Summary: Researchers identified a specific brain signal that acts as a precursor to attention lapses in children. The study demonstrates that monitoring this “attention signature” in real-time allows for targeted interventions that can immediately restore focus.
This breakthrough offers a potential new path for supporting youth with ADHD or epilepsy, where natural fluctuations in attention often lead to academic and psychosocial challenges.
Key Research Findings
- The Predictive Signature: Using machine learning and intracranial recordings, researchers discovered a specific pattern of neural activity that arises milliseconds before a child’s attention shifts or delays.
- Timing is Everything: Targeted electrical stimulation delivered precisely at the moment this signal was detected allowed every child in the study to stay engaged and perform tasks faster and more accurately. Stimulation delivered at any other time actually caused performance to decline.
- Precision Circuitry: The study pinpointed the neural networks involved in “attentional flexibility,” providing a map for precision health interventions that current medications cannot match.
- Non-Invasive Success: The researchers successfully replicated these results in typically developing children and those with ADHD using non-invasive tools like TMS-EEG. A single magnetic pulse to the target area improved both reaction time and accuracy without the need for implanted electrodes.
- World-First Approach: This represents the first time a closed-loop approach—predicting an attention lapse and intervening in real-time—has been studied in humans, specifically in a pediatric population.
Source: Hospital for Sick Children
Inside a world-leading deep brain stimulation program at The Hospital for Sick Children (SickKids), researchers have discovered a brain signal that predicts when a child is about to lose attention — and that a brief, targeted intervention in response to that signal can restore their focus.
Their study, published in Nature Neuroscience, represents the first time this approach for attention control has been studied in people.
“Few aspects of the human experience are as integral as attention,” says lead author Dr. George Ibrahim, neurosurgeon and Senior Scientist in the Neurosciences & Mental Health program. “It shapes our perceptions, memories and interactions, but what happens when it is compromised?”
While fluctuations in attention are natural, disruptions in “attentional flexibility” that occur in youth with attention deficit/hyperactivity disorder (ADHD) can have negative behavioural, psychosocial and academic consequences. Medications used today are limited in their impact because, up to now, we didn’t know exactly how attention lapses happen nor which neural networks in the brain are involved.
Unique study offers new insights in the brain
The study began first with an attentional set-shifting task — which measures how attention shifts between stimuli — in a group of 30 children with epilepsy, a condition that significantly raises one’s risk for ADHD.
The team performed intracranial recordings, in which electrodes record directly from the depth of the brain, enabling them to monitor neural activity in milliseconds. At the same time, they used machine learning models to predict fluctuations in attention — which is a world-first. Through the models, they pinpointed a specific pattern of brain activity that anticipated slow or fast attention shifts in all children over several days.
“We were amazed to detect a signature in the brain that arose just before each child’s attention shifting performance was delayed,” says Dr. Nebras Warsi, first author and paediatric neurosurgeon-scientist studying in the Ibrahim Lab.
“With precision electrical stimulation right at these moments in time, every child stayed engaged despite the difficult tasks and performed them faster and more accurately.”
During various 20- to 30-minute tasks, they monitored the children’s performance through eye-tracking, reaction time and accuracy to spot lapses in attention. The brief electrical stimulation saved their attention only when delivered right at exact moments; when delivered at other times, the participant’s performance declined.
In short: timing was everything.
Expanding the scope to other children
Could the same results be expected in other children without epilepsy? To find out, the researchers used non-invasive magnetoencephalography imaging in 37 typically developing kids and 25 with ADHD.
By targeting that same signal in their brains, researchers could once again predict attention delays. Next, they used noninvasive transcranial magnetic stimulation-electroencephalography (TMS-EEG) and found that one pulse, delivered to that target area, led to significantly improved reaction time and accuracy. This time with a simple EEG cap and TMS coil, with no need for intracranial brain electrodes.
This suggests long-term potential for non-invasive tools that could support attention right when it’s needed most.
While these technologies are still in their early days, Ibrahim says this opens a promising new direction for understanding attention challenges and being able to advance Precision Child Health at SickKids, and around the world, by supporting each child in an individual way.
“Many people are studying neurological and neuropsychiatric disorders in adults, but very few people are expanding into paediatrics,” says Ibrahim, who is also the Abe Bresver Chair in Functional Neurosurgery. “We need to ethically advance possible therapies for children and youth and, to do that, we need to understand neural circuitry.
“The potential to change the lives of so many children is profoundly important.”
Funding: The study is supported by the Canadian Institutes of Health Research (CIHR), Brain Canada through an Azrieli Future Leader in Canadian Brain Research Award, and the Abe Bresver Chair in Functional Neurosurgery at SickKids. Dr. Warsi is supported by the CIHR Vanier Scholarship, the James and Mari Rutka Surgeon-Scientist Award, and the Edward Christie Stevens Fellowship in Medicine.
Key Questions Answered:
A: While these technologies are in early stages, the study suggests we can support “attentional flexibility” right when it is needed most. It moves us toward Precision Child Health, where interventions are tailored to an individual child’s real-time brain activity.
A: Attention is dynamic. The study found that the brain signature appears just before a lapse occurs. Intervening at that exact micro-moment “saves” the attention; intervening at random times disrupts the brain’s natural processing and makes performance worse.
A: The success of non-invasive TMS-EEG and EEG caps suggests a long-term potential for wearable tools that monitor and support focus without surgery. However, researchers emphasize that more work is needed to understand these circuits ethically and effectively in broader pediatric settings.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- Journal paper reviewed in full.
- Additional context added by our staff.
About this ADHD and neurotech research news
Author: Jeff Jurmain
Source: Hospital for Sick Children
Contact: Jeff Jurmain – Hospital for Sick Children
Image: The image is credited to Neuroscience News
Original Research: Closed access.
“Closed-loop stimulation modulates attention shifting in children” by Nebras M. Warsi, Simeon M. Wong, Karim Mithani, Sebastian C. Coleman, Olivia N. Arski, Hrishikesh Suresh, Jürgen Germann, Alexandre Boutet, Lauren Erdman, Flavia Venetucci Gouveia, Barbara Berger, Tamas Minarik, Fa-Hsuan Lin, Hsin-Ju Lee, Benjamin R. Morgan, Elizabeth Kerr, Mary Lou Smith, Ayako Ochi, Hiroshi Otsubo, Rohit Sharma, Carolina Gorodetsky, Puneet Jain, Shelly Weiss, Elizabeth J. Donner, Andres M. Lozano, O. Carter Snead, Sabine Kastner, Margot J. Taylor & George M. Ibrahim. Nature Neuroscience
DOI:10.1038/s41593-026-02294-0
Abstract
Closed-loop stimulation modulates attention shifting in children
Spontaneous fluctuations in attention can impede adaptation to changing goals and environments. Endogenous control over attentional shifts, referred to as attentional flexibility, is prone to disruption in children with attention deficit disorders.
Here we studied in vivo intracranial recordings in children with epilepsy to identify a reproducible neural signature of attentional control that could predict and prevent impending lapses in real time.
Machine learning classifiers were trained on intracranial signals while each child performed an attentional set-shifting task and predicted delays in attention shifting over multiple days and across several pediatric populations.
Intracranial electrical stimulation in response to impending delays rescued attention shifts indexed by eye tracking, reaction time and accuracy.
Simultaneous electroencephalography identified corresponding scalp signatures that enabled noninvasive modulation of attention shifting in healthy participants.
These findings provide insight into the neural basis of attentional shifts with implications for targeted neuromodulation and exogenous attentional control.
