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Zhang C, Zhou X, Hu N, Xu L. Effect of biofeedback intervention on neurological characteristics of children with attention deficit hyperactivity disorder. Int J Neurosci 2024:1-8. [PMID: 38416571 DOI: 10.1080/00207454.2024.2325029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/25/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To evaluate the effects of biofeedback intervention on the neurological characteristics of children with attention deficit hyperactivity disorder (ADHD). METHODS 150 children aged 6-12 years with ADHD were divided into two groups according to the treatment method. The atomoxetine group received atomoxetine drug treatment, and the combined treatment group received EEG biofeedback therapy. Continuous performance test (CPT), SNAP-IV and WFIRS-P were used to assess attention and behavior, and functional magnetic resonance imaging (fMRI) was used to observe changes in brain activity. RESULTS The response time, error times, error response rate and attention fluctuation index of CPT in the combined treatment group were significantly lower than those in the atomoxetine group (p < 0.05), and the correct response rate was higher than that in the atomoxetine group (p < 0.05). After intervention, SNAP-IV and WFIRS-P scores in the combined treatment group were significantly lower than those in the atomoxetine group (p < 0.001). fMRI results showed that the activity of the prefrontal, parietal, amygdala and hippocampus in the combined treatment group was significantly higher than that in the atomoxetine group (p < 0.001). CONCLUSION Biofeedback intervention can significantly improve the attention and behavior of ADHD children and positively regulate the neural activity in related brain areas on the basis of drug treatment, suggesting that biofeedback therapy can be considered as a potential effective nondrug treatment option for ADHD children.
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Affiliation(s)
- Cai Zhang
- Department of Pediatrics, Brain Hospital of Hunan Province (The Second People's Hospital of Hunan Province) College of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
| | - Xiaoxuan Zhou
- Department of Pediatrics, Brain Hospital of Hunan Province (The Second People's Hospital of Hunan Province) College of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
| | - Nanfei Hu
- Department of Pediatrics, Brain Hospital of Hunan Province (The Second People's Hospital of Hunan Province) College of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
| | - Lin Xu
- Department of Pediatrics, Brain Hospital of Hunan Province (The Second People's Hospital of Hunan Province) College of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, P.R. China
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2
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Results of Neurofeedback in Treatment of Children with ADHD: A Systematic Review of Randomized Controlled Trials. Appl Psychophysiol Biofeedback 2022; 47:145-181. [PMID: 35612676 DOI: 10.1007/s10484-022-09547-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/02/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent disorders in children and adolescents. Neurofeedback, a nonpharmaceutical treatment, has shown promising results. To review the evidence of efficacy of neurofeedback as a treatment for children and adolescents with ADHD. A systematic review of the specific scientific studies published in 1995-2021, identifying and analyzing randomized controlled trials (RCT). A total of 1636 articles were identified and 165 met inclusion criteria, of which 67 were RCTs. Neurofeedback training was associated with significant long-term reduction in symptoms of ADHD. Though limitations exist regarding conclusions about the specific effects of neurofeedback, the review documents improvements in school, social, and family environments.
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Cabaleiro P, Cueli M, Cañamero LM, González-Castro P. A Case Study in Attention-Deficit/Hyperactivity Disorder: An Innovative Neurofeedback-Based Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010191. [PMID: 35010449 PMCID: PMC8751092 DOI: 10.3390/ijerph19010191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022]
Abstract
In research about attention-deficit/hyperactivity disorder (ADHD) there is growing interest in evaluating cortical activation and using neurofeedback in interventions. This paper presents a case study using monopolar electroencephalogram recording (brain mapping known as MiniQ) for subsequent use in an intervention with neurofeedback for a 10-year-old girl presenting predominantly inattentive ADHD. A total of 75 training sessions were performed, and brain wave activity was assessed before and after the intervention. The results indicated post-treatment benefits in the beta wave (related to a higher level of concentration) and in the theta/beta ratio, but not in the theta wave (related to higher levels of drowsiness and distraction). These instruments may be beneficial in the evaluation and treatment of ADHD.
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4
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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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5
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A randomized-controlled neurofeedback trial in adult attention-deficit/hyperactivity disorder. Sci Rep 2021; 11:16873. [PMID: 34413344 PMCID: PMC8376871 DOI: 10.1038/s41598-021-95928-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
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.
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6
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Investigation on Identifying Implicit Learning Event from EEG Signal Using Multiscale Entropy and Artificial Bee Colony. ENTROPY 2021; 23:e23050617. [PMID: 34065692 PMCID: PMC8155885 DOI: 10.3390/e23050617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 12/02/2022]
Abstract
The way people learn will play an essential role in the sustainable development of the educational system for the future. Utilizing technology in the age of information and incorporating it into how people learn can produce better learners. Implicit learning is a type of learning of the underlying rules without consciously seeking or understanding the rules; it is commonly seen in small children while learning how to speak their native language without learning grammar. This research aims to introduce a processing system that can systematically identify the relationship between implicit learning events and their Encephalogram (EEG) signal characteristics. This study converted the EEG signal from participants while performing cognitive task experiments into Multiscale Entropy (MSE) data. Using MSE data from different frequency bands and channels as features, the system explored a wide range of classifiers and observed their performance to see how they classified the features related to participants’ performance. The Artificial Bee Colony (ABC) method was used for feature selection to improve the process to make the system more efficient. The results showed that the system could correctly identify the differences between participants’ performance using MSE data and the ABC method with 95% confidence.
