注意缺陷多动障碍执行功能训练的神经机制及临床应用新进展

Advances in neural mechanisms and clinical applications of executive function training for attention-deficit/hyperactivity disorder

摘要

注意缺陷多动障碍(ADHD)是儿童青少年最常见的神经发育障碍,其核心病理特征之一为执行功能缺陷,主要表现为抑制控制、工作记忆、认知灵活性及计划组织能力的全面受损,且该缺陷常伴随患者从儿童期延伸至成年期,引发学业落后、社交障碍、职业适应困难及情绪调节异常等系列功能损害,形成 “缺陷-损害-二次伤害” 的恶性循环。本文结合近年国内外高质量研究成果,从 ADHD 执行功能缺陷的神经机制与异质性临床特征切入,系统阐述执行功能训练的理论支撑、核心实施方法及临床应用成效,重点聚焦不同年龄阶段(学龄前、学龄期、青少年期)与不同亚型(注意缺陷为主型、多动冲动为主型、混合型)患者的个性化训练策略设计与实践要点;同时剖析当前执行功能训练在临床应用中面临的关键挑战,包括评估工具标准化不足、训练效果的维持与迁移困难、专业人才与资源短缺等核心问题,并针对性提出未来发展方向,为 ADHD 患者执行功能缺陷的精准化、高效化干预及全周期康复提供系统性参考与实践指导。

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is the most prevalent neurodevelopmental disorder among children and adolescents.Executive function deficits represent one of its core pathological features, mainly manifested as broad impairments in inhibitory control, working memory, cognitive flexibility, and planning and organizational abilities.These deficits often persist from childhood into adulthood and may lead to a range of functional impairments, including academic underachievement, social difficulties, occupational maladjustment, and emotional dysregulation, thereby creating a vicious cycle of deficit-impairment-secondary harm.Based on the latest research findings, this review elucidates the neural mechanisms and clinical manifestations associated with executive function deficits in ADHD.It systematically elucidates the theoretical basis, core methodologies, and advancements in clinical applications of executive function training.Furthermore, it emphasizes the analysis of individualized training strategies for patients across various age groups and subtypes.The review also identifies the challenges currently faced in clinical application of executive function training, including insufficient standardization of assessment tools, difficulties in maintaining and transferring training effects, and shortages of specialized personnel and resources.Finally, future directions are proposed to provide valuable insights for the precise diagnosis, treatment and life-course rehabilitation interventions for individuals with ADHD.

关键词

注意缺陷多动障碍 / 执行功能训练 / 神经可塑性 / 个性化干预 / 临床应用 / 认知训练

Key words

attention-deficit/hyperactivity disorder / executive function training / neural plasticity / individualized intervention / clinical application / cognitive training

