Cognitive training for children and adolescents with fragile X syndrome: a randomized controlled trial of Cogmed. 2019

David Hessl, and Julie B Schweitzer, and Danh V Nguyen, and Yingratana A McLennan, and Cindy Johnston, and Ryan Shickman, and Yanjun Chen
MIND Institute, University of California Davis Medical Center, 2825 50th St, Sacramento, CA, 95817, USA. drhessl@ucdavis.edu.

Individuals with fragile X syndrome (FXS) typically demonstrate profound executive function (EF) deficits that interfere with learning, socialization, and emotion regulation. We completed the first large, non-pharmacological controlled trial for FXS, designed to evaluate the efficacy of Cogmed, a computer/tablet-based working memory (WM) training program. The study was a randomized, blinded, parallel two-arm controlled trial in 100 children and adolescents with FXS (63 male, 37 female; 15.28 ± 3.36 yrs.). Participants were randomized equally to adaptive (difficulty level adjusted to performance) or non-adaptive (control) Cogmed training. Participants were assessed at home using objective measures of WM (primary outcome) and EF at baseline, following 20-25 caregiver-supported sessions over 5-6 weeks, and at follow-up 3 months after cessation of training. Parents and teachers provided ratings of WM, attention, and EF. The WM composite and selective domains of EF (distractibility, cognitive flexibility), as well as parent- and teacher-reported attention and EF, significantly improved across the full study sample, with many changes maintained at follow-up. However, comparisons of improvement between adaptive and non-adaptive control conditions did not differ, showing that progressively challenging the WM system by expanding span length did not provide added benefit overall. Further experimental comparisons are needed before Cogmed working memory training can be considered empirically validated for children with FXS, forming the basis of treatment recommendation. However, given that prior studies show no significant changes on these measures in FXS without treatment, that improvements were maintained for 3 months, and that blinded teachers reported improvements in the classroom, the modest benefits seen in both adaptive and non-adaptive groups overall are unlikely to be attributable to placebo or practice effects alone. Future analyses examining inter-individual differences (e.g., baseline capacity, training efficiency, co-morbidity, training environment, characteristics of training aide) may help to link this intervention to outcomes and potential transfer effects. US National Institutes of Health (ClinicalTrials.gov), NCT02747394 .

UI MeSH Term Description Entries
D008297 Male Males
D008570 Memory, Short-Term Remembrance of information for a few seconds to hours. Immediate Recall,Memory, Immediate,Working Memory,Memory, Shortterm,Immediate Memories,Immediate Memory,Immediate Recalls,Memories, Immediate,Memories, Short-Term,Memories, Shortterm,Memory, Short Term,Recall, Immediate,Recalls, Immediate,Short-Term Memories,Short-Term Memory,Shortterm Memories,Shortterm Memory,Working Memories
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D005260 Female Females
D005600 Fragile X Syndrome A condition characterized genotypically by mutation of the distal end of the long arm of the X chromosome (at gene loci FRAXA or FRAXE) and phenotypically by cognitive impairment, hyperactivity, SEIZURES, language delay, and enlargement of the ears, head, and testes. INTELLECTUAL DISABILITY occurs in nearly all males and roughly 50% of females with the full mutation of FRAXA. (From Menkes, Textbook of Child Neurology, 5th ed, p226) FRAXA Syndrome,FRAXE Syndrome,Martin-Bell Syndrome,Fra(X) Syndrome,Fragile X Mental Retardation Syndrome,Fragile X-F Mental Retardation Syndrome,Mar (X) Syndrome,Marker X Syndrome,Mental Retardation, X-Linked, Associated With Fragile Site Fraxe,Mental Retardation, X-Linked, Associated With Marxq28,X-Linked Mental Retardation and Macroorchidism,FRAXA Syndromes,FRAXE Syndromes,Fragile X Syndromes,Marker X Syndromes,Martin Bell Syndrome,Syndrome, FRAXA,Syndrome, FRAXE,Syndrome, Fragile X,Syndrome, Marker X,Syndrome, Martin-Bell,Syndromes, FRAXA,Syndromes, FRAXE,Syndromes, Fragile X,Syndromes, Marker X,X Linked Mental Retardation and Macroorchidism
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000072466 Cognitive Remediation Behavioral treatment that uses drill and practice, compensatory and adaptive strategies to facilitate improvement in targeted learning areas. Remediation, Cognitive
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D013813 Therapy, Computer-Assisted Computer systems utilized as adjuncts in the treatment of disease. Computer-Assisted Therapy,Protocol-Directed Therapy, Computer-Assisted,Computer-Assisted Protocol-Directed Therapy,Therapy, Computer-Assisted Protocol-Directed,Computer Assisted Protocol Directed Therapy,Computer Assisted Therapy,Computer-Assisted Protocol-Directed Therapies,Computer-Assisted Therapies,Protocol Directed Therapy, Computer Assisted,Protocol-Directed Therapies, Computer-Assisted,Therapies, Computer-Assisted,Therapies, Computer-Assisted Protocol-Directed,Therapy, Computer Assisted,Therapy, Computer Assisted Protocol Directed
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes

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