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March 1987

Cognitive Training in Treatment of Hyperactivity in Children

Arch Gen Psychiatry. 1987;44(3):296. doi:10.1001/archpsyc.1987.01800150120014

To the Editor.—  An article in the Archives by Abikoff and Gittelman1 reported on the outcome of a cognitive training program in the treatment of juvenile hyperactivity. The report is a noteworthy contribution to this important and somewhat controversial field. Accordingly, the authors' conclusion that cognitive training provides no additional benefit when combined with medication in treating hyperactive children who respond to stimulants requires clarification and commentary.Our first concern is that the cognitive intervention employed by Abikoff and Gittelman lacked a truly behavioral component (eg, did not include response contingencies in the training) and, therefore, differs meaningfully from the cognitive-behavioral approaches championed by other researchers and buttressed by their data. Rewards were dispensed by Abikoff and Gittleman but in a manner not indicative of proper contingency management; rewards were not tied to learning the program. Models for cognitive processes in the learning of behavioral self-control have consistently emphasized