Brain-Computer Interface Design and Neurofeedback Training in the Case of ADHD Rehabilitation.

Neurofeedback video games respond to electrical brain signals instead to a mouse, joystick, or game controller input. These games embody the concept of improving physiological functioning by rewarding specific healthy body signals with success at playing a video game. In this paper, a threefold framework in reference to attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) treatment blending with neurofeedback techniques and video game implementation is presented. In particular, the specifications of a neurofeedback-based video game for children dealing with ADHD, in order to enhance attention and concentration skills, are analyzed. Potential boundaries of this cognitive enhancement approach and authors future directions are also discussed.

The influence of mindfulness meditation on inattention and physiological markers of stress on students with learning disabilities and/or attention deficit hyperactivity disorder.

BACKGROUND: Over recent decades, the number of students diagnosed with learning disabilities and/or attention deficit hyperactivity disorders has substantially increased. These students face various challenges and experience stress when receiving higher education. AIMS: The purpose of this study was to compare two non-pharmacological interventions: mindfulness and device-guided slow breathing, with a control group. METHODS: Seventy-three students (age = 25.76, std. dev = 3.10) with attention problems and/or learning disabilities were randomly assigned to three groups: mindfulness meditation, device guided breathing practice and waiting-list control. Before and after the intervention physiological and psychological measures were collected. RESULTS: Our results show that only mindfulness practice improved awareness of the present moment and decreased hyperactivity and inattention. Furthermore, both mindfulness and practice with device-guided breathing were associated with stress reduction, as shown by an increase in the galvanic skin response only in the control group. CONCLUSIONS: Implementation of the study results may lead to an advance in treating attention deficit disorders and learning disabilities, especially among higher education students.

Effect of combined neurofeedback and game-based cognitive training on the treatment of ADHD: A randomized controlled study.

Neurofeedback (NF) is referred to as a "possibly efficacious" treatment in the current evidence-based reviews; therefore, more research is needed to determine its effects especially in combination with other treatments. The present study examines the effect of NF and game-based cognitive training on children with attention deficit hyperactivity disorder (ADHD). Thirty-two male students with ADHD were assigned to NF (N = 16; Mage=10.20; SD = 1.03) and waiting list control (N = 16; Mage = 10.05; SD = 0.83) in a randomized double-blind trial. The children in the NF group based on quantitative electroencephalography (QEEG) attended 30 three times-weekly sessions. The children were examined in pretest and post-test with EEG, Integrated Visual and Auditory Continuous Performance (IVA), and Conners Parent, and Teacher Rating Scales-Revised. The treatment was found significant all the symptom variables except for attention deficit (AD) and auditory response control (ARC). Normalization of the atypical EEG features with reduced [Formula: see text] wave and increased sensory motor (SMR) activity in central zero (Cz) was recorded in the NF condition participants. However, except for SMR activity there were no significant changes in the waves of frontocentral zero (FCz). It is concluded that technology developments provide an interesting vehicle for interposing interventions and that combined NF and game-based cognitive training can produce positive therapeutic effects on brainwaves and ADHD symptomatology.

Effects of neurofeedback on the dysregulation profile in children with ADHD: SCP NF meets SDQ-DP - a retrospective analysis.

BACKGROUND: As children with attention-deficit/hyperactivity disorder (ADHD) usually show psychopathological signs beyond their core symptoms (e.g. elevated scores of the dysregulation profile (DP) in 30-40%), treatments with a broader approach to self-regulation skills may be supportive. Neurofeedback (NF) may reflect such an option. Aim of the present analysis was to compare the effects of slow cortical potential (SCP) NF and θ/ß NF on the DP using data from a previous trial. METHODS: Thirty children with ADHD (aged 8-12 years) and a DP score in the Strengths and Difficulties Questionnaire (SDQ-DP) ⩾ 3 were included. NF treatment consisted of one block of SCP NF and one block of θ/ß NF (18 units per block) allowing an intraindividual comparison. Effects of the NF protocols were also contrasted to a control group (n = 18) that completed an attention skills training (between-group analysis). RESULTS: Regarding the SDQ-DP, SCP NF was superior to θ/ß NF and the control condition. Effects of SCP NF and θ/ß NF on ADHD symptom severity were not significantly different. The SDQ-DP score did not correlate with EEG-related measures previously found to be predictors for SCP NF on ADHD symptoms. CONCLUSIONS: SCP NF may reflect a more general approach to improve cognitive, emotional and behavioral self-regulation skills. If confirmed in a larger sample, the SDQ-DP score could be used as an indication criterion and contribute to the individualization of NF in ADHD. Overall, the differential effect provides further evidence for the specificity of NF effects.

