Efficacy of Synergized Cognitive-Physical Training for Children with Inattention

Background: Children with issues of attention have difficulties in their everyday life and school function due to deficiencies in these abilities. Cognitive training and physical exercise have both been shown to improve attention, providing an alternative approach to prescribed medications. Here we posit that a synergistic training platform for children across the inattention spectrum, including children with ASD, may lead to improved cognitive control abilities.

Objectives: To use a custom-designed, motion-capture, video game-based intervention (pediatric body-brain trainer (pediBBT)) adapted for school-aged children and deployed at a local elementary school to evidence potential improvements in cognitive control. Our first aim was to determine whether pediBBT is feasible in a school based setting. Aim 2 was to determine if this platform improves cognitive control abilities in children with and without clinically significant inattention as measured behaviorally and neurally via electroencephalography (EEG).

Methods: Eight children (7 boys), aged 7-12 years, underwent 24 pediBBT sessions across eight weeks. 7 out of 8 completed all pre and post assessments. PediBBT consists of three modules aimed at training attention, working memory, and goal management in which subjects respond to stimuli by reaching, squatting, or running. ADHD symptoms and cognitive abilities, specifically sustained attention, response inhibition, and working memory, were assessed prior to and following intervention using parent report (Vanderbilt ADHD Diagnostic Parent Rating Scale) and direct assessment (Test of Variables of Attention (TOVA), Attend-Ignore Distractor (AID)). Additionally, we assessed for changes in midline frontal theta, an EEG marker associated with focused attention processing, using a custom designed perceptual discrimination task.

Results: Regarding Aim 1 (feasibility), 100% of children completed all 24 sessions. In response to the question: “Overall, how would you rate you/your child's experience with pediBBT?” on a scale of 1-100, the mean score was 87, with a range of 70-100. On parent report measures of inattention, 3 out of 8 participants scored in the clinically significant range for ADHD at baseline -- 1 Inattentive, 1 Hyperactive, and 1 Combined type. Out of the 3 participants with parent-report based ADHD, 2 participants no longer meet criteria after pediBBT intervention. Direct assessment using TOVA showed statistically significant improvement in response time in 6 out of 7 children (p=.027) and response time variability (p=.01) in all 7 children. On our test of working memory, all 3 of the children with issues of inattention showed improvement. Our neural analyses using EEG event related spectral analysis showed an increase of midline frontal theta across the cohort.

Conclusions: These findings provide initial evidence that an eight week, in-school, synergistic cognitive-physical training is feasible in children 7-12 years of age. Furthermore, it may improve cognitive abilities in children with attention challenges. We continue to enroll participants and analyze data and will be able to present outcomes of a larger sample in May of 2019. We also plan to recruit control groups with cognitive only and physical only training to determine the most effective outcome.