Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Sep 30;27(11):111087.
doi: 10.1016/j.isci.2024.111087. eCollection 2024 Nov 15.

Neuromonitoring-guided working memory intervention in children with ADHD

Ali Rahimpour Jounghani  1 , Elveda Gozdas  1 , Lauren Dacorro  1 , Bárbara Avelar-Pereira  1   2 , Samantha Reitmaier  1 , Hannah Fingerhut  1 , David S Hong  1 , Glen Elliott  1 , Antonio Y Hardan  1 , Stephen P Hinshaw  3   4 , S M Hadi Hosseini  1
Affiliations

Neuromonitoring-guided working memory intervention in children with ADHD

Ali Rahimpour Jounghani et al. iScience. .

Abstract

We proposed a personalized intervention that integrates computerized working memory (WM) training with real-time functional neuromonitoring and neurofeedback (NFB) to enhance frontoparietal activity and improve cognitive and clinical outcomes in children with attention-deficit/hyperactivity disorder (ADHD). The study involved 77 children with ADHD aged 7-11 years, who were assigned to either 12 sessions of NFB or treatment-as-usual (i.e., received standard clinical care) groups. Real-time neuromonitoring with functional near-infrared spectroscopy (fNIRS) and fMRI measured frontoparietal activity during n-back task at baseline and post-intervention. Thirty-six participants (21 NFB, 15 treatment-as-usual) completed the study. Significant improvements in NFB group were observed in frontoparietal brain activity and WM performance (primary outcomes). NFB group also showed improvements in Behavior Rating Inventory of Executive Function (BRIEF-2) WM t-scores and Conners 3 ADHD index scores (secondary outcomes) compared to treatment-as-usual group. These findings suggest that neuromonitoring-guided NFB effectively enhances cognitive and clinical outcomes in children with ADHD by targeting brain mechanisms underlying WM deficits.

Keywords: Clinical neuroscience; Cognitive neuroscience; Neuroscience.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

None
Graphical abstract
Figure 1
Figure 1
HbO Beta value changes of targeted brain regions (I) Left-vlPFC (p = 0.02); (II) left-dlPFC (p = 0.0001); (III) right-dlPFC (p = 0.0001); (IV) right-dmPFC (p = 0.003) between averages of the first two sessions and the last two sessions. One participant (out of a total of 21) was excluded due to low data quality of intervention in targeted brain regions.
Figure 2
Figure 2
Significant association between average behavioral accuracy across 12 intervention sessions and WM 2-back accuracy in post-session (left) and also the average of WM 1-back and 2-back accuracy (right)
Figure 3
Figure 3
Significant association between HbO Beta value of left-vlPFC during NFB intervention and WM 2-back accuracy (left) and also the average of WM 1-back and 2-back accuracy between post-intervention and pre-intervention (right)
Figure 4
Figure 4
Channel map of brain regions that showed significant group by session interaction effect in cortical HbO activation The graphs show corresponding changes in group-average HbO Beta values for each group and session. d indicates Cohen’s d effect size.
Figure 5
Figure 5
Group by session interaction effect in (A) fMRI task activation and (B) fMRI signal changes in the left dlPFC (dorsal and lateral) and anterior PFC for each group and session during the working memory task (measured by 2-back + 1-back versus 0-back) The violin plots represent the distribution of the fMRI signal and changes across the groups and sessions.
Figure 6
Figure 6
Changes in n-back WM performance accuracy during fNIRS and in BRIEF-2 WM T-scores and Conners 3 ADHD index scores baseline and post-intervention for each group
See this image and copyright information in PMC

References

    1. Polanczyk G.V., Willcutt E.G., Salum G.A., Kieling C., Rohde L.A. ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int. J. Epidemiol. 2014;43:434–442. - PMC - PubMed
    1. Kowalczyk O.S., Cubillo A.I., Criaud M., Giampietro V., O'Daly O.G., Mehta M.A., Rubia K. Single-dose effects of methylphenidate and atomoxetine on functional connectivity during an n-back task in boys with ADHD. Psychopharmacology. 2023;240:2045–2060. - PMC - PubMed
    1. Roording-Ragetlie S., Spaltman M., de Groot E., Klip H., Buitelaar J., Slaats-Willemse D. Working memory training in children with borderline intellectual functioning and neuropsychiatric disorders: a triple-blind randomised controlled trial. J. Intellect. Disabil. Res. 2022;66:178–194. - PMC - PubMed
    1. Martinussen R., Hayden J., Hogg-Johnson S., Tannock R. A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. J. Am. Acad. Child Adolesc. Psychiatry. 2005;44:377–384. - PubMed
    1. Biederman J., Monuteaux M.C., Doyle A.E., Seidman L.J., Wilens T.E., Ferrero F., Morgan C.L., Faraone S.V. Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children. J. Consult. Clin. Psychol. 2004;72:757–766. - PubMed