Alternative treatments for adults with attention-deficit hyperactivity disorder (ADHD)

Chiral Materials: Progress, Applications, and Prospects

Chirality is a universal phenomenon in molecular and biological systems, denoting an asymmetric configurational property where an object cannot be superimposed onto its mirror image by any kind of translation or rotation, which is ubiquitous on the scale from neutrinos to spiral galaxies. Chirality plays a very important role in the life system. Many biological molecules in the life body show chirality, such as the "codebook" of the earth's biological diversity-DNA, nucleic acid, etc. Intriguingly, living organisms hierarchically consist of homochiral building blocks, for example, l-amino acids and d-sugars with unknown reason. When molecules with chirality interact with these chiral factors, only one conformation favors the positive development of life, that is, the chiral host environment can only selectively interact with chiral molecules of one of the conformations. The differences in chiral interactions are often manifested by chiral recognition, mutual matching, and interactions with chiral molecules, which means that the stereoselectivity of chiral molecules can produce changes in pharmacodynamics and pathology. Here, the latest investigations are summarized including the construction and applications of chiral materials based on natural small molecules as chiral source, natural biomacromolecules as chiral sources, and the material synthesized by design as a chiral source.

Ketogenic diet ameliorates attention deficit hyperactivity disorder in rats via regulating gut microbiota

Attention deficit hyperactivity disorder (ADHD) is a common mental behavioral disorder in children. Alterations in gut microbiota composition are associated with neurological disorders. We aimed to investigate whether a ketogenic diet (KD) can be an alternative therapy for ADHD by altering the gut microbiota. Male spontaneously hypertensive rats (SHR) and Wistar Kyoto (WKY) rats were randomly allocated to the normal diet (ND), methylphenidate (MPH), and KD groups. SHR in groups KD and MPH exhibited a significant increase in behavioral characteristics of ADHD, such as distance moved and immobility time. KD and MPH treatment led to a significant elevation in concentrations of 5-HT, AC, cAMP, and NE of brain tissue and the expression of DRD1, DAT, PKA, DARPP32, and cAMP at the protein level in WKY rats and SHR. KD and MPH significantly increased the richness and diversity of gut microbiota in SHR. The abundance of Ruminococcus_gauvreauii_group, Bacteroides, Bifidobacterium, and Blautia significantly increased, whereas that of Lactobacillus, Romboutsia, Facklamia, and Turicibacter significantly declined in the KD group compared with the ND group. The gut microbiota in the KD group of SHR mainly participated in amino acid metabolism- and sugar metabolism-related pathways. KD might alleviate behavioral disorders in ADHD by regulating gut microbiota. This study provides novel insights for the use of KD in treating ADHD.

A randomized-controlled neurofeedback trial in adult attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is a childhood onset disorder persisting into adulthood for a large proportion of cases. Neurofeedback (NF) has shown promising results in children with ADHD, but randomized controlled trials in adults with ADHD are scarce. We aimed to compare slow cortical potential (SCP)- and functional near-infrared spectroscopy (fNIRS) NF to a semi-active electromyography biofeedback (EMG-BF) control condition regarding changes in symptoms and the impact of learning success, as well as changes in neurophysiological parameters in an adult ADHD population. Patients were randomly assigned to SCP-NF (n = 26), fNIRS-NF (n = 21) or EMG-BF (n = 20). Outcome parameters were assessed over 30 training sessions (pre, intermediate, post) and at 6-months follow-up (FU) including 3 booster sessions. EEG was recorded during two auditory Go/NoGo paradigms assessing the P300 and contingent negative variation (CNV). fNIRS measurements were conducted during an n-back- as well as a Go/NoGo task. All three groups showed equally significant symptom improvements suggesting placebo- or non-specific effects on the primary outcome measure. Only when differentiating between learners and non-learners, fNIRS learners displayed stronger reduction of ADHD global scores compared to SCP non-learners at FU, and fNIRS learners showed specifically low impulsivity ratings. 30.8% in the SCP-NF and 61.9% of participants in the fNIRS-NF learned to regulate the respective NF target parameter. We conclude that some adults with ADHD learn to regulate SCP amplitudes and especially prefrontal hemodynamic activity during NF. We did not find any significant differences in outcome between groups when looking at the whole sample. When evaluating learners only, they demonstrate superior effects as compared to non-learners, which suggests specific effects in addition to non-specific effects of NF when learning occurs.

