John Hasslinger

Purpose: Returning results from psychological assessments is increasingly viewed as an ethical duty and a way to strengthen engagement and trust. The WHO International Classification of Functioning, Disability and Health (ICF) offers a framework to describe functioning across strengths, challenges, and contextual facilitators/barriers. Although ICF-based approaches map functioning in autism and ADHD, their use for individualized feedback to caregivers is underexamined. We evaluated caregivers’ perceptions of a digital summary report derived from a proxy-rated ICF-based assessment for children and adolescents with autism and/or ADHD. Methods: A multiple-methods survey was sent to 707 caregivers from a prior ICF Core Sets study; 357 provided valid responses. Items covered perceived accuracy, changes in awareness and agency, and perceived usefulness in healthcare, education, and social services. Quantitative data were analysed with nonparametric statistics; qualitative responses were thematically categorized. Results: Caregivers rated the report accurate for their child’s strengths (91.3%) and challenges (92.2%). About half reported increased awareness of strengths (49.9%), challenges (48.7%), and environmental facilitators (49.3%) and barriers (49.6%). Many reported greater ability to use strengths (53.2%), manage difficulties (48.4%), and seek help (39.5%). Parents of autistic children reported larger awareness gains than parents of children with ADHD; no differences emerged by caregiver or child gender. The report was considered useful in healthcare (62.1%), education (65.3%), and social services (60%). Conclusion: ICF-based feedback was perceived as accurate, useful, and empowering, supporting clinical and educational practice. Impact may increase if delivered earlier and further tailored. Implementation studies should assess usability, acceptability, and benefits for decision-making.

A diagnosis of autism does not provide sufficient information to understand how the world is experienced by an autistic person. The World Health Organisation's International Classification of Functioning (ICF) Core Sets for autism provides a framework from which a more in-depth understanding of an autistic person's profile of strengths and needs can be acquired. This is the first U.K. evaluation of the ICF CoreSets for Autism platform, an operationalisation of the ICF Core Sets for Autism via an online assessment. In a Development Phase, 20 autistic adults were supported to complete the assessment, provide feedback via think-aloud interviews and to evaluate it. In a Main Study, which was pre-registered, 464 autistic adults completed the assessment independently online and evaluated it. A participatory approach was used throughout. Using standardised questionnaires, overall autistic adults found the assessment to be ‘acceptable’ and usability was rated as ‘ok’ or better. This was also true for subgroups of autistic adults who expressed clinically significant autistic traits, anxiety or depression, those from minoritised ethnicities, older adults and who were unemployed. The findings suggest the ICF CoreSets for Autism platform has potential as a standardised evidence-based tool to improve understanding of autistic adults’ strengths and needs.

The WHO's International Classification of Functioning, Disability and Health (ICF) provides a biopsychosocial perspective on health-related functioning, highly relevant for conditions like autism and ADHD. Despite the ICF's many benefits, including providing a holistic assessment of individual challenges and resources, its widespread use has been prevented by its complexity, lack of operationalization, and limited specificity for certain diagnoses. To improve usability and implementation of the ICF, diagnosis-specific ICF Core Sets have been developed, revised, operationalized, and integrated on a digital platform. This psychometric study evaluates the self-and proxy-report versions of the Core Set operationalization. This is a cross-sectional study drawing on data collected from individuals diagnosed with autism (n = 54), ADHD (n = 41), autism and ADHD (n = 42), and general population samples (n = 174), as well as 71 paired assessments. Depending on ICF domain, inter-rater reliability and internal consistency was moderate to high. The Core Sets' ability to distinguish between neurodivergent and general population groups, and the functioning profiles within groups, indicate diagnostic and construct validity. Findings add psychometric evidence to previous results on feasibility and further endorse the adequacy of the Core Sets operationalization for use in basic and applied autism and ADHD science.

