Can Remote Computer-Based Training Help Children with ADHD?

What you need to know

• Remote computer-based training programs can help improve symptoms, executive function, and daily functioning in children with ADHD
• Three types of training - neurofeedback, cognitive training, and combined training - all showed similar positive effects
• The training also led to changes in brain activity, specifically increased alpha waves, which may reflect improved cognitive function
• Children with higher alpha wave activity before training tended to show greater symptom improvement

Background on ADHD and Treatment Options

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition that affects many children. It is characterized by difficulties with attention, hyperactivity, and impulsivity. While medication is often used to treat ADHD, there is increasing interest in non-medication approaches, especially those that can be delivered remotely via computer.

This study examined three types of computer-based training for children with ADHD:

1. Neurofeedback training (NFT): This involves monitoring brain activity and providing real-time feedback to help children learn to self-regulate their brain waves.

2. Computerized cognitive training (CCT): This uses games and exercises designed to improve specific cognitive skills like attention and working memory.

3. Combined NFT/CCT: This integrates both neurofeedback and cognitive training elements.

How the Study Worked

The researchers recruited 121 children diagnosed with ADHD and randomly assigned them to one of the three training groups. The children completed 3 months of at-home training using tablet computers. Before and after the training period, the researchers assessed:

• ADHD symptoms (rated by parents)
• Executive function skills like inhibition and working memory
• Daily functioning in areas like school and life skills
• Brain activity patterns measured by EEG

80 children completed the full training program and assessments.

Key Findings

Improvements in Symptoms and Functioning

After 3 months of training, all three groups showed significant improvements in:

• Inattention symptoms
• Hyperactivity/impulsivity symptoms
• Inhibition (ability to control impulses)
• Working memory
• Learning and life skills

Importantly, there were no significant differences between the three training approaches - they all seemed to be similarly effective.

Changes in Brain Activity

The researchers also observed changes in the children’s brain activity after training. Specifically, there was an increase in alpha wave activity when the children’s eyes were open. Alpha waves are a type of brain wave associated with a relaxed but alert state. This increase may reflect improvements in cognitive functioning and attention.

Predictors of Improvement

Interestingly, children who had higher alpha wave activity before starting the training tended to show greater improvement in their ADHD symptoms. This suggests that pre-training brain activity patterns may help predict which children are most likely to benefit from this type of intervention.

On the flip side, children with more severe inattention symptoms before training tended to show smaller increases in alpha wave activity. This indicates that the training may be less effective at changing brain activity patterns in children with more pronounced attention difficulties.

Implications and Future Directions

This study provides evidence that remote, computer-based training programs can be effective for improving symptoms and cognitive functioning in children with ADHD. The fact that all three approaches showed similar benefits suggests that families and clinicians have flexibility in choosing an approach that works best for them.

The observed changes in brain activity are particularly intriguing, as they provide objective evidence of the training’s effects beyond just parent-reported improvements. The link between pre-training alpha wave activity and symptom improvement could potentially help identify children who are most likely to benefit from this type of intervention.

However, it’s important to note some limitations of the study:

• There was no untreated control group, so some of the improvements may have been due to factors other than the training itself.
• The sample size was relatively small, especially for the brain activity analyses.
• Most families were from middle to high socioeconomic backgrounds, so the results may not generalize to all populations.

Future research should aim to replicate these findings with larger, more diverse samples and include long-term follow-up to see if the benefits are maintained over time. It would also be valuable to directly compare these computer-based interventions to other treatment approaches like medication or traditional therapy.

Conclusions

• Remote computer-based training programs show promise as interventions for children with ADHD
• Neurofeedback, cognitive training, and combined approaches all led to improvements in symptoms and functioning
• Changes in brain activity patterns provide objective evidence of the training’s effects
• Pre-training brain activity may help predict which children are most likely to benefit
• More research is needed to confirm these findings and determine the best ways to implement these interventions in clinical practice