The increase in theta/beta ratio on resting-state EEG in boys with attention-deficit/hyperactivity disorder is mediated by slow alpha peak frequency

The effects of individual upper alpha neurofeedback in ADHD: an open-label pilot study

Standardized neurofeedback (NF) protocols have been extensively evaluated in attention-deficit/hyperactivity disorder (ADHD). However, such protocols do not account for the large EEG heterogeneity in ADHD. Thus, individualized approaches have been suggested to improve the clinical outcome. In this direction, an open-label pilot study was designed to evaluate a NF protocol of relative upper alpha power enhancement in fronto-central sites. Upper alpha band was individually determined using the alpha peak frequency as an anchor point. 20 ADHD children underwent 18 training sessions. Clinical and neurophysiological variables were measured pre- and post-training. EEG was recorded pre- and post-training, and pre- and post-training trials within each session, in both eyes closed resting state and eyes open task-related activity. A power EEG analysis assessed long-term and within-session effects, in the trained parameter and in all the sensors in the (1-30) Hz spectral range. Learning curves over sessions were assessed as well. Parents rated a clinical improvement in children regarding inattention and hyperactivity/impulsivity. Neurophysiological tests showed an improvement in working memory, concentration and impulsivity (decreased number of commission errors in a continuous performance test). Relative and absolute upper alpha power showed long-term enhancement in task-related activity, and a positive learning curve over sessions. The analysis of within-session effects showed a power decrease ("rebound" effect) in task-related activity, with no significant effects during training trials. We conclude that the enhancement of the individual upper alpha power is effective in improving several measures of clinical outcome and cognitive performance in ADHD. This is the first NF study evaluating such a protocol in ADHD. A controlled evaluation seems warranted due to the positive results obtained in the current study.

A Matter of Time: The Influence of Recording Context on EEG Spectral Power in Adolescents and Young Adults with ADHD

Elevated theta or theta/beta ratio is often reported in attention deficit hyperactivity disorder (ADHD), but the consistency across studies and the relation to hypoarousal are increasingly questioned. Reports of elevated delta related to maturational lag and of attenuated beta activity are less well replicated. Some critical inconsistencies could relate to differences in recording context. We examined if resting-state EEG power or global field synchronization (GFS) differed between recordings made at the beginning and end of a 1.5 h testing session in 76 adolescents and young adults with ADHD, and 85 controls. In addition, we aimed to examine the effect of IQ on any potential group differences. Both regional and midline electrodes yielded group main effects for delta, trends in theta, but no differences in alpha or theta/beta ratio. An additional group difference in beta was detected when using regions. Group by time interactions in delta and theta became significant when controlling for IQ. The ADHD group had higher delta and theta power at time-1, but not at time-2, whereas beta power was elevated only at time-2. GFS did not differ between groups or condition. We show some ADHD-control differences on EEG spectral power varied with recording time within a single recording session, with both IQ and electrode selection having a small but significant influence on observed differences. Our findings demonstrate the effect of recording context on resting-state EEG, and highlight the importance of accounting for these variables to ensure consistency of results in future studies.

Cortical activity differs during nicotine deprivation versus satiation in heavy smokers

RATIONALE

Research suggests that nicotine deprivation among smokers is associated with lesser resting cortical activity (i.e., greater power density in theta and alpha-1 EEG bands and lesser power in beta bands). These changes in cortical activity may be indicative of withdrawal-related cognitive deficits, yet the markers of differences in cortical activity are not well-established.

OBJECTIVE

The objective of the study was to clarify the EEG frequency bands affected by nicotine deprivation and assess prospective moderators.

METHOD

One hundred twenty-four heavy smokers visited the laboratory on two occasions following overnight smoking/nicotine deprivation. Prior to collecting 3 min of resting EEG data, participants smoked two very low nicotine cigarettes (<0.05 mg nicotine yield) at one session and two moderate nicotine cigarettes (0.60 mg nicotine yield) at the other.

RESULTS

Theta and alpha-1 band (4-7 and 8-10 Hz) was greater in the very low nicotine (deprivation) relative to higher nicotine (satiation) condition. There were no condition differences in the beta-1 and beta-2 bands (14-20 and 21-30 Hz).

