Integrating single-channel EEG neurofeedback into video game-based digital therapeutics for ADHD

BACKGROUND: Digital therapeutics have emerged as a promising non-pharmacological intervention for children with attention-deficit/hyperactivity disorder (ADHD). Personalized adaptation is key to the success of digital therapeutics. However, most existing systems depend solely on observable performance rather than real-time internal attentional state, which lead to misinterpretation or delayed adaptation. METHODS: In this study, we evaluated the effects of a tablet-based attention training game with and without EEG-informed real-time neurofeedback in children with ADHD. Participants were assigned to one of two groups: a neurofeedback group (NFb) in which the game adapted in real time based on single-channel frontal EEG signals and a standard game intervention group without neurofeedback (n-NFb). Attention and cognitive control were assessed before and after a one-month intervention. RESULTS: All children showed improvements in attention in both parent report and children's performance in attentional tasks. The NFb group showed greater improvements in hitting accuracy (go trials) and less reductions in inhibition accuracy (no-go trials) than the n-NFb group. Both groups had significantly shorter reaction times after training. EEG analyses revealed greater improvement in attention index during training for NFb group. CONCLUSION: Our findings suggest that video game-based digital therapeutics with EEG-informed real-time neurofeedback can effectively enhance attention in children with ADHD. The results support the potential of using adaptive neurofeedback with portable devices to enhance intervention effects.