Purpose: Recent reviews have proposed that scientifically validated standard EEG neurofeedback (NF) protocols are an efficacious and specific treatment for attention-deficit hyperactivity disorder (ADHD). Here, we review the current evidence for the treatment efficacy and clinical effectiveness of NF in ADHD to investigate whether NF treatment personalization (standard protocols matched to the electrophysiological features of ADHD) and combination with other interventions (psychosocial, sleep hygiene and nutritional advice) might yield superior long-term treatment outcomes relative to non-personalized NF and medication monotreatments. Methods: The electronic databases PubMed and PsycINFO were systematically searched using our key terms. Of the 38 resulting studies, 11 randomized controlled trials (RCTs) and open-label studies were eligible for inclusion. Studies were analyzed for effect sizes and remission rates at the end of treatment and at follow-up. The effects of personalized and multimodal NF treatments were compared to non-personalized NF monotreatments and with two benchmark medication studies. Results: The analysis of RCTs indicated that the long-term effects of personalized NF interventions were superior to non-personalized NF and comparable to those of medication alone or in combination with behavioral intervention. The analysis of open-label trials further indicates that the interaction of NF with parental interventions, sleep and nutritional advice might yield superior clinical effectiveness relative to NF and medication monotreatments. Conclusion: Personalized and multimodal NF interventions seem to yield superior treatment efficacy relative to NF alone and superior clinical effectiveness relative to medication. We propose that treatment outcomes may be further enhanced by adjusting NF non-specific factors (eg, reinforcement contingencies) to specific ADHD characteristics (eg, reward sensitivity). Future NF research should focus on the systematic evaluation of the treatment outcomes of personalized and multimodal treatments.

Attention-deficit/hyperactivity disorder (ADHD) has been associated with hyperfocus, a transient experience of enhanced attentional focus and diminished awareness of time and the environment. This study aims to investigate the association between the frequency, duration and pervasiveness of hyperfocus across different situations in adults with and without ADHD. Within a healthy sample (n = 1124), we analysed correlations between scores on the ADHD Rating Scale and self-reports of frequency, duration and pervasiveness of hyperfocus. An ADHD patient group (n = 78) was compared to matched healthy participants on all hyperfocus variables. In healthy adults, the frequency of hyperfocus was positively correlated with ADHD traits; older age and higher education were correlated with fewer hyperfocus occurrences in a smaller number of situations. ADHD patients and matched controls did not differ in the occurrence, frequency, duration and pervasiveness of hyperfocus, but hyperfocus was less likely to occur in educational and social situations in ADHD patients. Hyperfocus experiences are not specific of ADHD patients. The divergent findings might reflect multiple hyperfocus dimensions (situational and motivational) assessed in different studies which need to be addressed in future research.

Hyperfocus, a state of intense, narrow and prolonged attentional focus, has been associated with symptoms of attention-deficit/hyperactivity disorder (ADHD) in both clinical and non-clinical populations. Hyperfocus may be explained by difficulties in executive control, typically observed in ADHD. To investigate (1) whether ADHD and executive functions (EF) are associated with hyperfocus and (2) whether EF mediate the relationship between ADHD symptoms and hyperfocus. A non-clinical sample of 380 university students (264 females) completed self-reports of ADHD, EF, hyperfocus and hyperfocus during rewarding activities. Increased difficulties in EF and severity of ADHD symptoms were significantly and positively correlated with a higher frequency of hyperfocus. Moreover, EF difficulties partially mediated the relationship between ADHD and hyperfocus (after controlling for sex and substance use), but not the relationship between ADHD and hyperfocus during rewarding activities. Difficulties in EF partially explained the higher frequency of hyperfocus, but not of hyperfocus during rewarding activities, among university students reporting more severe ADHD symptoms. Future research should investigate whether and how specific EF and other ADHD-related neurocognitive difficulties (e.g., reward sensitivity) contribute to various types of hyperfocus experiences in ADHD. WHAT THIS PAPER ADDS?: This paper is a first attempt to explain the relationship between adult ADHD symptoms and hyperfocus experiences. Our findings suggest that, although highly correlated, existing self-reports of hyperfocus measure different aspects of this experience: hyperfocus and reward-related hyperfocus. We replicate previous findings that indicated a greater frequency of both types of hyperfocus in ADHD. Additionally, we demonstrate a connection between EF difficulties and different aspects of hyperfocus. Finally, we extend previous findings by proposing that EF difficulties partially explain the relationship between ADHD and hyperfocus, but not the relationship between ADHD and reward-related hyperfocus. We hypothesize that other neurocognitive difficulties (e.g., reward sensitivity) may contribute to explain the relationship between ADHD and different aspects of hyperfocus.

This study measured the severity and frequency of self-reported symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in Psychology students in a Dutch university before and during the COVID-19 pandemic, providing insights into how this population navigated the challenges of emerging adulthood amidst a global crisis. In total, 1446 first-year Psychology students in a Dutch university were recruited in four cohorts: 2018 (n = 404), 2019 (n = 277), 2020 (n = 350), and 2021 (n = 415). The cohorts in 2020 and 2021 were recruited during the COVID-19 pandemic. Responses on the Conners’ Adult ADHD Rating Scale (CAARS) Long Form were collected. For each cohort, scale scores were calculated, as well as frequencies of students screening positive for elevated ADHD symptoms. The proportion of participants screening positive for elevated ADHD symptoms was 21%, which did not significantly differ between cohorts (p = 0.076) and gender (p = 0.206). Subscale scores were indicative of a small increase in inattention symptoms with increasing duration of the pandemic from cohort 2018 to 2021. Small gender differences were found on the subscales. Roughly one in five first-year Psychology students in university screens positive for elevated ADHD symptoms. This pattern is stable across men and women and across four cohorts of students before and during the COVID-19 pandemic. Inattention symptoms slightly increased with increasing duration of the pandemic in cohort 2021.