Predictive factors of success in neurofeedback training for children with ADHD.

INTRODUCTION: Neurofeedback (NF) training aims the enhancement of self-regulation over brain activities. While it is largely recognized as an effective treatment for attention deficit hyperactivity disorder (ADHD), the existence of non-learners has also been reported. The present study explored pre-training assessment indices that could predict learners prior to NF training. METHODS: Twenty-two children with ADHD participated in slow cortical potential (SCP) NF training and completed pre- and post-training assessments. Participants were classified into learners or non-learners based on their progress in the SCP regulation, and pre-training indices that differentiate the two groups were examined by decision tree analysis. RESULTS AND DISCUSSION: The learner rate in NF training was 45.5%. Learners were predicted by pre-training cognitive and neurophysiological measures regarding Stroop tasks, which suggested relatively intact executive function as their characteristics. Given that NF training is not universally effective for children with ADHD, further studies are necessary to establish application criteria.

Effects of a mindfulness-based intervention (MYmind) for children with ADHD and their parents: protocol for a randomised controlled trial.

INTRODUCTION: Mindfulness is one of the potential alternative interventions for children with attention-deficit hyperactivity disorder (ADHD). Some evidence suggests that mindfulness is related to changes in brain regions associated with ADHD. The potential benefits of mindfulness on children with ADHD, as well as the feasibility of this intervention approach, are warranted through prior local and foreign studies. This study aims to evaluate the effect of mindfulness-based group intervention for children with ADHD and their respective parents through a robust research design. METHODS AND ANALYSIS: This study will adopt a randomised controlled trial design including 140 children aged 8-12 years with ADHD together with one of their parents (n=140). These families will be randomised into intervention group (n=70) who will be offered the MYmind programme delivered by trained healthcare professionals, and an active control group (n=70) who will be offered the CBT programme. The intervention includes 8 weekly 90 min group sessions for children with ADHD (aged 8-12 years) and their respective parents. The primary and secondary outcomes will include children's attention, ADHD-related symptoms, behaviours, executive function and mindfulness levels measured by validated objective measures and parent's reported instruments. Parents' parental stress, parenting styles, ADHD related symptoms, well-being, rumination level and mindfulness levels will also be measured. Analysis is by intention to treat. The effects of intervention will be evaluated by comparing outcomes between the two arms, as well as comparing outcomes within subject through comparing measurements at baseline (T0), immediately after the 8 week intervention (T1) and at 3 (T2) and 6 (T3) months postintervention. ETHICS AND DISSEMINATION: Ethics approval has been granted by the Joint Chinese University of Hong Kong - New Territories East Cluster Clinical Research Ethics Committee (The Joint CUHK-NTEC CREC). Participants will be required to sign informed consent form from both parents and children. Findings will be reported in conferences and peer-reviewed publications in accordance with recommendations of Consolidated Standards of Reporting Trials. TRIAL REGISTRATION NUMBER: ChiCTR1800014741; Pre-results.

Effects of Neurofeedback Training on Performing Bimanual Coordination In-phase and Anti-phase Patterns in Children with ADHD.