CONCLUSIONS

Greater slow wave resting EEG may serve as a reliable marker of decreased cortical activity during smoking deprivation and, in turn, of withdrawal-related deficits in cognitive functioning. This research may inform the development of adjunct strategies for smoking cessation.

Electroencephalographic activity before and after cognitive effort in children with attention deficit/hyperactivity disorder

Numerous studies have detected elevated electroencephalographic (EEG) theta/beta ratio (TBR) or theta power in children with attention deficit/hyperactivity disorder (ADHD) and therefore TBR has been suggested to be a promising biomarker of ADHD. At the same time, recent theoretical models have emphasized the heterogeneity of ADHD and the notion that cognitive deficits in ADHD are not fixed but fluctuate according to contextual and state factors. Surprisingly, so far the context- or state-dependency of EEG abnormalities in ADHD has hardly been addressed. Therefore, in the current study, 3 minutes eyes closed resting EEG before and after execution of 3 n-back tasks were compared between 21 children with ADHD and 22 typically developing children. No difference between groups was found for TBR or theta power (or other frequency bands), neither before nor after task execution, indicating that enhanced TBR or theta power is not to be considered universal for the disorder. Hence, cautiousness is warranted in using these indices for diagnostic purposes in ADHD. Across groups, posterior theta power, as well as central and posterior beta power was attenuated after task execution, which was interpreted as the children experiencing a more alert state after cognitive effort. Yet, this EEG modulation was similar in both groups, providing no support for a context-or state-dependency of EEG abnormalities in ADHD. However, in light of the absence of any group differences in EEG parameters, further research is warranted.

Effects of physical exercise on individual resting state EEG alpha peak frequency

Previous research has shown that both acute and chronic physical exercises can induce positive effects on brain function and this is associated with improvements in cognitive performance. However, the neurophysiological mechanisms underlying the beneficial effects of exercise on cognitive processing are not well understood. This study examined the effects of an acute bout of physical exercise as well as four weeks of exercise training on the individual resting state electroencephalographic (EEG) alpha peak frequency (iAPF), a neurophysiological marker of the individual's state of arousal and attention, in healthy young adults. The subjects completed a steady state exercise (SSE) protocol or an exhaustive exercise (EE) protocol, respectively, on two separate days. EEG activity was recorded for 2 min before exercise, immediately after exercise, and after 10 min of rest. All assessments were repeated following four weeks of exercise training to investigate whether an improvement in physical fitness modulates the resting state iAPF and/or the iAPF response to an acute bout of SSE and EE. The iAPF was significantly increased following EE (P = 0.012) but not following SSE. It is concluded that the iAPF is increased following intense exercise, indicating a higher level of arousal and preparedness for external input.

Electroencephalography as a clinical tool for diagnosing and monitoring attention deficit hyperactivity disorder: a cross-sectional study

OBJECTIVES

The aim of this study was to develop and test, for the first time, a multivariate diagnostic classifier of attention deficit hyperactivity disorder (ADHD) based on EEG coherence measures and chronological age.

SETTING

The participants were recruited in two specialised centres and three schools in Reykjavik.

PARTICIPANTS

The data are from a large cross-sectional cohort of 310 patients with ADHD and 351 controls, covering an age range from 5.8 to 14 years. ADHD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria using the K-SADS-PL semistructured interview. Participants in the control group were reported to be free of any mental or developmental disorders by their parents and had a score of less than 1.5 SDs above the age-appropriate norm on the ADHD Rating Scale-IV. Other than moderate or severe intellectual disability, no additional exclusion criteria were applied in order that the cohort reflected the typical cross section of patients with ADHD.

RESULTS

Diagnostic classifiers were developed using statistical pattern recognition for the entire age range and for specific age ranges and were tested using cross-validation and by application to a separate cohort of recordings not used in the development process. The age-specific classification approach was more accurate (76% accuracy in the independent test cohort; 81% cross-validation accuracy) than the age-independent version (76%; 73%). Chronological age was found to be an important classification feature.

