Evaluation of Neurofeedback Learning in Patients with ADHD: A Systematic Review.

NFB has a clear potential as a recognised treatment option for ADHD, but suffers from a lack of clarity about its efficacy, still unresolved after multiple controlled trials. Comparing learners and non-learners based on the evolution of patient-level indicators during the trial serves as a 'natural' control, and can help elucidate the mechanisms of NFB. We present a systematic review motivated by the need to establish the state of the art of patient learning during NFB treatment in current clinical literature. One particularly striking question we would like to answer here is whether existing NFB papers study learning variability, since only individual performance differences can give us information about mechanisms of learning. The results show that very few clinical trial reports have dealt with the heterogeneity of NFB learning, nor analysed whether NFB efficacy is dependent on NFB learning, even though NFB is believed to be a treatment based on learning to perform. In this systematic review we examine not only what has been reported, but also provide a critical analysis of possible flaws or gaps in existing studies, and discuss why no generalized conclusions about NFB efficacy have yet been made. Future research should focus on finding reliable ways of identifying the performers and studying participants' individual learning trajectories as it might enhance prognosis and the allocation of clinical resources.

Children's inhibition skills are associated with their P3a latency-results from an exploratory study.

BACKGROUND: The P3a response is thought to reflect involuntary orienting to an unexpected stimulus and has been connected with set-shifting and inhibition in some studies. In our exploratory study, we investigated if the amplitude and the latency of the P3a response were associated with the performance in a modified flanker task measuring inhibition and set-shifting in 10-year-old children (N = 42). Children participated in electroencephalography (EEG) measurement with an auditory multifeature paradigm including standard, deviating, and novel sounds. In addition, they performed a separate flanker task requiring inhibition and set-shifting skills. RESULTS: The P3a latencies for deviant sounds were associated with the reaction time reflecting inhibition: the shorter the response latencies were, the faster the reaction time was. The P3a latencies for novel sounds were not linked to the reaction times reflecting either inhibition or set-shifting. In addition, the magnitude of the P3a response was not associated with the performance in the flanker task. CONCLUSIONS: Our results suggest that P3a response latency and reaction speed reflecting inhibitory skills are based on shared neural mechanism. Thus, the present study brings new insight to the field investigating the associations between behavior and its neural indices.

Psychometric analysis of the flow short scale translated to Finnish.

Flow is a well-known construct describing the experience of deep absorption in a task, typically demanding but intrinsically motivating, and conducted with high skill. Flow is operationalized by self-report, and various instruments have been developed for this, but none have been made available in the Finnish language in thoroughly validated form. We present a psychometric scale-validation study for the Finnish translation of the Flow Short Scale (FSS). We collected data from 201 Finnish speaking participants using the Prolific Academic platform. We assessed the scale's factorial structure using Mokken scale analysis, Parallel Analysis, Very Simple Structures analysis and a standard Confirmatory Factor Analysis. We then evaluated how correlated was the FSS with the Flow State Scale and Flow Core Scale. Finally, we evaluated how well the FSS distinguished Flow-inducing experiences from boring (non-Flow-inducing) experiences. Taken together, our results show that an 8-item, two-factor version of the scale was a justified instrument with good psychometric properties.

Inter-brain synchronization occurs without physical co-presence during cooperative online gaming.

Inter-brain synchronization during social interaction has been linked with several positive phenomena, including closeness, cooperation, prosociality, and team performance. However, the temporal dynamics of inter-brain synchronization during collaboration are not yet fully understood. Furthermore, with collaboration increasingly happening online, the dependence of inter-brain phase synchronization of oscillatory activity on physical presence is an important but understudied question. In this study, physically isolated participants performed a collaborative coordination task in the form of a cooperative multiplayer game. We measured EEG from 42 subjects working together as pairs in the task. During the measurement, the only interaction between the participants happened through on-screen movement of a racing car, controlled by button presses of both participants working with distinct roles, either controlling the speed or the direction of the car. Pairs working together in the task were found to have elevated neural coupling in the alpha, beta, and gamma frequency bands, compared to performance matched false pairs. Higher gamma synchrony was associated with better momentary performance within dyads and higher alpha synchrony was associated with better mean performance across dyads. These results are in line with previous findings of increased inter-brain synchrony during interaction, and show that phase synchronization of oscillatory activity occurs during online real-time joint coordination without any physical co-presence or video and audio connection. Synchrony decreased during a playing session, but was found to be higher during the second session compared to the first. The novel paradigm, developed for the measurement of real-time collaborative performance, demonstrates that changes in inter-brain EEG phase synchrony can be observed continuously during interaction.

Reduced Power in Fronto-Parietal Theta EEG Linked to Impaired Attention-Sampling in Adult ADHD.

