Publication: Impacto del entrenamiento cognitivo NEXXO sobre la atención y funciones ejecutivas en edad escolar
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2021-05-25
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Universidad Complutense de Madrid
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Abstract
El origen de esta tesis se remonta a la propia práctica clínica con niños con Trastorno por Déficit de Atención e Hiperactividad (TDAH). Abordando la intervención psicoeducativa y neuropsicológica de este trastorno observé la necesidad de implementar un programa de intervención que tratase aspectos básicos de la atención y de las funciones ejecutivas, como son la vigilancia y la inhibición (Figueroa y Youmans, 2012; Rueda, Posner y Rothbart, 2005), con el objetivo final de entrenar el control atencional y el control ejecutivo. Un programa que, además, fuese dirigido por profesionales donde, además, se aplicasen pautas y estrategias metacognitivas que consolidasen y generalizasen la intervención. Como se ha dicho anteriormente, la idea inicial fue abordar el entrenamiento de la vigilancia y de la inhibición, aspectos deficitarios para estos pacientes en las reconocidas pruebas de ejecución continua como Conners Continous Performance Test II (CPT-II) (Conners et al., 2000), Conners Kiddie Continuous Performance Test (K-CPT V.5) (Conners y Staff, 2001) o CSAT-R tarea de atención sostenida en la infanciarevisada (Servera y Llabrés, 2015). Al diseñar el entrenamiento, nos centramos en elcontrol atencional y ejecutivo, y los procesos relacionados con los mismos. Entre otrascosas, por ello, entrenamiento debía estar acompañado de ciertas pautas y estrategias quepudieran ayudar a asimilar de forma más adecuada el entrenamiento, estrategiasmetacognitivas. El entrenamiento “Nexxo” surgió de una necesidad: entrenar procesosbásicos de atención y funciones ejecutivas con un enfoque determinado (desde laneuropsicología infantil), un programa que además incorporase estrategiasmetacognitivas para su consolidación; un programa inexistente en el mercado, y, portanto, inaccesible en ese momento.
Parasuraman y Giambra (1991) consideran la vigilancia y la atención sostenida como la misma habilidad, una habilidad en la que el observador debe mantener su foco de atención y su estado de alerta durante tiempos prolongados. La principal distinción es que en las tareas de vigilancia la frecuencia con la que el observador debe detectar un estímulo relevante es baja (Hauke et al., 2011). Esta habilidad se considera crucial para el desempeño de tareas de atención sostenida y de atención dividida, aspectos relevantes para la vida diaria (Figueroa y Youmans, 2012). La vigilancia se ha visto afectada en trastornos como el Trastorno por Déficit de Atención e Hiperactividad (TDAH) (Huang- Pollock, Karalunas, Tam, y Moore, 2012; Michelini et al., 2016), ansiedad (Price et al., 2013) y autismo (Christakou et al., 2013) entre otros. Por su parte la inhibición es uno de los aspectos principales de las funciones ejecutivas (Miyake y Friedman, 2012; Miyake et al., 2000). La inhibición supone dos habilidades básicas, por un lado, la habilidad de suprimir una respuesta automática o una tendencia en favor de otra, lo que se conoce como inhibición de respuesta, por otro, la selección de la información relevante en presencia de distractores, conocido como control de la interferencia (Miyake et al., 2000; Tamm y Nakonezny, 2015). Déficits en inhibición se encuentran en trastornos como TDAH, (Barkley, 1997), trastorno obsesivo-compulsivo y autismo (Ozonoff y Jensen,1999). Se consideran por tanto aspectos relevantes a incorporar en un entrenamiento de la atención y las funciones ejecutivas...