CONCLUSIONS

The novel application of EEG-based classification methods presented here can offer significant benefit to the clinician by improving both the accuracy of initial diagnosis and ongoing monitoring of children and adolescents with ADHD. The most accurate possible diagnosis at a single point in time can be obtained by the age-specific classifiers, but the age-independent classifiers are also useful as they enable longitudinal monitoring of brain function.

Electrophysiological correlates of long-term Soto Zen meditation

This study aimed to verify the electrophysiological correlates of the changes in long-term regular meditators. We use modern techniques of high-resolution electroencephalography applied to slow potentials, power spectra, and potencies related to the events. To obtain encephalographic records, we use an assembly of 128 channels in 31 subjects (17 Soto Zen Buddhist meditators). The motivation of this study was to determine whether the induced beta power would present an increase in meditators as well as a decrease in induced theta/beta ratio in absolute and relative values. However, opposite to what we expected, no significant change was found in the beta frequency. In contrast, the main findings of the study were correlations between the frequency of weekly meditation practice and the increased theta induced relative power, increase of induced power ratio (ratio theta/beta), and increase of the ratio of induced relative powers (theta/beta ratio) during our task that featured an "adapted meditation," suggesting that the meditative state of "mindfulness" is much more related to the permittivity of "distractions" by the meditators, with a deliberate reduction of attention.

Physical Fitness and Resting EEG in Children With Attention Deficit Hyperactivity Disorder

Children with attention deficit hyperactivity disorder (ADHD) are characterized by a deviant pattern of brain oscillations during resting state, particularly elevated theta power and increased theta/alpha and theta/beta ratios that are related to cognitive functioning. Physical fitness has been found beneficial to cognitive performance in a wide age population. The purpose of the present study was to investigate the relationship between physical fitness and resting-state electroencephalographic (EEG) oscillations in children with ADHD. EEG was recorded during eyes-open resting for 28 children (23 boys and 5 girls, 8.66 ± 1.10 years) with ADHD, and a battery of physical fitness assessments including flexibility, muscular endurance, power, and agility tests were administered. The results indicated that ADHD children with higher power fitness exhibited a smaller theta/alpha ratio than those with lower power fitness. These findings suggest that power fitness may be associated with improved attentional self-control in children with ADHD.

Electroencephalography and externalizing behavior: a meta-analysis

Electroencephalography (EEG) has been used to examine the possibility of dysfunctional brain activity in externalizing behavior, but findings across studies have been inconsistent. Furthermore, studies of attention-deficit/hyperactivity disorder (ADHD) versus other externalizing behaviors, such as disruptive behavior disorders or antisocial behavior, have developed parallel literatures. The purpose of the present study was to reconcile these two literatures. A meta-analysis of 62 studies of EEG power at rest in relationship to externalizing behaviors was performed. Results of the meta-analyses showed significantly higher delta (Hedges's g=0.25) and theta power (g=0.40) and lower beta power (g=-0.22) in externalizing participants compared to controls. Alpha (g=-0.26) and gamma power (g=-0.26) were marginally lower in externalizing samples. Results were not moderated by type of externalizing behavior. Overall, the results of the meta-analyses were consistent with the hypoarousal theory of externalizing behavior.

State-related electroencephalographic deviances in attention deficit hyperactivity disorder

This study investigated the stability and state-related characteristics of electroencephalographic (EEG) deviances in attention-deficit/hyperactivity disorder (ADHD). Three minutes resting EEG with eyes closed and eyes open were compared between 21 children with ADHD and 29 typically developing children. Across resting conditions, children with ADHD exhibited divergent topographic distribution for theta, alpha and beta power compared to typically developing children. In addition, less alpha and theta suppression to eye opening was found in children with ADHD, but only in those without comorbid ODD/CD. Findings of the present study refer to a consistent divergence in topographic distribution in ADHD across resting state conditions, yet demonstrate that state-related factors and comorbidity may also contribute to resting EEG deviances in ADHD. The state-related findings are in accord with several theoretical accounts emphasizing the role of contextual and state factors defining deficits in ADHD.