Attention-deficit/hyperactivity disorder (ADHD) in adults is understudied, especially regarding neural mechanisms such as oscillatory control of attention sampling. We report an electroencephalography (EEG) study of such cortical mechanisms, in ADHD-diagnosed adults during administration of Test of Variables of Attention (TOVA), a gold-standard continuous performance test for ADHD that measures the ability to sustain attention and inhibit impulsivity. We recorded 53 adults (28 female, 25 male, aged 18-60), and 18 matched healthy controls, using 128-channel EEG. We analyzed sensor-space features established as neural correlates of attention: timing-sensitivity and phase-synchrony of response activations, and event-related (de)synchronization (ERS/D) of α and θ frequency band activity; in frontal and parietal scalp regions. TOVA test performance significantly distinguished ADHD adults from neurotypical controls, in commission errors, response time variability (RTV) and d' (response sensitivity). The ADHD group showed significantly weaker target-locked and response-locked amplitudes, that were strongly right-lateralized at the N2 wave, and weaker phase synchrony (longer reset poststimulus). They also manifested significantly less parietal prestimulus 8-Hz θ ERS, less frontal and parietal poststimulus 4-Hz θ ERS, and more frontal and parietal prestimulus α ERS during correct trials. These differences may reflect excessive modulation of endogenous activity by strong entrainment to stimulus (α), combined with deficient modulation by neural entrainment to task (θ), which in TOVA involves monitoring stimulus spatial location (not predicted occurrence onset which is regular and task-irrelevant). Building on the hypotheses of θ coding for relational structure and rhythmic attention sampling, our results suggest that ADHD adults have impaired attention sampling in relational categorization tasks.

Neurofeedback Learning Is Skill Acquisition but Does Not Guarantee Treatment Benefit: Continuous-Time Analysis of Learning-Curves From a Clinical Trial for ADHD.

Neurofeedback for attention deficit/hyperactivity disorder (ADHD) has long been studied as an alternative to medication, promising non-invasive treatment with minimal side-effects and sustained outcome. However, debate continues over the efficacy of neurofeedback, partly because existing evidence for efficacy is mixed and often non-specific, with unclear relationships between prognostic variables, patient performance when learning to self-regulate, and treatment outcomes. We report an extensive analysis on the understudied area of neurofeedback learning. Our data comes from a randomised controlled clinical trial in adults with ADHD (registered trial ISRCTN13915109; N = 23; 13:10 female:male; age 25-57). Patients were treated with either theta-beta ratio or sensorimotor-rhythm regimes for 40 one-hour sessions. We classify 11 learners vs 12 non-learners by the significance of random slopes in a linear mixed growth-curve model. We then analyse the predictors, outcomes, and processes of learners vs non-learners, using these groups as mutual controls. Significant predictive relationships were found in anxiety disorder (GAD), dissociative experience (DES), and behavioural inhibition (BIS) scores obtained during screening. Low DES, but high GAD and BIS, predicted positive learning. Patterns of behavioural outcomes from Test Of Variables of Attention, and symptoms from adult ADHD Self-Report Scale, suggested that learning itself is not required for positive outcomes. Finally, the learning process was analysed using structural-equations modelling with continuous-time data, estimating the short-term and sustained impact of each session on learning. A key finding is that our results support the conceptualisation of neurofeedback learning as skill acquisition, and not merely operant conditioning as originally proposed in the literature.

Improved Auditory Function Caused by Music Versus Foreign Language Training at School Age: Is There a Difference?

In adults, music and speech share many neurocognitive functions, but how do they interact in a developing brain? We compared the effects of music and foreign language training on auditory neurocognition in Chinese children aged 8-11 years. We delivered group-based training programs in music and foreign language using a randomized controlled trial. A passive control group was also included. Before and after these year-long extracurricular programs, auditory event-related potentials were recorded (n = 123 and 85 before and after the program, respectively). Through these recordings, we probed early auditory predictive brain processes. To our surprise, the language program facilitated the children's early auditory predictive brain processes significantly more than did the music program. This facilitation was most evident in pitch encoding when the experimental paradigm was musically relevant. When these processes were probed by a paradigm more focused on basic sound features, we found early predictive pitch encoding to be facilitated by music training. Thus, a foreign language program is able to foster auditory and music neurocognition, at least in tonal language speakers, in a manner comparable to that by a music program. Our results support the tight coupling of musical and linguistic brain functions also in the developing brain.

Resting-State Network Plasticity Induced by Music Therapy after Traumatic Brain Injury.