The origin of this thesis comes from my own clinical practice with children with attention deficit disorder (ADHD). To intervene neuropsychologically with these patients, I realised about the need of developing a program aimed to attention and executive functions (EF), such as vigilance and inhibitory control (Figueroa y Youmans, 2012; Rueda, Posner y Rothbart, 2005) with the final goal of training attentional and executive control. This program should be directed by professionals who applied metacognitive strategies to better implement the training. By doing this, there are a higher likehood of transference. As mentioned, the original idea was to train vigilance and inhibition, aspects were ADHD patients have some handicaps as it seems in tests such as Conners Continous Performance Test II (CPT-II) (Conners et al., 2000), Conners Kiddie Continuous Performance Test (K-CPT V.5) (Conners y Staff, 2001) or CSAT-R (task of sustained attention in childhood) (Servera y Llabrés, 2015). When designing the training, we focused on attentional and executive control as well as processes related. The training had to be applied with some strategies to better assimilate it, those strategies are metacognitive. “Nexxo” training emerged from a specific need: to train basic processes of attention and EF with a particular scope (from child neuropsychology). A program that incorporates metacognitive strategies to better assimilate training, a program that does not previously exist. Parasuraman y Giambra (1991) consider vigilance and sustained attention as the same ability, an ability in which observers must maintain their focus of awareness and alertness for prolonged periods. The main distinction is that in vigilance tasks, observers must respond to infrequently occurring signals (Hauke, Fimm, y Sturm, 2011). Those are easily detected in short periods but not in long ones. These abilities are relevant to develop attention tasks; this is relevant in daily life (Figueroa y Youmans, 2012). Failures in this process have been found in attention deficit hyperactivity disorder (ADHD) (Huang- Pollock, Karalunas, Tam, y Moore, 2012; Michelini et al., 2016), anxiety (Price et al., 2013) and autism (Christakou et al., 2013). Inhibition is one of the core elements of EF (Miyake y Friedman, 2012; Miyake et al., 2000). Inhibition is not only the ability to suppress a dominant response but also the ability to select relevant stimuli when a distractor appears (Miyake et al., 2000; Tamm y Nakonezny, 2015) Failures in inhibitory processes have been found in disorders such as ADHD (Barkley, 1997), obsessive-compulsive disorder, and autism (Ozonoff y Jensen, 1999). For these reasons, both aspects are relevant to the design of attention and EF training...
The origin of this thesis comes from my own clinical practice with children with attention deficit disorder (ADHD). To intervene neuropsychologically with these patients, I realised about the need of developing a program aimed to attention and executive functions (EF), such as vigilance and inhibitory control (Figueroa y Youmans, 2012; Rueda, Posner y Rothbart, 2005) with the final goal of training attentional and executive control. This program should be directed by professionals who applied metacognitive strategies to better implement the training. By doing this, there are a higher likehood of transference. As mentioned, the original idea was to train vigilance and inhibition, aspects were ADHD patients have some handicaps as it seems in tests such as Conners Continous Performance Test II (CPT-II) (Conners et al., 2000), Conners Kiddie Continuous Performance Test (K-CPT V.5) (Conners y Staff, 2001) or CSAT-R (task of sustained attention in childhood) (Servera y Llabrés, 2015). When designing the training, we focused on attentional and executive control as well as processes related. The training had to be applied with some strategies to better assimilate it, those strategies are metacognitive. “Nexxo” training emerged from a specific need: to train basic processes of attention and EF with a particular scope (from child neuropsychology). A program that incorporates metacognitive strategies to better assimilate training, a program that does not previously exist. Parasuraman y Giambra (1991) consider vigilance and sustained attention as the same ability, an ability in which observers must maintain their focus of awareness and alertness for prolonged periods. The main distinction is that in vigilance tasks, observers must respond to infrequently occurring signals (Hauke, Fimm, y Sturm, 2011). Those are easily detected in short periods but not in long ones. These abilities are relevant to develop attention tasks; this is relevant in daily life (Figueroa y Youmans, 2012). Failures in this process have been found in attention deficit hyperactivity disorder (ADHD) (Huang- Pollock, Karalunas, Tam, y Moore, 2012; Michelini et al., 2016), anxiety (Price et al., 2013) and autism (Christakou et al., 2013). Inhibition is one of the core elements of EF (Miyake y Friedman, 2012; Miyake et al., 2000). Inhibition is not only the ability to suppress a dominant response but also the ability to select relevant stimuli when a distractor appears (Miyake et al., 2000; Tamm y Nakonezny, 2015) Failures in inhibitory processes have been found in disorders such as ADHD (Barkley, 1997), obsessive-compulsive disorder, and autism (Ozonoff y Jensen, 1999). For these reasons, both aspects are relevant to the design of attention and EF training...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Psicología, Departamento de Psicología Experimental, Procesos Cognitivos y Logopedia, leída el 16/12/2020. Tesis formato europeo (compendio de artículos)