Literature Review on Executive Function Training
Study & Aim
1/ Executive Function Training
for Children with ADHD, Shuai
et.al. (2017)
-EF program evaluation
Subjects Targeted EF skills Study Design Intervention Outcome measures Results
-44 school age ADHD and -inhibition Pre- and post- -12 sessions of EF (Neuropsychological -improved EF skills from
their parents -working comparison between training (once per tests) neuropsychological tests
-88 health controls memory groups week) -Stroop test -reduced ADHD symptoms and
-ADHD with severe -planning and -EF training for -Rey-Osterrieth complex behavioral problems
comorbidities such as organization ADHD children and figure test -EF capacity and its associated
major depression, mania -shifting behavioral -Trail making test levels of brain activity are not
and bipolar disorder -theory of mind intervention for -Tower of Hanoi static but may be altered by
were excluded -time parents -False-belief task task-repetition or training
-Full scale IQ <80 were management -one 90-minute (Daily life) -cognitive remediation therapy
excluded -emotional sessions (60-min for -ADHD rating scale-IV increased activation of frontal
-5 children were taking regulation children, 30-min for -Conners’ parent rating lobe
medication, they are parents except the scale -medication improved some EF
asked to maintain a first and the last -BRIEF elements in tests but EF
stable medication status session which was program could teach children
during the intervention for parents only) appropriate coping skills and
and evaluation period per week for 12 strategies
weeks -children got better scores in
-home program for later exaiminations, and
skills generalization increased their rank in the class
-Parent sessions -EF coordinated the temporal
(psychoeducation and spatial processes of
about ADHD), mathematics and filters
behavioral irrelevant information during
management skills calculation and reading
(behavioral contract -the benefits of EF training
and response cost), program especially targeting on

2/Executive Functioning in
subtypes of ADHD (Bahcivan
Saydam et.al. 2015)
-evaluate EF such as inhibition,
planning, working memory
and set shifting in children
with ADHD by comparing
three ADHD subtype groups
(ADHD-inattentive,
ADHD-combined,
ADHD-comorbid and normal
control group
living skills inhibition, working memory,
(eye-contact, giving and planning could be extended
short direction, to child’s learning skills and
capturing good various aspects of schooling
moment)
-111 children with ADHD, -inhibition Comparison Nil Scales for screening of -children in ADHD-I group had
(ADHD-I: Inattentive, -working children: significantly better performance
ADHD-C: Combined, memory -Conners’ Parent and in verbal working memory and
ADHD-Comorbid) and -planning Teacher Rating Scales verbal category shifting than
control group -set shifting -Wechsler Intelligence children in ADHD-C groups in
-aged 7-12 years -verbal fluency Scale-Revised terms of inhibition, set shifting,
EF assessment: verbal fluency, cognitive
-Tower of London test flexibility and planning
-Wisconsin Card Sorting -ADHD-comorbid group
Test displayed more severe
-Stroop Color-word test impairments in EF measures
-Verbal Fluency test than ADHD-C group but the
severity as not statistically
significant
-EF performances of children in
control group were similar to
children in ADHD-I group but
better than children in ADHD-C
and ADHD-comorbid group
-The outcome indicated that
subjects in ADHD-comorbid and
ADHD-C groups had more
severe EF deficits than subjects

3/Attention and Executive
Function in Children
Diagnosed with Attention
Deficit Hyperactivity Disorder
and Comorbid Disorders,
Ter-Stepanian et.al. (2017)
-to examine the relationship
between comorbid disorders
and EF in children diagnosed
with ADHD
4/Relationship between
executive functioning and
symptoms of ADHD and ASD
in 6-8 years old children, Jane
Neely et.al. (2016)
-aims to examine relationships
between executive functioning
and ADHD/ASD symptoms
-to characterize EF profiles
(response inhibition, verbal
working memory and
reasoning) associated with
ADHD and ADHD+ASD
-355, 6-12 years old
children diagnosed with
ADHD
-comorbid anxiety
disorders, ODD and CD
were examined
-339, 6-8 years old
children
-exclusion criteria: taking
medication at the time of
assessment due to
potential effects of such
medication on EF
in ADHD-I and control groups
-deficits in EF Cohort Nil -Conners’ Continuous -children with comorbid anxiety
domains of Performance Test (CPT) disorders performed worse in
response -Wisconsin Card Sorting domains measured by CPT and
inhibition and Test (WCST) prior to controlling for age and
execution, -Tower of London (ToL) sex by FW
vigilance, -Finger Window (FW) -children with CD obtained
working memory, -Self Ordered Pointing lower scores on WCST
set and Test (SOPT) -conclusion: comorbid disorders
task-switching / should be carefully examined as
cognitive they play a significant role in EF
flexibility and performance and subsequently
planning (Toplak in day-to-day functioning of
et al. 2009) children with ADHD
-EF are -longitudinal Nil Executive Function: -EF profile of children with
conceptualized community cohort -Verbal working memory ADHD+ASD did not differ from
as an by Digit Span Backward ADHD alone and that
intercorrelated from WISC-IV lower-order cognitive skills
system of -Non-verbal problem contributed significantly to EF
