Impacto del entrenamiento cognitivo NEXXO sobre la atención y funciones ejecutivas en edad escolar

El origen de esta tesis se remonta a la propia práctica clínica con niños con Trastorno por Déficit de Atención e Hiperactividad (TDAH). Abordando la intervención psicoeducativa y neuropsicológica de este trastorno observé la necesidad de implementar un programa de intervención que tratase aspectos básicos de la atención y de las funciones ejecutivas, como son la vigilancia y la inhibición (Figueroa y Youmans, 2012; Rueda, Posner y Rothbart, 2005), con el objetivo final de entrenar el control atencional y el control ejecutivo. Un programa que, además, fuese dirigido por profesionales donde, además, se aplicasen pautas y estrategias metacognitivas que consolidasen y generalizasen la intervención. Como se ha dicho anteriormente, la idea inicial fue abordar el entrenamiento de la vigilancia y de la inhibición, aspectos deficitarios para estos pacientes en las reconocidas pruebas de ejecución continua como Conners Continous Performance Test II (CPT-II) (Conners et al., 2000), Conners Kiddie Continuous Performance Test (K-CPT V.5) (Conners y Staff, 2001) o CSAT-R tarea de atención sostenida en la infanciarevisada (Servera y Llabrés, 2015). Al diseñar el entrenamiento, nos centramos en elcontrol atencional y ejecutivo, y los procesos relacionados con los mismos. Entre otrascosas, por ello, entrenamiento debía estar acompañado de ciertas pautas y estrategias quepudieran ayudar a asimilar de forma más adecuada el entrenamiento, estrategiasmetacognitivas. El entrenamiento “Nexxo” surgió de una necesidad: entrenar procesosbásicos de atención y funciones ejecutivas con un enfoque determinado (desde laneuropsicología infantil), un programa que además incorporase estrategiasmetacognitivas para su consolidación; un programa inexistente en el mercado, y, portanto, inaccesible en ese momento. Parasuraman y Giambra (1991) consideran la vigilancia y la atención sostenida como la misma habilidad, una habilidad en la que el observador debe mantener su foco de atención y su estado de alerta durante tiempos prolongados. La principal distinción es que en las tareas de vigilancia la frecuencia con la que el observador debe detectar un estímulo relevante es baja (Hauke et al., 2011). Esta habilidad se considera crucial para el desempeño de tareas de atención sostenida y de atención dividida, aspectos relevantes para la vida diaria (Figueroa y Youmans, 2012). La vigilancia se ha visto afectada en trastornos como el Trastorno por Déficit de Atención e Hiperactividad (TDAH) (Huang- Pollock, Karalunas, Tam, y Moore, 2012; Michelini et al., 2016), ansiedad (Price et al., 2013) y autismo (Christakou et al., 2013) entre otros. Por su parte la inhibición es uno de los aspectos principales de las funciones ejecutivas (Miyake y Friedman, 2012; Miyake et al., 2000). La inhibición supone dos habilidades básicas, por un lado, la habilidad de suprimir una respuesta automática o una tendencia en favor de otra, lo que se conoce como inhibición de respuesta, por otro, la selección de la información relevante en presencia de distractores, conocido como control de la interferencia (Miyake et al., 2000; Tamm y Nakonezny, 2015). Déficits en inhibición se encuentran en trastornos como TDAH, (Barkley, 1997), trastorno obsesivo-compulsivo y autismo (Ozonoff y Jensen,1999). Se consideran por tanto aspectos relevantes a incorporar en un entrenamiento de la atención y las funciones ejecutivas..

Schoolchildren’s compensatory strategies and skills in relation to attention and executive function app training

Background: Given the importance of attention and executive functions (EF) in children’s behavior, programs aimed at improving these processes are of special interest. Nexxo-training combines the use of the Nexxo touchscreen application (inhibition and vigilance tasks) with procedural metacognitive strategies (imparted by an instructor) for all the individuals using the app, regardless of their level of ability, plus compensatory strategies based on individual child performance. This study presents an analysis of the compensatory strategies that schoolchildren (aged 6–8 years old) receive when experiencing difficulties with EF tasks, in addition to an analysis of the developmental factors and cognitive skills that may modulate EF task performance. Methods: For this study, we use data from a previous randomized active-controlled study (under review), in which forty-six typically developing children aged between 6 and 8 years old (24 girls/22 boys) were enrolled in the training group. The selected children were in the 1st grade (n = 28, Nx = 78.32 4.037 months) and 3rd grade of primary education (n = 18, Nx = 102.11 3.445). We collected data on EF training performance, compensatory strategies needed and neuropsychological assessments. Results: A total of 80.43% participants required some form of compensatory strategy during training. Regarding required compensatory strategies, those who had lower scores in EF training needed more compensatory strategies, in particular, instructional comprehension (r = -0.561, p < 0.001 for inhibition-tasks; r = -0.342, p < 0.001 for vigilance-tasks). Concerning developmental factors, age significantly predicted better performance in both EF tasks (b = 0.613, p < 0.001 for inhibition; b = 0.706, p < 0.001 for attention). As regards task performance, those with better performance in inhibition tasks also had better performance in vigilance tasks (r = 0.72, p < 0.001). Finally, regarding cognitive skills, participants with higher performance in fluid intelligence (Q1, n = 12) had higher scores (U = 14.5, p < 0.05) than the group with the lowest performance (Q4, n = 11) in vigilance Conclusion: As previous literature suggests, inhibition is one of the core processes of EF. Therefore, we should focus training on the core EF processes. Inhibition and vigilance are closely related processes. In terms of the use of compensatory strategies, these are more needed for participants with lower levels of performance in inhibition or vigilance. Regarding strategy analysis, instructional comprehension and self-instruction (goal setting and planning) seem to be the most useful strategies for those with difficulties in inhibitory and vigilance task performance. Regarding development, as expected, age moderates task performance in inhibition and attention. Finally, cognitive skills, such as fluid intelligence and cognitive flexibility, predicted better results in attention. EF training using not only an app, but also compensatory strategies based on user performance, is a new research direction offering more opportunities to generalize EF training in everyday lif

