Near-infrared spectroscopy (NIRS) neurofeedback as a treatment for children with attention deficit hyperactivity disorder (ADHD)-a pilot study

Anna-Maria Marx, Ann-Christine Ehlis, Adrian Furdea, Martin Holtmann, Tobias Banaschewski, Daniel Brandeis, Aribert Rothenberger, Holger Gevensleben, Christine M Freitag, Yvonne Fuchsenberger, Andreas J Fallgatter, Ute Strehl, Anna-Maria Marx, Ann-Christine Ehlis, Adrian Furdea, Martin Holtmann, Tobias Banaschewski, Daniel Brandeis, Aribert Rothenberger, Holger Gevensleben, Christine M Freitag, Yvonne Fuchsenberger, Andreas J Fallgatter, Ute Strehl

Abstract

In this pilot study near-infrared spectroscopy (NIRS) neurofeedback was investigated as a new method for the treatment of Attention Deficit-/Hyperactivity Disorder (ADHD). Oxygenated hemoglobin in the prefrontal cortex of children with ADHD was measured and fed back. 12 sessions of NIRS-neurofeedback were compared to the intermediate outcome after 12 sessions of EEG-neurofeedback (slow cortical potentials, SCP) and 12 sessions of EMG-feedback (muscular activity of left and right musculus supraspinatus). The task was either to increase or decrease hemodynamic activity in the prefrontal cortex (NIRS), to produce positive or negative shifts of SCP (EEG) or to increase or decrease muscular activity (EMG). In each group nine children with ADHD, aged 7-10 years, took part. Changes in parents' ratings of ADHD symptoms were assessed before and after the 12 sessions and compared within and between groups. For the NIRS-group additional teachers' ratings of ADHD symptoms, parents' and teachers' ratings of associated behavioral symptoms, childrens' self reports on quality of life and a computer based attention task were conducted before, 4 weeks and 6 months after training. As primary outcome, ADHD symptoms decreased significantly 4 weeks and 6 months after the NIRS training, according to parents' ratings. In teachers' ratings of ADHD symptoms there was a significant reduction 4 weeks after the training. The performance in the computer based attention test improved significantly. Within-group comparisons after 12 sessions of NIRS-, EEG- and EMG-training revealed a significant reduction in ADHD symptoms in the NIRS-group and a trend for EEG- and EMG-groups. No significant differences for symptom reduction were found between the groups. Despite the limitations of small groups and the comparison of a completed with two uncompleted interventions, the results of this pilot study are promising. NIRS-neurofeedback could be a time-effective treatment for ADHD and an interesting new option to consider in the treatment of ADHD.

Keywords: attention deficit hyperactivity disorder (ADHD); children; fNIRS; near-infrared spectroscopy (NIRS); neurofeedback; prefrontal cortex (PFC).

Figures

Figure 1
Figure 1
Trial design of NIRS-, EEG- and EMG- blocks. One NIRS session consisted of 2 feedback blocks each with 12 trials and 1 transfer block with 8 trials. An EEG and EMG session consisted of 3 feedback blocks and 1 transfer block each with 40 trials.
Figure 2
Figure 2
Alignment of the 44 NIRS channels on the cortex surface (Marx, 2014). The eight channels from which the feedback signal was computed are marked with blue (figure buildt with MATLAB based on MNI coordinates, available: http://www.jichi.ac.jp/brainlab/virtual_registration/Result3x5_E.html, Tzourio-Mazoyer et al., ; Tsuzuki et al., 2007).
Figure 3
Figure 3
FBB-ADHS total score of parents’ and teachers’ ratings for all meeasurement points. Middle line of boxes = median, box = interquartile range, error bars = minimum respectively maximum, * = significant.
Figure 4
Figure 4
SDQ total score of parents’ and teachers’ ratings for all measurement points. Middle line of boxes = median, box = interquartile range, error bars = minimum respectively maximum, * = significant.
Figure 5
Figure 5
Medians of reaction times for the TAP subtests Go/NoGo and Flexibility for all measurement points. Middle line of boxes = median, box = interquartile range, error bars = minimum respectively maximum, * = significant.
Figure 6
Figure 6
Standard deviations of reaction times for the TAP subtests Go/NoGo and Flexibility for all measurement points. Middle line of boxes = median, box = interquartile range, error bars = minimum respectively maximum, * = significant.
Figure 7
Figure 7
Commissions in the TAP subtests Go/NoGo and Flexibility for all measurement points. Middle line of boxes = median, box = interquartile range, error bars = minimum respectively maximum, * = significant.
Figure 8
Figure 8
FBB-ADHS total score of parents’ ratings for NIRS-, EEG- and EMG-group at pretest and post test 1. Middle line of boxes = median, box = interquartile range, error bars = minimum respectively maximum, * = significant.

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