NEUROFEEDBACK on Event-Related Potential (ERP)

Study Overview
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Brief Summary
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This project aims to assess the evolution of symptoms in ADHD children from 8 to 17 years, with various types of attention training. Different groups A, B and C will be evaluated: the first with Neurofeedback training, the second with a similar training but not indexed on brain activity and the third without training. 30 patients will be randomly assigned to groups A and B according to a ratio 2:1. Others patients who meet the same criteria but for logistical reasons cannot comply with the training constraints will be assigned to group C. Children included in groups A and B will participate in training sessions (Neurofeedback and control training, respectively) as well as in four evaluation sessions. Children in group C will only participate in evaluation sessions (baseline control group). Patients of groups A and B will be followed over 6 months: 4 months of training and a follow-up evaluation 2 months after training. Patients of group C will be followed each 2 months for 6 months. This study uses electro-encephalography measures, serious video game, neuropsychological tests and questionnaires. It also uses actigraphy measures to evaluate sleep quality.

Official Title
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Clinical Evaluation of a Brain Computer Interfaces (BCI)-Based Training of Attention in Children With Attention Deficit Hyperactivity Disorder (ADHD)

Conditions
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Attention Deficit Disorder With Hyperactivity

Intervention / Treatment
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* Other: Neurofeedback training
* Other: Active Sham control
* Other: Baseline control group


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children and teenagers aged from 8 to 17 years' old Children and teenagers with a deficit attention disorder with or without hyperactivity, in the mixed form or in a pure inattentive form according to Diagnostique et Statistique des troubles Mentaux (DSM)-V. Children and teenagers having a score in Verbal Comprehension Index (or Index Verbal Reasoning) and Perceptual Reasoning Index (or Index Reasoning fluid) ≥ 80 of WISC IV or V test, not older than two years. Children and teenagers without psychostimulant treatment Children and teenagers with psychostimulant treatment agreed to achieve a therapeutic break at each visit day and with a stable dose during all the study. Children and teenagers whose parents have agreed and signed informed consent form of the study. Exclusion Criteria: Children aged less than 8 and teenagers are more than 18 years' old. Children and teenagers having a score in Verbal Comprehension Index (or Index Verbal Reasoning) and Perceptual Reasoning Index (or Index Reasoning fluid) < 80 of WISC IV or V test, not older than two years. Children and teenagers with developmental disorder except Dys disorders. Children and teenagers with pure hyperactivity (without attentional deficit) Children and teenagers with epilepsy except benign epilepsies (without brain damage), free of crisis for two years and without treatment. Children and teenagers with ADHD with conduct disorders and aggression Children and teenagers with ADHD and Tourette's syndrome. Patients treated by anti / epilepsy or psychotropic treatments (with the exception of psychostimulant treatment). Patients with psychostimulant treatment and whose parents aren't agreed to achieve a therapeutic break at each visit day. Patients with visual deficiency uncorrectable with lenses or glasses.

