Effects of computerized cognitive training on brain function in children with ADHD: A longitudinal neuroimaging study...

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity. Emerging evidence suggests that ADHD is linked to hypofunction of the prefrontal-parietal attention network, accompanied by compensatory hyperactivation in the cerebellum and brainstem. However, the underlying neural mechanisms remain insufficiently understood. In recent years, computerized cognitive training has gained attention as a promising non-pharmacological intervention for alleviating ADHD symptoms, though its mechanisms of action and effects on neural plasticity remain contentious. This study utilized longitudinal neuroimaging to investigate abnormal brain function in individuals with ADHD, assess the effects of personalized computerized cognitive training (PCCT) on core symptoms, and examine the relationship between functional brain changes and behavioral improvements.

Sixteen children with ADHD (ADHD group) and sixteen age- and sex-matched healthy controls (HC group) were recruited. All participants underwent resting-state functional magnetic resonance imaging (rs-fMRI) within three days of clinical assessment. The fractional amplitude of low-frequency fluctuations (fALFF) was calculated to evaluate spontaneous neural activity. The ADHD group received a 16-week PCCT intervention consisting of interference inhibition, sustained inhibition, and dominant inhibition training, administered once per week for 60 min per session. Baseline differences in fALFF between the groups were examined, along with pre- and post-intervention changes in clinical scores and fALFF values within the ADHD group. Correlation analyses were conducted between changes in fALFF and behavioral measures.

1.At baseline, the ADHD group showed significantly higher scores than the healthy control (HC) group in SNAP (hyperactivity/inattention rating scale), CPT (Continuous Performance Test), and MMFT (Memory Function Test) (P < 0.05). fALFF analysis revealed decreased fALFF values in the precuneus, angular gyrus, and postcentral gyrus, and increased fALFF values in the cerebellum and brainstem in the ADHD group (P < 0.05, GRF-corrected).2.Effects of PCCT: Following the intervention, the ADHD group demonstrated significant reductions in SNAP-IV, CPT, and MMFT scores (P < 0.05), along with improved performance in all three inhibitory control tasks. fALFF values increased in the precuneus and lingual gyrus and decreased in the cerebellum and hippocampus, indicating modulation of abnormal neural activity.3.Correlation Analysis: The fALFF value in the right cerebellar lobule IX was positively correlated with CPT scores (r = 0.715), and the fALFF value in the left hippocampus was also positively correlated with CPT scores (r = 0.642). In contrast, the fALFF value in the right superior temporal gyrus was negatively correlated with MMFT scores (r = -0.721). These findings suggest that the cerebellar-prefrontal circuit, hippocampus, and superior temporal gyrus play important roles in the regulation of cognitive functions in children with ADHD.

This study revealed widespread functional abnormalities in the brains of children with ADHD, characterized by inefficiencies in the prefrontal-parietal network and compensatory hyperactivation in the cerebellum and brainstem. PCCT effectively improved core ADHD symptoms and induced neuroplastic changes in specific brain regions, including reduced activity in the cerebellum and hippocampus and increased activity in the precuneus and lingual gyrus. Furthermore, fALFF changes in the cerebellar lobule IX, hippocampus, and superior temporal gyrus were closely associated with cognitive improvements, supporting the central role of the cerebellar-prefrontal circuitry in modulating executive functions in ADHD. These findings provide new evidence for neural compensation mechanisms and non-pharmacological treatment strategies for ADHD. Future studies may explore precision interventions targeting the cerebellar-prefrontal network, such as combining neuromodulation with cognitive training, to optimize long-term outcomes in ADHD.