Comparing the Transfer Effects of Three Neurocognitive Training Protocols in Children With Attention-Deficit/Hyperactivity Disorder: A Single-Case Experimental Design

Abstract

The current study used behavioural and electroencephalograph measures to compare the transferability of three home-based interventions — cognitive training (CT), neurofeedback training (NFT), and CT combined with NFT — for reducing symptoms in children with attention-deficit/hyperactivity disorder (AD/HD). Following a multiple-baseline single-case experimental design, twelve children were randomised to a training condition. Each child completed a baseline phase, followed by an intervention phase. The intervention phase consisted of 20 sessions of at-home training. Tau-U analysis and standardised visual analysis were adopted to detect effects. Results showed that CT improved inhibitory function and NFT improved alpha EEG activity and working memory. The combined condition, which was a reduced ‘dose’ of CT and NFT, did not show any improvements. The three conditions did not alleviate AD/HD symptoms. While CT and NFT may have transfer effects on executive functions, considering the lack of improvement in symptoms, this study does not support CT and NFT on their own as a treatment for children with AD/HD.

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

“…The primary outcome of AD/HD-RS evaluated by parents showed a significant improvement after 3 months of training, as well as executive and daily functions, verifying the training effect of the Focus Pocus program [ 28 – 30 , 33 ]. Compared to traditional laboratory-based tasks, inhibition and working memory assessed by the BRIEF questionnaire are believed to have more ecological validity [ 41 ], and improved functional ability, indicating that NFT and CCT could train core defects in children with AD/HD, which is consistent with previous findings [ 42 , 43 ].…”

“…Using a validated portable Bluetooth EEG acquisition device [31,32], effective NFT and CCT training can be carried out at home for children with AD/ HD with some assistance from their parents. Studies have confirmed the beneficial effects of this type of training on AD/HD symptoms and academic performance [29,30,33]. These studies have examined the effect of combined NFT/ CCT training; to date, no study has examined the efficacy of NFT and CCT as independent components compared with combined NFT/CCT training.…”

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.…”

“…As a rough approximation, studies with CT typically involve 1096 minutes of training spread over multiple training sessions (Veloso et al, 2020). Insufficient training may impair training effects (Zhang et al, 2021), and prolonged training may not result in a greater improvement (Wiemers et al, 2018). Further studies are needed to provide a nuanced relationship between duration and training effects.…”

“…The specificity of NFT, however, has been questioned -neuroplastic changes are not limited to the targeted brain regions and frequency bands. For example, a frontal alpha NFT also generates effects on posterior alpha in children with AD/HD (Zhang et al, 2021). As a result of the specialty issue, it becomes difficult to infer the brain mechanism underpinning NFT's therapeutic effect (Zuberer et al, 2015;Kvamme et al, 2022).…”