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Computer Attention Training in Schools for Children with ADHD

Naomi Steiner, MD, Principal Investigator

For the article on the pilot study using computer attention training with and without neurofeedback click HERE.

The symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) pose significant challenges for children and families.  Although treatment with stimulant medication is effective for many children, parents are often resistant to pharmacological treatment and continuing to take the medication is also a well known challenge.  Additionally, many children show partial or lack of response to medication. 

In addition to the classic ADHD symptoms of poor attention span, high activity level, and impulsivity, children with ADHD are at substantial risk for behavioral problems at school, academic underperformance and failure, and dropout.  Inattention and hyperactivity also present a significant challenge for classroom teachers, who often find that they are spending a disproportionate amount of time and attention redirecting children with ADHD.  In light of this, schools – as well as parents and clinicians – have a vested interest in identifying effective, pragmatic treatments for ADHD.

Interest in treatments such as computer-based attention training systems has increased in recent years. There are two groups of computer attention training systems: one uses neurofeedback (or EEG biofeedback) to train children with ADHD to focus on a task, and the other uses a standard computer for cognitive retraining via specific computer tasks. Given their commercial development, academic research on their efficacy has been limited.  Our team has developed an innovative partnership between an academic medical center and two public school systems in Massachusetts, with two main goals:  1) to examine both computer attention training systems in a formal, randomized controlled trial over 4 years, and 2) to examine the feasibility of implementing these treatments within the school system, during the school day.  Our study is funded by the Federal Department of Education and includes elementary school children.

We have enrolled children in 19 elementary schools. The participants are randomized (like flipping a coin) to receive one of two computer attention training systems (the programs are considered clinically equal) or to be placed on a waitlist.  Children assigned to one of the interventions receive three sessions a week, under the supervision of a coach, who has received standardized training on the computer attention training systems, for a target goal of 40 sessions per child.  Waitlisted children receive the computer intervention during the following school year.  Assessments, including parent and teacher feedback and classroom observations, are conducted at baseline, post-treatment, and at 6-month follow-up.  Our study aims to gather information on how these computer attention training works.

Running the attention training treatment intervention in the schools is important because it renders it accessible to all children. Clinicians who work with children are sensitive to the many barriers to successful provision of longer-term behavioral interventions, including transportation issues, competing family priorities, cost, and the typical difficulties associated with adherence to any long-term treatment.  Additionally, school staff, including special education staff and paraprofessionals, can be easily trained to be “coaches” in order to sustain the program outside of a research context.  If we are able to demonstrate that these programs are effective as well as feasible to conduct within a public school system, it will have broad implications regarding increased access to care and effective spending of education dollars.