higher-order solving (reasoning) by -ASD and inattention symptoms
cognitive Matrix Reasoning from were differentially associated
processes the Wechsler Intelligence with EF, whereas hyperactivity
(Miyake et.al. Scale for Children symptoms were unrelated to EF
2000) that allow -Response inhibition by -Greater ASD or inattention
purposeful, Walk-Don’t from TEA-Ch symptoms were associated with
goal-directed poorer reasoning and response
behavior in novel Lower-order Cognitive inhibition
or complex Function: -Greater inattention symptoms
circumstances -Auditory processing were linked to poorer verbal
(Walsh 1988). capacity by Digit Span working memory
-They include Forward from WISC-IV -ADHD+ASD display similar
planning and deficits in reasoning to children
reasoning, with ADHD alone
cognitive
flexibility,
response
inhibition and
working memory
-ASD appears
more closely
associated with
deficits in
planning,
set-shifting,
self-monitoring
and organization
(Geurts et al.
2004)
-ADHD appears
uniquely
associated with
verbal working
memory deficits
(Takeuchi et al.
2013)
-
5/Impact of the
Cognitive-Functional
(Cog-Fun) Intervention on
Executive Functions and
Participation Among Children
With ADHD: A Randomized
Controlled Trial,
Hahn-Markowitz et.al. (2017)
-aims to examine the effect of
the Cog-Fun OT intervention
on EF and participation among
children with ADHD
-107 children age 7-10 Randomized, -Cog-Fun is a -BRIEF (Behavioral Rating -Significant improvements were
years diagnosed with controlled study with manualized Inventory of Executive found on both BRIEF and COPM
ADHD were allocated to a crossover design approach (Maeir et Function) after intervention with large
treatment or waitlist al. 2012) that -COPM (Canadian treatment effects
control group supports Occupational
-control group received participation via Performance Measure)
treatment after 3-mo metacognitive
wait learning of EF (e.g.
stop, recruit effort
and persist, check,
plan) in an enabling
context
-Cog-Fun
certification (6-mo,
60-hr theoretical
training course and
4-mo practicum)
-program involves
12 consecutive 1-hr
weekly sessions
with child and
parent
-e.g. inhibit strategy
practiced in games
such as “Red light,
green light”,
simulated in social
context e.g. “will
wait until friend
finishes her turn
during a game
before taking a turn
-support from
parent: provide
necessary
modification
(preparing materials
in advance,
reducing clutter and
distractions), and
supports (positive
verbal mediation,
daily planner, timer,
checklists)
-weekly
communication
session by phone or
email with parents
-protocol consists of
seven intervention
units: an evaluation
unit, four units of
executive strategy
acquisition, a home
visit, and a
summary unit
******
Occupational Goals:
 1/Social
participation
2/ADLs
3/Academics
4/Leisure
(inhibit strategy,
recruit effort and
persevere strategy,
check strategy, plan
strategy,
7/Effectiveness of executive -62 participants Definition of -A double-blind -30 minutes training ****** -EF training group had
function training on mental - three EF randomized session three times -mental set shifting statistically significant higher
set shifting, working memory, components: controlled trials per week for 8 measured by Wisconsin scores of mental set shifting and
inhibition in healthy older 1/Mental set weeks card sorting test working memory at immediate
adults: A double-blind shifting – the -EF training group -working memory follow-up and that its effect on
randomized controlled trials, capacity to shift received the measured by digit span mental set shifting could be
Chiu et.al. (2017) between training content -inhibition measured by maintained for 3-6 months
different tasks, that focused on Stroop color word test -this training did not have any
operations or mental set shifting, statistically significant results on
mental sets working memory inhibition
2/ Working and inhibition
memory – -Active control
updates and group engaged in
monitors passive information
according to activities
performance, -Rehacom cognitive
encodes training software is
task-related used
 messages and
corrects old and
irrelevant
messages
3/ Inhibition –
ability to
intentionally
suppress
advantageous,
automatic or
expected
responses to
implement a
target behavior
8/ Effect of daily life executive - 16 aged 7-10 years old - Attention - Quasi-experimenta - 11 sessions of - clinical interview - Subjects of experimental
functions training on with ADHD who were - Emotional l research and executive - SNAP-IV Grading scale group had significant
symptoms and adaptive skills not on medication, inhibition pretest-posttest functions training - Barkley Functional reduction in posttest scores of
in children with attention they were randomly ability with control group based on daily life Impairment SNAP-IV scale than the
deficit/ hyperactivity disorder, assigned to - Time - Once a week Scale-Children and control group (i.e. improved
Roghayeh N.J., et al. (2018) experimental group management - 1 hour session Adolescents (BFIS-CA) ADHD symptoms)
(n=8) and control - Organization (30 mins child; - Significant reduction was
group (n=8) 30mins parent) observed in the scores of BFIS
- Predominantly - 2 training sessions scale in the experimental
inattentive subtype, for parents; 9 group for both Home-school
predominantly joint parent-child impairment and
hyperactive/impulsive training sessions Community-Leisure
subtype diagnosis, - List of impairment subtests (i.e.
