fMRI Neurofeedback Training for Increasing Anterior Cingulate Cortex Activation in Adult Attention Deficit Hyperactivity Disorder. An Exploratory Randomized, Single-Blinded Study

• Published in: PloS one Vol. 12; no. 1; p. e0170795
• Main Authors: Zilverstand, Anna, Sorger, Bettina, Slaats-Willemse, Dorine, Kan, Cornelis C, Goebel, Rainer, Buitelaar, Jan K
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 26.01.2017; Public Library of Science (PLoS)
• Subjects: Activation; Addictive behaviors; Adult; Adults; Attention Deficit Disorder with Hyperactivity - diagnostic imaging; Attention Deficit Disorder with Hyperactivity - physiopathology; Attention Deficit Disorder with Hyperactivity - therapy; Attention deficit hyperactivity disorder; Behavior; Biofeedback; Biology and Life Sciences; Brain; Brain Mapping; Care and treatment; Child & adolescent psychiatry; Children & youth; Cognition & reasoning; Cognition - physiology; Cognitive ability; Cognitive Therapy - methods; Cortex (cingulate); Development and progression; Diagnosis; Electroencephalography; Feasibility studies; Feedback; Female; Functional magnetic resonance imaging; Gyrus Cinguli - diagnostic imaging; Gyrus Cinguli - physiopathology; Humans; Hyperactivity; Magnetic Resonance Imaging; Male; Medical imaging; Medicine and Health Sciences; Memory; Middle Aged; Neurofeedback; Neuropsychological Tests; Neurosciences; Randomization; Research and Analysis Methods; Single-Blind Method; Social Sciences; Studies; Substance abuse treatment; Training; United States; Netherlands
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0170795

Attention Deficit Hyperactivity Disorder (ADHD) is characterized by poor cognitive control/attention and hypofunctioning of the dorsal anterior cingulate cortex (dACC). In the current study, we investigated for the first time whether real-time fMRI neurofeedback (rt-fMRI) training targeted at increasing activation levels within dACC in adults with ADHD leads to a reduction of clinical symptoms and improved cognitive functioning. An exploratory randomized controlled treatment study with blinding of the participants was conducted. Participants with ADHD (n = 7 in the neurofeedback group, and n = 6 in the control group) attended four weekly MRI training sessions (60-min training time/session), during which they performed a mental calculation task at varying levels of difficulty, in order to learn how to up-regulate dACC activation. Only neurofeedback participants received continuous feedback information on actual brain activation levels within dACC. Before and after the training, ADHD symptoms and relevant cognitive functioning was assessed. Results showed that both groups achieved a significant increase in dACC activation levels over sessions. While there was no significant difference between the neurofeedback and control group in clinical outcome, neurofeedback participants showed stronger improvement on cognitive functioning. The current study demonstrates the general feasibility of the suggested rt-fMRI neurofeedback training approach as a potential novel treatment option for ADHD patients. Due to the study's small sample size, potential clinical benefits need to be further investigated in future studies. ISRCTN12390961.