EMG biofeedback training in adult attention-deficit/hyperactivity disorder: An active (control) training?

OBJECTIVE

The present study aimed at revealing neurophysiological effects induced by electromyography (EMG) based biofeedback, considered as a semi-active control condition in neurofeedback studies, in adult attention-deficit/hyperactivity disorder (ADHD) patients.

METHODS

20 adult ADHD patients trained their muscle activity in the left and right supraspinatus muscle over the course of 30 EMG biofeedback sessions. Changes induced by the EMG feedback were evaluated at a clinical and neurophysiological level; additionally, the relation between changes in EEG activity recorded at the vertex over the training course and changes of symptom severity over the treatment course were assessed in order to investigate the mechanisms underlying clinical effects of EMG biofeedback.

RESULTS

Participants showed significant behavioral improvements on a self-rating scale. There was a significant increase in alpha power, but no significant changes in the delta frequency range; changes in the theta and beta frequency range were not significant after adjustment for multiple comparisons. No statistically significant correlation was found between changes in EEG frequency bands and changes in ADHD symptoms.

CONCLUSIONS

The current results assessed by means of a single-electrode EEG constitute a starting point regarding a clearer understanding of mechanisms underlying clinical effects of EMG biofeedback. Although we did not reveal systematic effects induced by EMG feedback on brain activity it remains an open question whether EMG biofeedback induces changes in brain regions or parameters we did not gather in the present study (e.g. motor cortex).

Neurofeedback of Slow Cortical Potentials in Children with Attention-Deficit/Hyperactivity Disorder: A Multicenter Randomized Trial Controlling for Unspecific Effects

Background: Neurofeedback (NF) in children with attention-deficit/hyperactivity disorder (ADHD) has been investigated in a series of studies over the last years. Previous studies did not unanimously support NF as a treatment in ADHD. Most studies did not control for unspecific treatment effects and did not demonstrate that self-regulation took place. The present study examined the efficacy of NF in comparison to electromyographic (EMG) feedback to control for unspecific effects of the treatment, and assessed self-regulation of slow cortical potentials (SCPs).

Methods: A total of 150 children aged 7–9 years diagnosed with ADHD (82% male; 43% medicated) were randomized to 25 sessions of feedback of SCPs (NF) or feedback of coordination of the supraspinatus muscles (EMG). The primary endpoint was the change in parents’ ratings of ADHD core symptoms 4 weeks after the end of treatment compared to pre-tests.

Results: Children in both groups showed reduced ADHD-core symptoms (NF 0.3, 95% CI -0.42 to -0.18; EMG 0.13, 95% CI -0.26 to -0.01). NF showed a significant superiority over EMG (treatment difference 0.17, 95% CI 0.02–0.3, p = 0.02). This yielded an effect size (ES) of d = 0.57 without and 0.40 with baseline observation carried forward (BOCF). The sensitivity analysis confirmed the primary result. Successful self-regulation of brain activity was observed only in NF. As a secondary result teachers reported no superior improvement from NF compared to EMG, but within-group analysis revealed effects of NF on the global ADHD score, inattention, and impulsivity. In contrast, EMG feedback did not result in changes despite more pronounced self-regulation learning.

Conclusions: Based on the primary parent-rated outcome NF proved to be superior to a semi-active EMG feedback treatment. The study supports the feasibility and efficacy of NF in a large sample of children with ADHD, based on both specific and unspecific effects.

Trial Register: Current controlled trials ISRCTN76187185, registered 5 February 2009.

