A Brain-Computer Interface Based Attention Training Program for Treating Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) symptoms can be difficult to treat. We previously reported that a 20-session brain-computer interface (BCI) attention training programme improved ADHD symptoms. Here, we investigated a new more intensive BCI-based attention training game system on 20 unmedicated ADHD children (16 males, 4 females) with significant inattentive symptoms (combined and inattentive ADHD subtypes). This new system monitored attention through a head band with dry EEG sensors, which was used to drive a feed forward game. The system was calibrated for each user by measuring the EEG parameters during a Stroop task. Treatment consisted of an 8-week training comprising 24 sessions followed by 3 once-monthly booster training sessions. Following intervention, both parent-rated inattentive and hyperactive-impulsive symptoms on the ADHD Rating Scale showed significant improvement. At week 8, the mean improvement was −4.6 (5.9) and −4.7 (5.6) respectively for inattentive symptoms and hyperactive-impulsive symptoms (both p<0.01). Cohen’s d effect size for inattentive symptoms was large at 0.78 at week 8 and 0.84 at week 24 (post-boosters). Further analysis showed that the change in the EEG based BCI ADHD severity measure correlated with the change ADHD Rating Scale scores. The BCI-based attention training game system is a potential new treatment for ADHD. Trial Registration ClinicalTrials.gov NCT01344044

[1]  A. Kaufman,et al.  Review Article: Introduction to the Kaufman Assessment Battery for Children (K-ABC) for Pediatric Neuroclinicians , 1987, Journal of child neurology.

[2]  Colin M. Macleod.  Half a century of research on the Stroop effect: an integrative review. , 1991, Psychological bulletin.

[3]  G. DuPaul.  Parent and Teacher Ratings of ADHD Symptoms: Psychometric Properties in a Community-Based Sample , 1991 .

[4]  M. Sterman,et al.  Physiological origins and functional correlates of EEG rhythmic activities: Implications for self-regulation , 1996, Biofeedback and self-regulation.

[5]  D. Shaffer,et al.  NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. , 2000, Journal of the American Academy of Child and Adolescent Psychiatry.

[6]  Robert J. Barry,et al.  Excess beta activity in children with attention-deficit/hyperactivity disorder: an atypical electrophysiological group , 2001, Psychiatry Research.

[7]  Vincent J Monastra,et al.  The Effects of Stimulant Therapy, EEG Biofeedback, and Parenting Style on the Primary Symptoms of Attention-Deficit/Hyperactivity Disorder , 2002, Applied psychophysiology and biofeedback.

[8]  H. Persson,et al.  Altered cortical activity in children with attention-deficit/hyperactivity disorder during attentional load task. , 2002, Journal of the American Academy of Child and Adolescent Psychiatry.

[9]  Joel F Lubar,et al.  EEG differences in ADHD-combined type during baseline and cognitive tasks. , 2003, Pediatric neurology.

[10]  R. Barry,et al.  A review of electrophysiology in attention-deficit/hyperactivity disorder: I. Qualitative and quantitative electroencephalography , 2003, Clinical Neurophysiology.

[11]  Steven M Butnik,et al.  Neurofeedback in adolescents and adults with attention deficit hyperactivity disorder. , 2005, Journal of clinical psychology.

[12]  Sandra K Loo,et al.  Clinical Utility of EEG in Attention-Deficit/Hyperactivity Disorder: A Research Update , 2005, Neurotherapeutics.

[13]  J. Hall,et al.  A Meta-analysis of Quantitative EEG Power Associated With Attention-Deficit Hyperactivity Disorder , 2006, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[14]  Johanne Lévesque,et al.  Functional Magnetic Resonance Imaging Investigation of the Effects of Neurofeedback Training on the Neural Bases of Selective Attention and Response Inhibition in Children with Attention-Deficit/Hyperactivity Disorder , 2006, Applied psychophysiology and biofeedback.

[15]  S. Pliszka,et al.  Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[16]  Yehoshua Tsal,et al.  Computerized Progressive Attentional Training (CPAT) Program: Effective Direct Intervention for Children with ADHD , 2007, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[17]  Martijn Arns,et al.  EEG phenotypes predict treatment outcome to stimulants in children with ADHD. , 2008, Journal of integrative neuroscience.

[18]  M. Arns,et al.  Efficacy of Neurofeedback Treatment in ADHD: The Effects on Inattention, Impulsivity and Hyperactivity: A Meta-Analysis , 2009, Clinical EEG and neuroscience.

[19]  Keng Peng Tee,et al.  Learning EEG-based spectral-spatial patterns for attention level measurement , 2009, 2009 IEEE International Symposium on Circuits and Systems.

[20]  J. Leon Kenemans,et al.  The effectiveness of EEG-feedback on attention, impulsivity and EEG: A sham feedback controlled study , 2010, Neuroscience Letters.

[21]  H. Heinrich,et al.  Neurofeedback training in children with ADHD: 6-month follow-up of a randomised controlled trial , 2010, European Child & Adolescent Psychiatry.

[22]  S. Faraone,et al.  How persistent is ADHD? A controlled 10-year follow-up study of boys with ADHD , 2010, Psychiatry Research.

[23]  C. G. Lim,et al.  Effectiveness of a brain-computer interface based programme for the treatment of ADHD: a pilot study. , 2010, Psychopharmacology bulletin.

[24]  Jinung An,et al.  Decision Support Algorithm for Diagnosis of ADHD Using Electroencephalograms , 2012, Journal of Medical Systems.

[25]  Radley Christopher Sheldrick,et al.  Computer-Based Attention Training in the Schools for Children With Attention Deficit/Hyperactivity Disorder: A Preliminary Trial , 2011, Clinical pediatrics.

[26]  P. Asherson,et al.  Electrophysiological markers of genetic risk for attention deficit hyperactivity disorder , 2011, Expert Reviews in Molecular Medicine.

[27]  M. Monuteaux,et al.  Predictors of ADHD Persistence in Girls at 5-Year Follow-Up , 2011, Journal of attention disorders.

[28]  Mohammad Javad Rezai,et al.  Neurofeedback in ADHD: a single-blind randomized controlled trial , 2011, European Child & Adolescent Psychiatry.

[29]  Fabrice Wallois,et al.  Dynamic changes in quantitative electroencephalogram during continuous performance test in children with attention-deficit/hyperactivity disorder. , 2011, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[30]  Robert J. Barry,et al.  Childhood EEG as a predictor of adult attention-deficit/hyperactivity disorder , 2011, Clinical Neurophysiology.

[31]  L Eugene Arnold,et al.  A Review of Neurofeedback Treatment for Pediatric ADHD , 2012, Journal of attention disorders.

[32]  H. Heinrich,et al.  Neurofeedback in children with ADHD: validation and challenges , 2012, Expert review of neurotherapeutics.