It is generally accepted that children with attention-deficit/hyperactivity disorder (ADHD) have poor motor control, especially in bimanual coordination tasks. Such children characteristically have impaired fine motor ability, problems with force control, and poor motor coordination. They are at particular risk of loss of motor control and reduced bimanual coordination. We tested whether, compared to a control condition, neurofeedback training (NFT) could improve bimanual coordination among children with ADHD. 20 Children with ADHD (mean age 7.9 years; SD 2.11) were randomly assigned either to NFT or to a control condition. All participants completed a bimanual coordination test at the following time points: baseline, assessment 1, assessment 2, assessment 3, and again 12 session later at posttest. NFT consisted of Sensory Motor Rhythm (SMR) training to achieve increased SMR in C3 and C4, while participants in the control condition were under mock NFT conditions. Bimanual coordination accuracy and consistency improved from baseline to completion of the intervention (significant Time effect), but in the NFT condition (significant time × group interaction). Compared to the control condition, the NFT group had fewer errors in both patterns of bimanual coordination (significant Group effect). Among children with ADHD, SMR neurofeedback training (NFT) led to significant improvements in a bimanual coordination task. The SMR NFT thus appears to have the potential to improve and enhance the motor control of ADHD patients.

Effects of Yoga on Attention, Impulsivity, and Hyperactivity in Preschool-Aged Children with Attention-Deficit Hyperactivity Disorder Symptoms.

OBJECTIVE: Behavioral therapies are first-line for preschoolers with attention-deficit hyperactivity disorder (ADHD). Studies support yoga for school-aged children with ADHD; this study evaluated yoga in preschoolers on parent- and teacher-rated attention/challenging behaviors, attentional control (Kinder Test of Attentional Performance [KiTAP]), and heart rate variability (HRV). METHODS: This randomized waitlist-controlled trial tested a 6-week yoga intervention in preschoolers with ≥4 ADHD symptoms on the ADHD Rating Scale-IV Preschool Version. Group 1 (n = 12) practiced yoga first; Group 2 (n = 11) practiced yoga second. We collected data at 4 time points: baseline, T1 (6 weeks), T2 (12 weeks), and follow-up (3 months after T2). RESULTS: At baseline, there were no significant differences between groups. At T1, Group 1 had faster reaction times on the KiTAP go/no-go task (p = 0.01, 95% confidence interval [CI], -371.1 to -59.1, d = -1.7), fewer distractibility errors of omission (p = 0.009, 95% CI, -14.2 to -2.3, d = -1.5), and more commission errors (p = 0.02, 95% CI, 1.4-14.8, d = 1.3) than Group 2. Children in Group 1 with more severe symptoms at baseline showed improvement at T1 versus control on parent-rated Strengths and Difficulties Questionnaire hyperactivity inattention (ß = -2.1, p = 0.04, 95% CI, -4.0 to -0.1) and inattention on the ADHD Rating Scale (ß = -4.4, p = 0.02, 95% CI, -7.9 to -0.9). HRV measures did not differ between groups. CONCLUSION: Yoga was associated with modest improvements on an objective measure of attention (KiTAP) and selective improvements on parent ratings.

Children with ADHD draw-and-tell about what makes their life really good.

PURPOSE: The purpose of this study was to engage children with attention deficit hyperactivity disorder (ADHD) in a developmentally sensitive way to explore the children's subjective well-being. Explicitly, their life satisfaction, or what makes their life "really good." To date, little is known about the subjective life experience of children with ADHD or how incorporating children's views separate from the purview of adults and pathology might enhance our understanding or change our approach to evaluation and/or intervention. DESIGN AND METHODS: A parallel convergent mixed-methods design was used to collect data from a convenience sample of children with ADHD (N = 20) ages 7 to 11 years old. This article focuses solely on the qualitative data obtained through semi-structured interviews using the art-based approach draw-and-tell conversation (DTC). The DTC data were analyzed using qualitative content analysis. In addition, each parent (N = 20) independently completed demographic and health-related forms to provide descriptive and contextual variables. RESULTS: Three themes were discerned in the DTC analysis-activity, nature, and connections. Most children (90%) described engaging in some form of activity, often outdoors, and with others; though the focus of activity was varied. Nature was evidenced directly and indirectly in many of the children's (85%) stories. Over half (65%) of the children described some variation in relational connection across a continuum that contributed to, or detracted from, their sense of well-being/life satisfaction. PRACTICE IMPLICATIONS: Children shared that doing things, outdoors, with others, [emphasis added] made their life "really good". Children's stories yielded insightful and actionable information that is relevant to each individual child/family, and to nursing assessment, intervention, and advocacy. These child-granted insights also extend our attention beyond pharmacological and behavioral focused interventions, to include the children's own innate health promoting interests that help to make their life really good.

