A randomized controlled study of remote computerized cognitive, neurofeedback, and combined training in the treatment of children with attention-deficit/hyperactivity disorder

Abstract

There is an increasing interest in non-pharmacological treatments for children with attention-deficit/hyperactivity disorder (AD/HD), especially digital techniques that can be remotely delivered, such as neurofeedback (NFT) and computerized cognitive training (CCT). In this study, a randomized controlled design was used to compare training outcomes between remotely delivered NFT, CCT, and combined NFT/CCT training approaches. A total of 121 children with AD/HD were randomly assigned to the NFT, CCT, or NFT/CCT training groups, with 80 children completing the training program. Pre- and post-training symptoms (primary outcome), executive and daily functions were measured using questionnaires as well as resting EEG during eyes-closed (EC) and eyes-open (EO) conditions. After 3 months of training, the inattentive and hyperactive/impulsive symptoms, inhibition, working memory, learning and life skills of the three groups of children were significantly improved. The objective EEG activity showed a consistent increase in the relative alpha power in the EO condition among the three training groups. Training differences were not observed between groups. There was a positive correlation between pre-training EO relative alpha power and symptom improvement scores of inattention and hyperactivity/impulsivity, as well as a negative correlation between pre-training inattention scores and change in EO relative alpha. This study verified the training effects of NFT, CCT, and combined NFT/CCT training in children with AD/HD and revealed an objective therapeutic role for individual relative alpha activity. The verified feasibility and effectiveness of home-based digital training support promotion and application of digital remote training. Supplementary Information The online version contains supplementary material available at 10.1007/s00787-022-01956-1.

The Effect of Cognitive Training with Neurofeedback on Cognitive Function in Healthy Adults: A Systematic Review and Meta-Analysis

“…It is necessary to examine whether similar results can be obtained for patients or subclinical groups. For example, CTNF studies with children with attention deficit/hyper activity disorder have shown a reduction in their symptoms and problems related to executive function and working memory [ 56 , 57 ], an area in which CTNF is expected to be applied. Fourth, the results of the quality assessment using the PEDro scale indicated that the studies included in our meta-analysis were of low quality as RCTs, in particular, in terms of blinding the study.…”

Remote neurocognitive interventions for attention-deficit/hyperactivity disorder – opportunities and challenges

“…Interestingly, Minder et al (2018) found that the effect of NFT conducted in schools did not differ from that of NFT conducted in outpatient clinics (Minder et al, 2018), which alleviates the concern about the quality of NFT in remote settings. While NFT has shown promise in home settings as well (Johnstone et al, 2017;Luo et al, 2022;Zhang et al, 2021), a recent large-scale noninferiority study found that at-home NFT may be less effective than front-line methylphenidate treatment in improving AD/HD symptom scores rated by clinicians (Purper-Ouakil et al, 2022). It should be noted that this study only examined the immediate effect after NFT but not the long-term effect.…”

Perspectives on heterogeneity-informed cognitive training for attention-deficit/hyperactivity disorder

“…Secondly, CT protocols can leverage motivation to boost training of sustained attention and EF. The effectiveness of CT requires multiple sessions of intensive training, which can be challenging for AD/HD as evidenced by the high dropout rate in previous studies [e.g., ( 25 , 26 )]. Boosting motivation is an immediate solution to this problem.…”