EEG Differences Between the Combined and Inattentive Types of Attention-Deficit/Hyperactivity Disorder in Girls: A Further Investigation

This study further investigated electroencephalogram (EEG) differences between girls with the Combined and Inattentive types of attention-deficit/hyperactivity disorder (AD/HD). We selected subjects with widely separated scores on hyperactivity-impulsivity symptoms to behaviorally exaggerate diagnostic group differences. Twenty girls with AD/HD Combined type, 20 girls with AD/HD Inattentive type, and 20 controls (aged 7-12 years) had an eyes-closed resting EEG recorded from 19 electrodes. The EEG was fast Fourier transformed, and estimates for total power, absolute and relative power in the delta, theta, alpha, and beta frequency bands, and the theta/beta ratio were calculated and analyzed in 9 scalp regions. Girls of the Combined type, compared with girls of the Inattentive type, had elevated midline total power, elevated temporal absolute alpha activity, elevated posterior absolute beta activity, reduced right hemisphere relative delta and reduced left hemisphere relative alpha activity, and reduced theta/beta ratio in the left hemisphere. Although topographic differences were again found between the AD/HD types, significant global differences remain elusive in the EEGs of girls with the Combined and Inattentive types. Despite creating behaviorally exaggerated AD/HD type groups, girls' EEG activity failed to replicate differences found previously in mixed-sex groups. The EEG profiles of AD/HD types in girls are markedly different from those found in boys. This reinforces the notion that it is no longer appropriate to apply the male-based literature to all AD/HD groups; rather, the use of single-sex subject groups is necessary in EEG research of AD/HD.

The EEG as an index of neuromodulator balance in memory and mental illness

There is a strong correlation between signature EEG frequency patterns and the relative levels of distinct neuromodulators. These associations become particularly evident during the sleep-wake cycle. The monoamine-acetylcholine balance hypothesis is a theory of neurophysiological markers of the EEG and a detailed description of the findings that support this proposal are presented in this paper. According to this model alpha rhythm reflects the relative predominance of cholinergic muscarinic signals and delta rhythm that of monoaminergic receptor effects. Both high voltage synchronized rhythms are likely mediated by inhibitory Gαi/o-mediated transduction of inhibitory interneurons. Cognitively, alpha and delta EEG measures are proposed to indicate automatic and flexible strategies, respectively. Sleep is associated with marked changes in relative neuromodulator levels corresponding to EEG markers of distinct stages. Sleep studies on memory consolidation present some of the strongest evidence yet for the respective roles of monoaminergic and cholinergic projections in declarative and non-declarative memory processes, a key theoretical premise for understanding the data. Affective dysregulation is reflected in altered EEG patterns during sleep.

Classification of intelligence quotient via brainwave sub-band power ratio features and artificial neural network

This paper elaborates on the novel intelligence assessment method using the brainwave sub-band power ratio features. The study focuses only on the left hemisphere brainwave in its relaxed state. Distinct intelligence quotient groups have been established earlier from the score of the Raven Progressive Matrices. Sub-band power ratios are calculated from energy spectral density of theta, alpha and beta frequency bands. Synthetic data have been generated to increase dataset from 50 to 120. The features are used as input to the artificial neural network. Subsequently, the brain behaviour model has been developed using an artificial neural network that is trained with optimized learning rate, momentum constant and hidden nodes. Findings indicate that the distinct intelligence quotient groups can be classified from the brainwave sub-band power ratios with 100% training and 88.89% testing accuracies.

Reorganization of the brain and heart rhythm during autogenic meditation

The underlying changes in heart coherence that are associated with reported EEG changes in response to meditation have been explored. We measured EEG and heart rate variability (HRV) before and during autogenic meditation. Fourteen subjects participated in the study. Heart coherence scores were significantly increased during meditation compared to the baseline. We found near significant decrease in high beta absolute power, increase in alpha relative power and significant increases in lower (alpha) and higher (above beta) band coherence during 3~min epochs of heart coherent meditation compared to 3~min epochs of heart non-coherence at baseline. The coherence and relative power increase in alpha band and absolute power decrease in high beta band could reflect relaxation state during the heart coherent meditation. The coherence increase in the higher (above beta) band could reflect cortico-cortical local integration and thereby affect cognitive reorganization, simultaneously with relaxation. Further research is still needed for a confirmation of heart coherence as a simple window for the meditative state.