Mindfulness vs psychoeducation in adult ADHD: a randomized controlled trial.

BACKGROUND: Mindfulness training is a promising treatment approach in adult ADHD. However, there has not yet been a randomized controlled trial comparing mindfulness to an active control condition. In this study, we assessed the efficacy of a mindfulness training program (MAP) compared to structured psychoeducation (PE). METHODS: After randomization 81 medication-free adult ADHD patients participated either in an 8-week MAP or PE group program. At baseline (T1), after 8 weeks (T2) and after 8 months (T3), severity of ADHD and associated symptoms (depression, general psychopathology, quality of life) were measured with the Conner's ADHD Rating Scales (CAARS), the Beck Depression Inventory (BDI), the Brief Symptom Inventory (BSI) and the SF-36 by self and blind observer ratings. RESULTS: Both groups showed significant pre-post improvements in observer-rated Inattention scale (p < .001, partial η2 = 0.18) and in associated symptomatology, which persisted through 6 months of follow-up. There were no significant differences regarding symptom reduction between the treatment groups. Women benefited more compared to men irrespective of treatment group. Men showed the most pronounced changes under MAP. CONCLUSIONS: In the current study, MAP was not superior to PE regarding symptom reduction in adult ADHD. Both interventions, mindfulness meditation and PE, were efficacious in reducing symptom load in adult ADHD. Furthermore in exploratory post hoc tests the study provides evidence for a potential gender-specific treatment response in adult ADHD.

The Dance of Attention: Toward an Aesthetic Dimension of Attention-Deficit.

What role does the aesthetics of bodily movement play in the understanding of attention among children diagnosed with attention-deficit/hyperactivity disorder (ADHD)? This article animates a phenomenological approach to attention and embodiment with a special focus on the relation between aesthetic or expressive bodily movement and behavioral awareness in children diagnosed with ADHD. However, beyond this it is argued that the aesthetic aspect of movement calls for an expansion of the phenomenological perspective. In this context Gilles Deleuze's notion of aesthetics as a "science of the sensible" is activated and discussed in relation to the phenomenological concept of perception. Empirically the article takes point of departure in a qualitative study conducted with a group of children with attention-deficit practicing the Afro-Brazilian marital art, capoeira. Combining ethnographic and phenomenological methods, it is demonstrated that capoeira can be considered a form of aesthetic movement that offers a transition of attention-deficit into a productive force of expression that changes the notions of sensation and movement in ADHD.

Neurofeedback Training Effects on Inhibitory Brain Activation in ADHD: A Matter of Learning?

Neurofeedback training (NF) is a promising non-pharmacological treatment for ADHD that has been associated with improvement of attention-deficit/hyperactivity disorder (ADHD)-related symptoms as well as changes in electrophysiological measures. However, the functional localization of neural changes following NF compared to an active control condition, and of successful learning during training (considered to be the critical mechanism for improvement), remains largely unstudied. Children with ADHD (N=16, mean age: 11.81, SD: 1.47) were randomly assigned to either slow cortical potential (SCP, n=8) based NF or biofeedback control training (electromyogram feedback, n=8) and performed a combined Flanker/NoGo task pre- and post-training. Effects of NF, compared to the active control, and of learning in transfer trials (approximating successful transfer to everyday life) were examined with respect to clinical outcome and functional magnetic resonance imaging (fMRI) changes during inhibitory control. After 20 sessions of training, children in the NF group presented reduced ADHD symptoms and increased activation in areas associated with inhibitory control compared to baseline. Subjects who were successful learners (n=9) also showed increased activation in an extensive inhibitory network irrespective of the type of training. Activation increased in an extensive inhibitory network following NF training, and following successful learning through NF and control biofeedback. Although this study was only powered to detect large effects and clearly requires replication in larger samples, the results suggest a crucial role for learning effects in biofeedback trainings.

