Computerised Training of Working Memory in an Adult Prison Population Diagnosed With Attention Deficit Hyperactivity Disorder (DAT1)

• Change from baseline in Working Memory Capacity at 8 weeks [ Time Frame: Baseline 3-6 days before training starts, post-training 14-27 days after completed training ] [ Designated as safety issue: No ]

  WMC is measured with:

  • Digit Span
  • Listening Span
  • Spanboard forward/backward
  • Operation Span
  • Continuous Performance Test (CPT-2)
  
  
• Change from baseline in Working Memory Capacity at 30 weeks [ Time Frame: Baseline 3-6 days before training starts, post-training 168-171 days after completed training ] [ Designated as safety issue: No ]

  WMC is measured with:

  • Digit Span
  • Listening Span
  • Spanboard forward/backward
  • Operation Span
  • Continuous Performance Test (CPT-2)
  
  

• subjective adhd symptoms [ Time Frame: Baseline 3-6 days before training, 14-27 days post-training ] [ Designated as safety issue: No ]
  • Adult ADHD Self-Report Scale (ASRS-v1.1)
  • Brown Attention-Deficit Disorder Scale (BADDS)
  • Behavior Rating Inventory of Executive Function-Adult (BRIEF-A)
  
  
• Objective adhd symptoms [ Time Frame: Baseline 3-6 days before training, 14-27 days post-training ] [ Designated as safety issue: No ]
  • Conners' Adult ADHD Rating Scale (CAARS)
  • KV-informantskattning which is based on the adhd DSM-IV criteria and specifically designed to fit the prison context in which staff is to rate study participants overt adhd symptoms
  
  
• Global Impression [ Time Frame: Baseline 3-6 days before training, 14-27 days post-training ] [ Designated as safety issue: No ]
  • Clinical Global Impression - Severity (CGI-S)
  • Clinical Global Impression - Change (CGI-C), only at follow-up
  • Adult ADHD Quality of Life Measure (AAQoL)
  • EQ-5D self-report questionnaire
  
  
• subjective adhd symptoms [ Time Frame: Baseline 3-6 days before training, 84-87 days post-training ] [ Designated as safety issue: No ]
  • Adult ADHD Self-Report Scale (ASRS-v1.1)
  • Brown Attention-Deficit Disorder Scale (BADDS)
  • Behavior Rating Inventory of Executive Function-Adult (BRIEF-A)
  
  
• subjective adhd symptoms [ Time Frame: Baseline 3-6 days before training, 168-171 days post-training ] [ Designated as safety issue: No ]
  • Adult ADHD Self-Report Scale (ASRS-v1.1)
  • Brown Attention-Deficit Disorder Scale (BADDS)
  • Behavior Rating Inventory of Executive Function-Adult (BRIEF-A)
  
  
• Global Impression [ Time Frame: Baseline 3-6 days before training, 84-87 days post-training ] [ Designated as safety issue: No ]
  • Clinical Global Impression - Severity (CGI-S)
  • Clinical Global Impression - Change (CGI-C)
  • Adult ADHD Quality of Life Measure (AAQoL)
  • EQ-5D self-report questionnaire
  
  
• Global Impression [ Time Frame: Baseline 3-6 days before training, 168-171 days post-training ] [ Designated as safety issue: No ]
  • Clinical Global Impression - Severity (CGI-S)
  • Clinical Global Impression - Change (CGI-C)
  • Adult ADHD Quality of Life Measure (AAQoL)
  • EQ-5D self-report questionnaire
  
  
• Objective adhd symptoms [ Time Frame: Baseline 3-6 days before training, 84-87 days post-training ] [ Designated as safety issue: No ]
  • Conners' Adult ADHD Rating Scale (CAARS)
  • KV-informantskattning which is based on the adhd DSM-IV criteria and specifically designed to fit the prison context in which staff is to rate study participants overt adhd symptoms
  
  
• Objective adhd symptoms [ Time Frame: Baseline 3-6 days before training, 168-171 days post-training ] [ Designated as safety issue: No ]
  • Conners' Adult ADHD Rating Scale (CAARS)
  • KV-informantskattning which is based on the adhd DSM-IV criteria and specifically designed to fit the prison context in which staff is to rate study participants overt adhd symptoms
  
  
• Distribution of polymorphic variance i DRD2, COMT and SNAP25 [ Time Frame: Once, 3-6 days before training ] [ Designated as safety issue: No ]
  Blood samples are taken with approval from participants.
  
  

The prevalence of attention deficit/hyperactivity disorder (ADHD) is estimated to 3-4% among children/adolescents and 2-4% among adults. Although hyperactivity tends to be less prominent in the adult population, deficits in attention generally persists and may even get more salient with the natural process of aging. ADHD symptoms in children/adolescents are sometimes linked to behavioral dysfunction, e.g. conduct disorders, oppositional defiant disorder which in turn is precursors to antisocial personality disorder, drug abuse and criminality. Data shows a significant overrepresentation of ADHD related symptoms among the population within correctional facilities. The possible benefits of identifying and treating individuals with ADHD are extensive. Especially when the deficits can be considered a contributing factor to behavior causing great cost on a societal, as well as an individual level. Treatment of ADHD is preferably multimodal, i.e. consisting of more than one intervention. Medical treatment with central nervous system stimulants and Atomoxetine has so far the greatest scientific support as treatment for ADHD while Cognitive Behavior Therapy (CBT) and Dialectic Behavior Therapy (DBT)has somewhat less evidence. The need for new or complementary treatments is indisputable. Dysfunction in working memory capacity is a prominent feature in the clinical picture of attention deficits and therefore a key target in developing treatment. Studies have shown that working memory is not entirely a fixed feature of attention, but subject to plasticity and therefore possible to affect with training. Such training has been conducted with ADHD-diagnosed children/adolescents and have shown to produce statistically significant improvement in working memory capacity. We want to test the hypothesis that the same improvements can be achieved within an adult population. To the authors knowledge, no randomized, double-blind study of computerised training of working memory in adults has been done.

The primary research question is whether adults with ADHD, with or without ongoing medical treatment, can improve working memory capacity and if such potential improvement will generalize to other cognitive functions such as episodic memory, attention and impulsivity measured with neuropsychological tests. The secondary research question concerns the possible generalization of training effects to overt and covert ADHD symptoms, general function and perceived quality of life measured with questionnaires to study participants, prison staff and clinical investigators. Finally, we want to investigate the possible link between different genetic variants, degree of ADHD symptoms and effects of working memory training. Data indicate a possible link between differences in the polymorphic combinations of genes coding for dopamine receptors, i.e. DRD2, COMT and SNAP25, and regulation of working memory functions. Blood samples will be taken, with the study participants approval, and analysed for comparison with other data.

The study is randomized, controlled and double blind by design. Total number of participants is 50 divided into 2 groups. Experimental group receives training with a computerised program (FLEX) designed to enhance working memory by presenting tasks that demand effortful use of working memory functions. The program is dynamic, meaning that task difficulty will increase gradually following the trainees level of performance. Non-experimental group receives identical training but without the component of progressive increase in level of difficulty which has been shown to be a crucial factor in earlier studies on this type of training. Each participant receives training in 30-40 minute sessions, 5 days per week over 5 weeks. The training is supervised by prison staff who have been adequately instructed by study investigators.