Brain Training in Children and Adolescents: Is It Scientifically Valid?

Background: Brain training products are becoming increasingly popular for children and adolescents. Despite the marketing aimed at their use in the general population, these products may provide more benefits for specific neurologically impaired populations. A review of Brain Training (BT) products analyzing their efficacy while considering the methodological limitations of supporting research is required for practical applications.Method: searches were made of the PubMed database (until March 2017) for studies including: (1) empirical data on the use of brain training for children or adolescents and any effects on near transfer (NT) and/or far transfer (FT) and/or neuroplasticity, (2) use of brain training for cognitive training purposes, (3) commercially available training applications, (4) computer-based programs for children developed since the 1990s, and (5) relevant printed and peer-reviewed material.Results: Database searches yielded a total of 16,402 references, of which 70 met the inclusion criteria for the review. We classified programs in terms of neuroplasticity, near and far transfer, and long-term effects and their applied methodology. Regarding efficacy, only 10 studies (14.2%) have been found that support neuroplasticity, and the majority of brain training platforms claimed to be based on such concepts without providing any supporting scientific data. Thirty-six studies (51.4%) have shown far transfer (7 of them are non-independent) and only 11 (15.7%) maintained far transfer at follow-up. Considering the methodology, 40 studies (68.2%) were not randomized and controlled; for those randomized, only 9 studies (12.9%) were double-blind, and only 13 studies (18.6%) included active controls in their trials.Conclusion: Overall, few independent studies have found far transfer and long-term effects. The majority of independent results found only near transfer. There is a lack of double-blind randomized trials which include an active control group as well as a passive control to properly control for contaminant variables. Based on our results, Brain Training Programs as commercially available products are not as effective as first expected or as they promise in their advertisements

A randomized placebo controlled clinical trial to evaluate the efficacy and safety of minocycline in patients with Angelman syndrome (A-MANECE study)

Abstract Background Minocycline is an old tetracycline antibiotic that has shown antiinflammatory and antiapoptotic properties in different neurological disease mouse models. Previous single arm study in humans demonstrated benefits in individuals with Angelman Syndrome (AS); however, its efficacy in patients with Angelman Syndrome has not been assessed in a controlled trial. This was a randomized, double-blind, placebo-controlled, crossover trial in individuals with AS, aged 6 years to 30 years (n = 32, mean age 12 [SD 6·29] years). Participants were randomized to minocycline or placebo for 8 weeks and then switched to the other treatment (a subset of 22 patients) or to receive minocycline for up to 16 weeks (10 patients). After week 16, all patients entered a wash-out 8-week follow-up period. Results Thirty-six subjects were screened and 34 were randomized. Thirty two subjects (94·1%) completed at least the first period and all of them completed the full trial. Intention-to-treat analysis demonstrated the lack of significantly greater improvements in the primary outcome, mean changes in age equivalent of the development index of the Merrill-Palmer Revised Scale after minocycline compared with placebo (1·90 ± 3·16 and 2·00 ± 3·28, respectively, p = 0·937). Longer treatment duration up to 16 weeks did not result in better treatment outcomes (1·86 ± 3·35 for 8 weeks treatment vs 1·20 ± 5·53 for 16 weeks treatment, p = 0·667). Side effects were not significantly different during minocycline and placebo treatments. No serious adverse events occurred on minocycline. Conclusions Minocycline treatment for up to 16 weeks in children and young adults with AS resulted in lack of significant improvements in development indexes compared to placebo treatment. Treatment with minocycline appears safe and well tolerated; even if it cannot be completely ruled out that longer trials might be required for a potential minocycline effect to be expressed, available results and lack of knowledge on the actual mechanism of action do not support this hypothesis. Trial registration European Clinical Trial database (EudraCT 2013-002154-67), registered 16th September 2013; US Clinical trials database (NCT02056665), registered 6th February 2014