Personalized Medicine in ADHD and Depression: Use of Pharmaco-EEG

This chapter summarises recent developments on personalised medicine in psychiatry with a focus on ADHD and depression and their associated biomarkers and phenotypes. Several neurophysiological subtypes in ADHD and depression and their relation to treatment outcome are reviewed. The first important subgroup consists of the 'impaired vigilance' subgroup with often-reported excess frontal theta or alpha activity. This EEG subtype explains ADHD symptoms well based on the EEG Vigilance model, and these ADHD patients responds well to stimulant medication. In depression this subtype might be unresponsive to antidepressant treatments, and some studies suggest these depressive patients might respond better to stimulant medication. Further research should investigate whether sleep problems underlie this impaired vigilance subgroup, thereby perhaps providing a route to more specific treatments for this subgroup. Finally, a slow individual alpha peak frequency is an endophenotype associated with treatment resistance in ADHD and depression. Future studies should incorporate this endophenotype in clinical trials to investigate further the efficacy of new treatments in this substantial subgroup of patients.

Clinical advantages of quantitative electroencephalogram (QEEG)-electrical neuroimaging application in general neurology practice

QEEG-electrical neuroimaging has been underutilized in general neurology practice for uncertain reasons. Recent advances in computer technology have made this electrophysiological testing relatively inexpensive. Therefore, this study was conducted to evaluate the clinical usefulness of QEEG/electrical neuroimaging in neurological practice. Over the period of approximately 6 months, 100 consecutive QEEG recordings were analyzed for potential clinical benefits. The patients who completed QEEG were divided into 5 groups based on their initial clinical presentation. The main groups included patients with seizures, headaches, post-concussion syndrome, cognitive problems, and behavioral dysfunctions. Subsequently, cases were reviewed and a decision was made as to whether QEEG analysis contributed to the diagnosis and/or furthered patient's treatment. Selected and representative cases from each group are presented in more detail, including electrical neuroimaging with additional low-resolution electromagnetic tomography analysis or using computerized cognitive testing. Statistical analysis showed that QEEG analysis contributed to 95% of neurological cases, which indicates great potential for wider application of this modality in general neurology. Many patients also began neurotherapy, depending on the patient's desire to be involved in this treatment modality.

Reprint of "Neurofeedback and standard pharmacological intervention in ADHD: a randomized controlled trial with six-month follow-up"

The present study is a randomized controlled trial that aims to evaluate the efficacy of Neurofeedback compared to standard pharmacological intervention in the treatment of attention deficit/hyperactivity disorder (ADHD). The final sample consisted of 23 children with ADHD (11 boys and 12 girls, 7-14 years old). Participants carried out 40 theta/beta training sessions or received methylphenidate. Behavioral rating scales were completed by fathers, mothers, and teachers at pre-, post-treatment, two-, and six-month naturalistic follow-up. In both groups, similar significant reductions were reported in ADHD functional impairment by parents; and in primary ADHD symptoms by parents and teachers. However, significant academic performance improvements were only detected in the Neurofeedback group. Our findings provide new evidence for the efficacy of Neurofeedback, and contribute to enlarge the range of non-pharmacological ADHD intervention choices. To our knowledge, this is the first randomized controlled trial with a six-month follow-up that compares Neurofeedback and stimulant medication in ADHD.

Characterization of the theta to beta ratio in ADHD: identifying potential sources of heterogeneity

OBJECTIVE

The goal of this study is to characterize the theta to beta ratio (THBR) obtained from electroencephalogram (EEG) measures, in a large sample of community and clinical participants with regard to (a) ADHD diagnosis and subtypes, (b) common psychiatric comorbidities, and (c) cognitive correlates.