Ages Eligible for Study
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Minimum Age: 8 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group A<br>Children will be assigned to this group in a random fashion according to a ratio 2:1 with respect to group B (see below). 20 subjects will be included in this group. | Other: Neurofeedback training<br>* Children in group A will receive BCI-based training implemented through original P300-based controlled games. They will attend 30 1-hour long training sessions at a pace of 2 sessions per week. Each session includes: installation of the child, the EEG system and an eye-tracking system, a 5-minutes relaxation phase, a short EEG recording at rest, a brief reminder of the instructions, 30 minutes of training by playing video games and finally a time for the child to wash her/his hair. Moreover, 4 neuropsychological sessions will complement the 30 training sessions. During these sessions neuropsychological tests and quality of life questionnaires will be answered.<br>|
| Active Comparator: Group B<br>Children will be assigned in this group in a random fashion. 10 subjects will be included in this group. | Other: Active Sham control<br>* Children in group B will receive a training that is not based on brain activity, but in a blind fashion. They will attend 30 1-hour long training sessions at a pace of 2 sessions per week. Each session includes: installation of the child, setting up the EEG and eye-tracking systems, a 5-minutes relaxation phase, short EEG recording at rest, a brief reminder of the instructions, 30 minutes of video game based training and finally a time for the child to wash her/his hair. Besides, 4 neuropsychological sessions will complement the 30 training sessions. During these sessions neuropsychological tests and quality of life questionnaires will be performed.<br>|
| Active Comparator: Group C<br>Will be included in this group children who meet the inclusion criteria and who, with their families, are motivated to participate in the study but cannot claim to be part of groups A or B (because of logistical constraints: living too far away to comply with the frequency of the visits required by the training). Group C allows to follow the natural evolution of children with ADHD with no intervention. | Other: Baseline control group<br>* The children included in this group will not receive any training. They only take part to the 4 neuropsychological sessions. Like others, they will attend 1 neuropsychological session every two months over six months.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Evaluation of the relative effect on symptoms of inattention between the two proposed training techniques, A and B, with the ADHD Rating Scale in children with ADHD | Questions with odd numbers interested in the dimension inattentive will particularly be studied. The investigator expect an improvement in the type of score: ''ADHD-Inattentive'' children in group A compared to children in Group B. More specifically, he expect to improve responses to questions number 1,3,5,7,9,11,13,15 and 17. By definition, an evolving response would be to move from  2=Often; 3=Very often to  1=Sometimes; 0=Rarely/Never. | every two months over six months. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Neuropsychological assessments of effects of training on the symptoms of inattention in ADHD children | ADHD Rating Scale (questions with odd numbers) will be performed ADHD children from groups A, B and C will be compared | every months over six months. | 
| Neuropsychological assessments of effects of training on the symptoms of inattention in ADHD children | Bron/Lyon Attention Stability test (BLAST) test will be performed ADHD children from groups A, B and C will be compared | every months over six months. | 
| Neuropsychological assessments of effects of training on the symptoms of inattention in ADHD children | Wechsler Intelligence Scale for Children (WISC) subtests will be performed ADHD children from groups A, B and C will be compared | every months over six months. | 
| Neuropsychological assessments of the effects of the lack of training on the symptoms of inattention in ADHD children | Wechsler Intelligence Scale for Children (WISC) will be performed ADHD children from groups A, B and C will be compared | every months over six months. | 
| Neuropsychological assessments of the effects of the lack of training on the symptoms of inattention in ADHD children | ADHD Rating Scale (questions with odd numbers) will be performed ADHD children from groups A, B and C will be compared | every months over six months. | 
| Neuropsychological assessments of the effects of the lack of training on the symptoms of inattention in ADHD children | Bron/Lyon Attention Stability test (BLAST) will be performed ADHD children from groups A, B and C will be compared | every months over six months. | 
| Compare the effects of the two types of trainings on the hyperactivity symptoms in ADHD children using neuropsychological assessments. | ADHD Rating Scale (questions with even numbers), Test d'évaluation de l'Attention (TAP) and Continuous Performance Test (CPT) will be performed ADHD children from groups A, B and C will be compared | every two months over six months | 
| neuropsychological assessments of the effects of the two types of trainings on the hyperactivity symptoms in ADHD children | ADHD Rating Scale (questions with even numbers) will be performed ADHD children from groups A, B and C will be compared | every two months over six months | 
| neuropsychological assessments of the effects of the two types of trainings on the hyperactivity symptoms in ADHD children | Test d'évaluation de l'Attention (TAP) will be performed ADHD children from groups A, B and C will be compared | every two months over six months | 