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7
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Eroğlu G, Gürkan M, Teber S, Ertürk K, Kırmızı M, Ekici B, Arman F, Balcisoy S, Özgüz V, Çetin M. Changes in EEG complexity with neurofeedback and multi-sensory learning in children with dyslexia: A multiscale entropy analysis. APPLIED NEUROPSYCHOLOGY-CHILD 2020; 11:133-144. [DOI: 10.1080/21622965.2020.1772794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Günet Eroğlu
- Faculty of Engineering and Natural Sciences, Sabancı University, Istanbul, Turkey
| | - Mert Gürkan
- Faculty of Engineering and Natural Sciences, Sabancı University, Istanbul, Turkey
| | - Serap Teber
- Medical Faculty, Child Neurology Department, Ankara University, Ankara, Turkey
| | | | | | - Barış Ekici
- Özel Çocuk Nörolojisi Kliniği, Istanbul, Turkey
| | - Fehim Arman
- Neurology Department, Acıbadem Hastanesi Kadıköy, Istanbul, Turkey
| | - Selim Balcisoy
- Faculty of Engineering and Natural Sciences, Sabancı University, Istanbul, Turkey
| | - Volkan Özgüz
- Faculty of Engineering and Natural Sciences, Sabancı University, Istanbul, Turkey
| | - Müjdat Çetin
- Faculty of Engineering and Natural Sciences, Sabancı University, Istanbul, Turkey
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, New York, USA
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8
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Ros T, Enriquez-Geppert S, Zotev V, Young KD, Wood G, Whitfield-Gabrieli S, Wan F, Vuilleumier P, Vialatte F, Van De Ville D, Todder D, Surmeli T, Sulzer JS, Strehl U, Sterman MB, Steiner NJ, Sorger B, Soekadar SR, Sitaram R, Sherlin LH, Schönenberg M, Scharnowski F, Schabus M, Rubia K, Rosa A, Reiner M, Pineda JA, Paret C, Ossadtchi A, Nicholson AA, Nan W, Minguez J, Micoulaud-Franchi JA, Mehler DMA, Lührs M, Lubar J, Lotte F, Linden DEJ, Lewis-Peacock JA, Lebedev MA, Lanius RA, Kübler A, Kranczioch C, Koush Y, Konicar L, Kohl SH, Kober SE, Klados MA, Jeunet C, Janssen TWP, Huster RJ, Hoedlmoser K, Hirshberg LM, Heunis S, Hendler T, Hampson M, Guggisberg AG, Guggenberger R, Gruzelier JH, Göbel RW, Gninenko N, Gharabaghi A, Frewen P, Fovet T, Fernández T, Escolano C, Ehlis AC, Drechsler R, Christopher deCharms R, Debener S, De Ridder D, Davelaar EJ, Congedo M, Cavazza M, Breteler MHM, Brandeis D, Bodurka J, Birbaumer N, Bazanova OM, Barth B, Bamidis PD, Auer T, Arns M, Thibault RT. Consensus on the reporting and experimental design of clinical and cognitive-behavioural neurofeedback studies (CRED-nf checklist). Brain 2020; 143:1674-1685. [PMID: 32176800 PMCID: PMC7296848 DOI: 10.1093/brain/awaa009] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/10/2019] [Accepted: 10/28/2020] [Indexed: 02/02/2023] Open
Abstract
Neurofeedback has begun to attract the attention and scrutiny of the scientific and medical mainstream. Here, neurofeedback researchers present a consensus-derived checklist that aims to improve the reporting and experimental design standards in the field.
