Peer-reviewed published research
Below are the titles and abstracts of published research studies examining the training used in Focus Pocus
Jiang, H., Johnstone, S. J., Sun, L., Zhang, D. (in press). Effect of neurocognitive training for children with AD/HD at improving academic engagement in two learning settings. Journal of Attention Disorders, accepted 09/08/2018.
Objective: This preliminary study investigated effectiveness of neurocognitive training on academic engagement (AET) for children with ADHD. The training approach targeted working memory, inhibitory control, and attention/relaxation (via brain electrical activity). Method: A reversal design with a 2-week follow-up was used to assess the effectiveness of the treatment on two children with diagnosed ADHD in two learning settings. Direct observation was used to collect academic-related behavior. Results: Improvements in on-task expected behavior (ONT-EX) and general AET, as well as reductions in off-task motor activity (OFF-MA) and off-task passive behavior (OFF-PB) were observed for both students over baselines and across the settings. Moreover, differences in behavioral change were found between participants and settings. Conclusion: These findings support using the treatment for improving academic performance of children with ADHD. Future studies may investigate influences of contextual differences, nontreatment variables, or adult’s feedback during the training session on treatment effectiveness.
Johnstone, S. J., Roodenrys, S.J., Johnson, K., Bonfield, R., Bennett, S. J. (2017). Game-based combined cognitive and neurofeedback training using Focus Pocus reduces symptom severity in children with diagnosed AD/HD and subclinical AD/HD. International Journal of Psychophysiology, 116, 32-44.
Abstract: Previous studies report reductions in symptom severity after combined working memory (WM) and inhibitory control (IC) training in children with AD/HD. Based on theoretical accounts of the role of arousal/attention modulation problems in AD/HD, the current study examined the efficacy of combined WM, IC, and neurofeedback training in children with AD/HD and subclinical AD/HD. Using a randomized waitlist control design, 85 children were randomly allocated to a training or waitlist condition and completed pre- and post-training assessments of overt behavior, trained and untrained cognitive task performance, and resting and task-related EEG activity. The training group completed twenty-five sessions of training using Focus Pocus software at home over a 7 to 8-week period. Trainees improved at the trained tasks, while enjoyment and engagement declined across sessions. After training, AD/HD symptom severity was reduced in the AD/HD and subclinical groups according to parents, and in the former group only according to blinded teachers and significant-others. There were minor improvements in two of six near-transfer tasks, and evidence of far-transfer of training effects in four of five far-transfer tasks. Frontal region changes indicated normalization of atypical EEG features with reduced delta and increased alpha activity. It is concluded that technology developments provide an interesting a vehicle for delivering interventions and that, while further research is needed, combined WM, IC, and neurofeedback training can reduce AD/HD symptom severity in children with AD/HD and may also be beneficial to children with subclinical AD/HD.
Jiang, H., and Johnstone, S. J. (2015). A preliminary multiple case study report of neurocognitive training for children with ADHD in China. Sage Open, 5 (2), 1-13.
Broad summary: In this study, behaviour was assessed using standardised methods before and after Focus Pocus. Figure A shows parent-rated change in certain types of behaviour after Focus Pocus. Figure B shows teacher-rated changes. The broad range of benefits that result from the neurocognitive approach are seen in both parent and teacher ratings of behaviour and include substantial improvements in attention, behavioural control, social contacts, and anxiety/depression.
Objective: This preliminary study investigated effectiveness of neurocognitive training on academic engagement (AET) for children with ADHD. The training approach targeted working memory, inhibitory control, and attention/relaxation (via brain electrical activity). Method: A reversal design with a 2-week follow-up was used to assess the effectiveness of the treatment on two children with diagnosed ADHD in two learning settings. Direct observation was used to collect academic-related behavior. Results: Improvements in on-task expected behavior (ONT-EX) and general AET, as well as reductions in off-task motor activity (OFF-MA) and off-task passive behavior (OFF-PB) were observed for both students over baselines and across the settings. Moreover, differences in behavioral change were found between participants and settings. Conclusion: These findings support using the treatment for improving academic performance of children with ADHD. Future studies may investigate influences of contextual differences, nontreatment variables, or adult’s feedback during the training session on treatment effectiveness.
Johnstone, S. J., Roodenrys, S.J., Johnson, K., Bonfield, R., Bennett, S. J. (2017). Game-based combined cognitive and neurofeedback training using Focus Pocus reduces symptom severity in children with diagnosed AD/HD and subclinical AD/HD. International Journal of Psychophysiology, 116, 32-44.