METHOD

The sample includes 871 participants (595 youth and 276 adults) with and without ADHD. All participants underwent extensive assessment, including semistructured diagnostic interviews, cognitive testing, and EEG recording.

RESULTS

The THBR did not differ significantly by ADHD status for youth but was significantly lower in adults with ADHD compared with controls. ADHD subtype and psychiatric comorbidities such as disruptive behavior disorders and depression have opposing and significant mediating effects on the THBR.

CONCLUSION

The THBR is affected by several mediating factors associated with ADHD such as ADHD subtype and psychiatric comorbidity. More research is needed to understand the functional significance of the THBR in ADHD.

A decade of EEG Theta/Beta Ratio Research in ADHD: a meta-analysis

OBJECTIVE

Many EEG studies have reported that ADHD is characterized by elevated Theta/Beta ratio (TBR). In this study we conducted a meta-analysis on the TBR in ADHD.

METHOD

TBR data during Eyes Open from location Cz were analyzed from children/adolescents 6-18 years of age with and without ADHD.

RESULTS

Nine studies were identified with a total of 1253 children/adolescents with and 517 without ADHD. The grand-mean effect size (ES) for the 6-13 year-olds was 0.75 and for the 6-18 year-olds was 0.62. However the test for heterogeneity remained significant; therefore these ESs are misleading and considered an overestimation. Post-hoc analysis found a decreasing difference in TBR across years, explained by an increasing TBR for the non-ADHD groups.

CONCLUSION

Excessive TBR cannot be considered a reliable diagnostic measure of ADHD, however a substantial sub-group of ADHD patients do deviate on this measure and TBR has prognostic value in this sub-group, warranting its use as a prognostic measure rather than a diagnostic measure.

Neurofeedback training aimed to improve focused attention and alertness in children with ADHD: a study of relative power of EEG rhythms using custom-made software application

Neurofeedback is a nonpharmacological treatment for attention-deficit hyperactivity disorder (ADHD). We propose that operant conditioning of electroencephalogram (EEG) in neurofeedback training aimed to mitigate inattention and low arousal in ADHD, will be accompanied by changes in EEG bands' relative power. Patients were 18 children diagnosed with ADHD. The neurofeedback protocol ("Focus/Alertness" by Peak Achievement Trainer) has a focused attention and alertness training mode. The neurofeedback protocol provides one for Focus and one for Alertness. This does not allow for collecting information regarding changes in specific EEG bands (delta, theta, alpha, low and high beta, and gamma) power within the 2 to 45 Hz range. Quantitative EEG analysis was completed on each of twelve 25-minute-long sessions using a custom-made MatLab application to determine the relative power of each of the aforementioned EEG bands throughout each session, and from the first session to the last session. Additional statistical analysis determined significant changes in relative power within sessions (from minute 1 to minute 25) and between sessions (from session 1 to session 12). Analysis was of relative power of theta, alpha, low and high beta, theta/alpha, theta/beta, and theta/low beta and theta/high beta ratios. Additional secondary measures of patients' post-neurofeedback outcomes were assessed, using an audiovisual selective attention test (IVA + Plus) and behavioral evaluation scores from the Aberrant Behavior Checklist. Analysis of data computed in the MatLab application, determined that theta/low beta and theta/alpha ratios decreased significantly from session 1 to session 12, and from minute 1 to minute 25 within sessions. The findings regarding EEG changes resulting from brain wave self-regulation training, along with behavioral evaluations, will help elucidate neural mechanisms of neurofeedback aimed to improve focused attention and alertness in ADHD.

Neurofeedback and standard pharmacological intervention in ADHD: a randomized controlled trial with six-month follow-up

The present study is a randomized controlled trial that aims to evaluate the efficacy of Neurofeedback compared to standard pharmacological intervention in the treatment of attention deficit/hyperactivity disorder (ADHD). The final sample consisted of 23 children with ADHD (11 boys and 12 girls, 7-14 years old). Participants carried out 40 theta/beta training sessions or received methylphenidate. Behavioral rating scales were completed by fathers, mothers, and teachers at pre-, post-treatment, two-, and six-month naturalistic follow-up. In both groups, similar significant reductions were reported in ADHD functional impairment by parents; and in primary ADHD symptoms by parents and teachers. However, significant academic performance improvements were only detected in the Neurofeedback group. Our findings provide new evidence for the efficacy of Neurofeedback, and contribute to enlarge the range of non-pharmacological ADHD intervention choices. To our knowledge, this is the first randomized controlled trial with a six-month follow-up that compares Neurofeedback and stimulant medication in ADHD.

