Revolutionizing ADHD Treatment Through Neuromonitoring-Guided Working Memory Interventions

By Ali Rahimpour Jounghani, Ph.D.

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition affecting 5–7% of children globally. It manifests through challenges in attention regulation, impulse control, emotional regulation, and executive functioning. Among these, working memory (WM) deficits represent a core feature, significantly impacting learning, social interactions, and daily functioning. A recent study, published in iScience, introduces a groundbreaking neuromonitoring-guided intervention that directly targets these deficits, offering new hope for children with ADHD.

Understanding the Need for Precision in ADHD Interventions

Despite decades of research, current ADHD treatments, such as behavioral therapies and medications, often fail to address the neural mechanisms driving symptoms. While medications provide temporary symptom relief, their effects are not always consistent due to the substantial heterogeneity that exists in ADHD. Research in Stanford’s C-BRAIN Lab (Computational Brain Research & Intervention lab), led by Prof. Hadi Hosseini, aims to fill this gap by using real-time functional near-infrared spectroscopy (fNIRS) to personalize interventions for targeted enhancement of affected brain networks.

Innovative Approach: Merging Neuroscience and Intervention

The team developed an intervention that integrates computerized working memory (WM) training with real-time neuromonitoring and neurofeedback (NFB) for targeted enhancement of WM brain networks. During the 12-session program, children participated in cognitive exercises designed to challenge and improve WM capacity. fNIRS provided real-time feedback on brain activity, enabling children to reinforce their performance based on engagement of key brain regions, such as the dorsolateral prefrontal cortex (dlPFC), tailored for each individual.

 A randomized control trial on children with ADHD aged 7–11 years was conducted. Participants were assigned to either the NFB group or a treatment-as-usual group receiving standard clinical care. Of the 36 participants who completed the study, those in the NFB group showed substantial improvements in frontoparietal activity (measured via fMRI and fNIRS), working memory performance (assessed using n-back tasks), and ADHD symptoms (evaluated through Conners 3 and BRIEF-2 scores before and after the intervention).

Key Findings: Bridging Brain Activity and Behavior

The results were striking. In the NFB group:

• Neurocognitive improvements: 85% of participants demonstrated enhanced activity in brain regions critical for WM, including the dorsolateral and ventrolateral prefrontal cortex.
• Clinical and behavioral improvements: Significant reductions were observed in ADHD symptoms indicated by Conners 3 ADHD index scores and in real-life working memory abilities measured by BRIEF-2 WM T-scores, with over half of the participants achieving clinically meaningful improvements.
• WM performance gains: Accuracy in n-back WM task increased by an average of 8%, compared to a decline in the treatment-as-usual group.

These results not only validate the effectiveness of neuromonitoring-guided interventions but also highlight the potential of precision psychiatry to transform ADHD care.

Why fNIRS? Advancing Accessibility in Mental Health

Functional near-infrared spectroscopy emerged as the neuroimaging tool of choice due to its child-friendly design, affordability, and adaptability for naturalistic settings. Unlike fMRI, which requires participants to remain still in confined spaces, fNIRS allows for real-time brain monitoring in comfortable environments. Its portability makes it particularly well-suited for interventions that require repeated sessions, offering a scalable and cost-effective solution for families and clinicians.

Additionally, wearable fNIRS technology is advancing rapidly, with the potential for home-based use. “Imagine a future where children can engage in cognitive training at home, with caregivers and clinicians monitoring progress remotely through cloud-based systems. We are actively working on developing such a platform, aiming to bring personalized, neuromonitoring-guided interventions into everyday settings,” says Prof. Hosseini.

Implications for Precision Mental Health

The study marks a significant step forward in the evolution personalized interventions for ADHD. By focusing on the individual variability in brain activity, the team demonstrated that personalized interventions can yield profound improvements in cognitive and behavioral outcomes. This personalized approach aligns with the broader goals of precision mental health, where interventions are tailored not just to symptoms but to the underlying neural mechanisms.

Addressing Limitations and Future Directions

While findings are promising, they are not without limitations. The relatively small sample size limits generalizability, and further research with larger, more diverse populations is needed. Incorporating active control groups and exploring long-term effects will be critical for refining this intervention. The proposed intervention can be applied to other neurodevelopmental conditions extending its benefits beyond ADHD.

The Road Ahead: From Lab to Everyday Life

One of the most exciting prospects of the research lies in its scalability. The integration of wearable, portable fNIRS devices with real-time neuromonitoring opens the door to delivering interventions in real-life settings, such as homes or classrooms. “This aligns with our vision of making mental health treatments more accessible, especially for underserved populations. As we move forward, our focus will be on improving the affordability and user-friendliness of these technologies, ensuring that families and clinicians worldwide can benefit from precision psychiatry,” says Prof. Hosseini.

Conclusion: A New Era in ADHD Treatment

This study underscores the transformative potential of neuromonitoring-guided interventions in ADHD care. By combining cutting-edge neuroscience with practical, child-friendly tools, the team in the C-BRAIN Lab at Stanford U. offers a glimpse into a future where mental health treatments are as dynamic and individualized as the brains they aim to heal.

To explore the full findings, please refer to the study published in iScience: 10.1016/j.isci.2024.111087

Authors of the report affiliated with Stanford U. are Postdoctoral Researcher, Ali Rahimpour Jounghani; Instructor, Elveda Gozdas; Lauren Dacorro; Assistant Professor Bárbara Avelar-Pereira; Samantha Reitmaier; Hannah Fingerhut; Associate Professor David S. Hong; Professor Emeritus Glen Elliott, M.D.; Professor Antonio Y. Hardan, and Associate Professor S.M. Hadi Hosseini.  Stephen P. Hinshaw, Ph.D., is Distinguished Professor of Psychology at the University of California, Berkeley.

The study was funded by National Institute of Mental Health (R61MH119289). Prof. Hadi Hosseini’s effort was supported in part by NIA (R01AG073362, R01AG072470, R21AG064263, R21AG073973) and National Institute of Mental Health (NIMH; R61MH119289, R21MH123873).

The eWEAR-TCCI awards for science writing is a project commissioned by the Wearable Electronics Initiative (eWEAR) at Stanford University and made possible by funding through eWEAR industrial affiliates program member Shanda Group and the Tianqiao and Chrissy Chen Institute (TCCI®).