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Affiliation(s)
- Tomas Ros
- Departments of Neuroscience and Psychiatry, University of Geneva; Campus Biotech, Geneva, Switzerland
| | - Stefanie Enriquez-Geppert
- Department of Clinical Neuropsychology, University of Groningen, Groningen, The Netherlands
- Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, Groningen, The Netherlands
| | - Vadim Zotev
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Kymberly D Young
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Guilherme Wood
- Institute of Psychology, University of Graz, Graz, Austria
| | - Susan Whitfield-Gabrieli
- Massachusetts Institute of Technology, Cambridge, MA, USA
- Northeastern University, Boston, MA, USA
| | - Feng Wan
- Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau, China
| | | | | | - Dimitri Van De Ville
- Institute of Bioengineering, Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL); Campus Biotech, Geneva, Switzerland
| | - Doron Todder
- Faculty of Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Beer-Sheva Mental Health Center, Israel Ministry of Health, Beer-Sheva, Israel
| | - Tanju Surmeli
- Living Health Center for Research and Education, Istanbul, Turkey
| | - James S Sulzer
- Department of Mechanical Engineering, University of Texas at Austin, Austin, TX, USA
| | - Ute Strehl
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Maurice Barry Sterman
- Neurobiology and Biobehavioral Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Naomi J Steiner
- Boston University School of Medicine, Department of Pediatrics, Boston, MA, USA
| | - Bettina Sorger
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Surjo R Soekadar
- Clinical Neurotechnology Laboratory, Neuroscience Research Center (NWFZ), Department of Psychiatry and Psychotherapy (CCM), Charité - University Medicine Berlin, Berlin, Germany
| | - Ranganatha Sitaram
- Institute of Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Macul, Santiago, Chile
| | | | | | - Frank Scharnowski
- Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| | - Manuel Schabus
- University of Salzburg, Centre for Cognitive Neuroscience and Department of Psychology, Salzburg, Austria
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Miriam Reiner
- Technion, Israel Institute of Technology, Haifa, Israel
| | - Jaime A Pineda
- Cognitive Science Department, University of California, San Diego, CA, USA
| | - Christian Paret
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Alexei Ossadtchi
- National Research University Higher School of Economics, Moscow, Russia
| | - Andrew A Nicholson
- Department of Basic Psychological Research and Research Methods, Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| | - Wenya Nan
- Department of Psychology, Shanghai Normal University, Shanghai, China
| | | | | | - David M A Mehler
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Michael Lührs
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Joel Lubar
- Department of Psychology, University of Tennessee, Knoxville, USA
| | - Fabien Lotte
- Inria Bordeaux Sud-Ouest/LaBRI University of Bordeaux - CNRS-Bordeaux INP, Bordeaux, France
| | - David E J Linden
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Mikhail A Lebedev
- Center for Bioelectric Interfaces of the Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow, Russia
- Department of Information and Internet Technologies of Digital Health Institute; I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Duke Center for Neuroengineering, Duke University, Durham, NC, USA
| | - Ruth A Lanius
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Andrea Kübler
- Department of Psychology I, Psychological Intervention, Behavior Analysis and Regulation of Behavior, University of Würzburg
| | - Cornelia Kranczioch
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenberg, Germany
| | - Yury Koush
- Magnetic Resonance Research Center (MRRC), Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Lilian Konicar
- Medical University of Vienna, Department of Child and Adolescent Psychiatry, Vienna, Austria
| | - Simon H Kohl
- JARA-Institute Molecular neuroscience and neuroimaging (INM-11), Jülich Research Centre, Jülich, Germany
| | | | - Manousos A Klados
- Department of Psychology, The University of Sheffield International Faculty, City College, Thessaloniki, Greece
| | - Camille Jeunet
- CLLE Lab, CNRS, Université Toulouse Jean Jaurès, Toulouse, France
| | - T W P Janssen
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Rene J Huster
- Multimodal imaging and Cognitive Control Lab, Department of Psychology, University of Olso, Norway
| | - Kerstin Hoedlmoser
- University of Salzburg, Centre for Cognitive Neuroscience and Department of Psychology, Salzburg, Austria
| | | | - Stephan Heunis
- Electrical Engineering Department, Eindhoven University of Technology, The Netherlands
| | - Talma Hendler
- Sagol Brain Institute, Wohl Institute for Advanced Imaging, Sourasky Medical Center, Tel Aviv, Israel
| | - Michelle Hampson
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Adrian G Guggisberg
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital Geneva, Geneva, Switzerland
| | - Robert Guggenberger
- Division of Functional and Restorative Neurosurgery, University of Tübingen, Tübingen, Germany
| | - John H Gruzelier
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Rainer W Göbel
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Nicolas Gninenko
- Institute of Bioengineering, Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne (EPFL); Campus Biotech, Geneva, Switzerland
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Paul Frewen
- Department of Psychiatry, Western University, London, Ontario, Canada
| | - Thomas Fovet
- Univ. Lille, INSERM U1172, CHU LILLE, Centre Lille Neuroscience & Cognition, Pôle de Psychiatrie, F-59000, Lille, France
| | - Thalía Fernández
- UNAM Institute of Neurobiology, National Autonomous University of Mexico, Juriquilla, Mexico
| | | | - Ann-Christine Ehlis
