New Horizons in ADHD treatment: living Z score training from a circadian perspective

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by alterations such as impulsivity, hyperactivity, and inattention. New techniques have been developed to overcome adversities that traditional established treatments entail. This is the case of neurofeedback. New clinical research lines are recently applying Quantitative EEG (QEEG) guided neurofeedback with promising results. One version of this use of QEEG is Z-Score training, which focus on Z-Scores by comparing data with a normative database capable of calculating standard deviations. Additionally, ADHD has a strong relationship with sleep disturbances and circadian rhythm alterations. A new circadian perspective is required to be taken to approach ADHD. Measuring ADHD symptomatology and executive vigilance, our study has a two-fold aim: i) to compare QEEG Z-Score (individualized training) to standard traditional training, and ii) to adapt the intervention to the circadian rhythm. Thus, an intervention proposal has been designed in which adults with ADHD were trained by using two different neurofeedback protocol (QEEG Z-Score vs. standard) in their optimum time of day or not (adjusted to the chronotype vs. no adjusted to the chronotype). It was predicted a better outcome in individualized QEEG Z-Score training with chronotype adjustment reducing ADHD symptomatology and executive vigilance in comparison to standard training with no adjustment. To clarify our hypotheses and data analyses, we simulated data from 300 adults with ADHD that would participate in the intervention. We can conclude from simulated data that individualized training can reach higher improvement than traditional interventions in neurofeedback.