Kids With ADHD Can Train Their Brains, Study Finds

BY LINDA CARROLL

Kids with ADHD may be able to learn better focus through a computer game that trains the brain to pay attention, a new study suggests.

The game was part of a neurofeedback system that used bicycle helmets wired to measure brain waves and gave immediate feedback when kids were paying attention, researchers reported Monday in Pediatrics. 

Giving kids feedback on what their brains are doing is "like turning on a light switch," said Dr. Naomi Steiner, the study's lead author and a developmental and behavioral pediatrician at the Floating Hospital for Children at Tufts Medical Center. "Kids said 'Oh, this is what people mean when they tell me to pay attention.'"

To test the system, Steiner and her colleagues randomly assigned 104 Boston area elementary school children to one of three groups: no treatment, 40 half-hour sessions of neurofeedback or 40 sessions of cognitive therapy.

The kids getting neurofeedback wore standard bicycle helmets fitted with brain wave sensors while they performed a variety of exercises on the computer. In one exercise, kids were told to focus on a cartoon dolphin.

When people pay attention, theta wave activity goes down while beta waves increase, Steiner explained. If the kids' brains showed they were paying attention, the dolphin would dive to the bottom of the sea.

Parents' reports on ADHD symptoms six months later showed a lasting improvement in kids who had done neurofeedback. Perhaps more telling, kids in the other two groups needed an increase in medication after six months, while those in the neurofeedback group did not, said Dr. Anthony Rostain, an expert unaffiliated with the new study and a professor of psychiatry and pediatrics at the Perelman School of Medicine at the University of Pennsylvania.

"It is good news," Rostain said. "But the results were modest. It's not a magic bullet. It's not going to replace medication."

One major weakness of the new study is that it depended on parental observations, said Sandra Loo, an associate professor of psychiatry at UCLA. It's possible that some of what the researchers are seeing is a placebo effect, Loo said.

LINDA CARROLL

Linda Carroll is a regular contributor to NBC News. She writes about health and science and her work has appeared in The Science Times, Newsday and The Los Angeles Times as well as national magazines including Smart Money and Health. She is coauthor of "The Concussion Crisis: Anatomy of a Silent Epidemic" and the forthcoming "Duel for the Crown: Affirmed, Alydar, and Racing's Greatest Rivalry." She lives in rural New Jersey.

Neuroradiology

Intrinsic Brain Abnormalities in Attention Deficit Hyperactivity Disorder: A Resting-State Functional MR Imaging Study

Fei Li, PhD, Ning He, MD, Yuanyuan Li, MD, Lizhou Chen, MD, Xiaoqi Huang, PhD, Su Lui, PhD, Lanting Guo, MD, Graham J. Kemp, MA, DM, Qiyong Gong, MD, PhD

Introduction

Attention deficit hyperactivity disorder (ADHD), characterized by age-inappropriate degrees of inattention, hyperactivity, and impulsivity, affects about 5% of children and adolescents worldwide (1). Researchers who have performed functional magnetic resonance (MR) imaging studies exploiting blood oxygen level -dependent signal contrast have detected abnormalities in specific brain areas in ADHD, leading to the suggestion that frontostriatal dysfunction is important in the pathophysiologic functional changes of the disorder (2). However, reported results have been inconsistent: For example, in functional MR imaging with a response inhibition task, patients with ADHD have been reported as showing both decreased (3) and increased (4) activation in prefrontal regions. In view of this complexity, rather than focus on the dysregulation of particular areas in particular tasks, a better approach to the pathophysiologic functional changes of ADHD may be to consider the whole set of brain systems (5).

A task-independent approach to assessing regional and network-level brain function is resting-state functional MR imaging, in which spontaneous blood oxygen level-dependent fluctuations are thought to reflect spontaneous neural function in the resting state (6,7). Two derived measurement indexes, regional amplitude low frequency fluctuation (ALFF) and functional connectivity (FC), provide information on regional activity and network-level brain function, respectively (8,9). In contrast to the task-based approach, resting-state functional MR imaging is not susceptible to potential performance confounds and is relatively easy to implement in a clinical setting (10). Evidence from resting-state functional MR imaging has underpinned the development of models of ADHD that encompass a number of large-scale resting-state networks, suggesting that aberrant frontosubcortical circuits are not a sufficient explanation (5).

However, the specific neuropsychological dysfunction underlying such atypical brain network profiles remains poorly understood (11). Patients with ADHD often exhibit deficiencies in cognitive function, particularly in executive functions such as strategic planning, set switching, cognitive flexibility, and interference inhibition (12), which can be defined by neuropsychological tests such as the Wisconsin Card Sorting Test (WCST) (13) and the Stroop Color-Word Test (14). A link to executive dysfunction is central to models involving aberrant frontosubcortical circuits; however, there has been much debate about what core deficit of brain function might cause the impairments of ADHD (2).

The aims of the present study were to explore alterations of regional and network-level neural function by using resting-state functional MR imaging in children and adolescents with ADHD and to assess the association between these alterations of intrinsic neural activity and executive dysfunction in ADHD.