Real‐time fMRI neurofeedback in adolescents with attention deficit hyperactivity disorder

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) is associated with poor self‐control, underpinned by inferior fronto‐striatal deficits. Real‐time functional magnetic resonance neurofeedback (rtfMRI‐NF) allows participants to gain self‐control over dysregulated brain regions. Despite evidence for beneficial effects of electrophysiological‐NF on ADHD symptoms, no study has applied the spatially superior rtfMRI‐NF neurotherapy to ADHD. A randomized controlled trial tested the efficacy of rtfMRI‐NF of right inferior prefrontal cortex (rIFG), a key region that is compromised in ADHD and upregulated with psychostimulants, on improvement of ADHD symptoms, cognition, and inhibitory fMRI activation. To control for region‐specificity, an active control group received rtfMRI‐NF of the left parahippocampal gyrus (lPHG). Thirty‐one ADHD boys were randomly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI‐NF runs over 2 weeks. Feedback was provided through a video‐clip of a rocket that had to be moved up into space. A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life. Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11‐month follow‐up. Only the group targeting rIFG, however, showed a transfer effect, which correlated with ADHD symptom reductions, improved at trend level in sustained attention, and showed increased IFG activation during an inhibitory fMRI task. This proof‐of‐concept study demonstrates for the first time feasibility, safety, and shorter‐ and longer‐term efficacy of rtfMRI‐NF of rIFG in adolescents with ADHD. Hum Brain Mapp 38:3190–3209, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

Electrical fingerprint of the amygdala guides neurofeedback training for stress resilience

“…To enable a distinction between the global effects of the NF procedure and the specific effects of Amyg-EFP regulation, we designed a control condition that would account for the key common processes that underlie NF 23 (see supplementary information for more details) without targeting the neural circuit of interest (amygdala regulation and amygdala-mPFC connectivity). Therefore, similarly to the "different region" approach in fMRI-NF studies 9,12,24 , our control-NF condition was guided by the Alpha/Theta ratio (reduced Alpha and increased Theta ), a commonly used EEG-NF probe 25 . Moreover, since Theta and Alpha both contribute to the Amyg-EFP model (see Supplementary Figure 1) it was imperative to further demonstrate the specificity of the Amyg-EFP on limbic processing by not only using a correlative approach, as done previously 11 , but also causally showing amygdala related behavioral changes following Amyg-EFP-NF as compared to A/T-EEG-NF alone.…”

Control freaks: Towards optimal selection of control conditions for fMRI neurofeedback studies

“…Also, if participants are unable to regulate the control ROI as well as the experimental group, even if they are equally motivated, they will receive less rewarding feedback and consequently their placebo effects may be smaller. Neurofeedback research using this control methodology has produced mixed results: In an fMRI-neurofeedback training study with children with attention deficit hyperactivity disorder (ADHD), gaining control over any signal (the target or control ROI) resulted in clinical improvement, suggesting it may be the feeling of self-efficacy or learned control over hemodynamic activity in general that leads to clinical improvements in individuals with this disorder (37). In adults with major depressive disorder, however, learning to regulate a parietal region did not result in symptom improvement, while learning to regulate the amygdala did (33).…”

Effectiveness of neurofeedback versus medication for attention‐deficit/hyperactivity disorder

“…Therefore, alternative treatment is greatly needed, and neurofeedback (NF) is a promising treatment. There are many kinds of NF, for example functional magnetic resonance imaging (fMRI)‐NF, near‐infrared spectroscopy (NIRS)‐NF, and electroencephalogram (EEG)‐NF . To date, EEG‐NF has the most supportive evidence for treatment of ADHD in children .…”

“…There are many kinds of NF, for example functional magnetic resonance imaging (fMRI)-NF, near-infrared spectroscopy (NIRS)-NF, and electroencephalogram (EEG)-NF. [8][9][10] To date, EEG-NF has the most supportive evidence for treatment of ADHD in children. 10 EEG-NF works via the classical operant conditioning mechanisms of learning, and trains participants to regulate their brain activity by providing them with real-time feedback on EEG.…”