Evaluating the features of the brain waves to quantify ADHD improvement by neurofeedback.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD), as one of the most common neurological disorders in children and adolescents, is characterized by decentralization, slow learning, distraction and hyperactivity. Studies have shown that in addition to medication, neurofeedback training can also be used to partially control the brain activity of these patients. METHODS: In this study, using the brain signals processing before and after the treatment in 10 children treated by neurofeedback, the changes were evaluated by non-parametric statistical analysis and impact of neurofeedback on brain frequency bands was investigated. Finally, the results were compared with the protocols introduced in this paper and before researches. RESULTS: The results of Kruskal-Wallis test showed an approximately significant increase in the relative power of gamma and an approximately significant reduction in the ratio of relative power of alpha/beta. CONCLUSIONS: It represents the emotional response, elicited by the successful learning and diminished ratio of slow learning to active learning respectively.

EMG biofeedback training in adult attention-deficit/hyperactivity disorder: An active (control) training?

OBJECTIVE: The present study aimed at revealing neurophysiological effects induced by electromyography (EMG) based biofeedback, considered as a semi-active control condition in neurofeedback studies, in adult attention-deficit/hyperactivity disorder (ADHD) patients. METHODS: 20 adult ADHD patients trained their muscle activity in the left and right supraspinatus muscle over the course of 30 EMG biofeedback sessions. Changes induced by the EMG feedback were evaluated at a clinical and neurophysiological level; additionally, the relation between changes in EEG activity recorded at the vertex over the training course and changes of symptom severity over the treatment course were assessed in order to investigate the mechanisms underlying clinical effects of EMG biofeedback. RESULTS: Participants showed significant behavioral improvements on a self-rating scale. There was a significant increase in alpha power, but no significant changes in the delta frequency range; changes in the theta and beta frequency range were not significant after adjustment for multiple comparisons. No statistically significant correlation was found between changes in EEG frequency bands and changes in ADHD symptoms. CONCLUSIONS: The current results assessed by means of a single-electrode EEG constitute a starting point regarding a clearer understanding of mechanisms underlying clinical effects of EMG biofeedback. Although we did not reveal systematic effects induced by EMG feedback on brain activity it remains an open question whether EMG biofeedback induces changes in brain regions or parameters we did not gather in the present study (e.g. motor cortex).

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.

Real-time fMRI neurofeedback in adolescents with attention deficit hyperactivity disorder.

Attention Deficit Hyperactivity Disorder (ADHD) is associated with poor self-control, underpinned by inferior fronto-striatal deficits. Real-time functional magnetic resonance neurofeedback (rtfMRI-NF) allows participants to gain self-control over dysregulated brain regions. Despite evidence for beneficial effects of electrophysiological-NF on ADHD symptoms, no study has applied the spatially superior rtfMRI-NF neurotherapy to ADHD. A randomized controlled trial tested the efficacy of rtfMRI-NF of right inferior prefrontal cortex (rIFG), a key region that is compromised in ADHD and upregulated with psychostimulants, on improvement of ADHD symptoms, cognition, and inhibitory fMRI activation. To control for region-specificity, an active control group received rtfMRI-NF of the left parahippocampal gyrus (lPHG). Thirty-one ADHD boys were randomly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI-NF runs over 2 weeks. Feedback was provided through a video-clip of a rocket that had to be moved up into space. A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life. Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11-month follow-up. Only the group targeting rIFG, however, showed a transfer effect, which correlated with ADHD symptom reductions, improved at trend level in sustained attention, and showed increased IFG activation during an inhibitory fMRI task. This proof-of-concept study demonstrates for the first time feasibility, safety, and shorter- and longer-term efficacy of rtfMRI-NF of rIFG in adolescents with ADHD. Hum Brain Mapp 38:3190-3209, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.

The pragmatic language, communication skills, parent-child relationships, and symptoms of children with ADHD and their playmates 18-months after a parent-delivered play-based intervention.