higher or lower than problematic improved application of
7-10 years age, receive behaviors in psychosocial adaptation skills)
medication and children was
participation of any prepared
educational program (discussed what
or cognitive to treat each
interventions in session)
parallel of the study - Home programme
were excluded available
9/ A short executive function - 54 four-year-old
training program improves
preschoolers’ working
memory, Emma, B. & Daniel, J. - 26 in the training group
C. (2015)
- No exclusion criteria
10/ Executive function
predicts the visuospatial
working memory in Autism
Spectrum Disorder and
Attention-Deficit/Hyperactivity
Disorder, Zengjian Wang et al. 1/ 21 children with ASD
(2018)
11/ An open trial of a
metacognitive executive
- Working - Pre- and post- - 4 sessions in 1 - Working memory: - The training group improved
preschoolers were memory comparison month backward word span working memory and the
recruited - Inhibitory between groups - 20 mins - Inhibitory control: effect extended to a task
control computerized Peg-tapping task sharing few surface features
and 28 in the control - Cognitive tasks (E-Prime - Cognitive flexibility: with the trained tasks and
group flexibility software) The SwIFT continued to be apparent 3
- Working memory months later
mentioned training: Six Boxes - The benefits of training
task; One-back extended to a measure of
task mathematical reasoning 3
- Inhibitory control months later
training: Flanker
task; Go/No-Go
task
- Three groups of - Cognitive - Correlation study - Not mentioned - Revised Chinese - The ASD group showed
subjects aged 6-15 flexibility Wechsler Intelligence poorer performance in
years old and with - Planning Scale for Children (IQ) visuospatial working memory
IQ>=70 were - Set - Wisconsin Card Sorting (VSWM) than the ADHD and
examined: maintenance Test (executive TD group
- Inhibitory function) - For the ASD group, VSWM
2/ 28 children with ADHD control - Corsi Block Tapping was positively correlated with
3/ 28 typically developing - Visuospatial Test (visuospatial categories achieved (CA), and
(TD) children as control working working memory) was negatively correlated
- All subjects were asked memory with preservative errors (PE)
not to take any central and Total error (TE)
nervous system active - For the ADHD groups, failures
medications for at least to maintain set (FMS) showed
24 hours before all a negative relationship with
tests, ensuring VSWM
sufficient period for - The predicted the
fully washing-out performance of VSWM in ASD
group, while FMS predicted
VSWM in ADHD group
- The study results suggested
that VSWM was impaired in
ASD but not in ADHD
- The EF domains were
differently correlated with the
VSWM performance in ASD
and ADHD
- 24 children aged 3 to 7 - Attention - Pre- and post- - 8 consecutive - Executive function: - The intervention is feasible
years old with ADHD - Inhibition comparison sessions - NEPSY-Visual Attention and accepted by parents as
function training for young
children with ADHD, Leanne, T
(2012)
12/ Executive function training - 44 Chinese diagnosed
for children with attention
deficit hyperactivity disorder,
Lan, S. et al. (2017)
and their parents - Memory between groups - Once a week subtest for inhibition, shown by high
- Children with - Eye-hand - 1 hour per session scanning, vigilance and attendance/adherence, low
estimated Full Scale coordination - 4-6 children in a impulsivity attrition, and satisfaction
IQ<85, history of head - Balance group - The Clinical Evaluation ratings. Improvements in
injury or prenatal drug - Sensory - 3-4 activities a of Language executive functions
exposure, diagnosis awareness week Fundamentals, 4th (visual/auditory attention,
with congenital or - Listening skills - Children in small Edition working memory, and
acquired neurological - Visual focusing group; parents in (CELF-IV)-Concepts cognitive flexibility) with
conditions, pervasive large group held and Following corresponding improvements
developmental by psychologist Directions subtest for in parent ratings of executive
disorders, unknown - Home program: auditory and visual functioning were observed.