A diagnosis of autism does not provide sufficient information to understand how the world is experienced by an Autistic person. The World Health Organisation’s International Classification of Functioning (ICF) Core Sets for Autism provides a framework from which a more in-depth understanding of an Autistic person’s profile of strengths and needs can be acquired. This is the first UK evaluation of the ICF CoreSets for Autism platform, an operationalization of the ICF Core Sets for Autism via an online assessment. In Study 1, 20 Autistic adults were supported to complete the assessment, provide feedback via think-aloud interviews and to evaluate it. In Study 2, which was pre-registered, 464 Autistic adults and 481 Non-Autistic adults completed the assessment independently online and evaluated it. Both studies used a participatory approach. Using standardised questionnaires both studies found the assessment “acceptable” and found usability to be “ok” or better. This was also true for subgroups of Autistic adults who expressed clinically significant autistic traits, anxiety or depression, those from minoritised ethnicities, older adults and who were unemployed. The findings suggest the ICF CoreSets for Autism platform has potential as a standardised evidence-based tool to improve understanding of Autistic adults’ strengths and needs.

The International Classification of Functioning, Disability and Health (ICF) is the World Health Organization’s (WHO) standard for assessing individual functioning. Over the last decade, the ICF has been made more accessible for autism and ADHD through the development and validation of tailored shorter ICF versions for these diagnoses, ICF Core Sets. To further enhance their applicability in research and practice, these Core Sets have been operationalized and implemented on an online platform, the ICF CoreSets platform. Here, we describe the iterative development process of the CoreSets platform. This multiple-methods study examines user feedback on the operationalization of the Core Sets and the feasibility of the CoreSets platform as a functional assessment for autism and ADHD. We collected a total of 678 assessments from the CoreSets platform. Individuals diagnosed with autism and/or ADHD, their relatives, participants from the general population, and professionals completed and provided feedback on the usability of the CoreSets platform. Qualitative feedback via interviews and focus groups were also collected. Qualitative data were analysed via content analysis, while quantitative data were examined using univariate and descriptive techniques. Findings show that the ICF CoreSets platform is feasible and user-friendly, but areas for improvement were also indicated, leading to additional refinement of the operationalization and platform. The operationalization of the ICF Core Sets and their implementation in the CoreSets platform appears adequate for use in research and practice, particularly after revisions indicated by future users, and is now ready for psychometric standardization.

Neurofeedback (NF) aims to alter neural activity by enhancing self-regulation skills. Over the past decade NF has received considerable attention as a potential intervention option for many somatic and mental conditions and ADHD in particular. However, placebo-controlled trials have demonstrated insufficient superiority of NF compared to treatment as usual and sham conditions. It has been argued that the reason for limited NF effects may be attributable to participants' challenges to self-regulate the targeted neural activity. Still, there is support of NF efficacy when only considering so-called “standard protocols,” such as Slow Cortical Potential NF training (SCP-NF). This PROSPERO registered systematic review following PRISMA criteria searched literature databases for studies applying SCP-NF protocols. Our review focus concerned the operationalization of self-regulatory success, and protocol-details that could influence the evaluation of self-regulation. Such details included; electrode placement, number of trials, length per trial, proportions of training modalities, handling of artifacts and skill-transfer into daily-life. We identified a total of 63 eligible reports published in the year 2000 or later. SCP-NF protocol-details varied considerably on most variables, except for electrode placement. However, due to the increased availability of commercial systems, there was a trend to more uniform protocol-details. Although, token-systems are popular in SCP-NF for ADHD, only half reported a performance-based component. Also, transfer exercises have become a staple part of SCP-NF. Furthermore, multiple operationalizations of regulatory success were identified, limiting comparability between studies, and perhaps usefulness of so-called transfer-exercises, which purpose is to facilitate the transfer of the self-regulatory skills into every-day life. While studies utilizing SCP as Brain-Computer-Interface mainly focused on the acquisition of successful self-regulation, clinically oriented studies often neglected this. Congruently, rates of successful regulators in clinical studies were mostly low (<50%). The relation between SCP self-regulation and behavior, and how symptoms in different disorders are affected, is complex and not fully understood. Future studies need to report self-regulation based on standardized measures, in order to facilitate both comparability and understanding of the effects on symptoms. When applied as treatment, future SCP-NF studies also need to put greater emphasis on the acquisition of self-regulation (before evaluating symptom outcomes).Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260087, Identifier: CRD42021260087.

