Cognitive rehabilitation with neurodevelopmental disorder: A systematic review

2.1 Searching keywords

Through a thorough literature search, studies examining the effects of interventions used in relation to cognitive function in children with neurodevelopmental disorders were identified. Articles published in the past 10 years were searched for using PubMed and EBSCOhost, i.e., those published from January 1, 2006 until August 31, 2016. This review identified articles with the following the search keywords: “disease including neurodevelopmental disorder with DSM-5” AND “cognition”, and “disease including neurodevelopmental disorder with DSM-5” AND “cognitive function”. The final search expression was as follows: “cognition” AND “intellectual disability”, “cognitive function” AND “intellectual disability”, “cognition” AND “intellectual developmental disorder”, “cognitive function” AND “intellectual developmental disorder”, “cognition” AND “global developmental delay”, “cognitive function” AND “global developmental delay”, “cognition” AND “autism spectrum disorder”, “cognitive function” AND “autism spectrum disorder”, “cognition” AND “attention deficit hyperactivity disorder”, “cognitive function” AND “attention deficit hyperactivity disorder”, “cognition” AND “developmental coordination disorder”, “cognitive function” AND “developmental coordination disorder”, “cognition” AND “stereotypic movement disorder”, “cognitive function” AND “stereotypic movement disorder”, “cognition” AND “tic disorders”, “cognitive function” AND “Tic disorders”, “cognition” AND “Tourette disorder”, “cognitive function” AND “Tourette disorder”.

2.2 Searching process

This literature search was conducted for original articles that were published in academic journals, written in English, and met our inclusion and exclusion criteria. Using this method, a total of 3,115 articles were identified. Studies that were in accordance with the inclusion criteria or that could not be included based only on the content of the abstract were selected for a full-text review. Since it was not possible to automatically exclude animal trials in this search engine, this was done through hand search. Abstracts of the remaining publications were scrutinized for eligibility by two independent assessors (i.e. the authors, Ahn and Hwang), using the criteria described below. Thus, a total of 80 articles were included in the full-text review by both assessors. The following data were extracted from the selected studies: diagnosis of participants, age of participants, study design, methods of assessment, methods of intervention, and operational definition. The final list consisted of 26 studies (Fig. 1). Inclusion criteria were as follows: studies with the original text written in English; studies involving children as the participants to school age; and studies used for experimental design. The exclusion criteria were as follows: studies based on animals; studies that did not include an intervention (e.g., review articles and cross-sectional studies); and studies using drugs, injections and acupuncture as the intervention.

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Fig.1

Search process.

The level of evidence was used to evaluate the quality of criteria used in studies (Arbesman, Scheer, & Lieberman, 2008). For the purposes of this review, participants were classified according to their diagnoses, chronological ages, and developmental stages. The 26 articles for this literature review were classified according to the conducted intervention methods and the types of neurodevelopmental disorder diagnosis. In addition, the data were presented in accordance with the principle of PICO (Patients, Intervention, Comparison, and Outcome), which is a method used to systematically sort out the results of all of the studies (Appendix. I).

3.1 Results of methodological quality

Whether the articles met the different research quality criteria set out or not, the literature review divided the articles into five groups: 11 studies (42.3%) which were classified as randomized controlled trials (RCTs), nine studies (34.6%) which were classified as non-randomized comparative group studies, and six studies (23.1%) which were classified as non-randomized single-group studies. Thus, the RCTs were the majority of 26 articles in this review (Table 1).

This study analyzed the studies to evaluate the effects of cognitive therapy in neurodevelopmental disorders, as classified according to DSM-5 criteria (Table 2). Among the 26 studies that reported the effects of cognitive therapy, 12 studies (44.4%) involved participants with ASD, six articles (22.2%) involved ADHD, four articles (14.8%) involved global developmental disorder, and articles (7.4%) involved developmental coordination disorder. In the remaining three articles, there were in cerebral palsy, intellectual disability, and high risk for autism in each ones. In addition, when studies were classified according to the chronological ages of participants, the most commonly studied participants were of grade-school age (17 studies, 63.0%), followed by children (6 studies, 22.2%) (Table 2).

This study analyzed the types of cognitive therapy interventions in 26 articles. The results are shown in Table 3. Each article used the specific and various cognitive therapy programs according to the analysis. Each disorder was conducted on a wide variety of cognitive intervention. Seven level I studies met the criteria, four level II studies met the criteria, and two level III studies met for ASD and high risk for ASD. Three level I studies met the criteria, two level II studies met the criteria, and one level III study met the criteria for ADHD. Neurofeedback training, computerized working memory training and complex treatment (sensory and motor integration) were used as interventions in attention deficit/hyperactivity disorder. One level I study and one level III study met the criteria for GDD. One level II study met the criteria for CP and GDD, and two level II studies met the criteria for DCD. The interventions used in those with GDD included computerized programs and institutional-based therapy programs. Table-tennis training and neuromotor task training (Cognitive Orientation to daily Occupational Performance approach) were used in those with DCD. One level II study met the criteria for cochlear implants with ID and CP, and one level III study met the criteria for ID (Table 3).