[1] Nigg JT, Halperin JM, Barkley RA.Annual research review: Developmental trajectories of ADHD from childhood to adulthood: An update[J].J Child Psychol Psychiatry, 2022, 63(12): 1375-1395.
[2] Ayano G, Demelash S, Gizachew Y, The global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta-analyses[J].J Affect Disord 2023,339:860-866.
[3] Faraone SV,Bellgrove MA, Brikell I, et al.Attention-deficit/hyperactivity disorder[J].Nat Rev Dis Primers, 2024, 10: 11.
[4] Lee S.Cognitive flexibility and inhibitory control: The prefrontal-striatal-cerebellar network in neurodevelopmental disorders[J].Biol Psychiatry Cogn Neurosci Neuroimaging,2023, 121(1):65-94
[5] Cupertino RB, Soheili-Nezhad S, Grevet EH, et al.Reduced fronto-striatal volume in attention-deficit/hyperactivity disorder in two cohorts across the lifespan[J],Neuroimage: Clin, 2020, 28:102403.
[6] Chen C, Sun S, Chen R, et al.A multimodal neuroimaging meta-analysis of functional and structural brain abnormalities in attention-deficit/hyperactivity disorder[J].Prog Neuro Psychopharmacol Biol Psychiatry, 2025, 136: 111199.
[7] Norman SE, Faraone SV, Biederman J.Neurobiology of attention-deficit/hyperactivity disorder: An update[J].Ann Child Neurol, 2026, 34(1): 32-40.
[8] Franke B, Michelini G, Asherson P, et al.Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan[J].Eur Neuropsychopharmacol, 2018, 28(10): 1059-1088.
[9] Gao Y, Zhou Z, Bao W, et al.Multiscale functional connectivity reveals imbalanced interplay between higher- and lower-order brain networks in ADHD[J].Nat Ment Health, 2025, 3(11): 1331-1341.
[10] Mahone EM, Denckla MB.Attention-deficit/hyperactivity disorder: A historical neuropsychological perspective[J].J Int Neuropsychol Soc, 2017, 23(9-10): 916-929.
[11] Shaw P, Sudre G.Adolescent attention-deficit/hyperactivity disorder: Understanding teenage symptom trajectories[J].Biol Psychiatry, 2021, 89(2): 152-161.
[12] Dobrosavljevic M, Larsson H, Cortese S.The diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD) in older adults[J].Expert Rev Neurother, 2023, 23(10): 883-893.
[13] O’Neill S, Rajendran K, Mahbubani SM, et al.Preschoolpredictors of ADHD symptoms and impairment during childhood and adolescence[J].Curr Psychiatry Rep, 2017, 19(12): 95.
[14] van Emmerik-van Oortmerssen K, van de Glind G, Koeter MWJ, et al.Psychiatric comorbidity in treatment-seeking substance use disorder patients with and without attention deficit hyperactivity disorder: Results of the IASP study[J].Addiction, 2014, 109(2): 262-272.
[15] Francx W, Oldehinkel M, Oosterlaan J, et al.The executive control network and symptomatic improvement in attention-deficit/hyperactivity disorder[J].Cortex, 2015, 73: 62-72.
[16] SergeantJ.The cognitive-energetic model: An empirical approach to attention-deficit hyperactivity disorder[J].Neurosci Biobehav Rev, 2000, 24(1): 7-12.
[17] Beyens I, Valkenburg PM, Piotrowski JT.Screen media use and ADHD-related behaviors: Four decades of research[J].Proc Natl Acad Sci USA, 2018, 115(40): 9875-9881.
[18] Westwood SJ, Parlatini V, Rubia K, et al.Computerized cognitive training in attention-deficit/hyperactivity disorder (ADHD):A meta-analysis of randomized controlled trials with blinded and objective outcomes[J].Mol Psychiatry, 2023, 28(4): 1402-1414.
[19] Michelini G, Kitsune GL, CheungCHM, et al.Attention-deficit/hyperactivity disorder remission is linked to better neurophysiological error detection and attention-vigilance processes[J].Biol Psychiatry, 2016, 80(12): 923-932.
[20] Van Doren J, Arns M, Heinrich H, et al.Sustained effects of neurofeedback in ADHD:A systematic review and meta-analysis[J].Eur Child Adolesc Psychiatry, 2019, 28(3): 293-305.
[21] Rajendran K, Kruszewski E, Halperin JM.Parenting style influences bullying: A longitudinal study comparing children with and without behavioral problems[J].J Child Psychol Psychiatry, 2016, 57(2): 188-195.
