Objective: To examine cognitive effects of neurofeedback (NF) for attention-deficit hyperactivity disorder (ADHD) as a secondary outcome of a randomized clinical trial. Method: In a double-blind randomized clinical trial (NCT02251743), 133 7-10-year olds with ADHD received either 38 sessions of NF (n = 78) or control treatment (n = 55) and performed an integrated visual and auditory continuous performance test at baseline, mid-and end-treatment. We used the diffusion decision model to decompose integrated visual and auditory continuous performance test performance at each assessment into cognitive components: efficiency of integrating stimulus information (v), context sensitivity (c v ), response cautiousness (a), response bias (z /a), and nondecision time for perceptual encoding and response execution (T er ). Based on prior findings, we tested whether the components known to be deficient improved with NF and explored whether other cognitive components improved using linear mixed modeling. Results: Before NF, children with ADHD showed main deficits in integrating stimulus information (v), which led to less accurate and slower responses than healthy controls ( p = .008). The NF group showed significantly more improvement in integrating auditory stimulus information (v) than control treatment (significant group-by-time-by-modality effect: p = .044). Conclusions: NF seems to improve v, deficient in ADHD.
Key PointsQuestion: How does cognitive processing change in response to neurofeedback? Findings: Neurofeedback improves latent cognitive processes that are involved in integrating stimulus information and that are quantified with sequential sampling models. Importance: It is therefore critical to understand the underlying cognitive effects of neurofeedback, which can help to personalize treatment planning. Next Steps: More studies are needed that use process-oriented computational models, together with mechanistic neurocognitive tests, to disentangle the different therapeutic ingredients of neurofeedback.