OBJECTIVE: This study examined the communication skills, pragmatic language, parent-child relationships, and attention deficit hyperactivity disorder (ADHD) symptoms of children with ADHD and their playmates 18-months after a pilot parent-delivered intervention for improving social play skills and pragmatic language. METHODS: Participants were five children with ADHD, their parents, and five typically-developing playmates. Outcomes were measured immediately post and 18-months following the intervention. Parent-rated norm-based assessments and an observational measure were used. Differences within and between the ADHD and playmate groups were examined. RESULTS: Children maintained all skills gained 18-months following the intervention. Compared to a normative sample, children with ADHD remained below the average range on aspects of communication skills, parent-child relationships, and ADHD symptom levels 18-months following intervention. CONCLUSIONS: After intervention, children with ADHD still experienced pragmatic language skills below those of their peers on norm-based assessments that measure their skills across contexts. School-based interventions are needed to facilitate ongoing skill development and generalization.

Advancing services for adult ADHD: the development of the ADHD Star as a framework for multidisciplinary interventions.

BACKGROUND: Attention Deficit Hyperactivity Disorder is prevalent in adulthood, resulting in serious impairment across multiple domains of living. Despite clinical guidance recommendations, the relative infancy of research on service provision for adults with ADHD, along with the evidence transfer gap, means that there is a lack of specific frameworks for service delivery. Igniting research and developing service delivery frameworks within adult ADHD is an essential step in the provision of effective services for adults with ADHD. METHOD: Following the methodology used in previous related research that utilises a Participatory Action Research approach, we gathered data from clinicians and service users on the domains of living in which they wish to create change, and the steps and end point of the change process. This data was utilised, alongside data gathered from previous research and policies, to develop the domains of assessment for the ADHD Star, and the scale on which change is assessed. RESULTS: The resulting tool, the ADHD Star, consists of eight domains: understanding your ADHD, focus and attention, organising yourself, friends and social life, thinking and reacting, physical health, how you feel and meaningful use of time. Each domain is rated on a five-point scale, the 'ladder of change', ranging from 'stuck' to 'choice'. CONCLUSIONS: The ADHD Star offers a guiding framework for the development of care pathways and subsequent service provision for adults with ADHD, based on multi-disciplinary, holistic and person-centred care.

Benefits of an experimental program of equestrian therapy for children with ADHD.

BACKGROUND: Equestrian therapy has been shown to be a useful instrument in the sphere of the emotional wellbeing and mental health of different population groups. AIMS: To empirically determine the effects of a program of equestrian therapy on quality of life and various psychosocial variables of a group of 14 pupils diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), aged from 7 to 14 years. METHODS AND PROCEDURES: A quasi-experimental design, with a pre-test and a post-test, was implemented with an experimental group and a control group. The program consisted of 24 biweekly sessions, therefore lasting some 3 months. The data acquisition instruments used were: the "Behavior Assessment System for Children" (BASC) and an ad-hoc quality of life questionnaire. OUTCOMES AND RESULTS: The results deriving from the teachers' responses and the different scales of the BASC showed no significant group differences, but for the experimental group there was an improvement in the indicator corresponding to interpersonal relationships in the quality-of-life questionnaire. CONCLUSIONS AND IMPLICATIONS: It would seem that it is currently possible to recommend this activity, for this target population, as a sporting activity that provides similar benefits to other physical activities, but which is still far from being able to be recognized as a therapeutic activity.

Editorial Perspective: How to optimise frequency band neurofeedback for ADHD.

Attention deficit/hyperactivity disorder (ADHD) is one of the most prevalent paediatric neuropsychiatric disorders and is characterised by hyperactivity, inattention and increased impulsivity. Children with ADHD are often also characterised by deficits in a variety of cognitive domains, including problems in working memory, a generally slower and more variable style of information processing and deficits in temporal processing, inhibitory functions and delay processing. Overarching executive functions like information updating, response inhibition and mental set shifting are also impaired in many, but not all, children with ADHD, demonstrating the neuropsychological heterogeneity characterising this disorder. Deficits in executive functions can persist into adulthood and have a substantial negative impact on everyday life. A variety of approaches are commonly considered for the treatment of ADHD (including pharmacological interventions, patient-centred cognitive-behavioural therapy approaches and specific teacher/parent training programmes). More recently, adding to this multimodal treatment approach, neurofeedback has grown in popularity as an intervention option for patients with ADHD. This article considers this intervention approach and the opportunities for optimising treatment for executive control dysfunctions in ADHD using theta/beta neurofeedback.