Feeding the microbiota-gut-brain axis: diet, microbiome, and neuropsychiatry

The microbial population residing within the human gut represents one of the most densely populated microbial niche in the human body with growing evidence showing it playing a key role in the regulation of behavior and brain function. The bidirectional communication between the gut microbiota and the brain, the microbiota-gut-brain axis, occurs through various pathways including the vagus nerve, the immune system, neuroendocrine pathways, and bacteria-derived metabolites. This axis has been shown to influence neurotransmission and the behavior that are often associated with neuropsychiatric conditions. Therefore, research targeting the modulation of this gut microbiota as a novel therapy for the treatment of various neuropsychiatric conditions is gaining interest. Numerous factors have been highlighted to influence gut microbiota composition, including genetics, health status, mode of birth, and environment. However, it is diet composition and nutritional status that has repeatedly been shown to be one of the most critical modifiable factors regulating the gut microbiota at different time points across the lifespan and under various health conditions. Thus the microbiota is poised to play a key role in nutritional interventions for maintaining brain health.

[Mindfulness-based intervention in attention-deficit-/hyperactivity disorder (ADHD)]

This paper reviews the current literature on mindfulness-based interventions in the treatment of attention-deficit/hyperactivity disorder (ADHD). Mindfulness means paying attention and being aware of the experiences occurring in the present moment, and it is usually developed by the practice of meditation. Research shows that mindfulness training is associated with improved attention systems and self-regulation, and that it therefore fosters those skills that are underdeveloped in individuals with ADHD. Although only few studies have investigated the effectiveness of mindfulness training in ADHD (many of which showing methodological limitations), the findings do suggest that mindfulness may be useful in ADHD interventions.

Mindfulness training as an adjunct to evidence-based treatment for ADHD within families

OBJECTIVE

Individuals with ADHD face significant neurodevelopmental hurdles with inattention and/or hyperactive/impulsive behavior through their life span. Mindfulness training may be one self-regulatory method for strengthening attentional processes (orienting, alerting, and executive attention). This review's goals are to (a) argue for the use of mindfulness training as an adjunct to evidence-based treatment for ADHD and (b) call for improving psychosocial intervention for ADHD within families by integrating mindfulness training with behavioral parent training.

METHOD

EBSCOhost was utilized to search 29 psychology-related research databases through Athabasca University.

RESULTS

Mindfulness training should be incorporated into current treatment guidelines as a psychosocial option for families with ADHD.

CONCLUSION

Preliminary findings suggest significant improvements in attentional processes, and prominent mindfulness-based approaches have been successfully adapted for ADHD.

Neurofeedback in children with attention-deficit/hyperactivity disorder (ADHD)--a controlled multicenter study of a non-pharmacological treatment approach

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood and has often a chronic course persisting into adulthood. However, up to 30% of children treated with stimulants either fail to show an improvement or suffer adverse side effects, including decreased appetite, insomnia and irritability and there is no evidence of long term efficacy of stimulants for ADHD. A series of studies has shown that neurofeedback is an effective additional or alternative treatment for children with ADHD, leading to e.g. significant and stable improvement in behavior, attention and IQ. Significant treatment effects of neurofeedback have also been verified in meta-analyses. Most of the trials, however, have been criticized for methodological difficulties, particularly lacking appropriate control conditions and number of patients included. This randomized study examines the efficacy of slow cortical potentials (SCP) -neurofeedback, controlling unspecific effects of the setting by comparing two active treatment modalities.

METHODS/DESIGN

A total of 144 patients with ADHD, older than six and younger than ten years, in some cases with additional pharmacological treatment, are included in this trial. In five trial centres patients are treated either with SCP-feedback or electromyographic (EMG) -feedback in 25 sessions within 3 months. A comprehensive test battery is conducted before and after treatment and at follow-up 6 month later, to assess core symptoms of ADHD, general psychopathology, attentional performance, comorbid symptoms, intelligence, quality of life and cortical arousal.

