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fMRI Neurofeedback Ineffective in Improving Pediatric ADHD Symptoms
Functional MRI neurofeedback (fMRI-NF) may be ineffective in improving clinical symptoms or cognition in boys with attention-deficit/hyperactivity disorder (ADHD), according to a recent double-blind, sham-controlled randomized controlled trial. Researchers published their results in The American Journal of Psychiatry.
“A [previous] proof-of-concept randomized controlled trial of fMRI-NF of the right inferior frontal cortex (rIFC), compared to an active control condition, showed promising improvement of ADHD symptoms (albeit in both groups) and in brain function,” wrote lead author Sheut-Ling Lam, PhD, MSc, King’s College, London, United Kingdom, and co-authors. Their study, however, proved Dr. Lam and co-authors’ hypothesis to be incorrect.
To test the effectiveness and efficacy of fMRI-NF of the rIFC on symptoms and executive functions, researchers asked participants to control the speed and direction of an on-screen rocketeer flying from ground level into space. Participants, 88 boys with ADHD, were evenly split into active or sham fMRI-NF groups. In the active group, the level of brain activity in the rIFC controlled the speed of the rocketeer and its direction (upward or downward).
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To examine treatment-related changes, researchers compared the 2 groups at the posttreatment and 6-month follow-up assessments, controlling for baseline scores, age, and medication status. The primary outcome measure was the posttreatment score on the ADHD Rating Scale (ADHD-RS).
“No significant group differences were found on the ADHD-RS. Both groups showed similar decreases in other clinical and cognitive measures, except for a significantly greater decrease in irritability and improvement in motor inhibition in sham relative to active fMRI-NF at the posttreatment assessment, covarying for baseline,” researchers said.
The active group displayed enhanced activation in rIFC and other frontal and temporo-occipital-cer-ebellar self-regulation areas, compared with the sham group. However, “there was no progressive rIFC upregulation, correlation with ADHD-RS scores, or transfer of learning.”
No significant side effects or adverse events were reported.
“Standard approaches to ADHD management, in particular pharmacotherapy, are not without shortcomings but have an abundance of data supporting their acute benefits and long-term safety,” wrote James J. McGough, MD, professor of clinical psychiatry at the Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, in an editorial regarding the study, also published in the American Journal of Psychiatry. “Reliance on an unsubstantiated therapy in lieu of timely implementation of effective treatments cannot be in the best interests of children during periods of critical developmental change. Ongoing innovation in more effective and acceptable approaches to ADHD management is certainly essential and warranted.”
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