Game-based combined cognitive and neurofeedback training using Focus Pocus reduces symptom severity in children with diagnosed AD/HD and subclinical AD/HD.

Previous studies report reductions in symptom severity after combined working memory (WM) and inhibitory control (IC) training in children with AD/HD. Based on theoretical accounts of the role of arousal/attention modulation problems in AD/HD, the current study examined the efficacy of combined WM, IC, and neurofeedback training in children with AD/HD and subclinical AD/HD. Using a randomized waitlist control design, 85 children were randomly allocated to a training or waitlist condition and completed pre- and post-training assessments of overt behavior, trained and untrained cognitive task performance, and resting and task-related EEG activity. The training group completed twenty-five sessions of training using Focus Pocus software at home over a 7 to 8-week period. Trainees improved at the trained tasks, while enjoyment and engagement declined across sessions. After training, AD/HD symptom severity was reduced in the AD/HD and subclinical groups according to parents, and in the former group only according to blinded teachers and significant-others. There were minor improvements in two of six near-transfer tasks, and evidence of far-transfer of training effects in four of five far-transfer tasks. Frontal region changes indicated normalization of atypical EEG features with reduced delta and increased alpha activity. It is concluded that technology developments provide an interesting a vehicle for delivering interventions and that, while further research is needed, combined WM, IC, and neurofeedback training can reduce AD/HD symptom severity in children with AD/HD and may also be beneficial to children with subclinical AD/HD.

Trials and intensity effects in single-trial ERP components and autonomic responses in a dishabituation paradigm with very long ISIs.

The phasic orienting reflex (OR) was investigated using single-trial data collected concurrently from 4 autonomic measures and event-related potentials (ERPs). In an auditory dishabituation paradigm, twelve indifferent tones of two intensities (60 or 80 dB, intensity change on trial 11, counterbalanced between subjects) were presented at very long interstimulus intervals (ISIs). Novelty and intensity based stimulus-response patterns were examined seeking ERP analogues of autonomic measures representing pre-OR and OR processing. Skin conductance response (SCR) represented the phasic OR index. EOG-corrected ERP data for 16 subjects were decomposed by a temporal Principal Components Analysis (PCA). SCR diminished over 10 standard trials, recovered on change trial 11, dishabituated to the re-presentation of the standard tone on trial 12, and showed intensity effects at the change - formal requirements for an OR index. The evoked cardiac response (HR) showed no trial or intensity effects. Respiratory pause (RP) decreased linearly over trials and showed recovery but no dishabituation or intensity effect. Peripheral vasoconstriction (PVC) failed to decrement but exhibited an intensity effect. Ten identifiable ERP components were extracted: Na, P1, N1-1, PN, P2, P3a, P3b, a novelty-sensitive HabP3, an intensity-sensitive IntP3, and the Slow Wave (SW). Pattern 1 showed no trial or intensity effects (HR, P1, PN, P2); Pattern 2 showed no trial effect but an intensity effect (PVC, Na, N1-1, P3a); and Pattern 3 demonstrated habituation and an intensity effect (SCR, RP, P3b, HabP3, IntP3, SW). The observed fractionation of autonomic and central measures is consistent with Preliminary Process Theory (PPT) rather than the notion of a unitary OR.