarly for children with ADHD and/or anxiety.
“In contrast, working memory appears to affect response speeds more similarly for children with ADHD and/or anxiety, which is broadly consistent with prior experimental and RCT findings (55, 85, 115).”
From Working memory and inhibitory control deficits in children with ADHD: an experimental evaluation of competing model predictions (2024) · cites this paper as [115]
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Executive function deficits in attention-deficit/hyperactivity disorder and autism spectrum disorder
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“Consistent with this developmental evidence, the impairments on set shifting tests in youths with ADHD might be due not to the tests’ set shifting demands themselves, but to the inhibitory control and/or working memory demands required to perform these tests 80–82 .”
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- Authors
- Irwin Harper, L. N., Groves, N. B., Marsh, C. L., Cole, A. M., & Kofler, M. J.
- Affiliations
- Department of Psychology, Florida State University, Tallahassee, FL, USA
- Florida State University (US)
- Corresponding author
- Kofler, Michael J.
- Venue
- Child Neuropsychology
- Publisher
- Informa UK Limited
- Published
- 2022-11-04
- Volume
- 29
- Issue
- 5
- Pages
- 825-845
- ISSN
- 0929-7049 (ISSN-L)
- 1744-4136
- PMC
- PMC10156903
- OpenAlex
- W4308179883
- Cited by
- 12
- References
- 27
- Citations by year
- 2026: 4 · 2024: 6 · 2023: 2
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Child Neuropsychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NIH (R01 MH115048)
- 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 › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
- Keywords
- attention deficit hyperactivity disorder, set-shifting, inhibitory control training, working memory training, far transfer, executive function, neurocognitive training, digital therapeutics, children, cognitive flexibility
- MeSH terms
- Cognitive Training, Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Memory, Short-Term, Reaction Time, Executive Function
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