DISCUSSION

The efficacy of SCP-feedback training for children with ADHD is evaluated in this randomized controlled study. In addition to behavior ratings and psychometric tests neurophysiological parameters serve as dependent variables. Further, the choice of EMG-biofeedback as an active control condition is debated.

TRIALS REGISTRATION

Current Controlled Trials ISRCTN76187185. Registered 5 February 2009.

Differential EMG biofeedback for children with ADHD: a control method for neurofeedback training with a case illustration

The objective of the present paper was to develop a differential electromyographic biofeedback (EMG-BF) training for children with attention-deficit/hyperactivity disorder (ADHD) matching multiple neurofeedback training protocols in order to serve as a valid control training. This differential EMG-BF training method feeds back activity from arm muscles involved in fine motor skills such as writing and grip force control. Tonic EMG-BF training (activation and deactivation blocks, involving bimanual motor tasks) matches the training of EEG frequency bands, while phasic EMG-BF training (short activation and deactivation trials) was developed as an equivalent to the training of slow cortical potentials. A case description of a child who learned to improve motor regulation in most task conditions and showed a clinically relevant reduction of behavioral ADHD symptoms illustrates the training course and outcome. Differential EMG-BF training is feasible and provides well-matched control conditions for neurofeedback training in ADHD research. Future studies should investigate its value as a specific intervention for children diagnosed with ADHD and comorbid sensorimotor problems.

Neurofeedback in children with ADHD: validation and challenges

Neurofeedback (NF), a type of neurobehavioral training, has gained increasing attention in recent years, especially concerning the treatment of children with ADHD. Promising results have emerged from recent randomized controlled studies, and thus, NF is on its way to becoming a valuable addition to the multimodal treatment of ADHD. In this review, we summarize the randomized controlled trials in children with ADHD that have been published within the last 5 years and discuss issues such as the efficacy and specificity of effects, treatment fidelity and problems inherent in placebo-controlled trials of NF. Directions for future NF research are outlined, which should further address specificity and help to determine moderators and mediators to optimize and individualize NF training. Furthermore, we describe methodological (tomographic NF) and technical ('tele-NF') developments that may also contribute to further improvements in treatment outcome.

Management of attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD/ADD) is a neurobehavioral disorder of childhood onset characterized by severe, developmentally inappropriate motor hyperactivity, inattention, and impulsiveness that result in impairment in more than one setting. It affects the home, school, and community life of 39% of school-going children worldwide. There is increasing recognition that ADHD symptoms and clinically defined disorder can persist into adult life and are associated with later drug and alcohol misuse and social and work difficulties. Added to that is the extreme variability of the disorder over time, within the same individual, between individuals, and across different circumstances. Treatment with stimulants and nonstimulants has proven effective in different subgroups, with the effectiveness of specific agents most likely related to the primary neurotransmitter involved. However, stimulants with a short duration of action have been problematic for some patients. Parent training and cognitive behavioral therapies represent the most widely adjunct psychosocial interventions to pharmacotherapy.

Predictors of postural stability in children with ADHD

OBJECTIVE

As children with ADHD who have more inattention problems are more frequently with fine motor problems, it is not clear whether postural balance problems are associated with different subtypes of ADHD. This study investigates the predictors of postural stability in children with ADHD considering the covariant factors of age, gender, and comorbidities.

METHOD

A total of 103 children with ADHD are studied using Poor Postural Stability Questionnaire filled out by their parents.

RESULTS

Linear regression analysis indicates that only oppositional-defiant behavior score is the predictor of seeking-movement subscale score. ADHD type does not predict the score of avoiding-postural-instability subscale, whereas separation anxiety score did so.

CONCLUSION

ADHD subtypes do not have distinct clinical profiles of the balance problems. Postural stability in children with ADHD depends on the comorbid psychiatric disorders rather than ADHD subtypes.