RCTs have the highest qualitative criteria, which included independence from variables and randomization (Portney & Watkins, 2008). The cognitive therapies that were most commonly used in RCT studies for ASD and those at high risk for ASD included comprehensive autism program (CAP), attention training, SENSE theatre intervention, nonverbal communication, emotion recognition, and theory of mind training (NETT), early start Denver model intervention, interpersonal synchrony, and focused playtime intervention. The cognitive therapies most commonly used in RCTs for ADHD included neurofeedback training, computerized working memory training, and visuospatial working memory. The cognitive therapy most commonly used in RCTs for GDD was a home activity program.

As resulted analysis of this study, most interventions applied cognitive training were therapies related to attention for ASD and high risk for ASD, neurofeedback training for ADHD, computer based activities for GDD, and therapies based cognitive theory for DCD.

4.1 Autism spectrum disorder (ASD)

ASD was the neurodevelopmental disorder that was most commonly investigated in studies using the cognitive therapy was CAP, which is used to teach communication and social behavior skills (Young, Falco, & Hanita, 2016). SENSE theatre intervention was used to improve social relationships and adaptive behaviors through video modeling and concentration training to visually trace the opposite screen (Corbett et al., 2016). Nonverbal communication, emotion recognition, and theory of mind training (NETT), a treatment using a top-down approach as cognitive behavior therapy, was also used (Soorya et al., 2015). Early start Denver model intervention was used to train parents (Dawson et al., 2010). Focused playtime interventions were also used to educate parents (Kasari et al., 2014). Early intensive behavioral intervention (EIBI) was used to increase focus in early interactions and communication (Smith, Flanagan, Garon, & Bryson, 2015). In addition, music therapy, Natural setting-treatment and education of autistic and related communication handicapped children (NS-TEACCH), computer games, and application behavior analysis were also used (Panerai et al., 2009). These results suggest that cognitive therapy in children with ASD mostly involves training related to social relationships and adaptive behaviors, or parental education.

4.2 Attention-deficit/hyperactivity disorder (ADHD)

In ADHD, the most commonly investigated cognitive therapy was Neurofeedback training, i.e., electroencephalogram (EEG) training using biofeedback, followed by computerized working memory training, and visuospatial working memory training to facilitate time, hearing, memory, and visual tracking using computer programs (Bigorra, 2014). Besides that, there was also a complex treatment used that integrated visual-motor training, core body exercises, and visual-auditory stimulation (Park et al., 2013). Children with ADHD are characterized by attentional and behavioral problems, and so visual and auditory perception activities that promote increased attention and memory, and cognitive correction integrating sensory and motor activities, are used.

4.3 Global developmental disorder (GDD)

The cognitive function-related interventions used in GDD include computerized programs to increase eye tracking, emotion recognition and consideration, working memory, Vis-á-Vis (VAV), and home activity programs (Glaser et al., 2012). It is thought that interventions related to vision, perception and memory were applied in GDD because overall development is impaired.

4.4 Developmental coordination disorder (DCD)

The cognitive therapies used in DCD included table tennis activities, task-based training, and a Cognitive Orientation to daily Occupational Performance (CO-OP) approach to use problem-solving strategies based on tasks (Niemeijer, Smits-Engelsman, & Schoemaker, 2007). It is thought that training related to motor skills, such as the CO-OP approach, is appropriate because children with DCD mainly show problems related to motor function.

4.5 Suggestions

Children with neurodevelopmental disorders are not able to detect, process, or utilize various stimuli from the environment due to a variety of problems. In particular, their cognitive problems prevent them from performing tasks relevant to their developmental stage. As a result of this study, negative effects in relation to self-management and academic performance are seen as these children turn into adolescents, resulting in their limited participation in social activities. As mentioned in introduction, three challenges for the present systematic review would therefore be as followings: first challenge of this study was to suggest the cognitive therapeutic approaches for children with neurodevelopmental disorders. Second challenge was to identify the age group of children with neurodevelopmental disorders applying cognitive therapy. Finally challenge was to find out the cognitive treatment methods that are effective for each neurodevelopmental disorder. This study suggests that it is more beneficial to receive the intervention related cognitive function that promotes cognitive development in children with neurodevelopmental disorders as effective as possible when they are young. Cognitive therapy would have particularly a positive impact on cognitive function, motor learning, social participation and adaptive behaviors as well as cognitive therapy. Based on the results of this study, the intervention can be used to select the therapeutic approaches which can be verified to apply, and to select the clinical assessment tools to evaluate the problems of the cognitive function in children with neurodevelopmental disorder.

4.6 Study limitations

In this study, only published articles were reviewed in the search process, which may be a limitation since unpublished data and review papers or reports were excluded. Therefore, further research should be conducted through a broader search for studies on school-aged children. Nevertheless this study suggests various intervention methods to promote the cognitive function development of the children in the developmental stages. The cognitive function obtained at the early stage of development is essential for the achievement of the child. This study suggests that various cognitive approaches to rehabilitation therapy should be considered as it is an important skill for preparation for learning and learning.