To evaluate the effects of neurocognitive training methods on targeted cognitive functions in children and adolescent with ADHD. A pragmatic four-arm randomized controlled trial compared two types of neurofeedback (Slow Cortical Potential and Live Z-score) and Working-memory training (WMT) with treatment as usual. N = 202 participants with ADHD aged 9 to 17 years were included. A battery of cognitive function tests was completed pretreatment, posttreatment, and after 6-months. The effects of WMT on spatial and verbal working-memory were superior to neurofeedback and treatment as usual at posttreatment, but only partially sustained at follow-up. No other consistent effects were observed. We found no clear indications that effects were moderated by ADHD presentation, ongoing medication, age, or sex. The sustained effects of neurocognitive training on cognitive functioning in children and adolescents with ADHD may be limited. Future research should focus on more personalized forms of neurocognitive training.

Neurofeedback (NF) as a treatment for Attention Deficit Hyperactivity Disorder (ADHD) has been evaluated in several trials, but the specificity and generalizability of effects remain unclear. This four-arm randomized controlled trial evaluated the efficacy of Slow Cortical Potential (SCP; standard NF protocol) and Live Z-score (LZS; non-standard NF protocol) delivered in high-frequency format (five sessions per week during five weeks), compared to Working-memory training (WMT; active comparator) and Treatment-as-usual (TAU; passive comparator). N = 202 children/adolescents aged 9 to 17 years with ADHD participated. The primary outcome measure was multi-report (self-, teacher-, and parent-report) ADHD core symptoms on the Conners-3, assessed at baseline, posttreatment, and 6-months follow-up. Data were analyzed using a linear mixed model. Between-group differences were scarce and did not show a distinct pattern. Superiority of LZS over TAU at endpoint were observed for teacher-rated measures only, while significant differences between SCP and TAU were restricted to posttreatment measurements. Contrary to our expectations, LZS outperformed SCP at endpoint for teacher-rated hyperactivity (-5.37; 95% CI: -10.14 to -0.60; p = .028; d = -.36) and overall ADHD symptoms (-2.20; -4.18 to -0.22; p = .030; d = -.41). There was no indication that either form of NF was superior to WMT. No severe adverse events were reported during the trial, whereas transient stress-related problems were quite frequent. Overall, the results from this pragmatic trial do not provide convincing support for broad implementation of NF in child and adolescent psychiatric services. Future research should try to clarify for whom and under what circumstances NF might be a viable treatment option.

Neurofeedback (NF) as a treatment for children and adolescents with attention deficit hyperactivity disorder (ADHD) has gained growing interest in recent years. Most research has been quantitative, focusing on treatment outcomes, while qualitative approaches exploring the treatment process and participants’ experiences are scarce. The objective of this study was to examine NF participants’ use of cognitive and other strategies for approaching and solving NF tasks, their development over the course of the training and the influence of participants’ compliance. We collected 130 short semi-structured interviews following treatment sessions from 30 participants with ADHD receiving NF using slow cortical potential training (SCP). The interviews were transcribed verbatim and analyzed using thematic analysis. Themes where evaluated for changes over-time and between participants with high/low treatment compliance. Interviews from 14 participants who had undergone at least five completed interviews were examined in more depths, aiming to establish typical strategy/training profiles. We identified 16 strategies covering four domains: cognitive, physiological, emotional and unspecified. Typical of most strategies were that they served as a vehicle to regulate mental arousal. Overall, no clear patterns of changes over time were found. Highly compliant participants reported to use the strategies from the emotional domain and the strategy focus more frequently than neutral compliant participants did, while neutral compliant participants reported the use of the strategies muscular activity and passivity more often than participants did with high compliance. Across participants, three strategy profiles were derived, those who handled the task by manipulating their state of mind in relation to the NF task, those who were mainly manifest and concrete towards the task, and those who were mostly unaware of what they were doing. These profiles differed in self-regulatory performance, and only participants showing the state of mind profile experienced a decrease of ADHD symptoms accompanied by objectively measured improvements in self-regulation. In addition, compliance affected both how and what strategies were used. A heterogeneous array of cognitive and other strategies is used at varying levels of training compliance by participants with ADHD during SCP that could be condensed to three prototypical profiles. Future research should take compliance and strategy/training profiles into account when evaluating NF. The latter may help to clarify which and how brain activity regulating mechanisms drive training, individual response to NF, and how they are influenced by motivational factors. Our findings might also help to facilitate more effective instructions in how to approach SCP in clinical practice.

A comparative randomized controlled pragmatic trial of neurofeedback and working memory training for children with attention-deficit/hyperactivity disorder: protocol