Closed-loop digital meditation for neurocognitive and behavioral development in adolescents with childhood neglect

Abstract

Adverse childhood experiences are linked to poor attentive behaviors during adolescence, as well as increased risk for mental health disorders in adults. However, no study has yet tested targeted interventions to optimize neurocognitive processes in this population. Here, we investigated closed-loop digital interventions in a double-blind randomized controlled study in adolescents with childhood neglect, and evaluated the outcomes using multimodal assessments of neuroimaging, cognitive, behavioral, and academic evaluations. In the primary neuroimaging results, we demonstrate that a closed-loop digital meditation intervention can strengthen functional connectivity of the dorsal anterior cingulate cortex (dACC) in the cingulo-opercular network, which is critically developing during the adolescent period. Second, this intervention enhanced sustained attention and interference-resolution abilities, and also reduced behavioral hyperactivity at a 1-year follow-up. Superior academic performance was additionally observed in adolescents who underwent the digital meditation intervention. Finally, changes in dACC functional connectivity significantly correlated with improvements in sustained attention, hyperactivity, and academic performance. This first study demonstrates that closed-loop digital meditation practice can facilitate development of important aspects of neurocognition and real-life behaviors in adolescents with early childhood neglect.

Fig. 1. Study design overview.

In total, 45 adolescents with a history of childhood trauma completed the study. The study included multidimensional assessments of functional brain networks using neuroimaging, cognitive evaluations, inattention, and hyperactivity behavior ratings provided by caregivers, and teacher-based academic ratings. Assessments were phased at three time points, baseline time 1, post-intervention time 2 (i.e., 8 weeks from baseline), and 1-year follow-up time 3. Adolescents were cluster-randomized into three intervention arms, with double-blind intervention delivery.

Fig. 2. Study outcomes.

a At baseline, childhood neglect severity was negatively associated with mean dACC connectivity to the anterior insula/frontal operculum (aI/FO) regions in the developing cingulo-opercular network across all participants. b dACC connectivity to aI/FO significantly enhanced at time 2, only for the IAI group. c Seed–voxel group × time analyses (dACC seed in blue, aI/FO voxels in red) confirmed the result for the ROI–ROI analyses, showing enhanced connectivity in IAI vs. EAI/NI. d Cognitive changes at time 2 vs. time 1 showed improvements for IAI vs. EAI/NI for both sustained attention (i.e., reduced response time variance at post intervention, plotted as the time 1 minus 2 difference) and interference resolution (i.e., reduced interference response cost at post intervention, also plotted as the time 1 minus 2 difference). e Hyperactivity ratings continued to improve for IAI vs. EAI/NI at the 1-year follow-up, time 3 (plotted as the Z-score difference for baseline time 1 minus time 2 (top) or time 1 minus time 3 ratings (bottom)). f Teacher ratings of academic performance were significantly higher for IAI vs. EAI/NI at time 2.

Fig. 3. Neurobehavioral correlates.

Correlations between change (at time 2 vs. 1) in dACC connectivity to bilateral anterior insula/frontal operculum regions and outcomes across all participants, specifically a change in sustained attention performance, b change in hyperactivity, and c academic performance. Outcomes are depicted in Z scores with positive values indicating better outcomes.