Sexual arousal decreases the functional synchronization between cortical areas in young men

The prefrontal cortex and its connections with other cortical areas participate in processing erotic stimuli and hence sexual arousal. Visual erotic stimuli elicit sexual arousal that is associated with changes in electroencephalographic activity. The electroencephalographic correlation analysis provides information on the functional synchronization among areas. This study analyzed the functional interaction among the prefrontal, parietal, and temporal cortices during sexual arousal in young men induced by observing erotic photographs. In 2 groups of heterosexual men-an erotic stimulation group and a neutral stimulation group-the authors recorded electroencephalograms at the F3, F4, T3, T4, P3, and P4 derivations under 2 conditions: baseline and visual stimulation. Heart rate was monitored as a measure of peripheral activation. Participants in the erotic stimulation group reported a moderate degree of sexual arousal and a decrease in heart rate. Decreased inter- and intrahemispheric correlations of the fast frequencies were obtained only in erotic stimulation. These data support differential hemisphere participation in modulating sexual arousal and show that decreased synchronization patterns between prefrontal and posterior cortices (parietal and temporal) favor sexual arousal in young men. The results of this study may contribute to a better understanding of the central nervous system's mechanisms that underlie sexual arousal.

The effects of QEEG-informed neurofeedback in ADHD: an open-label pilot study

In ADHD several EEG biomarkers have been described before, with relevance to treatment outcome to stimulant medication. This pilot-study aimed at personalizing neurofeedback treatment to these specific sub-groups to investigate if such an approach leads to improved clinical outcomes. Furthermore, pre- and post-treatment EEG and ERP changes were investigated in a sub-group to study the neurophysiological effects of neurofeedback. Twenty-one patients with ADHD were treated with QEEG-informed neurofeedback and post-treatment effects on inattention (ATT), hyperactivity/impulsivity (HI) and comorbid depressive symptoms were investigated. There was a significant improvement for both ATT, HI and comorbid depressive complaints after QEEG-informed neurofeedback. The effect size for ATT was 1.78 and for HI was 1.22. Furthermore, anterior individual alpha peak frequency (iAPF) demonstrated a strong relation to improvement on comorbid depressive complaints. Pre- and post-treatment effects for the SMR neurofeedback sub-group exhibited increased N200 and P300 amplitudes and decreased SMR EEG power post-treatment. This pilot study is the first study demonstrating that it is possible to select neurofeedback protocols based on individual EEG biomarkers and suggests this results in improved treatment outcome specifically for ATT, however these results should be replicated in further controlled studies. A slow anterior iAPF at baseline predicts poor treatment response on comorbid depressive complaints in line with studies in depression. The effects of SMR neurofeedback resulted in specific ERP and EEG changes.

Clinical utility of EEG in attention-deficit/hyperactivity disorder: a research update

Psychiatric research applications of electroencephalography (EEG), the earliest approach to imaging human cortical brain activity, are attracting increasing scientific and clinical interest. For more than 40 years, EEG research has attempted to characterize and quantify the neurophysiology of attention-deficit/hyperactivity disorder (ADHD), most consistently associating it with increased frontocentral theta band activity and increased theta to beta (θ/β) power ratio during rest compared to non-ADHD controls. Recent reports suggest that while these EEG measures demonstrate strong discriminant validity for ADHD, significant EEG heterogeneity also exists across ADHD-diagnosed individuals. In particular, additional studies validating the use of the θ/β power ratio measure appear to be needed before it can be used for clinical diagnosis. In recent years, the number and the scientific quality of research reports on EEG-based neurofeedback (NF) for ADHD have grown considerably, although the studies reviewed here do not yet support NF training as a first-line, stand-alone treatment modality. In particular, more research is needed comparing NF to placebo control and other effective treatments for ADHD. Currently, after a long period of relative stasis, the neurophysiological specificity of measures used in EEG research is rapidly increasing. It is likely, therefore, that new EEG studies of ADHD using higher density recordings and new measures drawn from viewing EEG as a 3-dimensional functional imaging modality, as well as intensive re-analyses of existing EEG study data, can better characterize the neurophysiological differences between and within ADHD and non-ADHD subjects, and lead to more precise diagnostic measures and effective NF approaches.

