Effects of functional near-infrared spectroscopy (FNIRS)-based neurofeedback training with virtual reality for children with ADHD

Abstract

<p>Attention-Deficit/Hyperactivity Disorder (ADHD) affects a significant proportion of school-aged children. Neuroimaging studies have linked ADHD symptoms and executive functioning deficits to aberrant neurophysiological functioning in the prefrontal cortex. The current study investigated the efficacy and feasibility of functional near-infrared spectroscopy (fNIRS)-based neurofeedback training (NFT) within a virtual reality (VR) classroom setting to alleviate ADHD symptoms and improve self-regulation and executive functioning in children. Seventy-nine school-aged children with ADHD were randomly assigned to one of three groups: an experimental group receiving fNIRS-based NFT in a VR classroom (<em>n</em> = 17), an active control group receiving computerized cognitive training (Cogmed) (<em>n</em> = 32), and a waitlist control group (<em>n</em> = 30). Participants in the experiment and active control groups underwent 16 training sessions over 8 weeks. Outcomes were assessed for all participants at pre-intervention, post-intervention, and 2-month follow-up, including neuropsychological tests of sustained attention, response inhibition, working memory, and attention control/switching, as well as parent- and teacher-reported ADHD symptoms and self-regulation in the domains of behavior, emotion, and cognition.</p><p>Results indicated that the experimental group showed significantly greater reduction post-intervention in parent-reported hyperactivity/impulsivity symptoms (<em>β</em> = -3.52, <em>t</em>(112) = -2.77, <em>p</em> =.006) and improved behavioral regulation (<em>β</em> = -2.12, <em>t</em>(112) = -2.20, <em>p</em> =.03) compared to the waitlist control group. The active control group also demonstrated improved behavioral regulation reported by parents (<em>β</em> = -3.06, <em>t</em>(112) = -3.66, <em>p</em> <.001), compared to the waitlist control group, but the fNIRS-based NFT in VR yielded larger effects (<em>d_fNIRS-VR-NFT</em> = -.60, <em>d_cogmed</em> = -.25). However, no significant improvement was observed in executive functioning test performance or teacher-reported outcomes. Besides, participants in the experimental group reported high enjoyment of the VR training, despite some experience of cybersickness.</p><p>This study provides preliminary evidence for the efficacy and feasibility of fNIRS-based NFT within a VR classroom setting for self-regulation training in school-aged children with ADHD. Further research is warranted to elucidate the underlying neurophysiological mechanisms and explore potential methods for enhancing transferred effects to real-world functioning.</p><p><br></p>