Abstract: Previous studies report reductions in symptom severity after combined working memory (WM) and inhibitory control (IC) training in children with AD/HD. Based on theoretical accounts of the role of arousal/attention modulation problems in AD/HD, the current study examined the efficacy of combined WM, IC, and neurofeedback training in children with AD/HD and subclinical AD/HD. Using a randomized waitlist control design, 85 children were randomly allocated to a training or waitlist condition and completed pre- and post-training assessments of overt behavior, trained and untrained cognitive task performance, and resting and task-related EEG activity. The training group completed twenty-five sessions of training using Focus Pocus software at home over a 7 to 8-week period. Trainees improved at the trained tasks, while enjoyment and engagement declined across sessions. After training, AD/HD symptom severity was reduced in the AD/HD and subclinical groups according to parents, and in the former group only according to blinded teachers and significant-others. There were minor improvements in two of six near-transfer tasks, and evidence of far-transfer of training effects in four of five far-transfer tasks. Frontal region changes indicated normalization of atypical EEG features with reduced delta and increased alpha activity. It is concluded that technology developments provide an interesting a vehicle for delivering interventions and that, while further research is needed, combined WM, IC, and neurofeedback training can reduce AD/HD symptom severity in children with AD/HD and may also be beneficial to children with subclinical AD/HD.
Jiang, H., and Johnstone, S. J. (2015). A preliminary multiple case study report of neurocognitive training for children with ADHD in China. Sage Open, 5 (2), 1-13.
Broad summary: In this study, behaviour was assessed using standardised methods before and after Focus Pocus. Figure A shows parent-rated change in certain types of behaviour after Focus Pocus. Figure B shows teacher-rated changes. The broad range of benefits that result from the neurocognitive approach are seen in both parent and teacher ratings of behaviour and include substantial improvements in attention, behavioural control, social contacts, and anxiety/depression.
Figure A.
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Figure B.
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Abstract: This preliminary multiple case study examined the behavioral outcomes of neurocognitive training on children with attention-deficit/hyperactivity disorder (AD/HD) in China, as well as parent acceptance of the treatment. The training approach targeted working memory, impulse control, and attention/relaxation (via brain electrical activity). Outcome measures included overt behavior as rated by parents and teachers, AD/HD symptom frequency, and parent opinion/feedback. Training was completed by five individuals and delivered via a themed computer game with electroencephalogram (EEG) input via a wireless, single-channel, dry-sensor, portable measurement device. The objective (i.e., training outcomes and EEG) and subjective (i.e., parent ratings/feedback and teacher ratings) data suggested that use of the neurocognitive training resulted in reduced AD/HD behaviors and improvement in socially meaningful outcomes. The parents expressed satisfaction with the training procedure and outcomes. It is concluded that the innovative neurocognitive training approach is effective for improving behavior and reducing symptoms of AD/HD for children in China.
Johnstone, S. J., Roodenrys, S., Blackman, R., Johnston, E., Loveday, K., Mantz, S., Barratt, M. (2012). Neurocognitive training for children with and without AD/HD. ADHD Attention Deficit and Hyperactivity Disorders, 4, 11-23.
Abstract: There is accumulating evidence that computerised cognitive training of inhibitory control and/or working memory can lead to behavioural improvement in children with AD/HD. Using a randomised waitlist control design, the present study examined the effects of combined working memory and inhibitory control training, with and without passive attention monitoring via EEG, for children with and without AD/HD. One hundred and twenty-eight children (60 children with AD/HD, 68 without AD/HD) were randomly allocated to one of three training conditions (waitlist; working memory and inhibitory control with attention monitoring; working memory and inhibitory control without attention monitoring) and completed with pre- and post-training assessments of overt behaviour (from 2 sources), trained and untrained cognitive task performance, and resting EEG activity. The two active training conditions completed 25 sessions of training at home over a 4- 5-week period. Results showed significant improvements in overt behaviour for children with AD/HD in both training conditions compared to the waitlist condition as rated by a parent and other adult. Post-training improvements in the areas of spatial working memory, ignoring distracting stimuli, and sustained attention were reported for children with AD/HD. Children without AD/HD showed behavioural improvements after training. The improvements for both groups were maintained over the 6-week period following training. The passive attention monitoring via EEG had a minor effect on training outcomes. Overall, the results suggest that combined WM/IC training can result in improved behavioural control for children with and without AD/HD.
Johnstone, S. J., Roodenrys, S., Phillips, E., Watt, A. J. & Mantz, S. (2010). A pilot study of combined working memory and inhibition training for children with AD/HD. ADHD Attention Deficit and Hyperactivity Disorders, 2, 31-42.
