Luo X, Guo X, Zhao Q, Zhu Y, Chen Y, Zhang D, Jiang H, Wang Y, Johnstone S, Sun L. A randomized controlled study of remote computerized cognitive, neurofeedback, and combined training in the treatment of children with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2023;32(8):1475-1486. doi:10.1007/s00787-022-01956-1
While medication remains the primary method for improving attention-deficit/hyperactivity disorder (ADHD) symptoms, the development of home-based training tools provides promising support for the future of non-pharmacological care. In this randomized clinical trial three home-based training programs were tested. The first training program was electroencephalogram (EEG) neurofeedback training (NFT) used to adjust brain activity enough to improve attention and daily function. The second training program focused on computerized cognitive training (CCT). In CCT repetitive practice and reinforcement improves specific symptoms for patients. The third training program included training modules from both NFT and CCT programs. Children (84% male, Ages 7-12) were randomly assigned one of these programs NFT (n = 25), CCT (n = 27), or NFT/CCT (n = 28). All training was conducted at home using the Focus Pocus (Neurocognitive Solutions Pty Ltd.) training program. Following baseline assessment training was completed at home for three months (3-5 sessions/week, 14 mini-games/session). Portable Bluetooth devices recorded EEG during each session. In the NFT and NFT/CCT groups the EEG devices provided real-time feedback during high-attention activities. In the CCT program, EEG was recorded but only used to monitor attention levels to accurately provide rewards for high focus. All training programs decreased ADHD symptom severity (measured by AD/HD-RS; p < 0.001). None of the training programs improved symptoms more effectively than the other programs (all p > 0.05). At-home training, regardless of program type, also improved impulsiveness and short-term focus scores (impulsiveness: p = 0.001, short-term focus: p = 0.00). This data provides novel insight into the benefits of home-based NFT and CCT programs.