Neurofeedback in ADHD: a single-blind randomized controlled trial

Neurofeedback treatment has been demonstrated to reduce inattention, impulsivity and hyperactivity in children with attention deficit/hyperactivity disorder (ADHD). However, previous studies did not adequately control confounding variables or did not employ a randomized reinforcer-controlled design. This study addresses those methodological shortcomings by comparing the effects of the following two matched biofeedback training variants on the primary symptoms of ADHD: EEG neurofeedback (NF) aiming at theta/beta ratio reduction and EMG biofeedback (BF) aiming at forehead muscle relaxation. Thirty-five children with ADHD (26 boys, 9 girls; 6-14 years old) were randomly assigned to either the therapy group (NF; n = 18) or the control group (BF; n = 17). Treatment for both groups consisted of 30 sessions. Pre- and post-treatment assessment consisted of psychophysiological measures, behavioural rating scales completed by parents and teachers, as well as psychometric measures. Training effectively reduced theta/beta ratios and EMG levels in the NF and BF groups, respectively. Parents reported significant reductions in primary ADHD symptoms, and inattention improvements in the NF group were higher compared to the control intervention (BF, d (corr) = -.94). NF training also improved attention and reaction times on the psychometric measures. The results indicate that NF effectively reduced inattention symptoms on parent rating scales and reaction time in neuropsychological tests. However, regarding hyperactivity and impulsivity symptoms, the results imply that non-specific factors, such as behavioural contingencies, self-efficacy, structured learning environment and feed-forward processes, may also contribute to the positive behavioural effects induced by neurofeedback training.

Meditation therapies for attention-deficit/hyperactivity disorder (ADHD)

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common developmental disorders experienced in childhood and can persist into adulthood. The disorder has early onset and is characterized by a combination of overactive, poorly modulated behavior with marked inattention. In the long term it can impair academic performance, vocational success and social-emotional development. Meditation is increasingly used for psychological conditions and could be used as a tool for attentional training in the ADHD population.

OBJECTIVES

To assess the effectiveness of meditation therapies as a treatment for ADHD.

SEARCH STRATEGY

Our extensive search included: CENTRAL, MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, C2-SPECTR, dissertation abstracts, LILACS, Virtual Health Library (VHL) in BIREME, Complementary and Alternative Medicine specific databases, HSTAT, Informit, JST, Thai Psychiatric databases and ISI Proceedings, plus grey literature and trial registries from inception to January 2010.

SELECTION CRITERIA

Randomized controlled trials that investigated the efficacy of meditation therapy in children or adults diagnosed with ADHD.

DATA COLLECTION AND ANALYSIS

Two authors extracted data independently using a pre-designed data extraction form. We contacted study authors for additional information required. We analyzed data using mean difference (MD) to calculate the treatment effect. The results are presented in tables, figures and narrative form.

MAIN RESULTS

Four studies, including 83 participants, are included in this review. Two studies used mantra meditation while the other two used yoga compared with drugs, relaxation training, non-specific exercises and standard treatment control. Design limitations caused high risk of bias across the studies. Only one out of four studies provided data appropriate for analysis. For this study there was no statistically significant difference between the meditation therapy group and the drug therapy group on the teacher rating ADHD scale (MD -2.72, 95% CI -8.49 to 3.05, 15 patients). Likewise, there was no statistically significant difference between the meditation therapy group and the standard therapy group on the teacher rating ADHD scale (MD -0.52, 95% CI -5.88 to 4.84, 17 patients). There was also no statistically significant difference between the meditation therapy group and the standard therapy group in the distraction test (MD -8.34, 95% CI -107.05 to 90.37, 17 patients).

AUTHORS' CONCLUSIONS

As a result of the limited number of included studies, the small sample sizes and the high risk of bias, we are unable to draw any conclusions regarding the effectiveness of meditation therapy for ADHD. The adverse effects of meditation have not been reported. More trials are needed.

Theta activity and meditative states: spectral changes during concentrative meditation

Brain oscillatory activity is associated with different cognitive processes and plays a critical role in meditation. In this study, we investigated the temporal dynamics of oscillatory changes during Sahaj Samadhi meditation (a concentrative form of meditation that is part of Sudarshan Kriya yoga). EEG was recorded during Sudarshan Kriya yoga meditation for meditators and relaxation for controls. Spectral and coherence analysis was performed for the whole duration as well as specific blocks extracted from the initial, middle, and end portions of Sahaj Samadhi meditation or relaxation. The generation of distinct meditative states of consciousness was marked by distinct changes in spectral powers especially enhanced theta band activity during deep meditation in the frontal areas. Meditators also exhibited increased theta coherence compared to controls. The emergence of the slow frequency waves in the attention-related frontal regions provides strong support to the existing claims of frontal theta in producing meditative states along with trait effects in attentional processing. Interestingly, increased frontal theta activity was accompanied reduced activity (deactivation) in parietal-occipital areas signifying reduction in processing associated with self, space and, time.

Enhanced independence and quality of life through treatment with flotation-Restricted Environmental Stimulation Technique of a patient with both Attention Deficit Hyperactivity Disorder and Aspergers syndrome: a case report

Introduction

The objective of this qualitative case report was to describe experiences of flotation-Restricted Environmental Stimulation Technique from the perspective of a woman with Attention Deficit Hyperactivity Disorder, Aspergers syndrome and experiences of depression and distress.

Case presentation

The respondent is a 36-year-old woman from Sweden, assessed and diagnosed by a neuropsychological multi-professional team in 2006. The 19-session flotation series prolonged during almost one year.

Conclusion

The positive development of arousal control, activity regulation, sensory integration and interpretation, cognitive functioning and emotional maturity created experiences of personal independence and quality of life. Flotation-restrictive environmental stimulation technique was experienced as a meaningful treatment. Additional studies of treatment for Attention Deficit Hyperactivity Disorder and comorbid disorders in adults using the flotation-restrictive environmental stimulation technique are strongly encouraged.

Mindfulness meditation training in adults and adolescents with ADHD: a feasibility study

OBJECTIVE

ADHD is a childhood-onset psychiatric condition that often continues into adulthood. Stimulant medications are the mainstay of treatment; however, additional approaches are frequently desired. In recent years, mindfulness meditation has been proposed to improve attention, reduce stress, and improve mood. This study tests the feasibility of an 8-week mindfulness training program for adults and adolescents with ADHD.

METHOD

Twenty-four adults and eight adolescents with ADHD enrolled in a feasibility study of an 8-week mindfulness training program.

RESULTS

The majority of participants completed the training and reported high satisfaction with the training. Pre-post improvements in self-reported ADHD symptoms and test performance on tasks measuring attention and cognitive inhibition were noted. Improvements in anxiety and depressive symptoms were also observed.

CONCLUSION

Mindfulness training is a feasible intervention in a subset of ADHD adults and adolescents and may improve behavioral and neurocognitive impairments. A controlled clinical study is warranted.

Special considerations in diagnosing and treating attention-deficit/hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent chronic condition that affects people of all ages, including young children, school-aged children, adolescents, and adults. Symptoms can be noted as early as preschool age, tend to progress into functional impairment and behavioral problems in later childhood, and typically persist into adulthood. Contrary to previous belief, the disorder does not resolve with puberty for the majority of children; rather, the symptoms are manifested differently throughout the lifecycle. Presentation in adults is heavily biased toward inattentive symptoms, which are less likely to draw notice than hyperactive or impulsive symptoms and may contribute to the underrecognition of ADHD in this patient population. Diagnosis is particularly difficult due in large part to the pronounced comorbidity of psychiatric disorders in this patient population. Identification may be even more difficult in adults than children as the diagnostic criteria are not as clear, adults have difficulty remembering symptoms prior to 7 years of age, and there is a high prevalence of comorbid psychiatric disorders in adults. Early identification and treatment of symptoms of ADHD in preschool-age children is essential to effective long-term management of the disorder. Both medication and behavioral treatments appear to alleviate the symptoms of ADHD, and evidence suggests that discontinuation of treatment leads to the reemergence of the condition. Efforts are currently continuing toward understanding the genetic underpinnings of ADHD. This expert review supplement will address the prevalence, comorbidity, treatment issues, and special considerations surrounding ADHD management throughout each stage of the lifecycle beginning with ADHD in preschool-aged children, continuing with school-aged children and adolescents, and ending with adulthood.

