Abstract
Functional Magnetic Resonance Imaging Neurofeedback (fMRI-NF) targeting brain areas/networks shown to be dysfunctional by previous fMRI research is a promising novel neurotherapy for ADHD. Our pioneering study in 31 adolescents with ADHD showed that fMRI-NF of the right inferior frontal cortex (rIFC) and of the left parahippocampal gyrus (lPHG) was associated with clinical improvements. Previous studies using electro-encephalography-NF have shown, however, that not all ADHD patients learn to self-regulate, and the predictors of fMRI-NF self-regulation learning are not presently known. The aim of the current study was therefore to elucidate the potential predictors of fMRI-NF learning by investigating the relationship between fMRI-NF learning and baseline inhibitory brain function during an fMRI stop task, along with clinical and cognitive measures. fMRI-NF learning capacity was calculated for each participant by correlating the number of completed fMRI-NF runs with brain activation in their respective target regions from each run (rIFC or lPHG); higher correlation values were taken as a marker of better (linear) fMRI-NF learning. Linear correlations were then conducted between baseline measures and the participants’ capacity for fMRI-NF learning. Better fMRI-NF learning was related to increased activation in left inferior fronto-striatal regions during the fMRI stop task. Poorer self-regulation during fMRI-NF training was associated with enhanced activation in posterior temporo-occipital and cerebellar regions. Cognitive and clinical measures were not associated with general fMRI-NF learning across all participants. A categorical analysis showed that 48% of adolescents with ADHD successfully learned fMRI-NF and this was also not associated with any baseline clinical or cognitive measures except that faster processing speed during inhibition and attention tasks predicted learning. Taken together, the findings suggest that imaging data are more predictive of fMRI-NF self-regulation skills in ADHD than behavioural data. Stronger baseline activation in fronto-striatal cognitive control regions predicts better fMRI-NF learning in ADHD.
Highlights
Attention-Deficit/Hyperactivity Disorder (ADHD) is characterised by age-inappropriate, persistent and impairing symptoms of inattention and/or hyperactivity/impulsivity (American Psychiatric Association APA, 2013)
Functional magnetic resonance imaging studies have consistently shown that ADHD patients have reduced activation in key regions of the fronto-striato-parietal networks that mediate these functions, in particular in the right inferior frontal cortex, basal ganglia and medial frontal cortex during cognitive control (Hart et al, 2013; Norman et al, 2016), dorsolateral prefrontal cortex during working memory (McCarthy et al, 2014), dlPFC, parietal and
Our findings extend findings from an EEG-NF study in children with ADHD in which stronger baseline activation of left inferior PFC measured with near-infrared spectroscopy during a matching Stroop task predicted slow cortical potentials (SCP) EEG-NF regulation success, suggesting that NF training success may depend on the maturity of left PFC activation mediating executive processes in ADHD patients (Okumura et al, 2017)
Summary
Attention-Deficit/Hyperactivity Disorder (ADHD) is characterised by age-inappropriate, persistent and impairing symptoms of inattention and/or hyperactivity/impulsivity (American Psychiatric Association APA, 2013). More than 70% of children with ADHD persist with symptoms into adulthood (Sudre et al, 2018). ADHD patients have deficits in cognitive functions, most prominently in executive functions such as response inhibition, working memory, sustained attention and cognitive switching (Rubia et al, 2007a; Willcutt et al, 2005), as well as in timing (Coghill et al, 2018; Noreika et al, 2013) and reward based functions (Coghill et al, 2018). Functional magnetic resonance imaging (fMRI) studies have consistently shown that ADHD patients have reduced activation in key regions of the fronto-striato-parietal networks that mediate these functions, in particular in the right inferior frontal cortex (rIFC), basal ganglia and medial frontal cortex during cognitive control (Hart et al, 2013; Norman et al, 2016), dorsolateral prefrontal cortex (dlPFC) during working memory (McCarthy et al, 2014), dlPFC, parietal and
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