Abstract: Building on recent favourable outcomes using working memory (WM) training, this study examined the behavioural and physiological effect of concurrent computer-based WM and inhibition training for children with attention-deficit hyperactivity disorder (AD/HD). Using a double-blind active-control design, 29 children with AD/HD completed a 5-week at-home training programme and pre- and post-training sessions which included the assessment of overt behaviour, resting EEG, as well as task performance, skin conductance level and event-related potentials (ERPs) during a Go/Nogo task. Results indicated that after training, children from the high-intensity training condition showed reduced frequency of inattention and hyperactivity symptoms. Although there were trends for improved Go/Nogo performance, increased arousal and specific training effects for the inhibition-related N2 ERP component, they failed to reach standard levels of statistical significance. Both the low- and high-intensity conditions showed resting EEG changes (increased delta, reduced alpha and theta activity) and improved early attention alerting to Go and Nogo stimuli, as indicated by the N1 ERP component, post-training. Despite limitations, this preliminary work indicates the potential for cognitive training that concurrently targets the interrelated processes of WM and inhibition to be used as a treatment for AD/HD.
Abstract: There is accumulating evidence that computerised cognitive training of inhibitory control and/or working memory can lead to behavioural improvement in children with AD/HD. Using a randomised waitlist control design, the present study examined the effects of combined working memory and inhibitory control training, with and without passive attention monitoring via EEG, for children with and without AD/HD. One hundred and twenty-eight children (60 children with AD/HD, 68 without AD/HD) were randomly allocated to one of three training conditions (waitlist; working memory and inhibitory control with attention monitoring; working memory and inhibitory control without attention monitoring) and completed with pre- and post-training assessments of overt behaviour (from 2 sources), trained and untrained cognitive task performance, and resting EEG activity. The two active training conditions completed 25 sessions of training at home over a 4- 5-week period. Results showed significant improvements in overt behaviour for children with AD/HD in both training conditions compared to the waitlist condition as rated by a parent and other adult. Post-training improvements in the areas of spatial working memory, ignoring distracting stimuli, and sustained attention were reported for children with AD/HD. Children without AD/HD showed behavioural improvements after training. The improvements for both groups were maintained over the 6-week period following training. The passive attention monitoring via EEG had a minor effect on training outcomes. Overall, the results suggest that combined WM/IC training can result in improved behavioural control for children with and without AD/HD.
Johnstone, S. J., Roodenrys, S., Phillips, E., Watt, A. J. & Mantz, S. (2010). A pilot study of combined working memory and inhibition training for children with AD/HD. ADHD Attention Deficit and Hyperactivity Disorders, 2, 31-42.
Abstract: Building on recent favourable outcomes using working memory (WM) training, this study examined the behavioural and physiological effect of concurrent computer-based WM and inhibition training for children with attention-deficit hyperactivity disorder (AD/HD). Using a double-blind active-control design, 29 children with AD/HD completed a 5-week at-home training programme and pre- and post-training sessions which included the assessment of overt behaviour, resting EEG, as well as task performance, skin conductance level and event-related potentials (ERPs) during a Go/Nogo task. Results indicated that after training, children from the high-intensity training condition showed reduced frequency of inattention and hyperactivity symptoms. Although there were trends for improved Go/Nogo performance, increased arousal and specific training effects for the inhibition-related N2 ERP component, they failed to reach standard levels of statistical significance. Both the low- and high-intensity conditions showed resting EEG changes (increased delta, reduced alpha and theta activity) and improved early attention alerting to Go and Nogo stimuli, as indicated by the N1 ERP component, post-training. Despite limitations, this preliminary work indicates the potential for cognitive training that concurrently targets the interrelated processes of WM and inhibition to be used as a treatment for AD/HD.
Testimonials from users
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“David*, who is in Grade 6, has made amazing progress. David has been diagnosed AD/HD since Grade 3. Before training, he was very demotivated and underachieving at school, and could hardly pass any subject and had no friends. After 3 sessions he began to show improvements in class. He now has 2 friends. He has also made big progress in Maths, and seems more responsible and mature than before.” *Name changed
“According to his teacher, James* has made a lot of progress. He is much better in control himself and he can complete school work as quick as his peers. Before training he was very worried, demotivated and afraid to even hear any words that related to 'teacher'. Now he is a confident and happy boy.” *Name changed Are parents seeing any changes in their children’s behaviour after Focus Pocus? Parents completed an 18 item behaviour rating scale prior to, and at the end of, training with Focus Pocus. Figure 1 shows parent ratings of the frequency of three categories of behaviour, before and after training with Focus Pocus. After training with Focus Pocus there were reductions in the frequency of each category of behaviour. Parents made ratings of day-to-day behaviour at regular intervals during training (for example, after 5 training sessions had been completed). Figure 2 shows the parent ratings after 5, 10, 15 and 20 training sessions. The dark line shows the trend across training sessions, indicating improvement in behaviour across the training sessions. Are children learning awareness and control of brain states that will help them in everyday life? Children do a number of "benchmarking tests" of their ability to generate three different brain states spontaneously, without any on-screen assistance, to see if they are learning a skill they can use in everyday life. Figure 3 shows the brain state scores before and after training with Focus Pocus. The data shows increases in the ability to spontaneously produce each of the three brain state after training with Focus Pocus, with the largest increase in Focus. |
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