Omega-3 fatty acids in ADHD and related neurodevelopmental disorders

Omega-3 fatty acids are dietary essentials, and are critical to brain development and function. Increasing evidence suggests that a relative lack of omega-3 may contribute to many psychiatric and neurodevelopmental disorders. This review focuses on the possible role of omega-3 in attention-deficit/hyperactivity disorder (ADHD) and related childhood developmental disorders, evaluating the existing evidence from both research and clinical perspectives. Theory and experimental evidence support a role for omega-3 in ADHD, dyslexia, developmental coordination disorder (DCD) and autism. Results from controlled treatment trials are mixed, but the few studies in this area have involved different populations and treatment formulations. Dietary supplementation with fish oils (providing EPA and DHA) appears to alleviate ADHD-related symptoms in at least some children, and one study of DCD children also found benefits for academic achievement. Larger trials are now needed to confirm these findings, and to establish the specificity and durability of any treatment effects as well as optimal formulations and dosages. Omega-3 is not supported by current evidence as a primary treatment for ADHD or related conditions, but further research in this area is clearly warranted. Given their relative safety and general health benefits, omega-3 fatty acids offer a promising complementary approach to standard treatments.

Zur Wirksamkeit körperorientierter Therapieverfahren bei der Behandlung hyperaktiver Störungen: Ergebnisse einer kontrollierten Pilotstudie

Zusammenfassung: Fragestellung: Zur Effektivität körperorientierter Therapieverfahren bei hyperkinetischen Störungen liegen bisher kaum methodisch gut kontrollierte Studien vor. Ziel der Arbeit war die Prüfung der differentiellen Wirksamkeit eines an kindliche Bedürfnisse angepassten Yoga Trainings im Vergleich zu einem herkömmlichen Bewegungstraining. Methodik: Bei 19 Kindern mit klinischer Diagnose einer hyperkinetischen Störung (nach ICD-10) wurden nach randomisierter Gruppenzuordnung im 2×2 cross-over Design die Trainingseffekte (Yoga vs. Bewegungstraining) anhand von Varianzanalysen mit Messwiederholung geprüft. Ergebnisse: Es zeigte sich eine deutliche Überlegenheit des Yoga Trainings sowohl hinsichtlich der Verbesserungen der Testleitungen im Dortmunder Aufmerksamkeitstest (DAT) als auch bei der Reduktion der hyperkinetischen Symptomatik im standardisiert erhobenen Elternurteil mit Effektstärken (ES) im mittleren bis hohen Bereich (ES = 0.60-0.97). Bei Trainingsende lagen die Gruppenmittelwerte im unauffälligen Bereich und unterschieden sich nicht bedeutsam von den Werten einer repräsentativen Vergleichsstichprobe. Kinder mit Methylphenidat Behandlung profitierten mehr vom Training und zeigten aufgrund höherer Ausgangswerte zu Studienbeginn deutlichere Symptomverbesserungen als Kinder ohne pharmakologische Unterstützung. Schlussfolgerungen: Die Befunde der Pilotstudie legen nahe, dass Yoga als Intervention oder begleitende Therapie bei hyperkinetischen Störungen erfolgreich eingesetzt werden kann. Sie fordern dazu auf, die Wirksamkeit körperorientierter Therapieverfahren bei der Behandlung hyperaktiver Störungen in weiteren Studien systematisch zu prüfen.

