Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is characterized by poor cognitive control/attention and hypofunctioning of the dorsal anterior cingulate cortex (dACC). In the current study, we investigated for the first time whether real-time fMRI neurofeedback (rt-fMRI) training targeted at increasing activation levels within dACC in adults with ADHD leads to a reduction of clinical symptoms and improved cognitive functioning. An exploratory randomized controlled treatment study with blinding of the participants was conducted. Participants with ADHD (n = 7 in the neurofeedback group, and n = 6 in the control group) attended four weekly MRI training sessions (60-min training time/session), during which they performed a mental calculation task at varying levels of difficulty, in order to learn how to up-regulate dACC activation. Only neurofeedback participants received continuous feedback information on actual brain activation levels within dACC. Before and after the training, ADHD symptoms and relevant cognitive functioning was assessed. Results showed that both groups achieved a significant increase in dACC activation levels over sessions. While there was no significant difference between the neurofeedback and control group in clinical outcome, neurofeedback participants showed stronger improvement on cognitive functioning. The current study demonstrates the general feasibility of the suggested rt-fMRI neurofeedback training approach as a potential novel treatment option for ADHD patients. Due to the study’s small sample size, potential clinical benefits need to be further investigated in future studies.Trial Registration: ISRCTN12390961
Highlights
Attention Deficit Hyperactivity Disorder (ADHD) is a childhood-onset neuropsychiatric disorder characterized by a pervasive pattern of inattention, and/or hyperactivity and impulsivity [1,2]
During the first MRI session, all participants, including the control group, were informed that the goal of the study was to investigate if upregulation of dorsal anterior cingulate cortex (dACC) activation levels through performing a mental task would have a positive impact on ADHD symptoms and cognitive functioning
The coordinates of the dACC target regions were similar across groups and sessions (S1 Table), and the coordinates were similar as shown by previous studies with ADHD patients [26]
Summary
Attention Deficit Hyperactivity Disorder (ADHD) is a childhood-onset neuropsychiatric disorder characterized by a pervasive pattern of inattention, and/or hyperactivity and impulsivity [1,2]. The disorder persists into adulthood in one third of the cases or more, with prevalence in adults being 2–4% [3,4,5]. The first-line treatment is prescription of medication, mostly psychostimulants. Response rates in adults are only 20–50% [6], evidence for long-term efficacy of medication is inconsistent [7] and there are concerns about potential side-effects of long-term use of medication [8]. Novel non-pharmacological treatments are currently being developed, among which electroencephalography (EEG) neurofeedback. Neurofeedback training aims at the remediation of aberrant neuronal functioning, by allowing participants to gain self-control over certain brain-signal aspects, such as theta/beta frequency ratio in EEG neurofeedback training
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