| neuropsychological assessments of the effects of the two types of trainings on the hyperactivity symptoms in ADHD children | Continuous Performance Test (CPT) will be performed ADHD children from groups A, B and C will be compared | every two months over six months | 
| neuropsychological assessments of the effects of the lack of training on the impulsivity symptoms in ADHD children | Continuous Performance Test (CPT) will be performed ADHD children from groups A, B and C will be compared | every two months over six months | 
| neuropsychological assessments of the effects of the lack of training on the impulsivity symptoms in ADHD children | Test d'évaluation de l'Attention (TAP) will be performed ADHD children from groups A, B and C will be compared | every two months over six months | 
| neuropsychological assessments of the effects of the lack of training on the impulsivity symptoms in ADHD children | ADHD Rating Scale (questions with even numbers) will be performed ADHD children from groups A, B and C will be compared | every two months over six months | 
| neuropsychological assessments of the effects of the lack of training on the hyperactivity symptoms in ADHD children | Continuous Performance Test (CPT) will be performed ADHD children from groups A, B and C will be compared | every two months over six months | 
| neuropsychological assessments of the effects of the lack of training on the hyperactivity symptoms in ADHD children | ADHD Rating Scale (questions with even numbers) will be performed ADHD children from groups A, B and C will be compared | every two months over six months | 
| neuropsychological assessments of the effects of the lack of training on the hyperactivity symptoms in ADHD children | Test d'évaluation de l'Attention (TAP) will be performed ADHD children from groups A, B and C will be compared | every two months over six months | 
| Quantify whether the changes in inattentive symptoms in groups A (Neurofeedback training) correlate with changes in specific EEG parameter, namely the P300 wave. | ADHD Rating Scale (questions with odd numbers) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify whether the changes in inattentive symptoms in groups A (Neurofeedback training) correlate with changes in specific EEG parameter, namely the P300 wave. | TAP will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify whether the changes in inattentive symptoms in groups A (Neurofeedback training) correlate with changes in specific EEG parameter, namely the P300 wave. | CPT will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify whether the changes in inattentive symptoms in groups A (Neurofeedback training) correlate with changes in specific EEG parameter, namely the P300 wave. | BLAST will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify whether the changes in inattentive symptoms in groups A (Neurofeedback training) correlate with changes in specific EEG parameter, namely the P300 wave. | Attention and Distractibility Questionnaire (for children) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify whether the changes in inattentive symptoms in groups B (Neurofeedback training) correlate with changes in specific EEG parameter, namely the P300 wave. | ADHD Rating Scale (questions with odd numbers)will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify whether the changes in inattentive symptoms in groups B (Neurofeedback training) correlate with changes in specific EEG parameter, namely the P300 wave. | TAP will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify whether the changes in inattentive symptoms in groups B (Neurofeedback training) correlate with changes in specific EEG parameter, namely the P300 wave. | CPT will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify whether the changes in inattentive symptoms in groups B (Neurofeedback training) correlate with changes in specific EEG parameter, namely the P300 wave. | BLAST will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify whether the changes in inattentive symptoms in groups B (Neurofeedback training) correlate with changes in specific EEG parameter, namely the P300 wave. | Attention and Distractibility Questionnaire (for children) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify whether the changes in inattentive symptoms in groups C (Neurofeedback training) correlate with changes in specific EEG parameter, namely the P300 wave. | ADHD Rating Scale (questions with odd numbers) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify whether the changes in inattentive symptoms in groups C (Neurofeedback training) correlate with changes in specific EEG parameter, namely the P300 wave. | TAP will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify whether the changes in inattentive symptoms in groups C (Neurofeedback training) correlate with changes in specific EEG parameter, namely the P300 wave. | CPT will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify whether the changes in inattentive symptoms in groups C (Neurofeedback training) correlate with changes in specific EEG parameter, namely the P300 wave. | BLAST will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify whether the changes in inattentive symptoms in groups C (Neurofeedback training) correlate with changes in specific EEG parameter, namely the P300 wave. | Attention and Distractibility Questionnaire (for children) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify the evolution of the classical Neurofeedback biomarkers Slow Cortical Potential (SCP)) | ADHD Rating Scale (questions with odd numbers) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify the evolution of the classical Neurofeedback biomarkers Slow Cortical Potential (SCP)) | TAP will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify the evolution of the classical Neurofeedback biomarkers Slow Cortical Potential (SCP)) | BLAST will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify the evolution of the classical Neurofeedback biomarkers Slow Cortical Potential (SCP)) | Attention and Distractibility Questionnaire (child) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Assess whether the classical Neurofeedback biomarkers correlate with the evolution of behavioral and primary neurophysiological measures (P300) in all groups. | ADHD Rating Scale (questions with odd numbers) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Assess whether the classical Neurofeedback biomarkers correlate with the evolution of behavioral and primary neurophysiological measures (P300) in all groups. | TAP will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Assess whether the classical Neurofeedback biomarkers correlate with the evolution of behavioral and primary neurophysiological measures (P300) in all groups. | BLAST will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Assess whether the classical Neurofeedback biomarkers correlate with the evolution of behavioral and primary neurophysiological measures (P300) in all groups. | Attention and Distractibility Questionnaire (child) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify the evolution of the classical Neurofeedback biomarkers Theta/Beta Ratio (TBR) | ADHD Rating Scale (questions with odd numbers) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify the evolution of the classical Neurofeedback biomarkers Theta/Beta Ratio (TBR) | TAP will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify the evolution of the classical Neurofeedback biomarkers Theta/Beta Ratio (TBR) | BLAST will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify the evolution of the classical Neurofeedback biomarkers Theta/Beta Ratio (TBR) | Attention and Distractibility Questionnaire (child) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Assess whether the classical Neurofeedback biomarkers TBR correlate with the evolution of behavioral and primary neurophysiological measures (P300) in all groups. | ADHD Rating Scale (questions with odd numbers) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Assess whether the classical Neurofeedback biomarkers TBR correlate with the evolution of behavioral and primary neurophysiological measures (P300) in all groups. | TAP will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Assess whether the classical Neurofeedback biomarkers TBR correlate with the evolution of behavioral and primary neurophysiological measures (P300) in all groups. | BLAST will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Assess whether the classical Neurofeedback biomarkers TBR correlate with the evolution of behavioral and primary neurophysiological measures (P300) in all groups. | Attention and Distractibility Questionnaire (child) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify the evolution of the classical Neurofeedback biomarkers Sensori-Moteur Rythm (SMR) | ADHD Rating Scale (questions with odd numbers) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify the evolution of the classical Neurofeedback biomarkers Sensori-Moteur Rythm (SMR) | TAP will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify the evolution of the classical Neurofeedback biomarkers Sensori-Moteur Rythm (SMR) | BLAST will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Quantify the evolution of the classical Neurofeedback biomarkers Sensori-Moteur Rythm (SMR) | Attention and Distractibility Questionnaire (child) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Assess whether the Neurofeedback biomarkers SMR correlate with the evolution of behavioral and primary neurophysiological measures (P300) in all groups. | ADHD Rating Scale (questions with odd numbers)will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Assess whether the Neurofeedback biomarkers SMR correlate with the evolution of behavioral and primary neurophysiological measures (P300) in all groups. | TAP will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Assess whether the Neurofeedback biomarkers SMR correlate with the evolution of behavioral and primary neurophysiological measures (P300) in all groups. | BLAST will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Assess whether the Neurofeedback biomarkers SMR correlate with the evolution of behavioral and primary neurophysiological measures (P300) in all groups. | Attention and Distractibility Questionnaire (child) will be evaluated ADHD children of groups A, B and C will be compared | every two months over six months | 
| Evaluate the impact of the trainings on the sleep quality in ADHD children. | Sleep questionnaires will be distributed ADHD children in groups A, B and C will be compared. | every two months over six months. | 
| Evaluate the impact of the trainings on the sleep quality in ADHD children. | The sleep data may also be collected using an actigraph (ancillary study). ADHD children in groups A, B and C will be compared. | every two months over six months. | 
| Evaluating the impact of the trainings on the quality of life in ADHD children. | The Child Behavior CheckList (CBCL) questionnaire will be performed Groups A, B and C will be compared. | every two months over six months | 
| Evaluating the impact of the trainings on the quality of life in ADHD children. | Information about the quality of life will be also collected in a logbook by family members and provided at each visit. Groups A, B and C will be compared. | every two months over six months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Attention Deficit Disorder with Hyperactivity, ADHD, Children, Inattention, Hyperactivity, Neurofeedback, Neuropsychology