developmental and practice at least attention Reduced inattention
family history, and one of the - The Shape School symptoms were reported
participation in other activities with assessing inhibition - Executive functioning training
treatments for ADHD their children >= 3 and switching is a promising, approach to
(e.g. medication, times) - Wechsler Digit Span to treating young children with
neurofeedback, etc.) assess working ADHD and holds promise for
memory generalizability because
- Matrix Reasoning to parents are trained to be
assess cognitive interventionists and coached
flexibility to apply the strategies to
- Behavioral rating scale: alternative domains
- Swanson, Nolan, and
Pelham-IV (SNAP-IV)
inattention items
- Inhibition Pre- and post- - 12 weeks - Rating scales: - The results showed that after
with ADHD (23 - Working comparison between - 90 mins per - ADHD rating scale-IV intervention, the children
combined type, 18 memory groups session (60 mins (ADHD symptoms) with ADHD presented better
inattentive type and 3 - Planning for children, 30 - Conners’ parent rating performances of EF both in
hyperactive0impulsive - Organization mins for parents) scale (conduct, neuropsychological tests and
type) - Shifting - Aimed to help learning, reports of daily life. The
- Five participants were - ToM child develop psychosomatic, performances on EF tasks for
taking medications - Time skills and impulsive-hyperactive, children with ADHD after EF
(three children on management strategies needed anxiety problems, and training could match with the
methylphenidate and - Emotional to cope with the a hyperactivity index) level of HC children. The
two children on regulation difficulties and - Behavior rating ADHD symptoms and
atomoxetine) who impairments inventory of executive behavioral problems of the
were asked to maintain associated with function (BRIEF) children as reported by
a stable medication ADHD - Parent report and parents also reduced
status during the - Home programme satisfaction survey significantly after the
intervention and available - Neuropsychological intervention. Participants
evaluation period measures: reported that the EF training
 - 88 children as health - The stoop colour and program was feasible to
control (HC) were word test (inhibition administer and acceptable
recruited and matched component of EF) - The EF training program was
with the ADHD group - The Rey-Osterrieth feasible and acceptable to
by age (within 6 complex figure test children with ADHD and
months) and (RCFT) (visuospatial parents. Although replication
intelligence quotient construction ability with a larger sample and an
(IQ) (within 15-scaled and visual WM) active control group are
score points) - The trail making test needed, EF training program
- Subjects with severe (visual search speed, with multiple EF focus and
comorbidities such as visuomotor parent involving in real-life
major depression, functioning and shift activities could be a
mania, and bipolar time) potentially promising
disorder and subjects - The tower of Hanoi intervention associated with
with major (ToH) (planning) significant EF (near transfer)
sensory-motor - The VF test (verbal and ADHD symptoms
difficulties (e.g. fluency) improvement (far transfer)
paralysis, deafness, - The false-belief task
and blindness), a (hot EF)
history of brain
damage, epilepsy, or
an estimated full-scale
IQ of <80 were
excluded

13/ Attention and executive - 70 children with ADHD, - Sustained - Randomized, - Treatment as Cognitive - The multicenter randomized
functions computer training aged 6-13 were attention controlled trial usual (TAU): - Cambridge clinical trial found no
for Attention randomized to - Response Diagnosis and Neuropsychological significant beneficial effects of
Deficit-Hyperactivity Deficit intervention or control inhibition cognitive Test Automated cognitive training using the
Disorder (ADHD): Results from group - Cognitive assessment, Battery (CANTAB): computer program ACTIVATE
a randomized, controlled trial - Children who were flexibility psycho-education, - The motor screening on the primary or secondary
diagnosed of comorbid - Working pedagogical task (MOT) screening outcome measures in children
conduct disorder, ASD, memory counseling, and for visual, movement with ADHD. The study was
depression or - Pattern questionnaires for and comprehension likely underpowered to detect
schizophrenia; medical recognition parents and difficulties small to moderate changes
history of head injury - Category teachers, home Attention tests:
or a verified formation and and school visits - Attention Switching
neurological disorder; use and, for some Task (AST) (ability to
intelligence quotient children, medical switch attention and to
(IQ) <80l motor or treatment ignore task-irrelevant
perceptual handicaps AND information)
which would interfere - Computer - Rapid Visual