Traumatic brain injury (TBI) is characterized by a complex pattern of abnormalities in resting-state functional connectivity (rsFC) and network dysfunction, which can potentially be ameliorated by rehabilitation. In our previous randomized controlled trial, we found that a 3-month neurological music therapy intervention enhanced executive function (EF) and increased grey matter volume in the right inferior frontal gyrus (IFG) in patients with moderate-to-severe TBI (N = 40). Extending this study, we performed longitudinal rsFC analyses of resting-state fMRI data using a ROI-to-ROI approach assessing within-network and between-network rsFC in the frontoparietal (FPN), dorsal attention (DAN), default mode (DMN), and salience (SAL) networks, which all have been associated with cognitive impairment after TBI. We also performed a seed-based connectivity analysis between the right IFG and whole-brain rsFC. The results showed that neurological music therapy increased the coupling between the FPN and DAN as well as between these networks and primary sensory networks. By contrast, the DMN was less connected with sensory networks after the intervention. Similarly, there was a shift towards a less connected state within the FPN and SAL networks, which are typically hyperconnected following TBI. Improvements in EF were correlated with rsFC within the FPN and between the DMN and sensorimotor networks. Finally, in the seed-based connectivity analysis, the right IFG showed increased rsFC with the right inferior parietal and left frontoparietal (Rolandic operculum) regions. Together, these results indicate that the rehabilitative effects of neurological music therapy after TBI are underpinned by a pattern of within- and between-network connectivity changes in cognitive networks as well as increased connectivity between frontal and parietal regions associated with music processing.

Flow Experiences During Visuomotor Skill Acquisition Reflect Deviation From a Power-Law Learning Curve, but Not Overall Level of Skill.

Flow is a state of "optimal experience" that arises when skill and task demands match. Flow has been well studied in psychology using a range of self-report and experimental methods; with most research typically focusing on how Flow is elicited by a particular task. Here, we focus on how the experience of Flow changes during task skill development. We present a longitudinal experimental study of learning, wherein participants (N = 9) play a novel steering-game task designed to elicit Flow by matching skill and demand, and providing clear goals and feedback. Experimental design involves extensive in-depth measurement of behavior, physiology, and Flow self-reports over 2 weeks of 40 game trials in eight sessions. Here we report behavioral results, which are both strikingly similar and strong within each participant. We find that the game induces a near-constant state of elevated Flow. We further find that the variation in Flow across all trials is less affected by overall performance improvement than by deviation of performance from the expected value predicted by a power law model of learning.

Studying the integrated functional cognitive basis of sustained attention with a Primed Subjective-Illusory-Contour Attention Task.

Sustained attention plays an important role in everyday life, for work, learning, or when affected by attention disorders. Studies of the neural correlates of attention commonly treat sustained attention as an isolated construct, measured with computerized continuous performance tests. However, in any ecological context, sustained attention interacts with other executive functions and depends on lower level perceptual processing. Such interactions occur, for example, in inhibition of interference, and processing of complex hierarchical stimuli; both of which are important for successful ecological attention. Motivated by the need for more studies on neural correlates of higher cognition, I present an experiment to investigate these interactions of attention in 17 healthy participants measured with high-resolution electroencephalography. Participants perform a novel 2-alternative forced-choice computerised performance test, the Primed Subjective Illusory Contour Attention Task (PSICAT), which presents gestalt-stimuli targets with distractor primes to induce interference inhibition during complex-percept processing. Using behavioural and brain-imaging analyses, I demonstrate the novel result that task-irrelevant incongruency can evoke stronger behavioural and neural responses than the task-relevant stimulus condition; a potentially important finding in attention disorder research. PSICAT is available as an open-source code repository at the following url, allowing researchers to reuse and adapt it to their requirements. https://github.com/zenBen/Kanizsa_Prime/ .

Biosignals reflect pair-dynamics in collaborative work: EDA and ECG study of pair-programming in a classroom environment.

Collaboration is a complex phenomenon, where intersubjective dynamics can greatly affect the productive outcome. Evaluation of collaboration is thus of great interest, and can potentially help achieve better outcomes and performance. However, quantitative measurement of collaboration is difficult, because much of the interaction occurs in the intersubjective space between collaborators. Manual observation and/or self-reports are subjective, laborious, and have a poor temporal resolution. The problem is compounded in natural settings where task-activity and response-compliance cannot be controlled. Physiological signals provide an objective mean to quantify intersubjective rapport (as synchrony), but require novel methods to support broad deployment outside the lab. We studied 28 student dyads during a self-directed classroom pair-programming exercise. Sympathetic and parasympathetic nervous system activation was measured during task performance using electrodermal activity and electrocardiography. Results suggest that (a) we can isolate cognitive processes (mental workload) from confounding environmental effects, and (b) electrodermal signals show role-specific but correlated affective response profiles. We demonstrate the potential for social physiological compliance to quantify pair-work in natural settings, with no experimental manipulation of participants required. Our objective approach has a high temporal resolution, is scalable, non-intrusive, and robust.