- Psychophysiology and Optical Imaging, Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Renate Drechsler
- Department of Child and Adolescent, Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| | | | - Stefan Debener
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenberg, Germany
| | - Dirk De Ridder
- Department of Surgery, Section of Neurosurgery, University of Otago, Dunedin, New Zealand
| | - Eddy J Davelaar
- Department of Psychological Sciences Birkbeck, University of London, Bloomsbury, London, UK
| | - Marco Congedo
- GIPSA-lab, CNRS, University Grenoble Alpes, Grenoble-INP, Grenoble, France
| | - Marc Cavazza
- School of Computing and Mathematical Sciences, University of Greenwich, London, UK
| | - Marinus H M Breteler
- Radboud University Nijmegen, Department of Clinical Psychology, Nijmegen, The Netherlands
| | - Daniel Brandeis
- Department of Child and Adolescent, Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jerzy Bodurka
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Niels Birbaumer
- Institute for Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany
| | - Olga M Bazanova
- State Research Institute of Physiology and Basic Medicine, Novosibirsk, Russia
| | - Beatrix Barth
- Psychophysiology and Optical Imaging, Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | | | - Tibor Auer
- School of Psychology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Martijn Arns
- Brainclinics Foundation, Research Institute Brainclinics, Nijmegen, The Netherlands
| | - Robert T Thibault
- School of Psychological Science, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
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9
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Dam SA, Mostert JC, Szopinska-Tokov JW, Bloemendaal M, Amato M, Arias-Vasquez A. The Role of the Gut-Brain Axis in Attention-Deficit/Hyperactivity Disorder. Gastroenterol Clin North Am 2019; 48:407-431. [PMID: 31383279 DOI: 10.1016/j.gtc.2019.05.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Genetic and environmental factors play a role in the cause and development of attention-deficit/hyperactivity disorder (ADHD). Recent studies have suggested an important role of the gut-brain axis (GBA) and intestinal microbiota in modulating the risk of ADHD. Here, the authors provide a brief overview of the clinical and biological picture of ADHD and how the GBA could be involved in its cause. They discuss key biological mechanisms involved in the GBA and how these may increase the risk of developing ADHD. Understanding these mechanisms may help to characterize novel treatment options via identification of disease biomarkers.
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Affiliation(s)
- Sarita A Dam
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Kapittelweg 29, 6525 EN, Nijmegen, The Netherlands.
| | - Jeanette C Mostert
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Joanna W Szopinska-Tokov
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Mirjam Bloemendaal
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Maria Amato
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Alejandro Arias-Vasquez
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands; Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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10
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Bioulac S, Purper-Ouakil D, Ros T, Blasco-Fontecilla H, Prats M, Mayaud L, Brandeis D. Personalized at-home neurofeedback compared with long-acting methylphenidate in an european non-inferiority randomized trial in children with ADHD. BMC Psychiatry 2019; 19:237. [PMID: 31370811 PMCID: PMC6676623 DOI: 10.1186/s12888-019-2218-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 07/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neurofeedback (NF) has gained increasing interest among non-pharmacological treatments for Attention Deficit Hyperactivity Disorder (ADHD). NF training aims to enhance self-regulation of brain activities. The goal of the NEWROFEED study is to assess the efficacy of a new personalized NF training device, using two different protocols according to each child's electroencephalographic pattern, and designed for use at home. This study is a non-inferiority trial comparing NF to methylphenidate. METHODS The study is a prospective, multicentre, randomized, reference drug-controlled trial. One hundred seventy-nine children with ADHD, aged 7 to 13 years will be recruited in 13 clinical centres from 5 European countries. Subjects will be randomized to two groups: NF group (Neurofeedback Training Group) and MPH group (Methylphenidate group). Outcome measures include clinicians, parents and teachers' assessments, attention measures and quantitative EEG (qEEG). Patients undergo eight visits over a three-month period: pre-inclusion visit, inclusion visit, 4 "discovery" (NF group) or titration visits (MPH group), an intermediate and a final visit. Patients will be randomized to either the MPH or NF group. Children in the NF group will undergo either an SMR or a Theta/Beta training protocol according to their baselineTheta/Beta Ratio obtained from the qEEG. DISCUSSION This is the first non-inferiority study between a personalized NF device and pharmacological treatment. Innovative aspects of Mensia Koala™ include the personalization of the training protocol according to initial qEEG characteristics (SMR or Theta/Beta training protocols) and an improved accessibility of NF due to the opportunity to train at home with monitoring by the clinician through a dedicated web portal. TRIAL REGISTRATION NCT02778360 . Date registration (retrospectively registered): 5-12-2016. Registered May 19, 2016.
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Affiliation(s)
- Stéphanie Bioulac
- CHU Pellegrin, Clinique du Sommeil, F-33076, Bordeaux, France. .,Université de Bordeaux, Sommeil, Addiction et Neuropsychiatrie, USR 3413, F-33000, Bordeaux, France. .,CNRS, SANPSY, USR 3413, F-33000, Bordeaux, France.
