This small trial studied 31 right-handed boys aged 12 to 17 with ADHD, from South London clinics. Most (24) took stable stimulant medicine. Each boy watched live brain scan feedback on activity in one brain area. The boys were randomly assigned to two groups. One group of 18 was trained to raise activity in a right frontal area. A comparison group of 13 was trained on an area on the left side. Only 11 boys finished all 14 training runs.
Both groups learned to raise activity in their own target area. Only the frontal group showed this in a later run without feedback. ADHD symptoms dropped by a medium amount after training in both groups. In the frontal group, the drop in hyperactive and impulsive behavior was only a trend. The groups did not differ, so a benefit specific to the frontal area was not shown.
At follow-up, about 11 months on average, some symptom scores were lower within each group, with no clear group difference. Parents of eight boys did not return follow-up ratings. In an exploratory analysis of the frontal group, boys whose frontal activity rose more in the no-feedback run tended to show larger drops in parent-rated symptoms. The authors say the small sample especially limited this analysis.
The authors call this a proof-of-concept study, an early test of whether the method works. The same researchers ran training and scored questionnaires. There was no sham condition (fake feedback), so placebo effects could not be ruled out.
The numbers Stats and what the terms mean
The statistics behind the plain-language claims above.
- Alegría, 2017: drop in total ADHD symptoms (ADHD-RS) from before to after training, both groups together, F1,29 = 20.41, d = 0.69.
- Alegría, 2017: difference between the two groups in that change (ADHD-RS total), F1,29 = 0.33, P = 0.6.
- Alegría, 2017: drop in total ADHD symptoms from before training to follow-up, frontal group, F1,12 = 6.25, P = 0.03, d = 0.94.
- Alegría, 2017: drop in inattention scores from before training to follow-up, comparison group, F1,9 = 6.93, P = 0.03, d = 0.45.
- Alegría, 2017: difference between the two groups in change to follow-up (ADHD-RS total), F1,21 = 0.59, P = 0.5.
- Alegría, 2017: link between frontal activity change in the no-feedback run and drop in parent-rated symptoms (CPRS-R ADHD index), frontal group, r = −0.6, P = 0.02. What the terms mean:
- d is the size of a change. Roughly, 0.2 is small, 0.5 is moderate and 0.8 is large. A minus sign shows the direction of the change, not its size.
- F is a test score comparing changes over time or between groups; the numbers after it are degrees of freedom, technical counts tied to the number of groups and people in the test.
- P is how likely a result this large would be by chance alone; below 0.05 is usually treated as unlikely to be chance.
- r is how closely two measures move together, from 0 for no link to 1 for a perfect one; a minus sign means one goes up as the other goes down.
Source: Analucía A. Alegría, Melanie Wulff, Helen Brinson, et al.. Real‐time fMRI neurofeedback in adolescents with attention deficit hyperactivity disorder. Human Brain Mapping (2017). doi:10.1002/hbm.23584