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Right inferior frontal cortex (rIFC) is one of the most consistently underactivated brain regions in ADHD children during cognitive control tasks (Norman et al., 2015, Hart et al., 2012). Furthermore, we found this region to be a disorder-specific neurofunctional biomarker of ADHD relative to other childhood disorders (Rubia, 2011, Norman et al., 2016). rIFC is also the brain region that is most consistently upregulated with psychostimulant medication, which is the benchmark treatment for ADHD as it is effective in 70% of patients (Rubia et al., 2014). However, stimulant medication has side effects and long-term efficacy has not been demonstrated. In this study, we wanted to teach ADHD adolescents to self-upregulate this brain region which is consistently underactivated and most consistently upregulated with stimulant medication using real-time Neurofeedback with functional magnetic resonance imaging (rtfMRI-NF). For this purpose, we conducted a proof of concept randomised controlled trial (RCT) of rtfMRI-NF of rIFC in ADHD adolescents. We hypothesised that rtfMRI-NF would improve clinical symptoms of ADHD, cognitive control functions that are mediated by rIFC (such as sustained attention, inhibition, temporal discounting, time estimation) and the activation of rIFC during a motor inhibition stop task that is typically underactivated.

frontiers in human neuroscience

A randomized controlled clinical trial of real-time functional magnetic resonance imaging neurofeedback for adolescents with attention deficit hyperactivity disorder (ADHD)