| | - Diane Purper-Ouakil
- grid.414352.5Unit of Child and Adolescent Psychiatry (MPEA1), CHU Montpellier-Saint Eloi Hospital, Montpellier, France
| | - Tomas Ros
- 0000 0001 2322 4988grid.8591.5Department of Neurosciences, Laboratory for Neurology and Imaging of Cognition, University of Geneva, Geneva, Switzerland
| | - Hilario Blasco-Fontecilla
- 0000 0004 1767 8416grid.73221.35Department of Psychiatry, Segovia de Arana Health Research Institute (IDIPHISA)-Puerta de Hierro University Hospital, Avenida Manuel de Falla s/n, Majadahonda, Madrid, Spain ,0000000119578126grid.5515.4Autonoma University, Madrid, Spain
| | - Marie Prats
- grid.476574.3Mensia Technologies, 130, rue de Lourmel, 75015 Paris, France
| | - Louis Mayaud
- grid.476574.3Mensia Technologies, 130, rue de Lourmel, 75015 Paris, France
| | - Daniel Brandeis
- 0000 0004 1937 0650grid.7400.3University of Zurich and ETH Zurich, Neuroscience Center Zurich, Zurich, Switzerland ,0000 0004 0477 2235grid.413757.3Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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11
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Aggensteiner PM, Brandeis D, Millenet S, Hohmann S, Ruckes C, Beuth S, Albrecht B, Schmitt G, Schermuly S, Wörz S, Gevensleben H, Freitag CM, Banaschewski T, Rothenberger A, Strehl U, Holtmann M. Slow cortical potentials neurofeedback in children with ADHD: comorbidity, self-regulation and clinical outcomes 6 months after treatment in a multicenter randomized controlled trial. Eur Child Adolesc Psychiatry 2019; 28:1087-1095. [PMID: 30610380 DOI: 10.1007/s00787-018-01271-8] [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] [Received: 10/04/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
Despite sizeable short-term effects of neurofeedback (NF) therapy on attention-deficit and hyperactivity disorder (ADHD), longer-term clinical, comorbidity and self-regulation outcomes are less systematically studied. The aim of this largest NF follow-up to date was to evaluate these outcomes 6 months after NF compared to a semi-active control to disentangle specific from unspecific sustained effects. We performed a multicenter, randomized, parallel, controlled, clinical, superiority trial in five German university outpatient departments. Participants were eligible if they fulfilled DSM-IV-TR criteria for ADHD and were aged from 7 to 9 years. Participants were randomly assigned (1:1-ratio) to 25 sessions of slow cortical potential (SCP)-NF or electromyogram biofeedback (EMG-BF). Participants were not blinded, since they received instructions according to each treatment setting. Primary outcomes were parent ratings of ADHD. The trial was registered, number ISRCTN761871859. Both groups showed improvement of ADHD symptoms compared to baseline at 6-months follow-up with large effect sizes for SCP-NF (d = 1.04) and EMG-BF (d = 0.85), but without group differences. When analyzing all assessments (pre-test, post-test-1, post-test-2 and follow-up), a group-by-time interaction emerged (p = 0.0062), with SCP-NF showing stable improvement following treatment but EMG-BF showing a relapse from post-test-1 to post-test-2, and subsequent remission at follow-up. Six months after the end of treatment, improvement after SCP-NF remained large and stable. However, the lack of group differences at follow-up suggests shared specific and unspecific effects contributing to this clinical outcome. Our correlational results indicate specificity of SCP-NF for selected subscales after training, but not at follow-up.
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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/Heidelberg University, Mannheim, Germany.
| | - D 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 Centre Zurich, University and ETH Zurich, Zurich, Switzerland.,Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - S Millenet
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - S Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - C Ruckes
- Interdisciplinary Center for Clinical Trials, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - S Beuth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - B Albrecht
- Child and Adolescent Psychiatry, University Medical Center Göttingen, Göttingen, Germany
| | - G Schmitt
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - S Schermuly
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - S Wörz
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - H Gevensleben
- Child and Adolescent Psychiatry, University Medical Center Göttingen, Göttingen, Germany
| | - C M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - T Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - A Rothenberger
- Child and Adolescent Psychiatry, University Medical Center Göttingen, Göttingen, Germany
| | - U Strehl
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - M Holtmann
- LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
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12
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Pereira Júnior ADC, Castilho ECD, Borges TL, Santos PLD, Carvalho AMP, Miasso AI. An Integrative Review of Non-Pharmacological Therapeutic Interventions in Children with Mental Health Problems. Compr Child Adolesc Nurs 2019; 43:245-259. [PMID: 31161805 DOI: 10.1080/24694193.2019.1621961] [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: 10/26/2022]
Abstract
We provide an integrative review of non-pharmacological interventions for children with mental health problems. A total of 262 studies were found in three databases, of which 12 met the inclusion criteria, indicating a shortage of research on the subject. The most frequently used type of intervention was cognitive-behavioural therapy-based interventions, and attention deficit hyperactivity disorder was the most frequent problem. Non-pharmacological interventions help to improve the symptoms of childhood mental health problems, so there is a need to carry out further research on this issue in Brazil and the rest of Latin America.
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Affiliation(s)
| | | | - Tatiana Longo Borges
- Ribeirão Preto College of Nursing, University of São Paulo , Ribeirão Preto, Brazil
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13
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The impact of successful learning of self-regulation on reward processing in children with ADHD using fMRI. ATTENTION DEFICIT AND HYPERACTIVITY DISORDERS 2019; 11:31-45. [PMID: 30225805 DOI: 10.1007/s12402-018-0269-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 09/10/2018] [Indexed: 12/24/2022]
Abstract
Neurofeedback (NF) is a non-pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD) that is targeting self-regulation, is efficacious when standard protocols are used and induces partly specific neurophysiological changes in the inhibitory network. However, its effects on reward processing, which is also considered an important aspect of ADHD and has been linked to neurophysiological deficits, remain unknown. Children with ADHD (N = 15, mean age 11.8, SD 1.52) were randomly assigned to either slow cortical potential NF (n = 8) or EMG biofeedback control training (n = 7) and received 20 sessions of training under comparable conditions. Learning was defined as the slope of successful training runs across all transfer sessions. Whole brain analysis, region-of-interest analysis of anticipatory ventral striatal (VS) activation, and analysis of behavioral data were performed. Clinically, the NF group improved more than the EMG group. Whole brain analysis indicated increased activation in the left superior frontal gyrus in the control group only, and in medial prefrontal cortex and dorsolateral prefrontal gyrus (DLPFC) after treatment across all groups. Only successful learners of self-regulation (n = 8) showed increased left inferior frontal gyrus and DLPFC activation after treatment. Left VS activation was increased after treatment and showed a significant time*medication-status interaction. Specific treatment effects were found in left frontal regions for the control treatment and successful learners. Also, unmedicated participants, irrespective of treatment type or successful learning, showed treatment-induced improvement in reward processing. The results suggest no prominent specific effect of NF on reward processing. However, cautious interpretation is warranted due to the small sample.
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14
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Rajabi S, Pakize A, Moradi N. Effect of combined neurofeedback and game-based cognitive training on the treatment of ADHD: A randomized controlled study. APPLIED NEUROPSYCHOLOGY-CHILD 2019; 9:193-205. [PMID: 30734583 DOI: 10.1080/21622965.2018.1556101] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Neurofeedback (NF) is referred to as a "possibly efficacious" treatment in the current evidence-based reviews; therefore, more research is needed to determine its effects especially in combination with other treatments. The present study examines the effect of NF and game-based cognitive training on children with attention deficit hyperactivity disorder (ADHD). Thirty-two male students with ADHD were assigned to NF (N = 16; Mage=10.20; SD = 1.03) and waiting list control (N = 16; Mage = 10.05; SD = 0.83) in a randomized double-blind trial. The children in the NF group based on quantitative electroencephalography (QEEG) attended 30 three times-weekly sessions. The children were examined in pretest and post-test with EEG, Integrated Visual and Auditory Continuous Performance (IVA), and Conners Parent, and Teacher Rating Scales-Revised. The treatment was found significant all the symptom variables except for attention deficit (AD) and auditory response control (ARC). Normalization of the atypical EEG features with reduced [Formula: see text] wave and increased sensory motor (SMR) activity in central zero (Cz) was recorded in the NF condition participants. However, except for SMR activity there were no significant changes in the waves of frontocentral zero (FCz). It is concluded that technology developments provide an interesting vehicle for interposing interventions and that combined NF and game-based cognitive training can produce positive therapeutic effects on brainwaves and ADHD symptomatology.
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Affiliation(s)
- Soran Rajabi
- General Psychology, Persian Gulf University, Boushehr, Iran
| | - Ali Pakize
- General Psychology, Persian Gulf University, Boushehr, Iran
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15
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Bussalb A, Congedo M, Barthélemy Q, Ojeda D, Acquaviva E, Delorme R, Mayaud L. Clinical and Experimental Factors Influencing the Efficacy of Neurofeedback in ADHD: A Meta-Analysis. Front Psychiatry 2019; 10:35. [PMID: 30833909 PMCID: PMC6388544 DOI: 10.3389/fpsyt.2019.00035] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/21/2019] [Indexed: 11/13/2022] Open
Abstract
Meta-analyses have been extensively used to evaluate the efficacy of neurofeedback (NFB) treatment for Attention Deficit/Hyperactivity Disorder (ADHD) in children and adolescents. However, each meta-analysis published in the past decade has contradicted the methods and results from the previous one, thus making it difficult to determine a consensus of opinion on the effectiveness of NFB. This works brings continuity to the field by extending and discussing the last and much controversial meta-analysis by Cortese et al. (1). The extension comprises an update of that work including the latest control trials, which have since been published and, most importantly, offers a novel methodology. Specifically, NFB literature is characterized by a high technical and methodological heterogeneity, which partly explains the current lack of consensus on the efficacy of NFB. This work takes advantage of this by performing a Systematic Analysis of Biases (SAOB) in studies included in the previous meta-analysis. Our extended meta-analysis (k = 16 studies) confirmed the previously obtained results of effect sizes in favor of NFB efficacy as being significant when clinical scales of ADHD are rated by parents (non-blind, p-value = 0.0014), but not when they are rated by teachers (probably blind, p-value = 0.27). The effect size is significant according to both raters for the subset of studies meeting the definition of "standard NFB protocols" (parents' p-value = 0.0054; teachers' p-value = 0.043, k = 4). Following this, the SAOB performed on k = 33 trials identified three main factors that have an impact on NFB efficacy: first, a more intensive treatment, but not treatment duration, is associated with higher efficacy; second, teachers report a lower improvement compared to parents; third, using high-quality EEG equipment improves the effectiveness of the NFB treatment. The identification of biases relating to an appropriate technical implementation of NFB certainly supports the efficacy of NFB as an intervention. The data presented also suggest that the probably blind assessment of teachers may not be considered a good proxy for blind assessments, therefore stressing the need for studies with placebo-controlled intervention as well as carefully reported neuromarker changes in relation to clinical response.
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Affiliation(s)
- Aurore Bussalb
- Mensia Technologies SA, Paris, France.,Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - Marco Congedo
- GIPSA-Lab, Université Grenoble Alpes, CNRS, Grenoble-INP, Grenoble, France
| | | | | | - Eric Acquaviva
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
| | - Richard Delorme
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Paris, France
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16
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Hudak J, Rosenbaum D, Barth B, Fallgatter AJ, Ehlis AC. Functionally disconnected: A look at how study design influences neurofeedback data and mechanisms in attention-deficit/hyperactivity disorder. PLoS One 2018; 13:e0200931. [PMID: 30096196 PMCID: PMC6086395 DOI: 10.1371/journal.pone.0200931] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 07/04/2018] [Indexed: 01/13/2023] Open
Abstract
Neurofeedback (NF) is a form of behavioral therapy used to treat e.g. attention-deficit/hyperactivity disorder (ADHD). Briefly, subjects are fed-back a putatively dysfunctional parameter of their brain activity in real time and must learn to control it in a suggested direction. NF protocols for ADHD have been used in practice for decades, though no clear standards on NF design have been implemented. Furthermore, studies often present only data from the general outcome of the NF treatment and do not look at how exactly the NF paradigm affects brain functionality, or what exactly the NF is training. The current study is two-fold: firstly, we look at how the functional connectivity (FC) patterns within key networks associated with ADHD differ between rests, feedback trials, success and failure in a complete functional near-infrared spectroscopy-based NF experiment on adults with ADHD. Secondly, due to methodological concerns discovered during the analysis of our data, we address important considerations in the design of NF that are often ignored in protocols being used widely in therapy and research today. In particular, we examine the common average reference and its impact on network activity as well as the importance of balancing the randomization in a design. Finally, we discuss how these methodological considerations may have influenced our FC results.
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Affiliation(s)
- Justin Hudak
- LEAD Graduate School & Research Network, University of Tübingen, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- * E-mail:
| | - David Rosenbaum
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Beatrix Barth
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Centre for Integrative Neuroscience, University of Tübingen, Tübingen, Germany
| | - Andreas J. Fallgatter
- LEAD Graduate School & Research Network, University of Tübingen, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Graduate School of Neural and Behavioral Sciences, University of Tübingen, Tübingen, Germany
| | - Ann-Christine Ehlis
- LEAD Graduate School & Research Network, University of Tübingen, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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17
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Döpfner M, Hautmann C, Dose C, Banaschewski T, Becker K, Brandeis D, Holtmann M, Jans T, Jenkner C, Millenet S, Renner T, Romanos M, von Wirth E. ESCAschool study: trial protocol of an adaptive treatment approach for school-age children with ADHD including two randomised trials. BMC Psychiatry 2017; 17:269. [PMID: 28738794 PMCID: PMC5525245 DOI: 10.1186/s12888-017-1433-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/13/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The ESCAschool study addresses the treatment of school-age children with attention-deficit/hyperactivity disorder (ADHD) in a large multicentre trial. It aims to investigate three interrelated topics: (i) Clinical guidelines often recommend a stepped care approach, including different treatment strategies for children with mild to moderate and severe ADHD symptoms, respectively. However, this approach has not yet been empirically validated. (ii) Behavioural interventions and neurofeedback have been shown to be effective, but the superiority of combined treatment approaches such as medication plus behaviour therapy or medication plus neurofeedback compared to medication alone remains questionable. (iii) Growing evidence indicates that telephone-assisted self-help interventions are effective in the treatment of ADHD. However, larger randomised controlled trials (RCTs) are lacking. This report presents the ESCAschool trial protocol. In an adaptive treatment design, two RCTs and additional observational treatment arms are considered. METHODS The target sample size of ESCAschool is 521 children with ADHD. Based on their baseline ADHD symptom severity, the children will be assigned to one of two groups (mild to moderate symptom group and severe symptom group). The adaptive design includes two treatment phases (Step 1 and Step 2). According to clinical guidelines, different treatment protocols will be followed for the two severity groups. In the moderate group, the efficacy of telephone-assisted self-help for parents and teachers will be tested against waitlist control in Step 1 (RCT I). The severe group will receive pharmacotherapy combined with psychoeducation in Step 1. For both groups, treatment response will be determined after Step 1 treatment (no, partial or full response). In severe group children demonstrating partial response to medication, in Step 2, the efficacy of (1) counselling, (2) behaviour therapy and (3) neurofeedback will be tested (RCT II). All other treatment arms in Step 2 (severe group: no or full response; moderate group: no, partial or full response) are observational. DISCUSSION The ESCAschool trial will provide evidence-based answers to several important questions for clinical practice following a stepped care approach. The adaptive study design will also provide new insights into the effects of additional treatments in children with partial response. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00008973 . Registered 18 December 2015.