 with computer use; program Information Processing
medical condition ACTIVATETM (RVP) (sustained
requiring primary - Eight weeks attention)
treatment; and no - 6 times a week Executive function:
informed consent from - 3 home exercises: - Spatial Working
custody Catch the Ball, Memory (ability to
- Participants were Butterflies and retain and manipulate
asked not to change What Comes Next spatial information)
their medication status - Focused on: - Stockings of
during the intervention sustained Cambridge (SOC)
period; however two attention, (spatial planning test)
participants started response - Intra-Extra
medication during the inhibition, Dimensional Set Shift
intervention. They cognitive (IED) (rule acquisition,
were, like all other flexibility and reversal, attentional
participants required control, speed of set formation
not to take medication information maintenance, shifting
24 hours prior to the processing, and flexibility of
cognitive test multiple attention
simultaneous - Stop signal Task (SST)
attentions, (response inhibition)
working memory, - Reaction time
category - Reaction Time (RTI)
formation and (motor and mental
pattern response speeds and
recognition movement time)
Behavioral
- ADHD-Rating Scale-IV
- BRIEF
- WFIRS-P (functional
impairment over the
past month: family,
learning and school,
life skills, child’s
self-concept, social
activities and risky
activities)
14/ Executive function training - 10 children with SLI - Trained EF - A pretest one - “Braingame - Trained executive - Results showed significant
in children with specific aged 8-12 years old (visuospatial week before the Brian”, in which functions improvement of cognitive
language impairment (SLI): A were recruited WM, start of the three EFs - Visuospatial working flexibility and a positive trend
pilot study, Brigitte, V. et al. - Children with a inhibition, training, post-test (visuospatial WM, memory (The for visuospatial storage and
(2016) diagnosis of hearing cognitive at the conclusion inhibition and Automated Working inhibition. Besides, results

15/ Computerized Training of
Working Memory in Children
With ADHD—A Randomized,
Controlled Trial
(2005)
disorder, frank flexibility) on the training cognitive Memory Assessment) also showed significant
neurological disorders, period and a flexibility) are - Inhibition (The subtest improvement on sustained
or autism spectrum follow-up 6 trained, Walk Don’t Walk of the attention, attention control,
disorder were months later embedded in a TEA-Ch) parent-and teacher-rated
excluded. game-like - Cognitive flexibility attention behavior and
environment (The Trail Making Test parent-rated EF and
- 6 weeks – TMT) externalizing behavior with
- 4 times/week - Untrained medium effect sizes.
- 25 sessions of neurocognitive
45mins functions
- All sessions - Verbal working
contain 2 blocks memory (The subtest
(about 15 mins): 3 Digit Recall of the
training tasks in a Automated Working
fixed order – first Memory Assessment)
WM training, - Attention (The subtest
second inhibition Sky Search of the
training and third TEA-Ch)
cognitive - Planning (The subtest
flexibility training Six Elements of the
- Behavioral Assessment
of the Dysexecutive
Syndrome for Children)
- Fluency (The subtest
Verbal Fluency of the
Developmental
Neuropsychological
Assessment Battery)
- Behavioral rating
- EF behaviors (The
Behavior Rating
Inventory of Executive
Function – BRIEF)
- Behavioral problems
(The Child Behavior
Checklist - CBCL)
-53 children with ADHD Working Memory Pre-and port-(3 -Computer program, -The span-board task -For the span-board task, there was a
months later) “Cogmed” was
(9 girls; 15 of 53 comparison between provided on a CD to measure visuospatial significant treatment effect both post
inattentive subtype), group and used by the WM. intervention and at follow-up. In
child on a personal
aged 7 to 12 years, computer either at - Digit-span from the addition
without stimulant home or in school. WISC-III testing battery There were significant effects for
-Children performed
medication. 90 WM trials on was used to measure secondary outcome tasks measuring
each day of verbal WM. verbal WM, response inhibition, and
training.
-The Stroop interference complex reasoning.
-5 weeks
task Parent ratings showed significant
intervention and
to measure response reduction in symptoms of inattention
child was asked to
inhibition and hyperactivity/impulsivity, both
complete at least 25
-Raven’s Colored post-intervention and at follow-up
days of training
Progressive Matrices to
before the next visit.
measure nonverbal

reasoning ability

Exclusion criteria:
-fulfilling criteria for
diagnosis of clinically
significant oppositional
defiant disorder, autistic
syndrome,
Asperger’s syndrome or
depression;
-IQ <80 (based on an IQ
test or the physician’s
clinical impression and
school history