A Biofeedback Training in Schoolchildren With an Attention-Deficit/Hyperactivity Disorder (ADHD): Differential Effects of Training in a 2D or 3D Environment

1. Strategies 90 schoolchildren from Grade 1 to 4 that meet criteria for a DSM-V diagnosis of ADHD (any presentation) will be recruited. The design will involve three groups (n = 30 per group; N = 90) to which recruited children will be assigned randomly, but matched for age, gender, and medication. In addition to VR NIRS NF and VR EMG biofeedback groups, a third group will experience the NIRS NF in the exact same 2D classroom environment.
2. The Study 2.1. Testing Protocol Informed consent discussion: Parents of children pre-diagnosed with ADHD will not undergo a screening process. However, parents whose children have not been pre-diagnosed with ADHD before, will be provided with the German version of the Conners-3 parent ADHD-Index (C3-AI). Only if the screening indicates that the child is at an increased risk of having ADHD, will the investigators proceed with an informed consent discussion. If the screening indicates that it is unlikely that the child has ADHD, the investigators will exclude the child from the study. After the meeting, if the child was either pre-diagnosed with ADHD before, or the screening indicates an increased likelihood for the child to have ADHD, parents will have enough time to think about whether they want to give written informed consent to participate in the study.

If parents give written informed consent, the next step will be a session in which the ADHD diagnosis is verified. For this session, parents will be informed about three opportunities.

1. Diagnostic session in the scope of their participation in a second study at the pediatric clinic in Tübingen at the same time that they participate in our biofeedback study. This study is called "Aufmerksamkeit und Kognition bei Kindern mit Neurofibromatose Typ 1", which is still searching for children with ADHD only (without neurofibromatosis type 1) to form a control group.
2. Diagnostic session in the scope of the "Spezialsprechstunde ADHS" in the outpatient clinic of the department of child and adolescence psychiatry.
3. Diagnostic session within the scope of this biofeedback study as described below.

Diagnostic session: For a standardized confirmation as well as a characterization of the diagnosis, the long versions of the Conners-3 parent and teacher rating scales (3-P and 3-T) will be applied. Furthermore, the German version of the Strengths- and Difficulties Questionnaire (SDQ-Deu) is going to assess the severity of the symptoms as well as comorbidities from class teacher as well as parental perspective. In order to assess the actual quality of life of parents and child parents and children will be asked to fill out the Kiddy-Kindl in its appropriate version. Moreover, surrounding variables such as medication, prior treatment, other clinical diagnoses etc. will be assessed with a questionnaire. As neuropsychological variables, intelligence will be assessed using the short version of the Culture Fair Test (CFT 1-R or CFT 20-R).

Pre-Test: