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Hack RL, Aigner M, Musalek M, Crevenna R, Konicar L. Brain regulation training improves emotional competences in patients with alcohol use disorder. Soc Cogn Affect Neurosci 2024; 19:nsae048. [PMID: 38915188 PMCID: PMC11297497 DOI: 10.1093/scan/nsae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 05/14/2024] [Accepted: 06/22/2024] [Indexed: 06/26/2024] Open
Abstract
Alcohol use disorder (AUD) is defined as the impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences and still represents one of the biggest challenges for society regarding health conditions, social consequences, and financial costs, including the high relapse rates after traditional alcohol rehabilitation treatment. Especially, the deficient emotional competence in AUD is said to play a key role in the development of AUD and hinders the interruption of substance compulsion, often leading to a viscous circle of relapse. Although the empirical evidence of a neurophysiological basis of AUD is solid and increases even further, clinical interventions based on neurophysiology are still rare for individuals with AUD. This randomized controlled trial investigates changes in emotional competences, alcohol-related cognitions, and drinking behavior before and after an established alcohol rehabilitation treatment (control group: nCG = 29) compared to before and after an optimized, add-on neurofeedback (NF) training (experimental group: nEG = 27). Improvements on the clinical-psychological level, i.e. increases in emotional competences as well as life satisfaction, were found after the experimental electroencephalography (EEG) NF training. Neurophysiological measurements via resting-state EEG indicate decreases in low beta frequency band, while alpha and theta bands remained unaffected.
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Affiliation(s)
- Ramona L Hack
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna 1090, Austria
- Anton-Proksch-Institute, Vienna, Vienna 1230, Austria
| | - Martin Aigner
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, University Hospital Tulln, Tulln 3430, Austria
| | | | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna 1090, Austria
| | - Lilian Konicar
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna 1090, Austria
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Boxum M, Voetterl H, van Dijk H, Gordon E, DeBeus R, Arnold LE, Arns M. Challenging the Diagnostic Value of Theta/Beta Ratio: Insights From an EEG Subtyping Meta-Analytical Approach in ADHD. Appl Psychophysiol Biofeedback 2024:10.1007/s10484-024-09649-y. [PMID: 38858282 DOI: 10.1007/s10484-024-09649-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
The frequently reported high theta/beta ratio (TBR) in the electroencephalograms (EEGs) of children with attention-deficit/hyperactivity disorder (ADHD) has been suggested to include at least two distinct neurophysiological subgroups, a subgroup with high TBR and one with slow alpha peak frequency, overlapping the theta range. We combined three large ADHD cohorts recorded under standardized procedures and used a meta-analytical approach to leverage the large sample size (N = 417; age range: 6-18 years), classify these EEG subtypes and investigate their behavioral correlates to clarify their brain-behavior relationships. To control for the fact that slow alpha might contribute to theta power, three distinct EEG subgroups (non-slow-alpha TBR (NSAT) subgroup, slow alpha peak frequency (SAF) subgroup, not applicable (NA) subgroup) were determined, based on a halfway cut-off in age- and sex-normalized theta and alpha, informed by previous literature. For the meta-analysis, Cohen's d was calculated to assess the differences between EEG subgroups for baseline effects, using means and standard deviations of baseline inattention and hyperactivity-impulsivity scores. Non-significant, small Grand Mean effect sizes (-0.212 < d < 0.218) were obtained when comparing baseline behavioral scores between the EEG subgroups. This study could not confirm any association of EEG subtype with behavioral traits. This confirms previous findings suggesting that TBR has no diagnostic value for ADHD. TBR could, however, serve as an aid to stratify patients between neurofeedback protocols based on baseline TBR. A free online tool was made available for clinicians to calculate age- and sex-corrected TBR decile scores (Brainmarker-IV) for stratification of neurofeedback protocols.
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Affiliation(s)
- Marit Boxum
- Radboud University, Nijmegen, The Netherlands
- Research Institute Brainclinics, Brainclinics Foundation, Bijleveldsingel 32, 6524 AD, Nijmegen, The Netherlands
| | - Helena Voetterl
- Research Institute Brainclinics, Brainclinics Foundation, Bijleveldsingel 32, 6524 AD, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Hanneke van Dijk
- Research Institute Brainclinics, Brainclinics Foundation, Bijleveldsingel 32, 6524 AD, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Synaeda Psycho Medisch Centrum, Leeuwarden, The Netherlands
| | | | - Roger DeBeus
- The University of North Carolina at Asheville, Asheville, NC, USA
| | - L Eugene Arnold
- Department of Psychiatry &, Behavioral Health, Nisonger Center, Ohio State University, Columbus, OH, USA
| | - Martijn Arns
- Research Institute Brainclinics, Brainclinics Foundation, Bijleveldsingel 32, 6524 AD, Nijmegen, The Netherlands.
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
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Dentz A, Soelch CM, Fahim C, Torsello A, Parent V, Ponsioen A, Guay MC, Bioulac-Rogier S, Clément C, Bader M, Romo L. Non-pharmacological treatment of Attention Deficit Disorder with or without Hyperactivity (ADHD). Overview and report of the first international symposium on the non-pharmacological management of ADHD. L'ENCEPHALE 2024; 50:309-328. [PMID: 38326137 DOI: 10.1016/j.encep.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/24/2023] [Indexed: 02/09/2024]
Abstract
Attention Deficit Disorder with or without Hyperactivity (ADHD is a neurodevelopmental disorder which affects the day-to-day functioning of children and adults with this condition. Pharmacological treatment can reduce the symptoms associated with ADHD, but it has some limitations. The objective of this symposium is to determine the effects of non-pharmacological approaches on ADHD symptoms. Results indicate that the following intervention are promising approaches: cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), yoga, cognitive and metacognitive intervention, neurofeedback and parental training programs. Current research advocates multimodal approaches in conjunction with school or work accommodations integrating innovative technologies.
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Affiliation(s)
- Amélie Dentz
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland.
| | - Chantal Martin Soelch
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland
| | - Cherine Fahim
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland
| | - Alexandra Torsello
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland
| | | | | | | | | | - Céline Clément
- Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication (EA 2310), Université de Strasbourg, Strasbourg, France
| | - Michel Bader
- Unité de Recherche, Service de Psychiatrie de l'Enfant et de l'adolescent (SUPEA - DP CHUV), Lausanne, Switzerland
| | - Lucia Romo
- EA4430 CLIPSYD, UFR SPSE, Paris Nanterre Université, Nanterre, France
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Shanok NA, Jones NA. EEG Asymmetry Characteristics in Relation to Childhood Anxiety Subtypes: A Dimensional Approach. Clin EEG Neurosci 2024; 55:34-42. [PMID: 36604820 DOI: 10.1177/15500594221150213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Right frontal EEG asymmetry has been a commonly neurophysiological marker of anxiety and depressive symptoms throughout development. Method: In the current study, EEG asymmetry measures in frontal and parietal regions were examined as markers for specific subtypes of childhood anxiety disorder (eg, panic, generalized, social, separation, and school avoidance). Results: Notably, panic trait levels were significantly associated with prefrontal and lateral frontal alpha asymmetry, general anxiety was predicted by parietal beta asymmetry measures, and social anxiety levels were associated with mid-frontal alpha and beta asymmetry. School avoidance was significantly correlated with prefrontal and lateral frontal beta asymmetry scores; however, no significant findings were detected relating to separation anxiety which is considered unique to childhood anxiety. Discussion: In all cases, increased anxiety subtype scores related to a rightward shift in asymmetry, signifying this trait as a key neurophysiological marker of childhood anxiety symptoms. Conclusion: Overall, biomarker research of specific subtypes of broad conditions like anxiety could be highly useful for facilitating a deeper understanding of the mechanisms involved, as well as customizing treatment approaches.
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Affiliation(s)
- Nathaniel A Shanok
- Behavioral Sciences Department, Florida Atlantic University, Boca Raton, FL, USA
| | - Nancy Aaron Jones
- Behavioral Sciences Department, Florida Atlantic University, Boca Raton, FL, USA
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Zhang DW, Johnstone SJ, Sauce B, Arns M, Sun L, Jiang H. Remote neurocognitive interventions for attention-deficit/hyperactivity disorder - Opportunities and challenges. Prog Neuropsychopharmacol Biol Psychiatry 2023; 127:110802. [PMID: 37257770 DOI: 10.1016/j.pnpbp.2023.110802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
Improving neurocognitive functions through remote interventions has been a promising approach to developing new treatments for attention-deficit/hyperactivity disorder (AD/HD). Remote neurocognitive interventions may address the shortcomings of the current prevailing pharmacological therapies for AD/HD, e.g., side effects and access barriers. Here we review the current options for remote neurocognitive interventions to reduce AD/HD symptoms, including cognitive training, EEG neurofeedback training, transcranial electrical stimulation, and external cranial nerve stimulation. We begin with an overview of the neurocognitive deficits in AD/HD to identify the targets for developing interventions. The role of neuroplasticity in each intervention is then highlighted due to its essential role in facilitating neuropsychological adaptations. Following this, each intervention type is discussed in terms of the critical details of the intervention protocols, the role of neuroplasticity, and the available evidence. Finally, we offer suggestions for future directions in terms of optimizing the existing intervention protocols and developing novel protocols.
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Affiliation(s)
- Da-Wei Zhang
- Department of Psychology/Center for Place-Based Education, Yangzhou University, Yangzhou, China; Department of Psychology, Monash University Malaysia, Bandar Sunway, Malaysia.
| | - Stuart J Johnstone
- School of Psychology, University of Wollongong, Wollongong, Australia; Brain & Behaviour Research Institute, University of Wollongong, Australia
| | - Bruno Sauce
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Martijn Arns
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, Netherlands; Department of Experimental Psychology, Utrecht University, Utrecht, Netherlands; NeuroCare Group, Nijmegen, Netherlands
| | - Li Sun
- Peking University Sixth Hospital/Institute of Mental Health, Beijing, China; National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Han Jiang
- College of Special Education, Zhejiang Normal University, Hangzhou, China
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Wakelin C, Willemse M, Munnik E. A review of recent treatments for adults living with attention-deficit/hyperactivity disorder. S Afr J Psychiatr 2023; 29:2152. [PMID: 38126038 PMCID: PMC10730462 DOI: 10.4102/sajpsychiatry.v29i0.2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023] Open
Abstract
Background Attention-deficit/hyperactivity disorder (ADHD) is a neuro-developmental disorder prevalent among children and adults. Adults living with ADHD can experience significant distress affecting their daily functioning on emotional, physical, interpersonal, familial and financial levels. Intervention programmes may be a way to mitigate these challenges. Aim This review identified good evidence-based intervention studies for adults with ADHD and described the usefulness of these interventions. Method Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, articles were searched from 2009 to 2019 across four medical- and psychological-focused electronic databases using EBSCOhost. All articles selected for the review's thematic meta-synthesis were appraised by attaining a threshold score of at least 61%, using the Smith-Franciscus-Swartbooi appraisal tool. Two autonomous reviewers engaged in the review process. The study adhered to all ethical principles pertaining to systematic review practice. Results Forty studies were identified for summation, including pharmacological, non-pharmacological and neuro-stimulation approaches. Most interventions used a multimodal approach. Results indicated the most effective stimulant and non-stimulant as methylphenidate and atomoxetine, respectively. Effective non-pharmacological approaches to treatment were identified as cognitive-behavioural treatment, mindfulness-based approaches, psycho-education and dialectical-focused therapies. Bright light treatment and neurofeedback were reported as the most efficacious neuro-stimulatory methods. Conclusion Pharmacological and non-pharmacological approaches, as well as neuro-stimulation or a blend of these approaches were acknowledged as the most effective recent modalities in the treatment of adult ADHD. Contribution This review reported on the most current approaches to treat adult ADHD. This will facilitate a better understanding and informed decisions with regard to dealing with adult ADHD.
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Affiliation(s)
- Candice Wakelin
- Department of Psychology, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Michele Willemse
- Department of Psychology, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Erica Munnik
- Department of Psychology, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
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Kleih-Dahms SC, Botrel L. Neurofeedback therapy to improve cognitive function in patients with chronic post-stroke attention deficits: a within-subjects comparison. Front Hum Neurosci 2023; 17:1155584. [PMID: 37497040 PMCID: PMC10367101 DOI: 10.3389/fnhum.2023.1155584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/12/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction We investigated a slow-cortical potential (SCP) neurofeedback therapy approach for rehabilitating chronic attention deficits after stroke. This study is the first attempt to train patients who survived stroke with SCP neurofeedback therapy. Methods We included N = 5 participants in a within-subjects follow-up design. We assessed neuropsychological and psychological performance at baseline (4 weeks before study onset), before study onset, after neurofeedback training, and at 3 months follow-up. Participants underwent 20 sessions of SCP neurofeedback training. Results Participants learned to regulate SCPs toward negativity, and we found indications for improved attention after the SCP neurofeedback therapy in some participants. Quality of life improved throughout the study according to engagement in activities of daily living. The self-reported motivation was related to mean SCP activation in two participants. Discussion We would like to bring attention to the potential of SCP neurofeedback therapy as a new rehabilitation method for treating post-stroke cognitive deficits. Studies with larger samples are warranted to corroborate the results.
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Shanok NA, Rodriguez S, Muzac S, Del Pino CH, Brown L, Rodriguez R. Deep transcranial magnetic stimulation alters resting-state neurophysiological traits in major depressive disorder. J Affect Disord 2023:S0165-0327(23)00707-3. [PMID: 37230266 DOI: 10.1016/j.jad.2023.05.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Major depressive disorder (MDD) is one of the most prevalent and debilitating health conditions worldwide; unfortunately, many patients do not respond to traditional antidepressant medication or talk therapy approaches. Deep transcranial magnetic stimulation (Deep TMS) has emerged as an effective treatment option for such "treatmentresistant" cases; however, the mechanisms by which Deep TMS attenuates depressive symptoms are still ambiguous. METHODS In the current study, resting-state quantitative electroencephalography (QEEG) measures were assessed pre-and-post treatment to illustrate neurophysiological changes resulting from Deep TMS. RESULTS The results showed reduced slow-frequency brain activity (delta and theta waves) in the prefrontal cortex following 36 treatments. Additionally, baseline QEEG measures predicted treatment response with approximately 90 % accuracy. CONCLUSIONS These findings provide preliminary evidence that TMS improves depressive symptoms by mitigating slow-wave brain activity in the prefrontal cortex. SIGNIFICANCE Deep TMS paired with QEEG should continue to be utilized for treatment of MDD in clinical practice and future studies should explore its potential for other neuropsychiatric conditions.
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Affiliation(s)
- Nathaniel A Shanok
- Delray Center for Brain Sciences, 103 SE 4th St., Delray Beach, FL 33483, United States of America.
| | - Santiago Rodriguez
- Delray Center for Brain Sciences, 103 SE 4th St., Delray Beach, FL 33483, United States of America
| | - Sabrina Muzac
- Delray Center for Brain Sciences, 103 SE 4th St., Delray Beach, FL 33483, United States of America
| | - Carla Huertes Del Pino
- Delray Center for Brain Sciences, 103 SE 4th St., Delray Beach, FL 33483, United States of America
| | - Leah Brown
- Delray Center for Brain Sciences, 103 SE 4th St., Delray Beach, FL 33483, United States of America
| | - Raul Rodriguez
- Delray Center for Brain Sciences, 103 SE 4th St., Delray Beach, FL 33483, United States of America
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Krell J, Dolecki PK, Todd A. School-Based Neurofeedback Training for Sustained Attention. J Atten Disord 2023:10870547231168430. [PMID: 37122234 DOI: 10.1177/10870547231168430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To determine whether in situ neurofeedback training can be used as a tool to build sustained attention in the general student population and whether gains in attention translate to more effective work habits and learning skills. METHOD Students participated in attention training game-based neurofeedback in situ for a period of 35 sessions of 25 min each. The study was built as a one-group pretest-posttest quasi-experimental design. RESULTS This study supports that classroom-based neurofeedback may be an effective tool to build sustained attention and translate these gains into observable work habits and learning behaviors including planning and organization. CONCLUSION Neurofeedback has shown specificity in the treatment of Attention Deficit Hyperactivity Disorder. Published research has not, however, focused on its efficacy in developing attentional capacities in the general population. The promising results of this exploratory investigation warrant further applied research.
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Ging-Jehli NR, Kraemer HC, Eugene Arnold L, Roley-Roberts ME, deBeus R. Cognitive markers for efficacy of neurofeedback for attention-deficit hyperactivity disorder - personalized medicine using computational psychiatry in a randomized clinical trial. J Clin Exp Neuropsychol 2023; 45:118-131. [PMID: 37157126 PMCID: PMC10515439 DOI: 10.1080/13803395.2023.2206637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/20/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Exploring whether cognitive components (identified by baseline cognitive testing and computational modeling) moderate clinical outcome of neurofeedback (NF) for attention-deficit hyperactivity disorder (ADHD). METHOD 142 children (aged 7-10) with ADHD were randomly assigned to either NF (n = 84) or control treatment (n = 58) in a double-blind clinical trial (NCT02251743). The NF group received live, self-controlled downtraining of electroencephalographic theta/beta ratio power. The control group received identical-appearing reinforcement from prerecorded electroencephalograms from other children. 133 (78 NF, 55 control) children had cognitive processing measured at baseline with the Integrated Visual and Auditory Continuous Performance Test (IVA2-CPT) and were included in this analysis. A diffusion decision model applied to the IVA2-CPT data quantified two latent cognitive components deficient in ADHD: drift rate and drift bias, indexing efficiency and context sensitivity of cognitive processes involving information integration. We explored whether these cognitive components moderated the improvement in parent- and teacher-rated inattention symptoms from baseline to treatment end (primary clinical outcome). RESULTS Baseline cognitive components reflecting information integration (drift rate, drift bias) moderated the improvement in inattention due to NF vs. control treatment (p = 0.006). Specifically, those with either the most or least severe deficits in these components showed more improvement in parent- and teacher-rated inattention when assigned to NF (Cohen's d = 0.59) than when assigned to control (Cohen's d = -0.21). CONCLUSIONS Pre-treatment cognitive testing with computational modeling identified children who benefitted more from neurofeedback than control treatment for ADHD.
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Affiliation(s)
- Nadja R. Ging-Jehli
- Department of Psychology, The Ohio State University,
Columbus, OH 43210, USA; Department of Cognitive, Linguistic & Psychological
Sciences, Brown University, Providence, Rhode Island
| | - Helena C. Kraemer
- Department of Psychiatry and Behavioral Sciences, Stanford
University School of Medicine, Cupertino, CA 95014, USA
| | - L. Eugene Arnold
- Department of Psychiatry and Behavioral Health, The Ohio
State University; Nisonger Center UCEDD, Columbus, OH 43210, USA
| | | | - Roger deBeus
- Department of Psychology, University of North Carolina at
Asheville, Asheville, NC 28801, USA
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Evaluation of Neurofeedback Learning in Patients with ADHD: A Systematic Review. Appl Psychophysiol Biofeedback 2023; 48:11-25. [PMID: 36178643 PMCID: PMC9908642 DOI: 10.1007/s10484-022-09562-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/02/2022]
Abstract
NFB has a clear potential as a recognised treatment option for ADHD, but suffers from a lack of clarity about its efficacy, still unresolved after multiple controlled trials. Comparing learners and non-learners based on the evolution of patient-level indicators during the trial serves as a 'natural' control, and can help elucidate the mechanisms of NFB. We present a systematic review motivated by the need to establish the state of the art of patient learning during NFB treatment in current clinical literature. One particularly striking question we would like to answer here is whether existing NFB papers study learning variability, since only individual performance differences can give us information about mechanisms of learning. The results show that very few clinical trial reports have dealt with the heterogeneity of NFB learning, nor analysed whether NFB efficacy is dependent on NFB learning, even though NFB is believed to be a treatment based on learning to perform. In this systematic review we examine not only what has been reported, but also provide a critical analysis of possible flaws or gaps in existing studies, and discuss why no generalized conclusions about NFB efficacy have yet been made. Future research should focus on finding reliable ways of identifying the performers and studying participants' individual learning trajectories as it might enhance prognosis and the allocation of clinical resources.
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Ging-Jehli NR, Arnold LE, Roley-Roberts ME, deBeus R. Characterizing Underlying Cognitive Components of ADHD Presentations and Co-morbid Diagnoses: A Diffusion Decision Model Analysis. J Atten Disord 2022; 26:706-722. [PMID: 34085557 DOI: 10.1177/10870547211020087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To Explore whether subtypes and comorbidities of attention-deficit hyperactivity disorder (ADHD) induce distinct biases in cognitive components involved in information processing. METHOD Performance on the Integrated Visual and Auditory Continuous Performance Test (IVA-CPT) was compared between 150 children (aged 7 to 10) with ADHD, grouped by DSM-5 presentation (ADHD-C, ADHD-I) or co-morbid diagnoses (anxiety, oppositional defiant disorder [ODD], both, neither), and 60 children without ADHD. Diffusion decision modeling decomposed performance into cognitive components. RESULTS Children with ADHD had poorer information integration than controls. Children with ADHD-C were more sensitive to changes in presentation modality (auditory/visual) than those with ADHD-I and controls. Above and beyond these results, children with ADHD+anxiety+ODD had larger increases in response biases when targets became frequent than children with ADHD-only or with ADHD and one comorbidity. CONCLUSION ADHD presentations and comorbidities have distinct cognitive characteristics quantifiable using DDM and IVA-CPT. We discuss implications for tailored cognitive-behavioral therapy.
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Kaushik P, Jena SPK. Effect of cognitive behavioral intervention on electroencephalographic band powers of children with learning difficulty under eyes-closed and eyes-open conditions. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:224-232. [DOI: 10.1590/0004-282x-anp-2020-0503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 06/14/2021] [Indexed: 11/22/2022]
Abstract
ABSTRACT Background: Electroencephalography (EEG) plays an important role in assessing children with learning difficulties or related behavioral issues. Understanding EEG alterations in students with learning difficulties is crucial for evaluating cognitive functioning. Objective: The first aim was to examine the effects of the Program for Enhancing Academic and Behavioral Learning Skills (PEABLS), a cognitive-behavioral intervention on absolute and relative EEG band powers under eyes-closed and eyes-open conditions. Another aim was to examine the relationship between relative band powers of EEG waveforms through specific cognitive measurements like IQ, working memory and BGT for perceptual motor skills and organization. Methods: This study had a quasi-experimental pre-test post-test research design and involved a group of 50 students with learning problems. PEABLS, an accessible school-based intervention, was offered to academically low-performing students. EEG recordings were conducted before and after the intervention on prefrontal (FP1 FP2), temporal (T3 T4) and occipital (O1 O2) scalp locations. The data acquired were processed using MATLAB to find the absolute and relative band powers of waveforms. Results: Paired t tests on the recorded EEG data suggested that significant improvements in absolute and relative power values of waveforms were achieved, post-intervention. There were significant increases in relative alpha power values in the prefrontal and temporal regions under both eyes-closed and eyes-open conditions and significant increases in relative theta and delta power in the prefrontal and temporal regions. Pearson's correlation suggested that there was a significant relationship between relative alpha and beta power values in the prefrontal and occipital regions, through the cognitive measurements. Conclusion: PEABLS was significative in bringing changes to EEG band powers.
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Yao S, Zhu J, Li S, Zhang R, Zhao J, Yang X, Wang Y. Bibliometric Analysis of Quantitative Electroencephalogram Research in Neuropsychiatric Disorders From 2000 to 2021. Front Psychiatry 2022; 13:830819. [PMID: 35677873 PMCID: PMC9167960 DOI: 10.3389/fpsyt.2022.830819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND With the development of quantitative electroencephalography (QEEG), an increasing number of studies have been published on the clinical use of QEEG in the past two decades, particularly in the diagnosis, treatment, and prognosis of neuropsychiatric disorders. However, to date, the current status and developing trends of this research field have not been systematically analyzed from a macroscopic perspective. The present study aimed to identify the hot spots, knowledge base, and frontiers of QEEG research in neuropsychiatric disorders from 2000 to 2021 through bibliometric analysis. METHODS QEEG-related publications in the neuropsychiatric field from 2000 to 2021 were retrieved from the Web of Science Core Collection (WOSCC). CiteSpace and VOSviewer software programs, and the online literature analysis platform (bibliometric.com) were employed to perform bibliographic and visualized analysis. RESULTS A total of 1,904 publications between 2000 and 2021 were retrieved. The number of QEEG-related publications in neuropsychiatric disorders increased steadily from 2000 to 2021, and research in psychiatric disorders requires more attention in comparison to research in neurological disorders. During the last two decades, QEEG has been mainly applied in neurodegenerative diseases, cerebrovascular diseases, and mental disorders to reveal the pathological mechanisms, assist clinical diagnosis, and promote the selection of effective treatments. The recent hot topics focused on QEEG utilization in neurodegenerative disorders like Alzheimer's and Parkinson's disease, traumatic brain injury and related cerebrovascular diseases, epilepsy and seizure, attention-deficit hyperactivity disorder, and other mental disorders like major depressive disorder and schizophrenia. In addition, studies to cross-validate QEEG biomarkers, develop new biomarkers (e.g., functional connectivity and complexity), and extract compound biomarkers by machine learning were the emerging trends. CONCLUSION The present study integrated bibliometric information on the current status, the knowledge base, and future directions of QEEG studies in neuropsychiatric disorders from a macroscopic perspective. It may provide valuable insights for researchers focusing on the utilization of QEEG in this field.
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Affiliation(s)
- Shun Yao
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China.,Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jieying Zhu
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Shuiyan Li
- Department of Rehabilitation Medicine, School of Rehabilitation Medicine, Southern Medical University, Guangzhou, China
| | - Ruibin Zhang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Jiubo Zhao
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China.,Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xueling Yang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China.,Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - You Wang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China.,Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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15
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Paul P, Bennett CN. Review of Neuropsychological and Electrophysiological Correlates of Callous-unemotional Traits in Children: Implications for EEG Neurofeedback Intervention. Clin EEG Neurosci 2021; 52:321-329. [PMID: 33709806 DOI: 10.1177/1550059421997129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Conduct disorder is a significant psychiatric disorder of childhood and adolescence. The Diagnostic and Statistical Manual of Mental Disorders, fifth version (DSM-5), added the limited prosocial specifier to identify those individuals who exhibit a more severe pattern of behavior characterized by a callous and unemotional (CU) interpersonal style across multiple settings and relationships. This review has attempted to summarize the relevant research focusing on the significance of CU interpersonal style in the development of psychopathy. The primary focus was on the electrophysiological and neuropsychological correlates of CU traits and their implication on the treatment protocol using neurofeedback training for children with such traits. The source of the literature search was PubMed, which majorly uses the MEDLINE database. The keywords used included CU traits, conduct disorder, child psychopathy, empathy, electrophysiology, criminal behavior, neuropsychology, neurofeedback training, and so on. Studies from the last 15 years were considered for the review. This review revealed that children with conduct disorder and high-CU traits with a combination of reactive and proactive aggression are more likely to develop psychopathy. Evidence suggests that these children have distinct forms of electrophysiological and neuropsychological correlates. However, research in this area is still not conclusive as they yield variation in findings. Studies on the efficacy of neurofeedback training on reducing symptoms such as impulsivity, hostility, and psychopathy indicate that neurofeedback training can be a promising treatment alternative for children with severe conduct disorder.
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16
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Aggensteiner PM, Albrecht B, Strehl U, Wörz S, Ruckes C, Freitag CM, Rothenberger A, Gevensleben H, Millenet S, Hohmann S, Banaschewski T, Legenbauer T, Holtmann M, Brandeis D. Can neurophysiological markers of anticipation and attention predict ADHD severity and neurofeedback outcomes? Biol Psychol 2021; 165:108169. [PMID: 34416347 DOI: 10.1016/j.biopsycho.2021.108169] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 07/12/2021] [Accepted: 08/12/2021] [Indexed: 01/23/2023]
Abstract
Neurophysiological measures of preparation and attention are often atypical in ADHD. Still, replicated findings that these measures predict which patients improve after Neurofeedback (NF), reveal neurophysiological specificity, and reflect ADHD-severity are limited. METHODS We analyzed children's preparatory (CNV) and attentional (Cue-P3) brain activity and behavioral performance during a cued Continuous Performance Task (CPT) before and after slow cortical potential (SCP)-NF or semi-active control treatment (electromyogram biofeedback). Mixed-effects models were performed with 103 participants at baseline and 77 were assessed for pre-post comparisons focusing on clinical outcome prediction, specific neurophysiological effects of NF, and associations with ADHD-severity. RESULTS Attentional and preparatory brain activity and performance were non-specifically reduced after treatment. Preparatory activity in the SCP-NF group increased with clinical improvement. Several performance and brain activity measures predicted non-specific treatment outcome. CONCLUSION Specific neurophysiological effects after SCP-NF were limited to increased neural preparation associated with improvement on ADHD-subscales, but several performance and neurophysiological measures of attention predicted treatment outcome and reflected symptom severity in ADHD. The results may help to optimize treatment.
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Affiliation(s)
- Pascal-M Aggensteiner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Björn Albrecht
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany; Philipps-University Marburg, Department of Psychology, Marburg, Germany
| | - Ute Strehl
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Sonja Wörz
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials at the University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Aribert Rothenberger
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Holger Gevensleben
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Sabina Millenet
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tanja Legenbauer
- LWL-University Hospital for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Ruhr University Bochum, Hamm, Germany
| | - Martin Holtmann
- LWL-University Hospital for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Ruhr University Bochum, Hamm, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zürich, Zürich, Switzerland; Center for Integrative Human Physiology, University of Zürich, Zürich, Switzerland; Neuroscience Center Zürich, Swiss Federal Institute of Technology and University of Zürich, Zürich, Switzerland
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17
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Janssens SEW, Sack AT, Ten Oever S, de Graaf TA. Calibrating rhythmic stimulation parameters to individual EEG markers: the consistency of individual alpha frequency in practical lab settings. Eur J Neurosci 2021; 55:3418-3437. [PMID: 34363269 PMCID: PMC9541964 DOI: 10.1111/ejn.15418] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/18/2021] [Accepted: 08/02/2021] [Indexed: 11/27/2022]
Abstract
Rhythmic stimulation can be applied to modulate neuronal oscillations. Such 'entrainment' is optimized when stimulation frequency is individually-calibrated based on magneto/encephalography markers. It remains unknown how consistent such individual markers are across days/sessions, within a session, or across cognitive states, hemispheres, and estimation methods, especially in a realistic, practical, lab setting. We here estimated individual alpha frequency (IAF) repeatedly from short EEG measurements at rest or during an attention task (cognitive state), using single parieto-occipital electrodes in 24 participants on four days (between-sessions), with multiple measurements over an hour on one day (within-session). First, we introduce an algorithm to automatically reject power spectra without a sufficiently clear peak to ensure unbiased IAF estimations. Then we estimated IAF via the traditional 'maximum' method and a 'Gaussian fit' method. IAF was reliable within- and between-sessions for both cognitive states and hemispheres, though task-IAF estimates tended to be more variable. Overall, the 'Gaussian fit' method was more reliable than the 'maximum' method. Furthermore, we evaluated how far from an approximated 'true' task-related IAF the selected 'stimulation frequency' was, when calibrating this frequency based on a short rest-EEG, a short task-EEG, or simply selecting 10Hertz for all participants. For the 'maximum' method, rest-EEG calibration was best, followed by task-EEG, and then 10 Hertz. For the 'Gaussian fit' method, rest-EEG and task-EEG-based calibration were similarly accurate, and better than 10 Hertz. These results lead to concrete recommendations about valid, and automated, estimation of individual oscillation markers in experimental and clinical settings.
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Affiliation(s)
- Shanice E W Janssens
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht, the Netherlands
| | - Alexander T Sack
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht, the Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Brain+Nerve Centre , Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands.,Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, the Netherlands
| | - Sanne Ten Oever
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Language and Computation in Neural Systems Group, Max Planck Institute for Psycholinguistics, Nijmegen, the Netherlands.,Donders Centre for Cognitive Neuroimaging, Radboud University, Nijmegen, the Netherlands
| | - Tom A de Graaf
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht, the Netherlands.,Center for Integrative Neuroscience (CIN), Maastricht University, Maastricht, the Netherlands
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18
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Double-Blind Placebo-Controlled Randomized Clinical Trial of Neurofeedback for Attention-Deficit/Hyperactivity Disorder With 13-Month Follow-up. J Am Acad Child Adolesc Psychiatry 2021; 60:841-855. [PMID: 32853703 PMCID: PMC7904968 DOI: 10.1016/j.jaac.2020.07.906] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 07/01/2020] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine whether theta/beta-ratio (TBR) electroencephalographic biofeedback (neurofeedback [NF]) has a specific effect on attention-deficit/hyperactivity disorder (ADHD) beyond nonspecific benefit. METHOD In a 2-site double-blind randomized clinical trial, 144 children aged 7 to 10 years with rigorously diagnosed moderate/severe ADHD and theta/beta-ratio (TBR) ≥4.5 were randomized 3:2 to deliberate TBR downtraining versus a control of equal duration, intensity, and appearance. Two early dropouts left 142 children for modified intent-to-treat analysis. The control used prerecorded electroencephalograms with the participant's artifacts superimposed. Treatment was programmed via Internet by an off-site statistician-guided co-investigator. Fidelity was 98.7% by trainers/therapists and 93.2% by NF expert monitor. The primary outcome was parent- and teacher-rated inattention; analysis was mixed-effects regression. Because the expense and effort of NF can be justified only by enduring benefit, follow-ups were integrated. RESULTS Blinding was excellent. Although both groups showed significant improvement (p < .001, d = 1.5) in parent/teacher-rated inattention from baseline to treatment end and 13-month follow-up, NF was not significantly superior to the control condition at either time point on this primary outcome (d = 0.01, p = .965 at treatment end; d = 0.23, p = .412 at 13-month follow-up). Responders (Clinical Global Impression-Improvement [CGI-I] = 1-2) were 61% of NF and 54% of controls (p = .36). Adverse events were distributed proportionally between treatments. The 13-month follow-up found nonsignificant improvement from treatment end for NF (d = 0.1), with mild deterioration for controls (d = -0.07). NF required significantly less medication at follow-up (p = .012). CONCLUSION This study does not support a specific effect of deliberate TBR NF at either treatment end or 13-month follow-up. Participants will be reassessed at 25-month follow-up. CLINICAL TRIAL REGISTRATION INFORMATION Double-Blind 2-Site Randomized Clinical Trial of Neurofeedback for ADHD; https://clinicaltrials.gov/; NCT02251743.
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19
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Neurofeedback and Attention-Deficit/Hyperactivity-Disorder (ADHD) in Children: Rating the Evidence and Proposed Guidelines. Appl Psychophysiol Biofeedback 2021; 45:39-48. [PMID: 32206963 PMCID: PMC7250955 DOI: 10.1007/s10484-020-09455-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Stimulant medication and behaviour therapy are the most often applied and accepted treatments for Attention-Deficit/Hyperactivity-Disorder (ADHD). Here we explore where the non-pharmacological clinical intervention known as neurofeedback (NFB), fits on the continuum of empirically supported treatments, using standard protocols. In this quantitative review we utilized an updated and stricter version of the APA guidelines for rating ‘well-established’ treatments and focused on efficacy and effectiveness using effect-sizes (ES) and remission, with a focus on long-term effects. Efficacy and effectiveness are compared to medication and behaviour therapy using benchmark studies. Only recent systematic reviews and meta-analyses as well as multi-centre randomized controlled trials (RCT’s) will be included. Two meta-analyses confirmed significant efficacy of standard neurofeedback protocols for parent and teacher rated symptoms with a medium effect size, and sustained effects after 6–12 months. Four multicenter RCT’s demonstrated significant superiority to semi-active control groups, with medium-large effect sizes end of treatment or follow-up and remission rates of 32–47%. Effectiveness in open-label studies was confirmed, no signs of publication bias were found and no significant neurofeedback-specific side effects have been reported. Standard neurofeedback protocols in the treatment of ADHD can be concluded to be a well-established treatment with medium to large effect sizes and 32–47% remission rates and sustained effects as assessed after 6–12 months.
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20
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Deiber MP, Ammann C, Hasler R, Colin J, Perroud N, Ros T. Electrophysiological correlates of improved executive function following EEG neurofeedback in adult attention deficit hyperactivity disorder. Clin Neurophysiol 2021; 132:1937-1946. [PMID: 34153722 DOI: 10.1016/j.clinph.2021.05.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/13/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Event-related potentials (ERPs) are reported to be altered in relation to cognitive processing deficits in attention deficit hyperactivity disorder (ADHD). However, this evidence is mostly limited to cross-sectional data. The current study utilized neurofeedback (NFB) as a neuromodulatory tool to examine the ERP correlates of attentional and inhibitory processes in adult ADHD using a single-session, within-subject design. METHODS We recorded high-density EEG in 25 adult ADHD patients and 22 neurotypical controls during a Go/NoGo task, before and after a 30-minute NFB session designed to down-regulate the alpha (8-12 Hz) rhythm. RESULTS At baseline, ADHD patients demonstrated impaired Go/NoGo performance compared to controls, while Go-P3 amplitude inversely correlated with ADHD-associated symptomatology in childhood. Post NFB, task performance improved in both groups, significantly enhancing stimulus detectability (d-prime) and reducing reaction time variability, while increasing N1 and P3 ERP component amplitudes. Specifically for ADHD patients, the pre-to-post enhancement in Go-P3 amplitude correlated with measures of improved executive function, i.e., enhanced d-prime, reduced omission errors and reduced reaction time variability. CONCLUSIONS A single-session of alpha down-regulation NFB was able to reverse the abnormal neurocognitive signatures of adult ADHD during a Go/NoGo task. SIGNIFICANCE The study demonstrates for the first time the beneficial neurobehavioral effect of a single NFB session in adult ADHD, and reinforces the notion that ERPs could serve as useful diagnostic/prognostic markers of executive dysfunction.
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Affiliation(s)
- Marie-Pierre Deiber
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland; Functional Brain Mapping Laboratory, Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland.
| | - Camille Ammann
- Geneva Medical Center, University of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Julien Colin
- Geneva Medical Center, University of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Division of Psychiatric Specialties, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Tomas Ros
- Department of Psychiatry, University of Geneva, Geneva, Switzerland; Centre for Biomedical Imaging (CIBM) Lausanne-Geneva, Geneva, Switzerland; Functional Brain Mapping Laboratory, Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland
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21
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Pérez-Elvira R, Oltra-Cucarella J, Carrobles JA, Moltó J, Flórez M, Parra S, Agudo M, Saez C, Guarino S, Costea RM, Neamtu B. Enhancing the Effects of Neurofeedback Training: The Motivational Value of the Reinforcers. Brain Sci 2021; 11:brainsci11040457. [PMID: 33916676 PMCID: PMC8067059 DOI: 10.3390/brainsci11040457] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022] Open
Abstract
The brain activity that is measured by electroencephalography (EEG) can be modified through operant conditioning, specifically using neurofeedback (NF). NF has been applied to several disorders claiming that a change in the erratic brain activity would be accompanied by a reduction of the symptoms. However, the expected results are not always achieved. Some authors have suggested that the lack of an adequate response may be due to an incorrect application of the operant conditioning principles. A key factor in operant conditioning is the use of reinforcers and their value in modifying behavior, something that is not always sufficiently taken into account. This work aims to clarify the relevance of the motivational value versus the purely informational value of the reinforcer. In this study, 113 subjects were randomly assigned two different reinforcer conditions: a selected reinforcer—the subjects subjectively selected the reinforcers—or an imposed reinforcer—the reinforcers were assigned by the experimenter—and both groups undertook NF sessions to enhance the sensorimotor rhythm (SMR). In addition, the selected reinforcer group was divided into two subgroups: one receiving real NF and the other one sham NF. There were no significant differences between the groups at baseline in terms of SMR amplitude. After the intervention, only those subjects belonging to the selected reinforcer group and receiving real NF increased their SMR. Our results provide evidence for the importance of the motivational value of the reinforcer in Neurofeedback success.
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Affiliation(s)
- Rubén Pérez-Elvira
- Neuropsychophysiology Laboratory, NEPSA Rehabilitación Neurológica, 3003 Salamanca, Spain; (R.P.-E.); (M.A.); (C.S.)
| | - Javier Oltra-Cucarella
- Department of Health Psychology, Universidad Miguel Hernández de Elche, 03202 Elche, Spain
- Correspondence:
| | - José Antonio Carrobles
- Biological and Health Psychology Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain;
| | - Jorge Moltó
- PSYD-Neurofeedback, 46022 Valencia, Spain; (J.M.); (M.F.)
| | | | | | - María Agudo
- Neuropsychophysiology Laboratory, NEPSA Rehabilitación Neurológica, 3003 Salamanca, Spain; (R.P.-E.); (M.A.); (C.S.)
| | - Clara Saez
- Neuropsychophysiology Laboratory, NEPSA Rehabilitación Neurológica, 3003 Salamanca, Spain; (R.P.-E.); (M.A.); (C.S.)
| | - Sergio Guarino
- NEPSA Rehabilitación Neurológica, 47001 Valladolid, Spain;
| | - Raluca Maria Costea
- Research Department (Ceforaten), Sibiu Pediatric Hospital, 550178 Sibiu, Romania; (R.M.C.); (B.N.)
- Faculty of Medicine Lucian Blaga, University from Sibiu, 550169 Sibiu, Romania
| | - Bogdan Neamtu
- Research Department (Ceforaten), Sibiu Pediatric Hospital, 550178 Sibiu, Romania; (R.M.C.); (B.N.)
- Faculty of Medicine Lucian Blaga, University from Sibiu, 550169 Sibiu, Romania
- Faculty of Engineering, Lucian Blaga, University from Sibiu, 550025 Sibiu, Romania
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22
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Abstract
Two major trends have been dominant in health care in recent years. First, there is a growing consensus that standardization of health care procedures and methods can result in improved effectiveness and safety of treatments. Second, there is increased interest in "personalized medicine," which refers to the tailoring of treatments to individual patients. Here I discuss how these trends apply to the field of quantitative EEG (qEEG), where de-artifacted resting state EEGs of individuals are compared with a normative database in order to assess clinically meaningful deviations, which can be used for diagnostic procedures, to guide personalized treatment protocols, and to assess treatment effectiveness. Standardized and automated de-artifacting procedures are increasingly being used in scientific research and in clinical practice. The advantages of these procedures over manual de-artifacting will be discussed. The results of a systematic comparison between 2 commonly used qEEG databases show that these databases produce very comparable results, illustrating not only the validity and reliability of both databases but also the opportunity to move forward to a standardized use of qEEG in clinical practice. Finally, the standardization of qEEG interpretation as both a diagnostic and treatment selection tool provides an example of how qEEG can merge both personalized medicine and standardization in the treatment of psychological disorders.
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Affiliation(s)
- André W Keizer
- Neurofeedback Instituut Nederland, Eindhoven, the Netherlands.,qEEG-Pro. Eindhoven, the Netherlands
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23
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ADHD: Reviewing the Causes and Evaluating Solutions. J Pers Med 2021; 11:jpm11030166. [PMID: 33804365 PMCID: PMC7999417 DOI: 10.3390/jpm11030166] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/05/2021] [Accepted: 02/23/2021] [Indexed: 12/11/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder in which patients present inattention, hyperactivity, and impulsivity. The etiology of this condition is diverse, including environmental factors and the presence of variants of some genes. However, a great diversity exists among patients regarding the presence of these ADHD-associated factors. Moreover, there are variations in the reported neurophysiological correlates of ADHD. ADHD is often treated pharmacologically, producing an improvement in symptomatology, albeit there are patients who are refractory to the main pharmacological treatments or present side effects to these drugs, highlighting the importance of developing other therapeutic options. Different non-pharmacological treatments are in this review addressed, finding diverse results regarding efficacy. Altogether, ADHD is associated with different etiologies, all of them producing changes in brain development, leading to the characteristic symptomatology of this condition. Given the heterogeneous etiology of ADHD, discussion is presented about the convenience of personalizing ADHD treatment, whether pharmacological or non-pharmacological, to reach an optimum effect in the majority of patients. Approaches to personalizing both pharmacological therapy and neurofeedback are presented.
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24
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Turner RP. Clinical Application of Combined EEG-qEEG Functional Neuroimaging in the Practice of Pediatric Neuroscience: A Personal Perspective. Clin EEG Neurosci 2021; 52:126-135. [PMID: 33370176 DOI: 10.1177/1550059420982419] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This brief article is an overview of my personal experience over the past almost 10 years of the clinical use of EEG and quantitative EEG (qEEG) functional neuroimaging in a busy pediatric neurology practice. The concomitant use of surface EEG and functional electromagnetic EEG neuroimaging/qEEG in clinical practice provides significant additional clinical and neurophysiologic information. The qEEG is a noninvasive, inexpensive, portable technique with high temporal resolution (milliseconds) and improving spatial resolution (down to 3 mm3) and is an appropriate and validated tool for investigation of abnormal brain dynamics and connectivity of neuronal networks in clinical disorders of the brain. This article describes the daily applicability and utility of this modality in assisting diagnosis and clinical management of patients with a wide variety of presenting symptoms, including headaches, tics, autism spectrum disorder, inattention, sleep dysregulation, anxiety, and depression. The ease of data acquisition and analysis in clinical practices, coupled with skilled interpretation and clinical application, makes this tool one of the most valuable clinical tools to complement a thorough history and examination process.
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Affiliation(s)
- Robert P Turner
- Clinical Pediatrics, Medical University of South Carolina, Charleston, SC, USA.,Palmetto Health Children's Hospital, Columbia, SC, USA.,Network Neurology Health, Charleston, SC, USA.,Bon Secours Roper-St Francis Hospital System, Charleston, SC, USA.,HCA South Atlantic/Summerville Medical Center, Summerville, SC, USA.,MIND Research Institute, Irvine, CA, USA
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25
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The Current Evidence Levels for Biofeedback and Neurofeedback Interventions in Treating Depression: A Narrative Review. Neural Plast 2021; 2021:8878857. [PMID: 33613671 PMCID: PMC7878101 DOI: 10.1155/2021/8878857] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 12/28/2020] [Accepted: 01/25/2021] [Indexed: 12/22/2022] Open
Abstract
This article is aimed at showing the current level of evidence for the usage of biofeedback and neurofeedback to treat depression along with a detailed review of the studies in the field and a discussion of rationale for utilizing each protocol. La Vaque et al. criteria endorsed by the Association for Applied Psychophysiology and Biofeedback and International Society for Neuroregulation & Research were accepted as a means of study evaluation. Heart rate variability (HRV) biofeedback was found to be moderately supportable as a treatment of MDD while outcome measure was a subjective questionnaire like Beck Depression Inventory (level 3/5, “probably efficacious”). Electroencephalographic (EEG) neurofeedback protocols, namely, alpha-theta, alpha, and sensorimotor rhythm upregulation, all qualify for level 2/5, “possibly efficacious.” Frontal alpha asymmetry protocol also received limited evidence of effect in depression (level 2/5, “possibly efficacious”). Finally, the two most influential real-time functional magnetic resonance imaging (rt-fMRI) neurofeedback protocols targeting the amygdala and the frontal cortices both demonstrate some effectiveness, though lack replications (level 2/5, “possibly efficacious”). Thus, neurofeedback specifically targeting depression is moderately supported by existing studies (all fit level 2/5, “possibly efficacious”). The greatest complication preventing certain protocols from reaching higher evidence levels is a relatively high number of uncontrolled studies and an absence of accurate replications arising from the heterogeneity in protocol details, course lengths, measures of improvement, control conditions, and sample characteristics.
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Garcia Pimenta M, Brown T, Arns M, Enriquez-Geppert S. Treatment Efficacy and Clinical Effectiveness of EEG Neurofeedback as a Personalized and Multimodal Treatment in ADHD: A Critical Review. Neuropsychiatr Dis Treat 2021; 17:637-648. [PMID: 33658785 PMCID: PMC7920604 DOI: 10.2147/ndt.s251547] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/28/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Miguel Garcia Pimenta
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands
| | | | - Martijn Arns
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Location AMC, Amsterdam Neuroscience, Amsterdam, the Netherlands.,Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands.,Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Stefanie Enriquez-Geppert
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, the Netherlands.,Department of Biomedical Sciences of Cells & Systems, Section of Cognitive Neuropsychiatry, University of Groningen, Groningen, the Netherlands
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Weon HW, Lim J, Son HK. Correlates of the Mental Fitness of Female High School Freshmen: Focus on Multidimensional Empathy and Brain Function. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218290. [PMID: 33182503 PMCID: PMC7665129 DOI: 10.3390/ijerph17218290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/04/2020] [Accepted: 11/07/2020] [Indexed: 06/11/2023]
Abstract
We examined the association between multidimensional empathy, brain function, and mental fitness and identified correlates of mental fitness. In total, 146 female high school freshmen from a South Korean school participated in this cross-sectional study. Data were collected from March to April 2019, using a self-report questionnaire and quantitative electro-encephalographic data (QEEG). Instruments included the Interpersonal Reactivity Index and the Mental Fitness Scale, to access multidimensional empathy and mental fitness. Prefrontal cortex brain function was assessed with the brain quotient measure from the QEEG during free time after school. Data were analyzed using descriptive statistics, Pearson's correlation coefficient, and multiple regression analysis. Mental fitness had statistically significant relationships with multidimensional empathy (r = 0.36, p < 0.001) and brain quotient (r = 0.23, p = 0.005). Demographic factors affecting mental fitness included satisfaction with school life (β = 0.23, p = 0.001) and economic status (β = 0.17, p = 0.024). Factors from the subscales of multidimensional empathy included perspective taking (β = 0.26, p = 0.001), fantasy (β = 0.22, p = 0.004), and personal distress (β = -0.19, p = 0.010); and the brain function factor was brain quotient (β = 0.14, p = 0.038). The explanatory power of the model was 49.4% (F = 14.44, p < 0.001). There is a need for a concrete and objective understanding of mental fitness in adolescents to develop intervention programs for freshmen with various maladaptation problems.
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Affiliation(s)
- Hee Wook Weon
- Department of Brain and Cognitive Science, Seoul University of Buddhism, Seoul 08559, Korea;
| | - Jiyoung Lim
- College of Nursing, CHA University, Pochen-shi 11160, Korea;
| | - Hae Kyoung Son
- Department of Nursing, Eulji University, Seongnam-shi 13135, Korea
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A multicenter effectiveness trial of QEEG-informed neurofeedback in ADHD: Replication and treatment prediction. NEUROIMAGE-CLINICAL 2020; 28:102399. [PMID: 32891892 PMCID: PMC7481574 DOI: 10.1016/j.nicl.2020.102399] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/14/2020] [Accepted: 08/19/2020] [Indexed: 12/17/2022]
Abstract
QEEG-informed neurofeedback resulted in remission rates of 55%. In the total sample, non-remitters had higher hyperactivity scores at baseline. In women, non-remitters had longer P300 latencies. In boys, a low individual alpha peak frequency (iAPF) was associated with remission.
Introduction Quantitative Electroencephalogram-(QEEG-)informed neurofeedback is a method in which standard neurofeedback protocols are assigned, based on individual EEG characteristics in order to enhance effectiveness. Thus far clinical effectiveness data have only been published in a small sample of 21 ADHD patients. Therefore, this manuscript aims to replicate this effectiveness in a new sample of 114 patients treated with QEEG-informed neurofeedback, from a large multicentric dataset and to investigate potential predictors of neurofeedback response. Methods A sample of 114 patients were included as a replication sample. Patients were treated with standard neurofeedback protocols (Sensori-Motor-Rhythm (SMR), Theta-Beta (TBR), or Slow Cortical Potential (SCP) neurofeedback), in combination with coaching and sleep hygiene advice. The ADHD Rating Scale (ADHD-RS) and Pittsburgh Sleep Quality Index (PSQI) were assessed at baseline, every 10th session, and at outtake. Holland Sleep Disorder Questionnaire (HSDQ) was assessed at baseline and outtake. Response was defined as ≥25% reduction (R25), ≥50% reduction (R50), and remission. Predictive analyses were focused on predicting remission status. Results In the current sample, response rates were 85% (R25), 70% (R50), and remission was 55% and clinical effectiveness was not significantly different from the original 2012 sample. Non-remitters exhibited significantly higher baseline hyperactivity ratings. Women who remitted had significantly shorter P300 latencies and boys who remitted had significantly lower iAPF’s. Discussion In the current sample, clinical effectiveness was replicated, suggesting it is possible to assign patients to a protocol based on their individual baseline QEEG to enhance signal-to-noise ratio. Furthermore, remitters had lower baseline hyperactivity scores. Likewise, female remitters had shorter P300 latencies, whereas boys who remitted have a lower iAPF. Our data suggests initial specificity in treatment allocation, yet further studies are needed to replicate the predictors of neurofeedback remission.
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Chiang CT, Ouyang CS, Yang RC, Wu RC, Lin LC. Increased Temporal Lobe Beta Activity in Boys With Attention-Deficit Hyperactivity Disorder by LORETA Analysis. Front Behav Neurosci 2020; 14:85. [PMID: 32714161 PMCID: PMC7340165 DOI: 10.3389/fnbeh.2020.00085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/06/2020] [Indexed: 11/25/2022] Open
Abstract
Aim: Attention-deficit hyperactivity disorder (ADHD) is a common childhood neuropsychiatric disorder that affects 6.1 million US children. The mechanism of ADHD is currently unclear. Differences in ADHD presentations between boys and girls are well-established. In the present study, we used quantitative electroencephalography (EEG) to investigate the brain area and EEG bands of boys with ADHD. Methods: This study enrolled 40 boys with ADHD and 40 age-matched controls without ADHD. Low-resolution electromagnetic tomography (LORETA) and instantaneous frequency were used to analyze EEG data to reveal the mechanisms underlying ADHD in boys. Results: We found that the instantaneous frequencies in the T3 and T4 EEG channels in boys with ADHD were significantly higher than those in the controls. The beta band showed significant difference in current density between the ADHD and control groups. In the entire brain area, the bilateral inferior and middle temporal gyrus exhibited the most significant difference between the ADHD and control groups in the EEG beta band. Connectivity analysis revealed an increase in connectivity between the left middle frontal gyrus and fusiform gyrus of the temporal lobe in boys with ADHD. Conclusions: LORETA is a promising tool for analyzing EEG signals and can be used to investigate the mechanism of ADHD. Our results reveal that the inferior temporal gyrus, middle temporal gyrus, and fusiform gyrus of the temporal lobe are potentially involved in the pathogenesis of ADHD in boys. In comparison with other imaging methods, such as magnetic resonance imaging, EEG is easy to perform, fast, and low cost. Our study presents a new approach for investigating the pathogenesis of ADHD in boys.
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Affiliation(s)
- Ching-Tai Chiang
- Department of Computer and Communication, National Pingtung University, Pingtung, Taiwan
| | - Chen-Sen Ouyang
- Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Rei-Cheng Yang
- Departments of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Rong-Ching Wu
- Department of Electrical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Lung-Chang Lin
- Departments of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Pediatrics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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López-Pinar C, Martínez-Sanchís S, Carbonell-Vayá E, Sánchez-Meca J, Fenollar-Cortés J. Efficacy of Nonpharmacological Treatments on Comorbid Internalizing Symptoms of Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review. J Atten Disord 2020; 24:456-478. [PMID: 31189374 DOI: 10.1177/1087054719855685] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Attention-deficit/hyperactivity disorder (ADHD) is highly comorbid in adulthood. This meta-analysis was aimed at ascertaining the efficacy of different psychotherapies in improving comorbid internalizing symptoms in adults with ADHD. Method: Twenty randomized controlled trials and 12 uncontrolled pretest-posttest studies were included and combined using the inverse variance method. Risk of bias and heterogeneity assessment and moderator analyses were performed. Results: Cognitive-behavioral therapy (CBT) improved quality of life (QoL), emotional dysregulation (ED), depression, and anxiety symptoms, particularly at follow-up, which was predicted by core symptoms reduction. A significant between-group effect was obtained only on QoL, ED, and self-esteem for dialectical behavior therapy (DBT), mindfulness-based therapies (MBTs), and neurofeedback, respectively. Conclusion: Results support CBT efficacy for treating comorbid internalizing symptoms. More research is needed to determine the effectiveness of DBT, MBT, and neurofeedback. The small number of studies evaluating some therapies and the high risk of bias observed might limit these results.
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Late auditory ERP changes after sensorimotor rhythm neurofeedback training. VOJNOSANIT PREGL 2020. [DOI: 10.2298/vsp200516095s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Gerrits B, Vollebregt MA, Olbrich S, van Dijk H, Palmer D, Gordon E, Pascual-Marqui R, Kessels RPC, Arns M. Probing the "Default Network Interference Hypothesis" With EEG: An RDoC Approach Focused on Attention. Clin EEG Neurosci 2019; 50:404-412. [PMID: 31322000 DOI: 10.1177/1550059419864461] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Studies have shown that specific networks (default mode network [DMN] and task positive network [TPN]) activate in an anticorrelated manner when sustaining attention. Related EEG studies are scarce and often lack behavioral validation. We performed independent component analysis (ICA) across different frequencies (source-level), using eLORETA-ICA, to extract brain-network activity during resting-state and sustained attention. We applied ICA to the voxel domain, similar to functional magnetic resonance imaging methods of analyses. The obtained components were contrasted and correlated to attentional performance (omission errors) in a large sample of healthy subjects (N = 1397). We identified one component that robustly correlated with inattention and reflected an anticorrelation of delta activity in the anterior cingulate and precuneus, and delta and theta activity in the medial prefrontal cortex and with alpha and gamma activity in medial frontal regions. We then compared this component between optimal and suboptimal attentional performers. For the latter group, we observed a greater change in component loading between resting-state and sustained attention than for the optimal performers. Following the National Institute of Mental Health Research Domain Criteria (RDoC) approach, we prospectively replicated and validated these findings in subjects with attention deficit/hyperactivity disorder. Our results provide further support for the "default mode interference hypothesis."
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Affiliation(s)
- Berrie Gerrits
- 1 Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, the Netherlands.,2 Research Institute Brainclinics, Nijmegen, the Netherlands
| | - Madelon A Vollebregt
- 2 Research Institute Brainclinics, Nijmegen, the Netherlands.,3 Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Sebastian Olbrich
- 2 Research Institute Brainclinics, Nijmegen, the Netherlands.,4 Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry, Zurich, Switzerland
| | | | - Donna Palmer
- 5 Brain Resource Inc, Sydney, New South Wales, Australia
| | | | - Roberto Pascual-Marqui
- 7 The KEY Institute for Brain-Mind Research, University Hospital of Psychiatry, Zurich, Switzerland.,8 Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Roy P C Kessels
- 1 Donders Institute for Brain, Cognition, and Behaviour, Radboud University, Nijmegen, the Netherlands.,9 Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Martijn Arns
- 2 Research Institute Brainclinics, Nijmegen, the Netherlands.,10 Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands.,11 neuroCare Group, Munich, Germany
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Bussalb A, Collin S, Barthélemy Q, Ojeda D, Bioulac S, Blasco-Fontecilla H, Brandeis D, Purper Ouakil D, Ros T, Mayaud L. Is there a cluster of high theta-beta ratio patients in attention deficit hyperactivity disorder? Clin Neurophysiol 2019; 130:1387-1396. [PMID: 31176621 DOI: 10.1016/j.clinph.2019.02.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/15/2019] [Accepted: 02/27/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Aurore Bussalb
- Mensia Technologies SA, 130 rue de Lourmel, 75015 Paris, France; Assistance Publique-Hôpitaux de Paris, Robert Debré Hospital, Child and Adolescent Psychiatry, Paris, France.
| | - Sidney Collin
- Mensia Technologies SA, 130 rue de Lourmel, 75015 Paris, France
| | | | - David Ojeda
- Mensia Technologies SA, 130 rue de Lourmel, 75015 Paris, France
| | - Stephanie Bioulac
- Université de Bordeaux, Sommeil, Addiction et Neuropsychiatrie, USR 3413, F-33000 Bordeaux, France; CNRS, SANPSY, USR 3413, F-33000 Bordeaux, France; CHU Pellegrin, Clinique du Sommeil, F-33076 Bordeaux, France
| | - Hilario Blasco-Fontecilla
- Department of Psychiatry, Puerta de Hierro University Hospital-IDIPHIPSA, Autonoma University of Madrid, CIBERSAM, Madrid, Spain
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Diane Purper Ouakil
- CHU Montpellier-Saint Eloi Hospital, University of Montpellier, Unit of Child and Adolescent Psychiatry (MPEA1), Montpellier, France
| | - Tomas Ros
- Department of Neuroscience, Geneva, Switzerland
| | - Louis Mayaud
- Mensia Technologies SA, 130 rue de Lourmel, 75015 Paris, France
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Shereena EA, Gupta RK, Bennett CN, Sagar KJV, Rajeswaran J. EEG Neurofeedback Training in Children With Attention Deficit/Hyperactivity Disorder: A Cognitive and Behavioral Outcome Study. Clin EEG Neurosci 2019; 50:242-255. [PMID: 30453757 DOI: 10.1177/1550059418813034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) is a highly prevalent childhood disorder with symptoms of inattention, impulsivity, and hyperactivity. EEG neurofeedback training (NFT) is a new intervention modality based on operant conditioning of brain activity, which helps reduce symptoms of ADHD in children. METHODS AND PROCEDURES To examine the efficacy of NFT in children with ADHD, an experimental longitudinal design with pre-post comparison was adopted. A total of 30 children in the age range of 6 to 12 years diagnosed as ADHD with or without comorbid conditions were assigned to treatment group (TG; n = 15) and treatment as usual group (TAU; n = 15). TG received EEG-NFT along with routine clinical management and TAU received routine clinical management alone. Forty sessions of theta/beta NFT at the C3 scalp location, 3 to 4 sessions in a week for a period of 3.5 to 5 months were given to children in TG. Children were screened using sociodemographic data and Binet-Kamat test of intelligence. Pre-and postassessment tools were neuropsychological tests and behavioral scales. Follow-up was carried out on 8 children in TG using parent-rated behavioral measures. RESULTS Improvement was reported in TG on cognitive functions (sustained attention, verbal working memory, and response inhibition), parent- and teacher-rated behavior problems and on academic performance rated by teachers. Follow-up of children who received NFT showed sustained improvement in ADHD symptoms when assessed 6 months after receiving NFT. CONCLUSION The present study suggests that NFT is an effective method to enhance cognitive deficits and helps reduce ADHD symptoms and behavior problems. Consequently, academic performance was found to be improved in children with ADHD. Improvement in ADHD symptoms induced by NFT were maintained at 6-month follow-up in children with ADHD.
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Affiliation(s)
- E A Shereena
- 1 National Institute of Mental Health & Neuro Sciences, Bengaluru, Karnataka, India
| | - R K Gupta
- 1 National Institute of Mental Health & Neuro Sciences, Bengaluru, Karnataka, India
| | - C N Bennett
- 2 Department of Psychology, Christ (Deemed to be University), Bengaluru, Karnataka, India
| | - K J V Sagar
- 1 National Institute of Mental Health & Neuro Sciences, Bengaluru, Karnataka, India
| | - J Rajeswaran
- 1 National Institute of Mental Health & Neuro Sciences, Bengaluru, Karnataka, India
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Neurofeedback bei adulter Aufmerksamkeitsdefizit‑/Hyperaktivitätsstörung. PSYCHOTHERAPEUT 2019. [DOI: 10.1007/s00278-019-0350-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Iceta S, Benoit J, Cristini P, Lambert-Porcheron S, Segrestin B, Laville M, Poulet E, Disse E. Attentional bias and response inhibition in severe obesity with food disinhibition: a study of P300 and N200 event-related potential. Int J Obes (Lond) 2019; 44:204-212. [PMID: 30967609 DOI: 10.1038/s41366-019-0360-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 02/05/2019] [Accepted: 02/24/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND/OBJECTIVE In obesity there is growing evidence for common mechanism between food intake regulation and substance use disorders, especially more attentional bias and less cognitive control. In the present study we investigated whether severely obese subjects with or without disordered eating exhibit electroencephalographic (EEG) event-related potential (ERP) modifications as observed in substance abusers. SUBJECTS/METHODS A total of 90 women were included; 30 in the normal-weight (NW) group (18.5 < BMI < 24.5 kg/m2; no food disinhibition or restriction on the Three-Factor Eating Questionnaire) and 60 participants with BMI ≥ 35 kg/m2 were separated into two groups (n = 30): without food disinhibition (disinhibition score ≤8; ObFD- group) and with food disinhibition (score >8; ObFD+). Clinical and metabolic parameters as well as compartmental aspects (Eating Disorders Inventory-2, EDI-2) were assessed. Participants underwent an ERP recording with an auditory oddball paradigm. RESULTS The mean ± SD P300 amplitudes in Pz were significantly (p < 0.05) lower in ObFD- (12.4 ± 4.6) and ObFD+ (12.5 ± 4.4) groups than in the NW group (15.8 ± 5.9). The mean ± SD N200 amplitude in Cz was significantly lower in the ObFD- group (-2.0 ± 5.4) than in the NW group (-5.2 ± 4.2 vs; p = 0.035). N200 Cz amplitude was correlated with EDI-2 Binge eating risk score (ρ = 0.331; p = 0.01), EDI-2 Body Dissatisfaction score (ρ = 0.351; p = 0.007), and Drive for Thinness score (ρ = 0.26; p = 0.05). CONCLUSIONS The present study provides evidence for reduction of P300 and N200 amplitude in obese women and that N200 amplitude may be related to more disordered eating and eating disorder risk. This leads to consider attentional bias and response inhibition as core mechanisms in obesity and as possible targets for new therapeutic strategy.
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Affiliation(s)
- Sylvain Iceta
- Centre Référent pour l'Anorexie et les Troubles du Comportement Alimentaire (CREATYON), Hospices Civils de Lyon, Lyon, France. .,INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Centre de Recherche en Neurosciences de Lyon (CRNL), Equipe PSYR2 Centre Hospitalier Le Vinatier, Lyon, France. .,Centre Intégré de l'Obésité Rhône-Alpes; Fédération Hospitalo-Universitaire DO-iT, Service Endocrinologie-Diabète-Nutrition, Université de Lyon, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France.
| | - Julien Benoit
- Centre de Recherche en Nutrition Humaine Rhône-Alpes, Univ-Lyon, CarMeN Laboratory, Université Claude Bernard Lyon1, Hospices Civils de Lyon, CENS, FCRIN/FORCE Network, Pierre Benite, France
| | - Philippe Cristini
- Centre de Recherche en Nutrition Humaine Rhône-Alpes, Univ-Lyon, CarMeN Laboratory, Université Claude Bernard Lyon1, Hospices Civils de Lyon, CENS, FCRIN/FORCE Network, Pierre Benite, France
| | - Stéphanie Lambert-Porcheron
- Centre de Recherche en Nutrition Humaine Rhône-Alpes, Univ-Lyon, CarMeN Laboratory, Université Claude Bernard Lyon1, Hospices Civils de Lyon, CENS, FCRIN/FORCE Network, Pierre Benite, France
| | - Bérénice Segrestin
- Centre Référent pour l'Anorexie et les Troubles du Comportement Alimentaire (CREATYON), Hospices Civils de Lyon, Lyon, France.,Centre de Recherche en Nutrition Humaine Rhône-Alpes, Univ-Lyon, CarMeN Laboratory, Université Claude Bernard Lyon1, Hospices Civils de Lyon, CENS, FCRIN/FORCE Network, Pierre Benite, France
| | - Martine Laville
- Centre Intégré de l'Obésité Rhône-Alpes; Fédération Hospitalo-Universitaire DO-iT, Service Endocrinologie-Diabète-Nutrition, Université de Lyon, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France.,Centre de Recherche en Nutrition Humaine Rhône-Alpes, Univ-Lyon, CarMeN Laboratory, Université Claude Bernard Lyon1, Hospices Civils de Lyon, CENS, FCRIN/FORCE Network, Pierre Benite, France
| | - Emmanuel Poulet
- INSERM U1028, CNRS UMR5292, Université Claude Bernard Lyon 1, Centre de Recherche en Neurosciences de Lyon (CRNL), Equipe PSYR2 Centre Hospitalier Le Vinatier, Lyon, France
| | - Emmanuel Disse
- Centre Intégré de l'Obésité Rhône-Alpes; Fédération Hospitalo-Universitaire DO-iT, Service Endocrinologie-Diabète-Nutrition, Université de Lyon, Groupement Hospitalier Sud, Hospices Civils de Lyon, Lyon, France.,Centre de Recherche en Nutrition Humaine Rhône-Alpes, Univ-Lyon, CarMeN Laboratory, Université Claude Bernard Lyon1, Hospices Civils de Lyon, CENS, FCRIN/FORCE Network, Pierre Benite, France
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Cueli M, Rodríguez C, Cabaleiro P, García T, González-Castro P. Differential Efficacy of Neurofeedback in Children with ADHD Presentations. J Clin Med 2019; 8:E204. [PMID: 30736419 PMCID: PMC6406571 DOI: 10.3390/jcm8020204] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 01/28/2019] [Accepted: 02/04/2019] [Indexed: 12/11/2022] Open
Abstract
Training in neurofeedback (NF) reduces the symptomatology associated with attention deficit with hyperactivity disorder (ADHD). However, ADHD differs in terms of the type of presentation, i.e., inattentive (ADHD-I), impulsive/hyperactive (ADHD-HI), or combined (ADHD-C). This study examines the efficacy of NF in ADHD presentations. Participants were 64 students (8⁻12 years old). Cortical activation, executive control, and observed symptomatology by parents were assessed. Results indicated that ADHD-C and ADHD-HI demonstrated greater improvements than ADHD-I. It was concluded that this kind of training produces an improvement and that it is necessary to explore it further in terms of the protocol used.
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Affiliation(s)
- Marisol Cueli
- Department of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo (Asturias), Spain.
| | - Celestino Rodríguez
- Department of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo (Asturias), Spain.
| | - Paloma Cabaleiro
- Department of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo (Asturias), Spain.
| | - Trinidad García
- Department of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo (Asturias), Spain.
| | - Paloma González-Castro
- Department of Psychology, University of Oviedo, Plaza Feijoo s/n, 33003 Oviedo (Asturias), Spain.
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Wigton NL, Krigbaum G. Attention, Executive Function, Behavior, and Electrocortical Function, Significantly Improved With 19-Channel Z-Score Neurofeedback in a Clinical Setting: A Pilot Study. J Atten Disord 2019; 23:398-408. [PMID: 25823743 DOI: 10.1177/1087054715577135] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Neurofeedback (NF) is gaining recognition as an evidence-based intervention grounded in learning theory, and 19-channel z-score NF (19ZNF) is a new NF model. This pilot study sought to evaluate the efficacy of 19ZNF in a clinical setting. METHOD Outcome measures framed groups such that 19ZNF was evaluated, as it relates to the neuropsychological constructs of attention ( n = 10), executive function ( n = 12), behavior ( n = 14), and electrocortical functioning ( n = 21). One-tailed t tests compared pre-post difference scores. RESULTS For all pre-post comparisons, the direction of change was in the predicted direction, and differences were statistically significant ( p = .000 to p = .008, effect sizes 1.29 to 3.42). CONCLUSION Results suggest 19ZNF improved attention, executive function, behavior, and electrocortical function. This study provides beginning evidence of 19ZNF's efficacy, adds to what is known about 19ZNF, and offers an innovative approach for using quantitative electroencephalographic (QEEG) metrics as outcome measures.
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Affiliation(s)
- Nancy L Wigton
- 1 Grand Canyon University, Phoenix, AZ, USA.,2 Applied Neurotherapy Center, Scottsdale, AZ, USA
| | - Genomary Krigbaum
- 1 Grand Canyon University, Phoenix, AZ, USA.,3 Marian University College of Osteopathic Medicine, Indianapolis, IN, USA
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Okumura Y, Kita Y, Omori M, Suzuki K, Yasumura A, Fukuda A, Inagaki M. Predictive factors of success in neurofeedback training for children with ADHD. Dev Neurorehabil 2019; 22:3-12. [PMID: 28594254 DOI: 10.1080/17518423.2017.1326183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Neurofeedback (NF) training aims the enhancement of self-regulation over brain activities. While it is largely recognized as an effective treatment for attention deficit hyperactivity disorder (ADHD), the existence of non-learners has also been reported. The present study explored pre-training assessment indices that could predict learners prior to NF training. METHODS Twenty-two children with ADHD participated in slow cortical potential (SCP) NF training and completed pre- and post-training assessments. Participants were classified into learners or non-learners based on their progress in the SCP regulation, and pre-training indices that differentiate the two groups were examined by decision tree analysis. RESULTS AND DISCUSSION The learner rate in NF training was 45.5%. Learners were predicted by pre-training cognitive and neurophysiological measures regarding Stroop tasks, which suggested relatively intact executive function as their characteristics. Given that NF training is not universally effective for children with ADHD, further studies are necessary to establish application criteria.
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Affiliation(s)
- Yasuko Okumura
- a Department of Developmental Disorders , National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo , Japan
| | - Yosuke Kita
- a Department of Developmental Disorders , National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo , Japan
| | - Mikimasa Omori
- a Department of Developmental Disorders , National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo , Japan.,b Department of Psychology, Faculty of Humanities and Social Sciences , Showa Women's University , Tokyo , Japan
| | - Kota Suzuki
- a Department of Developmental Disorders , National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo , Japan
| | - Akira Yasumura
- a Department of Developmental Disorders , National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo , Japan.,c Department of Neuropsychiatry , The University of Tokyo Hospital , Tokyo , Japan
| | - Ayako Fukuda
- a Department of Developmental Disorders , National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo , Japan
| | - Masumi Inagaki
- a Department of Developmental Disorders , National Institute of Mental Health, National Center of Neurology and Psychiatry , Tokyo , Japan
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Fielenbach S, Donkers FC, Spreen M, Bogaerts S. Effects of a Theta/Sensorimotor Rhythm Neurofeedback Training Protocol on Measures of Impulsivity, Drug Craving, and Substance Abuse in Forensic Psychiatric Patients With Substance Abuse: Randomized Controlled Trial. JMIR Ment Health 2018; 5:e10845. [PMID: 30538087 PMCID: PMC6305873 DOI: 10.2196/10845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Forensic psychiatric patients are often diagnosed with psychiatric disorders characterized by high levels of impulsivity as well as comorbid substance use disorders (SUD). The combination of psychiatric disorders and SUD increases the risk of future violence. Chronic substance abuse can lead to a structural state of disinhibition, resulting in more drug taking and eventually loss of control over drug intake. When treating SUD, it is crucial to address high levels of impulsivity and lack of inhibitory control. OBJECTIVE This study set out to investigate the effects of a theta/sensorimotor rhythm (SMR) neurofeedback training protocol on levels of impulsivity, levels of drug craving, and actual drug intake in a population of forensic psychiatric patients with a diagnosis of SUD. METHODS A total of 21 participants received 20 sessions of theta/SMR neurofeedback training in combination with treatment-as-usual (TAU). Results of the intervention were compared with results from 21 participants who received TAU only. RESULTS SMR magnitude showed a significant (P=.02) increase post training for patients in the neurofeedback training group, whereas theta magnitude did not change (P=.71). Levels of drug craving as well as scores on the motor subscale of the Barratt Impulsivity Scale-11 decreased equally for patients in the neurofeedback training group and the TAU group. Other measures of impulsivity as well as drug intake did not change posttreatment (P>.05). Therefore, neurofeedback+TAU was not more effective than TAU only. CONCLUSIONS This study demonstrated evidence that forensic psychiatric patients are able to increase SMR magnitude over the course of neurofeedback training. However, at the group level, the increase in SMR activity was not related to any of the included impulsivity or drug craving measures. Further research should focus on which patients will be able to benefit from neurofeedback training at an early stage of the employed training sessions. TRIAL REGISTRATION Dutch National Trial Register: NTR5386; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5386 (Archived by WebCite at http://www.webcitation.org/6nXLQuoLl).
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Affiliation(s)
- Sandra Fielenbach
- Research Department, Forensic Psychiatric Centre Dr S van Mesdag, Groningen, Netherlands.,Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Franc Cl Donkers
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Marinus Spreen
- Research Department, Forensic Psychiatric Centre Dr S van Mesdag, Groningen, Netherlands
| | - Stefan Bogaerts
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands.,Fivoor Science and Treatment Innovation, Poortugaal, Netherlands
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Arns M, Vollebregt MA, Palmer D, Spooner C, Gordon E, Kohn M, Clarke S, Elliott GR, Buitelaar JK. Electroencephalographic biomarkers as predictors of methylphenidate response in attention-deficit/hyperactivity disorder. Eur Neuropsychopharmacol 2018; 28:881-891. [PMID: 29937325 DOI: 10.1016/j.euroneuro.2018.06.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 05/22/2018] [Accepted: 06/02/2018] [Indexed: 11/29/2022]
Abstract
UNLABELLED EEG biomarkers have shown promise in predicting non-response to stimulant medication in ADHD and could serve as translational biomarkers. This study aimed to replicate and extend previous EEG biomarkers. The international Study to Predict Optimized Treatment for ADHD (iSPOT-A), a multi-center, international, prospective open-label trial, enrolled 336 children and adolescents with ADHD (11.9 yrs; 245 males; prescribed methylphenidate) and 158 healthy children. Treatment response was established after six weeks using the clinician rated ADHD-Rating Scale-IV. Theta/Beta ratio (TBR) and alpha peak frequency (APF) were assessed at baseline as predictors for treatment outcome. No differences between ADHD and controls were found for TBR and APF. 62% of the ADHD group was classified as a responder. Responders did not differ from non-responders in age, medication dosage, and baseline severity of ADHD symptoms. Male-adolescent non-responders exhibited a low frontal APF (Fz: R = 9.2 Hz vs. NR = 8.1 Hz; ES = 0.83), whereas no effects were found for TBR. A low APF in male adolescents was associated with non-response to methylphenidate, replicating earlier work. Our data suggest that the typical maturational EEG changes observed in ADHD responders and controls are absent in non-responders to methylphenidate and these typical changes start emerging in adolescence. CLINICAL TRIALS REGISTRATION www.clinicaltrials.gov; NCT00863499 (https://clinicaltrials.gov/ct2/show/NCT00863499).
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Affiliation(s)
- Martijn Arns
- Research Institute Brainclinics, Bijleveldsingel 34, 6524 AD Nijmegen, The Netherlands; Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands.
| | - Madelon A Vollebregt
- Research Institute Brainclinics, Bijleveldsingel 34, 6524 AD Nijmegen, The Netherlands; Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Donna Palmer
- Brain Resource Ltd, Sydney, NSW, Australia; Brain Resource Ltd, San Francisco, CA, USA; Brain Dynamics Center, Sydney Medical School and Westmead Millenium Institute, University of Sydney, NSW, Australia
| | | | - Evian Gordon
- Brain Resource Ltd, Sydney, NSW, Australia; Brain Resource Ltd, San Francisco, CA, USA
| | - Michael Kohn
- Brain Dynamics Center, Sydney Medical School and Westmead Millenium Institute, University of Sydney, NSW, Australia; CRASH (Centre for Research into Adolescent'S Health) Westmead Hospital, Sydney Australia
| | - Simon Clarke
- Brain Dynamics Center, Sydney Medical School and Westmead Millenium Institute, University of Sydney, NSW, Australia; CRASH (Centre for Research into Adolescent'S Health) Westmead Hospital, Sydney Australia
| | - Glen R Elliott
- Children's Health Council, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, CA, USA
| | - Jan K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
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Leroy A, Petit G, Zarka D, Cebolla A, Palmero-Soler E, Strul J, Dan B, Verbanck P, Cheron G. EEG Dynamics and Neural Generators in Implicit Navigational Image Processing in Adults with ADHD. Neuroscience 2018; 373:92-105. [DOI: 10.1016/j.neuroscience.2018.01.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 01/12/2023]
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Bazanova OM, Auer T, Sapina EA. On the Efficiency of Individualized Theta/Beta Ratio Neurofeedback Combined with Forehead EMG Training in ADHD Children. Front Hum Neurosci 2018; 12:3. [PMID: 29403368 PMCID: PMC5785729 DOI: 10.3389/fnhum.2018.00003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/03/2018] [Indexed: 01/28/2023] Open
Abstract
Background: Neurofeedback training (NFT) to decrease the theta/beta ratio (TBR) has been used for treating hyperactivity and impulsivity in attention deficit hyperactivity disorder (ADHD); however, often with low efficiency. Individual variance in EEG profile can confound NFT, because it may lead to influencing non-relevant activity, if ignored. More importantly, it may lead to influencing ADHD-related activities adversely, which may even result in worsening ADHD symptoms. Electromyogenic (EMG) signal resulted from forehead muscles can also explain the low efficiency of the NFT in ADHD from both practical and psychological point-of-view. The first aim of this study was to determine EEG and EMG biomarkers most related to the main ADHD characteristics, such as impulsivity and hyperactivity. The second aim was to confirm our hypothesis that the efficiency of the TBR NFT can be increased by individual adjustment of the frequency bands and simultaneous training on forehead muscle tension. Methods: We recruited 94 children diagnosed with ADHD (ADHD) and 23 healthy controls (HC). All participants were male and aged between six and nine. Impulsivity and attention were assessed with Go/no-Go task and delayed gratification task, respectively; and 19-channel EEG and forehead EMG were recorded. Then, the ADHD group was randomly subdivided into (1) standard, (2) individualized, (3) individualized+EMG, and (4) sham NFT (control) groups. The groups were compared based on TBR and EEG alpha activity, as well as hyperactivity and impulsivity three times: pre-NFT, post-NFT and 6 months after the NFT (follow-up). Results: ADHD children were characterized with decreased individual alpha peak frequency, alpha bandwidth and alpha amplitude suppression magnitude, as well as with increased alpha1/alpha2 (a1/a2) ratio and scalp muscle tension when c (η2 ≥ 0.212). All contingent TBR NFT groups exhibited significant NFT-related decrease in TBR not evident in the control group. Moreover, we detected a higher overall alpha activity in the individualized but not in the standard NFT group. Mixed MANOVA considering between-subject factor GROUP and within-subject factor TIME showed that the individualized+EMG group exhibited the highest level of clinical improvement, which was associated with increase in the individual alpha activity at the 6 months follow-up when comparing with the other approaches (post hoc t = 3.456, p = 0.011). Conclusions: This study identified various (adjusted) alpha activity metrics as biomarkers with close relationship with ADHD symptoms, and demonstrated that TBR NFT individually adjusted for variances in alpha activity is more successful and clinically more efficient than standard, non-individualized NFT. Moreover, these training effects of the individualized TBR NFT lasted longer when combined with EMG.
