2026 ECNP Congress

PS02-2152

Electroencephalography-based evaluation of cognitive training outcomes in children with attention-deficit and hyperactivity disorder

Ana Khachidze — I. Khachidze, K. Parkosadze, M. Advadze · Georgian National University SEU, Faculty of Medicine, Tbilisi, Georgia

2026 ECNP Congress

Introduction

Attention Deficit/Hyperactivity Disorder (ADHD) is among the most prevalent neurodevelopmental disorders in childhood, with a worldwide prevalence estimated at 5–10% [1]. ADHD is characterized by neurocognitive deficits and behavioral dysregulation affecting executive functioning and social behavior, underpinned by dysregulation of fronto cortical and subcortical networks [2]. Cognitive training is proposed as an approach that enhance executive functions by engaging and strengthening processes linked to frontal network functioning [3]. Electroencephalography (EEG) reflects cortical electrical activity and indicates functional alterations in brain networks involved in cognitive control. For this reason, it is considered one of the important neurophysiological measures in ADHD. This disorder is associated with atypical resting-state EEG and elevation of theta/beta ration (TBR). The elevated TBR is thought to reflect delayed cortical maturation and/or functional hypoarousal of the central nervous system, especially frontoparietal network implicated in attention, executive control, and inhibitory processes. The present study aimed to evaluate the outcomes of a cognitive training in children with ADHD, designed to enhance executive functions linked to frontal lobe activity, using electroencephalography as an objective neurophysiological measure.

Methods

Forty-eightmedication-naive children with ADHD (aged 7–11 years; 37 boys, 11 girls) were enrolled following formal multidisciplinary diagnosis. Children with psychiatric comorbidities or IQ below 80 were excluded. The cognitive training comprised two parallel components delivered over three months and targeting frontal executive functions: a twice-weekly computerized executive training (CCT) and daily paper-based cognitive exercises (CPE). Resting-state EEG was recorded before and after the training, across three conditions — resting wakefulness with eyes closed (CE1), with eyes open (OE), and with the eyes closed (CE2)[4]. Full electroencephalography recordings had a total duration of 11 minutes. Electroencephalography data were analyzed using a quantitative spectral power approach, assessing frequency–amplitude characteristics across multiple frequency bands - especially low-frequency band power and theta/beta ration.

Results

Following three months of trainingresults revealed observable cognitive improvements,while the electrophysiological profile showed no evidence of EEG-related changes. EEG recordings demonstrated, desynchronized background activity consistent with a typical ADHD electrophysiological profile. Spectral analysis revealed persistently elevated low-frequency activity over frontal and parietal regions. Before training, delta activity showed a distribution of 27% in the frontal region, 26% in the central region, and 24% in the parietal region; after three months of training, the same tendency was remained, with no statistically significant changes observed (p > 0.05). The theta/beta ration remained high in the frontal region both before and after training, with no statistically significant difference (p > 0.05).

Conclusions

A three-month cognitive training revealed measurable changes in cognitive performance in children with ADHD; however, these gains were not accompanied by corresponding alterations in objective EEG measures. These findings indicate that cognitive training alone may be insufficient to induce detectable neurophysiological changes, suggesting that neurochemical alterations potentially require pharmacological intervention. Overall, the results highlight the potential value of multimodal treatment strategies combining pharmacological approaches with cognitive training in children with ADHD to enhance both executive functioning and underlying neural activity. Therefore, pharmacological treatment may remain the key component of ADHD management.

References

  1. Ayano, G., Demelash, S., Gizachew, Y., Tsegay, L., Alati, R., 2023. The global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta-analyses. J. Affect. Disord. 339, 860–866. http://dx.doi.org/10.1016/j.jad.2023.07.071.
  2. Rubia, K., 2018. Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation. Front. Hum. Neurosci. 12, 100. http://dx.doi.org/10.3389/fnhum.2018.00100.
  3. Cortese, S., Ferrin, M., Brandeis, D., et al., 2015. Cognitive training for attention-deficit/hyperactivity disorder: Meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. J. Am. Acad. Child Adolesc. Psychiatry 54(3), 164–174. http://dx.doi.org/10.1016/j.jaac.2014.12.010.
  4. Khachidze, I., Parkosadze, K., Zhamureli, N., Khachidze, A., Advadze, M., 2026. Electrophysiological evaluation of cognitive intervention outcomes in children with attention deficit/hyperactivity disorder. Front. Neurosci. 20, 1777670. http://dx.doi.org/10.3389/fnins.2026.1777670.