Nonlinear dynamics measures applied to EEG recordings of patients with attention deficit/hyperactivity disorder: quantifying the effects of a neurofeedback treatment

This work presents the application of nonlinear dynamics measures to electroencephalograms (EEG) acquired from patients with Attention Deficit/Hyperactivity Disorder (ADHD) before and after a neurofeedback therapy, with the aim to assess the effects of the neurofeedback in a quantitative way. The database contains EEG registers of seven patients acquired in eyes-closed and eyes-opened conditions, in pre-and post-treatment phases. Five measures were applied: largest Lyapunov exponent, Lempel-Ziv complexity, Hurst exponent, and multiscale entropy on two different scales. The purpose is to test whether these measures are apt to detect and quantify differences from EEG registers between pre- and post-treatment. The results indicate that these measures could have a potential utility for detection of quantitative changes in specific EEG channels. In addition, the performance of some of these measures improved when the bandwidth was reduced to 3-30 Hz.

Assessment of Learners’ Motivation during Interactions with Serious Games: A Study of Some Motivational Strategies in Food-Force

This study investigated motivational strategies and the assessment of learners’ motivation during serious gameplay. Identifying and intelligently assessing the effects that these strategies may have on learners are particularly relevant for educational computer-based systems. We proposed, therefore, the use of physiological sensors, namely, heart rate, skin conductance, and electroencephalogram (EEG), as well as a theoretical model of motivation (Keller’s ARCS model) to evaluate six motivational strategies selected from a serious game called Food-Force. Results from nonparametric tests and logistic regressions supported the hypothesis that physiological patterns and their evolution are suitable tools to directly and reliably assess the effects of selected strategies on learners’ motivation. They showed that specific EEG “attention ratio” was a significant predictor of learners’ motivation and could relevantly evaluate motivational strategies, especially those associated with theAttentionandConfidencecategories of the ARCS model of motivation. Serious games and intelligent systems can greatly benefit from using these results to enhance and adapt their interventions.

ADHD and EEG-neurofeedback: a double-blind randomized placebo-controlled feasibility study

Electroencephalography (EEG)-neurofeedback has been shown to offer therapeutic benefits to patients with attention-deficit/hyperactivity disorder (ADHD) in several, mostly uncontrolled studies. This pilot study is designed to test the feasibility and safety of using a double-blind placebo feedback-controlled design and to explore the initial efficacy of individualized EEG-neurofeedback training in children with ADHD. Fourteen children (8–15 years) with ADHD defined according to the DSM-IV-TR criteria were randomly allocated to 30 sessions of EEG-neurofeedback (n = 8) or placebo feedback (n = 6). Safety measures (adverse events and sleep problems), ADHD symptoms and global improvement were monitored. With respect to feasibility, all children completed the study and attended all study visits and training sessions. No significant adverse effects or sleep problems were reported. Regarding the expectancy, 75% of children and their parent(s) in the active neurofeedback group and 50% of children and their parent(s) in the placebo feedback group thought they received placebo feedback training. Analyses revealed significant improvements of ADHD symptoms over time, but changes were similar for both groups. This pilot study shows that it is feasible to conduct a rigorous placebo-controlled trial to investigate the efficacy of neurofeedback training in children with ADHD. However, a double-blind design may not be feasible since using automatic adjusted reward thresholds may not work as effective as manually adjusted reward thresholds. Additionally, implementation of active learning strategies may be an important factor for the efficacy of EEG-neurofeedback training. Based on the results of this pilot study, changes are made in the design of the ongoing study.