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Affiliation(s)
- Olga M Bazanova
- Laboratory of Affective, Cognitive and Translational Neuroscience, Department of Experimental, Clinical Neuroscience, Federal State Research Institute of Physiology and Basic Medicine, Novosibirsk, Russia
- Department of Neuroscience, Novosibirsk State University, Novosibirsk, Russia
| | - Tibor Auer
- Department of Psychology, Royal Holloway University of London, Egham, United Kingdom
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Elena A Sapina
- Laboratory of Biofeedback Computer System, Research Institute of Molecular Biology and Biophysics, Novosibirsk, Russia
- Department of Psychology, Novosibirsk State University of Economics and Management, Novosibirsk, Russia
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Duric NS, Assmus J, Gundersen D, Duric Golos A, Elgen IB. Multimodal treatment in children and adolescents with attention-deficit/hyperactivity disorder: a 6-month follow-up. Nord J Psychiatry 2017; 71:386-394. [PMID: 28345387 DOI: 10.1080/08039488.2017.1305446] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Different treatment approaches aimed at reducing attention-deficit/hyperactivity disorder (ADHD) core symptoms are available. However, factors such as intolerance, side-effects, lack of efficacy, high new technology costs, and placebo effect have spurred on an increasing interest in alternative or complementary treatment. AIM The aim of this study is to explore efficacy of multimodal treatment consisting of standard stimulant medication (methylphenidate) and neurofeedback (NF) in combination, and to compare it with the single treatment in 6-month follow-up in ADHD children and adolescents. METHODS This randomized controlled trial with 6-month follow-up comprised three treatment arms: multimodal treatment (NF + MED), MED alone, and NF alone. A total of 130 ADHD children/adolescents participated, and 62% completed the study. ADHD core symptoms were recorded pre-/post-treatment, using parents' and teachers' forms taken from Barkley's Defiant Children: A Clinician's Manual for Assessment and Parent Training, and a self-report questionnaire. RESULTS Significant ADHD core symptom improvements were reported 6 months after treatment completion by parents, teachers, and participants in all three groups, with marked improvement in inattention in all groups. However, no significant improvements in hyperactivity or academic performance were reported by teachers or self-reported by children/adolescents, respectively, in the three groups. Changes obtained with multimodal treatment at 6-month follow-up were comparable to those with single medication treatment, as reported by all participants. CONCLUSIONS Multimodal treatment using combined stimulant medication and NF showed 6-month efficacy in ADHD treatment. More research is needed to explore whether multimodal treatment is suitable for ADHD children and adolescents who showed a poor response to single medication treatment, and for those who want to reduce the use of stimulant medication.
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Affiliation(s)
- Nezla S Duric
- a Department of Child and Adolescent Psychiatry , Helse Fonna , Haugesund , Norway
| | - Jørg Assmus
- b Centre for Clinical Research, Helse Bergen , Norway
| | - Doris Gundersen
- c Department of Research and Innovation , Helse Fonna HF , Haugesund , Norway
| | - Alisa Duric Golos
- d Department of Clinical Medicine , University of Sarajevo , Bosnia & Herzegovina
| | - Irene B Elgen
- e Department of Child and Adolescent Psychiatry , Haukeland University Hospital , Bergen , Norway.,f Department of Clinical Medicine , University of Bergen , Norway
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Arns M, Batail JM, Bioulac S, Congedo M, Daudet C, Drapier D, Fovet T, Jardri R, Le-Van-Quyen M, Lotte F, Mehler D, Micoulaud-Franchi JA, Purper-Ouakil D, Vialatte F. Neurofeedback: One of today's techniques in psychiatry? Encephale 2017; 43:135-145. [DOI: 10.1016/j.encep.2016.11.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 11/15/2022]
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Additive effects of neurofeedback on the treatment of ADHD: A randomized controlled study. Asian J Psychiatr 2017; 25:16-21. [PMID: 28262140 DOI: 10.1016/j.ajp.2016.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 03/03/2016] [Accepted: 09/01/2016] [Indexed: 11/20/2022]
Abstract
Neurofeedback (NF) has been identified as a "possibly efficacious" treatment in current evidence-based reviews; therefore, more research is needed to determine its effects. The current study examined the potential additive effect of NF for children diagnosed with ADHD beginning a medication trial first. Thirty-six children (6-12 years) with a DSM-IV-TR diagnosis of ADHD were randomly assigned to an NF with medication (NF condition) or a medication only condition. Children in the NF group attended 20 twice-weekly sessions. Outcome measures included individual cognitive performance scores (ADS, K-WISC-III), ADHD rating scores completed by their parents (ARS, CRS) and brainwave indices of left and right hemispheres before and after NF treatment. Significant additive treatment effect in any of the symptom variables was found and a reduction of theta waves in both the right and left hemispheres was recorded in NF condition participants. However our randomized controlled study could not demonstrate superior effects of combined NF on intelligent functioning compared to the medication treatment only. This study suggested any possible evidence of positive and additive treatment effects of NF on brainwaves and ADHD symptomatology.
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Fielenbach S, Donkers FCL, Spreen M, Visser HA, Bogaerts S. Neurofeedback Training for Psychiatric Disorders Associated with Criminal Offending: A Review. Front Psychiatry 2017; 8:313. [PMID: 29422873 PMCID: PMC5788905 DOI: 10.3389/fpsyt.2017.00313] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/29/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Effective treatment interventions for criminal offenders are necessary to reduce risk of criminal recidivism. Evidence about deviant electroencephalographic (EEG)-frequencies underlying disorders found in criminal offenders is accumulating. Yet, treatment modalities, such as neurofeedback, are rarely applied in the forensic psychiatric domain. Since offenders usually have multiple disorders, difficulties adhering to long-term treatment modalities, and are highly vulnerable for psychiatric decompensation, more information about neurofeedback training protocols, number of sessions, and expected symptom reduction is necessary before it can be successfully used in offender populations. METHOD Studies were analyzed that used neurofeedback in adult criminal offenders, and in disorders these patients present with. Specifically aggression, violence, recidivism, offending, psychopathy, schizophrenia, attention-deficit hyperactivity disorder (ADHD), substance-use disorder (SUD), and cluster B personality disorders were included. Only studies that reported changes in EEG-frequencies posttreatment (increase/decrease/no change in EEG amplitude/power) were included. RESULTS Databases Psychinfo and Pubmed were searched in the period 1990-2017 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, resulting in a total of 10 studies. Studies in which neurofeedback was applied in ADHD (N = 3), SUD (N = 3), schizophrenia (N = 3), and psychopathy (N = 1) could be identified. No studies could be identified for neurofeedback applied in cluster B personality disorders, aggression, violence, or recidivism in criminal offenders. For all treatment populations and neurofeedback protocols, number of sessions varied greatly. Changes in behavioral levels ranged from no improvements to significant symptom reduction after neurofeedback training. The results are also mixed concerning posttreatment changes in targeted EEG-frequency bands. Only three studies established criteria for EEG-learning. CONCLUSION Implications of the results for the applicability of neurofeedback training in criminal offender populations are discussed. More research focusing on neurofeedback and learning of cortical activity regulation is needed in populations with externalizing behaviors associated with violence and criminal behavior, as well as multiple comorbidities. At this point, it is unclear whether standard neurofeedback training protocols can be applied in offender populations, or whether QEEG-guided neurofeedback is a better choice. Given the special context in which the studies are executed, clinical trials, as well as single-case experimental designs, might be more feasible than large double-blind randomized controls.
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Affiliation(s)
- Sandra Fielenbach
- FPC Dr. S. van Mesdag, Groningen, Netherlands.,Tilburg University, Tilburg, Netherlands
| | | | | | | | - Stefan Bogaerts
- Tilburg University, Tilburg, Netherlands.,FPC De Kijvelanden, Poortugaal, Netherlands
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Krigbaum G, Wigton NL. A Methodology of Analysis for Monitoring Treatment Progression with 19-Channel Z-Score Neurofeedback (19ZNF) in a Single-Subject Design. Appl Psychophysiol Biofeedback 2016; 40:139-49. [PMID: 25777656 DOI: 10.1007/s10484-015-9274-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
19-Channel Z-Score Neurofeedback (19ZNF) is a modality using 19-electrodes with real-time normative database z-scores, suggesting effective clinical outcomes in fewer sessions than traditional neurofeedback. Thus, monitoring treatment progression and clinical outcome is necessary. The area of focus in this study was a methodology of quantitative analysis for monitoring treatment progression and clinical outcome with 19ZNF. This methodology is noted as the Sites-of-Interest, which included repeated measures analyses of variance (rANOVA) and t-tests for z-scores; it was conducted on 10 cases in a single subject design. To avoid selection bias, the 10 sample cases were randomly selected from a pool of 17 cases that met the inclusion criteria. Available client outcome measures (including self-report) are briefly discussed. The results showed 90% of the pre-post comparisons moved in the targeted direction (z = 0) and of those, 96% (80% Bonferroni corrected) of the t-tests and 96% (91% Bonferroni corrected) of the rANOVAs were statistically significant; thus indicating a progression towards the mean in 15 or fewer 19ZNF sessions. All cases showed and reported improvement in all outcome measures (including quantitative electroencephalography assessment) at case termination.
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Affiliation(s)
- Genomary Krigbaum
- Marian University College of Osteopathic Medicine, 3200 Cold Spring Road, Indianapolis, IN, 46222-1997, USA,
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Bluschke A, Roessner V, Beste C. Editorial Perspective: How to optimise frequency band neurofeedback for ADHD. J Child Psychol Psychiatry 2016; 57:457-61. [PMID: 26968314 DOI: 10.1111/jcpp.12521] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 11/28/2022]
Abstract
Attention deficit/hyperactivity disorder (ADHD) is one of the most prevalent paediatric neuropsychiatric disorders and is characterised by hyperactivity, inattention and increased impulsivity. Children with ADHD are often also characterised by deficits in a variety of cognitive domains, including problems in working memory, a generally slower and more variable style of information processing and deficits in temporal processing, inhibitory functions and delay processing. Overarching executive functions like information updating, response inhibition and mental set shifting are also impaired in many, but not all, children with ADHD, demonstrating the neuropsychological heterogeneity characterising this disorder. Deficits in executive functions can persist into adulthood and have a substantial negative impact on everyday life. A variety of approaches are commonly considered for the treatment of ADHD (including pharmacological interventions, patient-centred cognitive-behavioural therapy approaches and specific teacher/parent training programmes). More recently, adding to this multimodal treatment approach, neurofeedback has grown in popularity as an intervention option for patients with ADHD. This article considers this intervention approach and the opportunities for optimising treatment for executive control dysfunctions in ADHD using theta/beta neurofeedback.
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Affiliation(s)
- Annet Bluschke
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Veit Roessner
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
| | - Christian Beste
- Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany
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