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Brain Injury
Learning Disorders


ADHD: Attention-Deficit/Hyperactivity Disorder

  We are in the process of analyzing our internal data on ADHD.  However, we have definitely found that many older children and adolescents who have used the Brain Power® program to treat their processing disorder were able to reduce or completely discontinue their medication for ADHD.  The pattern that is emerging appears to suggest that the benefit is age related.  That is, the older the child, the greater the benefit, with older adolescents being the ones most likely to discontinue their medication.  No apparent benefit is seen in children under 11 years old. 

  This pattern would suggest that the development of the prefrontal regions of the cerebral cortex during adolescence seems to play a role in whether cognitive skills training produces a change in the deep brain structures that control concentration.  Those older adolescents with ADHD that we have followed, that have not gone through the Brain Power program, have not shown any change in the amount of medication that they require for their ADHD.  This suggests that the development of the prefrontal cortex, which is richly interconnected with the reticular activating system, is providing access to these subcortical pathways and allowing cognitive skills training to promote development in this area of the brain.


  Our findings indicate that neurodevelopment needs to be considered when looking for alternative ways to treat ADHD.  Hopefully this awareness may facilitate the development of new treatment approaches for ADHD.

Below are listed some research articles pertaining to cognitive skills training and ADHD.

1.  Enhanced Neural Activity In Frontal And Cerebellar Circuits After Cognitive Training In Children With Attention-Deficit/Hyperactivity Disorder.

Hoekzema E, Carmona S, Tremols V, Gispert JD, Guitart M, Fauquet J, Rovira M, Bielsa A, Soliva JC, Tomas X, Bulbena A, Ramos A, Casas M, Tobeña A, Vilarroya O.
Human Brain Mapping. 2010 Mar 24.

The brain is a plastic entity that can undergo dynamic changes throughout the lifespan as a result of training. Attention-deficit/hyperactivity disorder (ADHD) is commonly treated with psychostimulant medication, and the prevalence of ADHD medication prescription is a topic of heated scientific debate. In addition, cognitive training is frequently provided to patients with ADHD. Although psychostimulant effects have been thoroughly investigated, no previous studies have assessed the neural effects of cognitive training in ADHD. We applied fMRI-paradigms of response inhibition and selective attention to chart the effects of a 10-day cognitive training program in 19 unmedicated ADHD children receiving either cognitive or control training. The two resulting longitudinal datasets were analyzed using whole-brain random-effects general linear models. Although we observed no increases of activity in the control group, both fMRI-datasets revealed enhanced activity after cognitive training in neural structures closely related to ADHD pathophysiology. On the inhibition paradigm, our results indicated increases in orbitofrontal, superior frontal, middle temporal, and inferior frontal cortex. The attentional task was characterized by increased activity in the cerebellum, which correlated with improvement on in-scanner measures of attention. Our findings provide preliminary evidence that cognitive training enhances activity in neural structures typically affected by the disorder. Similar results have been obtained following methylphenidate administration, suggesting that training of cognitive functions may mimic the effects of psychostimulant medication on the brain. These findings postulate a neural account for the potency of cognitive training in ADHD, and hold clinical implications, supporting the inclusion of training programs in standard ADHD-treatment. Hum Brain Mapp, 2010. (c) 2010 Wiley-Liss, Inc.

2.  Attention Remediation Following Traumatic Brain Injury In Childhood And Adolescence.

Galbiati S, Recla M, Pastore V, Liscio M, Bardoni A, Castelli E, Strazzer S.
Neuropsychology. 2009 Jan;23(1):40-9.

Traumatic brain injury (TBI) frequently affects both the basic and the superordinate components of attention; deficits vary according to patient age. This study evaluated the efficacy of a specific remediation intervention for attention. Sixty-five TBI patients (aged 6-18 years) with attention deficit were assessed at baseline and at 1-year follow-up: 40 patients received attention-specific neuropsychological training for 6 months, and the control group comprised 25 patients. Cognitive assessment included a Wechsler Intelligence Scale (e.g., A. Orsini, 1993) and the Continuous Performance Test II (CPT II; C. K. Conners, 2000). The Vineland Adaptive Behavior Scales (VABS; S. Sparrow, D. Balla & D. V. Cicchetti, 1984) was administered to assess the treatment's ecological validity. At baseline, all patients presented with a mild intellectual disability and pathological scores on the CPT II. At follow-up, significant differences were found between the 2 groups on the CPT II and VABS: The clinical group improved more than the control group. Specific remediation training for attention, including a combination of a process-specific approach and metacognitive strategies, significantly improved attention performance. Improvement in attention skills also affected adaptive skills positively.

3.  Attention Training for School-Aged Children With ADHD: Results of an Open Trial.

Tamm L, Hughes C, Ames L, Pickering J, Silver CH, Stavinoha P, Castillo CL, Rintelmann J, Moore J, Foxwell A, Bolanos SG, Hines T, Nakonezny PA, Emslie G.
Journal or Attention Disorders. 2009 Oct 5.

The article discusses a feasibility study conducted to examine whether an attention training program, an intervention training sustained, selective, alternating, and divided attention, could be utilized in a clinical setting with children diagnosed with ADHD, and whether children who received the intervention made attention and executive functioning gains. Results: Parents and clinicians rated fewer ADHD symptoms following the intervention and report improvements in executive function. Child performance on neuropsychological tests showed improvements in fluid reasoning and cognitive flexibility and working memory. Conclusion: The findings suggest that attention training is effective as a treatment for attention and executive functioning deficits in ADHD.

4.  Computerized Training of Working Memory In Children With ADHD--A Randomized, Controlled Trial.

Klingberg T, Fernell E, Olesen PJ, Johnson M, Gustafsson P, Dahlström K, Gillberg CG, Forssberg H, Westerberg H.
J Am Acad Child Adolesc Psychiatry. 2005 Feb;44(2):177-86.

Deficits in executive functioning, including working memory (WM) deficits, have been suggested to be important in attention-deficit/hyperactivity disorder (ADHD). During 2002 to 2003, the authors conducted a multicenter, randomized, controlled, double-blind trial to investigate the effect of improving WM by computerized, systematic practice of WM tasks. Participants were randomly assigned to use either the treatment computer program for training WM or a comparison program. The main outcome measure was the span-board task, a visuospatial WM task that was not part of the training program. RESULTS: For the span-board task, there was a significant treatment effect both post-intervention and at follow-up. In addition, there were significant effects for secondary outcome tasks measuring verbal WM, response inhibition, and complex reasoning. Parent ratings showed significant reduction in symptoms of inattention and hyperactivity/impulsivity, both post-intervention and at follow-up. CONCLUSIONS: This study shows that WM can be improved by training in children with ADHD. This training also improved response inhibition and reasoning and resulted in a reduction of the parent-rated inattentive symptoms of ADHD.

5.  Remediation Of Attention Deficits In Children: A Focus On Childhood Cancer, Traumatic Brain Injury and Attention Deficit Disorder.

Penkman, L.
Pediatric Rehabilitation. 2004 Apr-Jun;7(2):111-23.

The purpose of this review was to examine the status of attention training in children. This body of literature was very small so the review examined available efficacy studies in three pediatric groups: children who had survived cancer affecting the central nervous system (CNS) or whose treatment had impacted the CNS, children with traumatic brain injury (TBI) and children with attention deficit disorder (ADD). Seven studies/case reports were reviewed. The results were encouraging, with six of seven describing some improvement on attention measures.