Abstract
ObjectiveThe use of brain-computer interface in neurofeedback therapy for attention deficit hyperactivity disorder (ADHD) is a relatively new approach. We conducted a randomized controlled trial (RCT) to determine whether an 8-week brain computer interface (BCI)-based attention training program improved inattentive symptoms in children with ADHD compared to a waitlist-control group, and the effects of a subsequent 12-week lower-intensity training.Study designWe randomized 172 children aged 6–12 attending an outpatient child psychiatry clinic diagnosed with inattentive or combined subtypes of ADHD and not receiving concurrent pharmacotherapy or behavioral intervention to either the intervention or waitlist-control group. Intervention involved 3 sessions of BCI-based training for 8 weeks, followed by 3 training sessions per month over the subsequent 12 weeks. The waitlist-control group received similar 20-week intervention after a wait-time of 8 weeks.ResultsThe participants’ mean age was 8.6 years (SD = 1.51), with 147 males (85.5%) and 25 females (14.5%). Modified intention to treat analyzes conducted on 163 participants with at least one follow-up rating showed that at 8 weeks, clinician-rated inattentive symptoms on the ADHD-Rating Scale (ADHD-RS) was reduced by 3.5 (SD 3.97) in the intervention group compared to 1.9 (SD 4.42) in the waitlist-control group (between-group difference of 1.6; 95% CI 0.3 to 2.9 p = 0.0177). At the end of the full 20-week treatment, the mean reduction (pre-post BCI) of the pooled group was 3.2 (95% CI 2.4 to 4.1).ConclusionThe results suggest that the BCI-based attention training program can improve ADHD symptoms after a minimum of 24 sessions and maintenance training may sustain this improvement. This intervention may be an option for treating milder cases or as an adjunctive treatment.
Highlights
Attention deficit hyperactivity disorder (ADHD) is a developmental disorder of childhood onset which can persist into adulthood[1] with negative academic and socio-occupational outcomes[2, 3]
At the end of the full 20-week treatment, the mean reduction of the pooled group was 3.2
The results suggest that the brain-computer interface (BCI)-based attention training program can improve ADHD symptoms after a minimum of 24 sessions and maintenance training may sustain this improvement
Summary
Attention deficit hyperactivity disorder (ADHD) is a developmental disorder of childhood onset which can persist into adulthood[1] with negative academic and socio-occupational outcomes[2, 3]. Worldwide, including Singapore, ADHD is associated with significant burden[4, 5]. Long term data from studies such as the Multimodal Treatment of ADHD (MTA) study, did not provide a clear answer about which approach would give the best outcome in the long term[8, 9]. Neurofeedback therapy is a promising approach based on normalizing abnormal EEG patterns in children with ADHD, with trials demonstrating non-inferiority to medication and increased efficacy in combination with medication[10,11,12,13,14].
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