In the Journals

Training program improved inattentive symptoms in children with ADHD

An 8-week intervention with a brain-computer interface-based attention training program significantly improved inattentive symptoms associated with attention-deficit/hyperactivity disorder in children aged 6 to 12 years, according to recent study results.

In previous trials, Choon Guan Lim, MD, of the department of child and adolescent psychiatry at the Institute for Mental Health in Singapore, and colleagues developed an intervention in which EEG-based biofeedback systems were used alongside a brain-computer interface-based attention training game system, enabling an individual to develop increasing attention while playing the game.

“In our first study, we found that intervention with a training program involving the [brain-computer interface]-based attention training game system improved parent-reported inattentive symptoms,” Lim and colleagues said.

“It also involved the use of a very simple game and a tethered connection to a computer,” they said. “Since then, we have developed a new version of the device that is simple, uses dry EEG electrodes and is connected by Bluetooth to the computer. A new game that could be calibrated based on the performance of the child was also developed. In addition, it was important to understand who would be the right candidates to benefit from this approach.”

To determine whether the newly developed game, as well as a more intensive training schedule involving three sessions per week for 8 weeks, would be more effective in improving ADHD symptoms, the researchers enrolled 20 unmedicated patients (mean age, 7.8 years; 16 boys) with ADHD, including 14 with combined subtype and six with the inattentive subtype of ADHD.

The brain-computer interface system consisted of a headband with mounted dry EEG sensors that transmitted EEG readings to the computer through Bluetooth-enabled protocol. The headband was worn around the forehead, with a grounding reference electrode clipped to the earlobe. Two dry EEG electrode sensors positioned to detect the EEG pattern were mounted on a headband.

Treatment consisted of an 8-week training period comprising 24 sessions followed by three once-monthly booster training sessions.

According to study results, both parent-rated inattentive and hyperactive-impulsive symptoms on the ADHD Rating Scale showed significant improvement. At week 8 of the training schedule, the mean improvement was –4.6 and –4.7, respectively, for inattentive symptoms and hyperactive-impulsive symptoms (both P<.01).

“Our results show that an 8-week intervention significantly improved inattentive symptoms of ADHD, based on a behavioral rating scale by parents,” Lim and colleagues said. “Among children with the combined subtype of ADHD, parents also reported a significant improvement in their hyperactive-impulsive symptoms on the ADHD Rating Scale. When these children received monthly training sessions subsequently, the behavioral improvements were sustained but did not further improve. Those with more severe symptoms were also the ones who showed greater improvement.”

According to researchers, 17 (85%) children completed the entire study. One boy dropped out before 4 weeks, as the parent felt there was no improvement in the child’s behavior. Two more boys dropped out between 4 and 8 weeks due to difficulty adhering to the treatment schedule.

Disclosure: The researchers reported a grant from the Institute for Infocomm Research, the developer of the brain-computer interface-based attention training game and a co-investigator on this project. The brain-computer interface-based attention training game system has been licensed by Atentiv Inc., and the researchers reported consulting relationships with Atentiv Inc.

An 8-week intervention with a brain-computer interface-based attention training program significantly improved inattentive symptoms associated with attention-deficit/hyperactivity disorder in children aged 6 to 12 years, according to recent study results.

In previous trials, Choon Guan Lim, MD, of the department of child and adolescent psychiatry at the Institute for Mental Health in Singapore, and colleagues developed an intervention in which EEG-based biofeedback systems were used alongside a brain-computer interface-based attention training game system, enabling an individual to develop increasing attention while playing the game.

“In our first study, we found that intervention with a training program involving the [brain-computer interface]-based attention training game system improved parent-reported inattentive symptoms,” Lim and colleagues said.

“It also involved the use of a very simple game and a tethered connection to a computer,” they said. “Since then, we have developed a new version of the device that is simple, uses dry EEG electrodes and is connected by Bluetooth to the computer. A new game that could be calibrated based on the performance of the child was also developed. In addition, it was important to understand who would be the right candidates to benefit from this approach.”

To determine whether the newly developed game, as well as a more intensive training schedule involving three sessions per week for 8 weeks, would be more effective in improving ADHD symptoms, the researchers enrolled 20 unmedicated patients (mean age, 7.8 years; 16 boys) with ADHD, including 14 with combined subtype and six with the inattentive subtype of ADHD.

The brain-computer interface system consisted of a headband with mounted dry EEG sensors that transmitted EEG readings to the computer through Bluetooth-enabled protocol. The headband was worn around the forehead, with a grounding reference electrode clipped to the earlobe. Two dry EEG electrode sensors positioned to detect the EEG pattern were mounted on a headband.

Treatment consisted of an 8-week training period comprising 24 sessions followed by three once-monthly booster training sessions.

According to study results, both parent-rated inattentive and hyperactive-impulsive symptoms on the ADHD Rating Scale showed significant improvement. At week 8 of the training schedule, the mean improvement was –4.6 and –4.7, respectively, for inattentive symptoms and hyperactive-impulsive symptoms (both P<.01).

“Our results show that an 8-week intervention significantly improved inattentive symptoms of ADHD, based on a behavioral rating scale by parents,” Lim and colleagues said. “Among children with the combined subtype of ADHD, parents also reported a significant improvement in their hyperactive-impulsive symptoms on the ADHD Rating Scale. When these children received monthly training sessions subsequently, the behavioral improvements were sustained but did not further improve. Those with more severe symptoms were also the ones who showed greater improvement.”

According to researchers, 17 (85%) children completed the entire study. One boy dropped out before 4 weeks, as the parent felt there was no improvement in the child’s behavior. Two more boys dropped out between 4 and 8 weeks due to difficulty adhering to the treatment schedule.

Disclosure: The researchers reported a grant from the Institute for Infocomm Research, the developer of the brain-computer interface-based attention training game and a co-investigator on this project. The brain-computer interface-based attention training game system has been licensed by Atentiv Inc., and the researchers reported consulting relationships with Atentiv Inc.