Effects of functional near-infrared spectroscopy-based neurofeedback training (fNIRS-based NFT) coupled with virtual reality (VR) technology for children with ADHD : a randomized controlled trial

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD) affects a significant proportion of the pediatric population, often hindering the academic and social potential of affected children, and a large number of cases continue to experience symptoms into adulthood. Neuroimaging studies have linked ADHD symptoms and executive functioning deficits to aberrant neurophysiological functioning in the prefrontal cortex. The current study investigated the and efficacy and feasibility of functional near-infrared spectroscopy (fNIRS)-based neurofeedback training (NFT) within a virtual reality (VR) classroom setting to improve symptoms of ADHD, self-regulation and executive functioning in school-aged children with ADHD. Seventy-nine school-aged children with ADHD were randomly assigned to one of three groups with age and baseline measurements matched: an experimental group receiving fNIRS-based NFT in a VR classroom (n = 17), an active control group receiving computerized cognitive training (Cogmed) (n = 32), and a waitlist control group (n = 30). Participants in the experiment and active control groups underwent 16 training sessions over 8 weeks. Outcomes were assessed 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. Results indicated that the experimental group showed significantly greater reductions in parent-reported hyperactivity/impulsivity symptoms and improved behavioral regulation compared to the waitlist control group. The active control group also demonstrated improved behavioral regulation, but the fNIRS-based NFT in VR yielded larger effects. However, no significant improvements were 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. 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 needed to elucidate the underlying neurophysiological mechanisms and explore potential methods for enhancing transfer to real-world functioning.