ADHD児におけるコンピュータ支援型認知柔軟性トレーニングの効果と神経症的傾向の調整的役割：ランダム化比較試験

Cognitive flexibility (CF) deficits significantly impact academic and social functioning in individuals with Attention Deficit Hyperactivity Disorder (ADHD). This study aimed to evaluate the efficacy of an 8-week computer-assisted cognitive flexibility training (CFT) program and explore the moderating effect of neuroticism on intervention outcomes.

A total of 203 children with ADHD (152 boys, 51 girls; aged 6-12 years) were enrolled between December 2024 and April 2025 and randomly assigned to CFT arm (CFTA, n = 70), pharmacological treatment arm (PTA, Atomoxetine, n = 67), or wait-list control arm (WLCA, n = 66). Outcomes were measured at baseline, week 4, and week 8 using the Wisconsin Card Sorting Test for CF, the Weiss Functional Impairment Rating Scale-Parent Form for functional impairments, and the Swanson, Nolan, and Pelham, Version IV- Scale for ADHD symptom severity.

Compared to PTA and WLCA, CFT was associated with significant near-transfer gains in CF and parent-reported improvements in life skills and social activities. In contrast, PTA yielded larger gains for inattention, learning and school, and risky activities, while both active arms surpassed the wait-list in reducing hyperactivity-impulsivity. Lower baseline neuroticism predicted greater CFT-related cognitive gains.

Targeted CFT demonstrated near-transfer cognitive gains and was associated with parent-reported improvements in some functional domains. Given its distinct profile from pharmacotherapy, CFT may be a promising adjunct, rather than a standalone treatment, for children with ADHD, particularly those with lower neuroticism.