Use of Virtual Reality Working Memory Task and Functional Near-Infrared Spectroscopy to Assess Brain Hemodynamic Responses to Methylphenidate in ADHD Children.

Sooah Jang,Joon Hee Kwon,Jooyoung Oh,Eunjoo Kim,Jongkwan Choi,Narae Hong,Jungyeon Yeom,Narae Lee,Jae-Jin Kim,Jieun Hong

doi:10.3389/fpsyt.2020.564618

Abstract

Virtual reality (VR) neuropsychological tests have emerged as a method to explore drug effects in real-life contexts in attention deficit hyperactivity disorder (ADHD) children. Functional near-infrared spectroscopy (fNIRS) is a useful tool to measure brain activity during VR tasks in ADHD children with motor restlessness. The present study aimed to explore the acute effects of methylphenidate (MPH) on behavioral performance and brain activity during a VR-based working memory task simulating real-life classroom settings in ADHD children. In total, 23 children with ADHD performed a VR n-back task before and 2 h after MPH administration concurrent with measurements of oxygenated hemoglobin signal changes with fNIRS. Altogether, 12 healthy control (HC) subjects participated in the same task but did not receive MPH treatment. Reaction time (RT) was shortened after MPH treatment in the 1-back condition, but changes in brain activation were not observed. In the 2-back condition, activation of the left dorsolateral prefrontal cortex (DLPFC) and bilateral medial prefrontal cortex (mPFC) was decreased alongside behavioral changes such as shorter RT, lower RT variability, and higher accuracy after MPH administration. Bilateral mPFC activation in the 2-back condition inversely correlated with task accuracy in the pre-MPH condition; this inverse correlation was not observed after MPH administration. In ADHD children, deactivation of the default mode network mediated by mPFC reduced during high working memory load, which was restored through MPH treatment. Our results suggest that the combination of VR classroom tasks and fNIRS examination makes it easy to assess drug effects on brain activity in ADHD children in settings simulating real-life.

Highlights

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children
We used a semi-immersive Virtual reality (VR) display, instead of a more immersive HMD version of virtual reality, since simultaneously wearing HMD and Functional near-infrared spectroscopy (fNIRS) devices is difficult due to space overlap. This is the first study to explore the effects of MPH on brain activity during a VR-based Working memory (WM) task reproducing real-classroom settings in ADHD children
We observed that activation of bilateral medial prefrontal cortex (mPFC) decreased after MPH treatment in a high-load WM task

Summary

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children. ADHD is defined by age-inappropriate symptoms of inattention, impulsivity, and hyperactivity. Patients with ADHD exhibit complex multisystem impairments in fronto-cingulo-striatothalamic and fronto-parieto-cerebellar networks that mediate attention, inhibition, working memory, and timing [1]. In addition to higher-order cognitive functions, abnormalities in sensorimotor processing and the default mode network have been identified in ADHD [1]. ADHD affects approximately 5% of school-aged children and often persists into adolescence and adulthood [2]. Patients with ADHD often experience impaired academic and social function, which increases the risk of other comorbidities including antisocial behavior, oppositional defiant disorder, and substance abuse [3]. Early diagnosis of ADHD and appropriate intervention are critical

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