[22] Sjöwall D, Bohlin G, Rydell AM, et al.Neuropsychological deficits in preschool as predictors of ADHD symptoms and academic achievement in late adolescence[J].Child Neuropsychol, 2017, 23(1): 111-128.
[23] Abikoff HB, Thompson M, Laver-Bradbury C, et al.Parent training for preschool ADHD: A randomized controlled trial of specialized and generic programs[J].J Child Psychol Psychiatry, 2015, 56(6): 618-631.
[24] Cao Y, Ma L, Liu N, et al.Virtual reality interventions for attention deficit/hyperactivity disorder: A systematic review[J].npj Digit Med, 2026, 9: 303.
[25] Bioulac S Laurent A, Cazalet S.Virtual classroom cognitive remediation for ADHD: A randomized controlled trial[J].J Atten Disord, 2024, 28(12): 1673-1683.
[26] Kay BP, Wheelock MD,Siegel JS, et al.Stimulant medications affect arousal and reward, not attention networks[J].Cell, 2025, 188(26): 7529-7546.e20.
[27] Coleman B, Marion S, Rizzo A,et al.Virtual reality assessment of classroom-related attention: An ecologically relevant approach to evaluating the effectiveness of working memory training[J].Front Psychol, 2019, 10: 1851.
[28] Sun Z, Sun Y, Zeng Y.BACNet: A multi-attention network for cross-subject and cross-task EEG-based pilot operational intent recognition[J].Comput Meth Programs Biomed, 2026, 274: 109134.
[29] Lim CG, Soh CP, Lim SSY, et al.Home-based brain-computer interface attention training program for attention deficit hyperactivity disorder: A feasibility trial[J].Child Adolesc Psychiatry Ment Health, 2023, 17(1): 15.
[30] Fiks AG, Ross ME, Mayne SL, et al.Preschool ADHD diagnosis and stimulant use before and after the 2011 AAP practice guideline[J].Pediatrics, 2016, 138(6): e20162025.
[31] Greenhill L, Kollins S, Abikoff H, et al.Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD[J].J Am Acad Child Adolesc Psychiatry, 2006, 45(11): 1284-1293.
[32] Sibley MH, Rohde LA, Swanson JM, et al.Late-onset ADHD reconsidered with comprehensive repeated assessments between ages 10 and 25[J].Am J Psychiatry, 2018, 175(2): 140-149.
[33] Crunelle CL,van den Brink W, Moggi F, et al.International consensus statement on screening, diagnosis and treatment of substance use disorder patients with comorbid attention deficit/hyperactivity disorder[J].Eur Addict Res, 2018, 24(1): 43-51.
[34] Stevens AJ, Purcell RV, Darling KA, et al.Human gut microbiome changes during a 10 week randomised control trial for micronutrient supplementation in children with attention deficit hyperactivity disorder[J].Sci Rep, 2019, 9(1): 10128.
[35] Skott E, Yang LL, Stiernborg M, et al.Effects of a synbiotic on symptoms, and daily functioning in attention deficit hyperactivity disorder-A double-blind randomized controlled trial[J].Brain Behav Immun, 2020, 89: 9-19.
[36] Checa-Ros A, Jeréz-Calero A, Molina-Carballo A, et al.Currentevidence on the role of the gut microbiome in ADHD pathophysiology and therapeutic implications[J].Nutrients, 2021, 13(1): 249.
[37] Rajendran K, O’Neill S, Marks DJ, et al.Latent profile analysis of neuropsychological measures to determine preschoolers′ risk for ADHD[J].J Child Psychol Psychiatry, 2015, 56(9): 958-965.
[38] Breaux RP, Griffith SF, Harvey EA.Preschool neuropsychological measures as predictors of laterattention deficit hyperactivity disorder[J].J Abnorm Child Psychol, 2016, 44(8): 1455-1471.
[39] van Lieshout M, Luman M, Twisk JWR, et al.A 6-year follow-up of a large European cohort of children with attention-deficit/hyperactivity disorder-combined subtype: Outcomes in late adolescence and young adulthood[J].Eur Child Adolesc Psychiatry, 2016, 25(9): 1007-1017.
[40] 卢燕彬, 李梅, 冯君, 等.脑电生物反馈及执行功能训练对注意缺陷多动障碍儿童的疗效因素分析[J].中国医药指南, 2025, 23(25): 5-8.
Lu YB, Li M, Feng J, et al.Analysis of the efficacy factors of electroencephalographic biofeedback and executive function training for children with attention deficit hyperactivity disorder[J].Guide China Med, 2025, 23(25): 5-8.(in Chinese)
[41] Sibley MH, Kurylowicz A, Liddle BA.Digital cognitive behavioral therapy apps for ADHD: A systematic review of recent evidence [J].Eur Psychiatry, 2025, 58 (1): 11-19.