Effects of a Novel Neurofeedback Protocol on ADHD Subcomponents

Study Overview
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Brief Summary
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Mounting evidence suggests that closed-loop brain-training, commonly known as neurofeedback (NFB), may represent a new therapeutic opportunity for patients with Attentional Deficit/Hyperactivity Disorder (ADHD), which manifests as difficulties with attention and inhibitory control. In this context, the investigators have focused on an attention-enhancing form of NFB based on the EEG alpha rhythm, known to influence sensory detection and attention. In light of recent evidence showing that both attention and impulsivity can be modified with a single-session of alpha-NFB, the objective is to determine whether these effects stabilize in the long-term, after multiple, daily sessions of training at home. A short- (single-session) and a long-term (multi-session) experimental design will be used to collect EEG, behavioral, and clinical data pre-to-post NFB. The single-blind study will recruit 48 adult ADHD participants randomly assigned to either NEUROFEEDBACK or CONTROL groups. Each participant will undergo individual at home sessions of 45-minute video-replay of popular television (TV) series while recording their 1-channel EEG (30 sessions, 5 sessions/week, 6 weeks total). In the NEUROFEEDBACK group, self-regulation of alpha rhythm will be reflected in the dynamically varying opacity of the video-replay window, i.e. the window would turn lighter/darker and reveal/obscure video content during episodes of low/high alpha amplitude, respectively. In the CONTROL group, the recording will be passive without real-time EEG neurofeedback (i.e. constant brightness and volume). Before and after at home training, each participant will have two visits in the lab: (1) complete clinical and neuropsychological evaluation and (2) EEG session including resting state and task-related EEG before and after a short NFB intervention (30 minutes). For the CONTROL group participants, the latter will be replaced by a sham intervention utilizing non-contingent feedback. Given that stronger alpha rhythmicity is associated with increases in inhibitory/excitatory balance, it is expected that alpha-NFB (i) will homeostatically normalize alpha rhythm power and (ii) the degree of normalization will be a dimensional predictor of individual improvement in behavioral and clinical measures of executive function, impulsivity and inattention. These results should lay the foundation for building neurocognitive treatments, by harnessing neuroplasticity mechanisms intrinsic to the brain.

Official Title
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Effect of Long-lasting EEG-Neurofeedback on Attention Control and Impulsivity in Adult Attention-Deficit/Hyperactivity Disorder (ADHD)

Conditions
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Attention Deficit Disorder With Hyperactivity

Intervention / Treatment
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* Other: NEUROFEEDBACK
* Other: CONTROL


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Clinical diagnosis of ADHD Currently stabilized (euthymic) General good health Normal or corrected-to normal visual acuity Exclusion Criteria: Mood Disorders PTSD Borderline Personality Disorder Substance Use Disorder Structural Brain Abnormalities Cerebrovascular Disease Epilepsy Stroke Head Trauma Cardiovascular Disease Renal Failure Hepatic Dysfunction Impaired visual acuity

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 50 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: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: NEUROFEEDBACK<br>Participants undergo individual at home sessions of 45-minute video-replay of popular TV series while recording their 1-channel EEG using a portable system. Self-regulation of alpha rhythm is reflected in the dynamically varying opacity of the video replay window, i.e. the window would turn lighter/darker and reveal/obscure video content during episodes of low/high alpha amplitude, respectively. | Other: NEUROFEEDBACK<br>* EEG recording during alpha-related TV viewing<br>|
| Placebo Comparator: CONTROL<br>Participants undergo individual at home sessions of 45-minute video-replay of popular TV series while recording their 1-channel EEG using a portable system. The recording is passive without real-time EEG neurofeedback (i.e. constant brightness and volume). | Other: CONTROL<br>* EEG recording during passive TV viewing<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in assessor-evaluated clinical ADHD status | Change in adult ADHD Child Evaluation (ACE+) scoring (min = 0, max = 36, higher score = worse outcome) | Change between day 10 pre-intervention and day 10 post-intervention | 
| Change in self-reported clinical ADHD status | Change in adult ADHD Self-Report Scale (ASRS) scoring (min = 0, max = 72, higher score = worse outcome) | Change between day 10 pre-intervention and day 10 post-intervention | 
| Change in Alpha Spectral Power | Absolute and relative spectral alpha power in the 8-12 Hz frequency range at rest (microvolts) | Change between day 2 pre-intervention and day 2 post-intervention | 
| Change in reaction time at the Continuous Performance Task (CPT) | Reaction time and reaction time variability (milliseconds) | Change between day 2 pre-intervention and day 2 post-intervention | 
| Change in error rates at the CPT | Number of omission and commission errors | Change between day 2 pre-intervention and day 2 post-intervention | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Electroencephalography, Alpha Rhythm, Attention, Impulsive Behavior, Neurofeedback