Near-infrared spectroscopy-based neurofeedback training (NIRS-based NFT) integrated in a virtual reality (VR) classroom in children with attention-deficit/hyperactivity disorder (ADHD)

Abstract

Young children with Attention-Deficit/Hyperactivity Disorder (ADHD) suffer from executive function difficulty and poor emotional management across different contexts. Previous studies have shown that the impairment in executive function and emotional management are associated with the dysregulation of prefrontal cortex activation. Non-pharmacological ADHD treatments such as traditional behavioural interventions can significantly improve executive function, but their long-term effects are inconclusive. In this study, we designed a novel training paradigm using functional near-infrared spectroscopy (fNIRS)-based neurofeedback (NF) to reinforce children with ADHD regulating their prefrontal cortex activation. Moreover, using virtual reality (VR) ensures the acquired self-regulation skills can generalize to everyday life scenarios. In this study, we examined the feasibility of combining an immersive classroom environment with fNIRS-based NF training in children with ADHD. We also preliminarily explored whether fNIRS-based NF training in the simulated classroom could improve the selfregulation of brain activation in the prefrontal cortex. We hypothesized that the training would enhance children’s ability to self-regulate their brain activity. Three participants in primary school age (7-11 years of age) with clinically diagnosed ADHD were recruited. Training consisted of two phases; each consisted of six training sessions with two sessions conducted per week and one week of break between the first and second phases. Results indicated that the severity of discomfort experienced during the VR training did not reach a concerning level. The prefrontal cortex activation was better regulated during activation and deactivation trials with NF after training. The prefrontal cortex activation regulation was also better post-training during activation and deactivation trials without any neurofeedback, suggesting the occurrence of skill transfer in these children. Our results suggest that the fNIRS-based NF training paradigm in a simulated classroom environment may be a promising intervention that can improve the symptoms of ADHD and facilitate the generalization of attentional and inhibitory control in real life for children with ADHD.