Efficacy of Integrated Neurofeedback and Virtual Reality Training in Children with ADHD: A Randomized Controlled Trial

Abstract Objective: This research aims to explore the therapeutic outcomes of combining Neurofeedback (NF) with Virtual Reality (VR) training on children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) through a randomized controlled trial. Methods: ADHD patients from the Children's Psychiatry Outpatient and Inpatient Departments of the Seventh People's Hospital in Hangzhou were randomly divided into two groups from March 2021 to December 2022. One group received standard neurofeedback therapy (control group), and the other underwent a combined neurofeedback therapy and a VR-based training system (intervention group). The intervention lasted for three months. This research utilized the SNAP-IV (Swanson, Nolan, and Pelham-IV) Attention Rating Scale for comparative analysis between the groups before and after the intervention. Results: This study found that combining neurofeedback and virtual reality training has a positive impact on inattention, hyperactivity/impulsivity, and oppositional defiant disorder (ODD)in children with ADHD. Specifically, within the intervention group, the average inattention score decreased significantly from 24.0 (SD = 2.6) before the intervention to 16.8 (SD = 2.7) after the intervention, with an effect size of 2.72 (95% CI: 2.01, 3.42). Similarly, the hyperactivity/impulsivity score decreased significantly from 19.0 (SD = 3.3) to 14.6 (SD = 2.8), with an effect size of 1.44 (95% CI: 0.87, 2.01), and the ODD score decreased from 16.6 (SD = 3.6) to 12.5 (SD = 2.2), with an effect size of 1.37 (95% CI: 0.81, 1.94). After the intervention, intergroup comparisons showed that compared to the intervention group (mean 16.8, SD=2.7), the control group (mean 19.9, SD=3.1) had significantly higher scores in inattention, with an effect size of 1.08 (95% CI: 0.54, 1.62). The difference in hyperactivity/impulsivity scores was smaller but statistically significant, with the control group averaging 16.17 (SD=2.84) and the intervention group 14.60 (SD=2.77), with an effect size of 0.56 (95% CI: 0.04, 1.07). The ODD scores were also higher in the control group (13.93, SD=2.98) compared to the intervention group (12.53, SD=2.21), with an effect size of 0.53 (95% CI: 0.02, 1.05). The intervention group, combining neurofeedback and VR attention training, showed a significant reduction in inattention (average decrease of 7.2, SD=3.6, effect size -0.68 (95% CI: -1.20, -0.16)), with less and non-significant reductions in hyperactivity/impulsivity and ODD symptoms, highlighting the targeted efficacy of the intervention on attention deficits. Conclusion: Integrating neurofeedback and VR training significantly reduces inattention in children with ADHD, offering a promising approach for targeting core symptoms of the disorder.