Clinical Utility of EEG in Attention Deficit Hyperactivity Disorder

Electrophysiological measures were among the first to be used to study brain processes in children with attention deficit hyperactivity disorder (ADHD; Diagnostic and Statistical Manual of Mental Disorders [4th ed.], American Psychiatric Association, 1994) and have been used as such for over 30 years (see Hastings & Barkley, 1978, for an early review). More recently, electroencephalography (EEG) has been used both in research to describe and quantify the underlying neurophysiology of ADHD, but also clinically in the assessment, diagnosis, and treatment of ADHD. This review will first provide a brief overview of EEG and then present some of the research findings of EEG correlates in ADHD. Then, the utility of EEG in making an ADHD diagnosis and predicting stimulant response will be examined. Finally, and more controversially, we will review the results of the most recent studies on EEG biofeedback (neurofeedback) as a treatment for ADHD and the issues that remain to be addressed in the research examining the efficacy this therapeutic approach.

Neurofeedback in der Behandlung der Aufmerksamkeitsdefizit-Hyperaktivitätsstörung (ADHS) im Kindes- und Jugendalter

Zusammenfassung: Einleitung: In der Therapie der Aufmerksamkeitsdefizit-Hyperaktivitätsstörung (ADHS) sind viele nicht-medikamentöse Behandlungsmethoden den Nachweis ihrer Wirksamkeit schuldig geblieben. Für das Neurofeedback (auch EEG-Biofeedback) hat sich die Evidenzbasis in den vergangenen Jahren verbessert. Neurofeedback bewirkt abhängig vom Trainings-Protokoll Veränderungen des EEG-Frequenzspektrums oder der ereigniskorrelierten Potentiale bei ADHS und strebt über die gelernte Modifikation dieser Parameter eine Verbesserung der ADHS-Kernsymptome an. Methoden: In dieser Übersichtsarbeit werden die vorliegenden Forschungsbefunde detailliert dargelegt. Ergebnisse: Die durch das Neurofeedback erreichten kurzfristigen Verbesserungen entsprachen in drei kontrollierten Studien denen einer pharmakotherapeutischen Stimulanzien-Behandlung. Neurofeedback führte zu einer signifikanten Reduktion von Unaufmerksamkeit, Impulsivität und Hyperaktivität. Darüber hinaus fand sich eine anhaltende Normalisierung des Spontan-EEGs, während eine Stimulanzientherapie keine vergleichbare Normalisierung bewirkte; es traten keine unerwünschten Wirkungen auf. Untersuchungen zur Wirkdauer der Neurofeedback-Effekte sind ermutigend, stützen sich aber auf kleine Patientenzahlen. Schlussfolgerung: Neurofeedback ist ein viel versprechender Ansatz in der Behandlung aufmerksamkeitsgestörter, hyperaktiver Kinder. Gleichwohl besteht Bedarf an weiteren kontrollierten Studien mit einheitlichen diagnostischen Kriterien, ausreichend großen Stichproben, geeigneten Veränderungsmaßen und Katamnese-Untersuchungen.

Laser acupuncture and low-calorie diet during visceral obesity therapy after menopause

BACKGROUND

To compare the efficiency of low-calorie diet and low-calorie diet applied together with laser acupuncture in the therapy of visceral obesity in postmenopausal women.

METHODS

The study population consisted of 74 postmenopausal females with visceral obesity who were divided into two groups according to an employed 6-month slimming procedure. In the first group (n = 36) a low-calorie diet was applied, while women in the second group (n = 38) were on the same kind of diet, having additionally one cycle of laser acupuncture procedure at the same time. At baseline and at the end of the study, body weight, body mass index and waist-to-hip ratio were determined in all women.

RESULTS

After 6 trial months both groups exhibited a statistically significant drop in body weight, body mass index and waist-to-hip ratio. The mean reduction of body weight, body mass index and waist-to-hip ratio was significantly higher in the second group of women (laser acupuncture plus low-calorie diet).

CONCLUSIONS

(1) Our results testify that the combination of a low-calorie diet and laser acupuncture is characterized by a higher efficacy than a low-calorie diet alone in lowering body weight, body mass index and waist-to-hip-ratio. (2) Laser acupuncture is an additional useful healing method in the therapy of visceral postmenopausal obesity.