Does fMRI neurofeedback improve symptoms, cognition in children with ADHD?

Nonpharmacological treatment with functional magnetic resonance imaging neurofeedback (fMRI-NF) of the right inferior frontal cortex (rIFC) does not seem effective in improving clinical symptoms or cognition in boys with attention deficit hyperactivity disorder (ADHD), reports a recent study.

In an earlier proof-of-concept randomized controlled trial, fMRI-NF of the rIFC, compared to an active control condition, showed promise in relieving ADHD symptoms and improving brain function. However, its efficacy must be tested in a larger trial with a placebo comparator.

A team of investigators then conducted a double-blind, sham-controlled randomized controlled trial to test the efficacy of fMRI-NF of the rIFC on symptoms and executive functions in 88 boys with ADHD (44 each in the active and sham groups).

The two groups were then compared at the post-treatment and 6-month follow-up assessments, controlling for baseline scores, age, and medication status to assess treatment-related changes. The primary endpoint was post-treatment score on the ADHD Rating Scale (ADHD-RS).

Scores on the ADHD-RS were not significantly different between the two groups. Both arms also demonstrated similar reductions in other clinical and cognitive measures, except for a significantly greater decrease in irritability and improvement in motor inhibition in sham vs active fMRI-NF at the post-treatment assessment, covarying for baseline.

Furthermore, no significant side effects or adverse events were reported. The active fMRI-NF vs the sham group had improved activation in rIFC and other frontal and temporo-occipital-cerebellar self-regulation areas. However, no progressive rIFC upregulation, association with ADHD-RS scores, nor transfer of learning was noted.

“Contrary to the hypothesis, the study findings do not suggest that fMRI-NF of the rIFC is effective in improving clinical symptoms or cognition in boys with ADHD,” the investigators concluded.