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Affiliation(s)
- Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Robert-Koch-Str. 10, 50931 Cologne, Germany
- School for Child and Adolescent Cognitive Behavioural Therapy (AKiP), University Hospital of Cologne, Cologne, Germany
| | - Christopher Hautmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Robert-Koch-Str. 10, 50931 Cologne, Germany
- School for Child and Adolescent Cognitive Behavioural Therapy (AKiP), University Hospital of Cologne, Cologne, Germany
| | - Christina Dose
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Robert-Koch-Str. 10, 50931 Cologne, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Katja Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the Philipps-University Marburg and University Hospital Marburg, Marburg, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Holtmann
- LWL-University Hospital Hamm, Ruhr-University Bochum, Hamm, Germany
| | - Thomas Jans
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Carolin Jenkner
- Clinical Trials Unit Freiburg, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sabina Millenet
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Tobias Renner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Elena von Wirth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Robert-Koch-Str. 10, 50931 Cologne, Germany
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18
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Strehl U, Aggensteiner P, Wachtlin D, Brandeis D, Albrecht B, Arana M, Bach C, Banaschewski T, Bogen T, Flaig-Röhr A, Freitag CM, Fuchsenberger Y, Gest S, Gevensleben H, Herde L, Hohmann S, Legenbauer T, Marx AM, Millenet S, Pniewski B, Rothenberger A, Ruckes C, Wörz S, Holtmann M. Neurofeedback of Slow Cortical Potentials in Children with Attention-Deficit/Hyperactivity Disorder: A Multicenter Randomized Trial Controlling for Unspecific Effects. Front Hum Neurosci 2017; 11:135. [PMID: 28408873 PMCID: PMC5374218 DOI: 10.3389/fnhum.2017.00135] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 03/08/2017] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Ute Strehl
- Institute for Medical Psychology and Behavioral Neurobiology, University of TübingenTübingen, Germany
| | - Pascal Aggensteiner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany
| | - Daniel Wachtlin
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany.,Interdisciplinary Center for Clinical Trials at the University Medical Center of the Johannes Gutenberg University of MainzMainz, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany.,Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of ZurichZurich, Switzerland.,Center for Integrative Human Physiology, University of ZurichZurich, Switzerland.,Neuroscience Center Zurich, University of Zurich and ETH ZurichZurich, Switzerland
| | - Björn Albrecht
- Child and Adolescent Psychiatry, University Medical Center GöttingenGöttingen, Germany
| | - Maria Arana
- Institute for Medical Psychology and Behavioral Neurobiology, University of TübingenTübingen, Germany
| | - Christiane Bach
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Hospital LeipzigLeipzig, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany
| | - Thorsten Bogen
- Landschaftsverband Westfalen-Lippe (LWL) University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University BochumHamm, Germany
| | - Andrea Flaig-Röhr
- Child and Adolescent Psychiatry, University Medical Center GöttingenGöttingen, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe UniversityFrankfurt am Main, Germany
| | - Yvonne Fuchsenberger
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe UniversityFrankfurt am Main, Germany
| | - Stephanie Gest
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe UniversityFrankfurt am Main, Germany
| | - Holger Gevensleben
- Child and Adolescent Psychiatry, University Medical Center GöttingenGöttingen, Germany
| | - Laura Herde
- Institute for Medical Psychology and Behavioral Neurobiology, University of TübingenTübingen, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany
| | - Tanja Legenbauer
- Landschaftsverband Westfalen-Lippe (LWL) University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University BochumHamm, Germany
| | - Anna-Maria Marx
- Institute for Medical Psychology and Behavioral Neurobiology, University of TübingenTübingen, Germany
| | - Sabina Millenet
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of HeidelbergMannheim, Germany
| | - Benjamin Pniewski
- Landschaftsverband Westfalen-Lippe (LWL) University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University BochumHamm, Germany
| | - Aribert Rothenberger
- Child and Adolescent Psychiatry, University Medical Center GöttingenGöttingen, Germany
| | - Christian Ruckes
- Interdisciplinary Center for Clinical Trials at the University Medical Center of the Johannes Gutenberg University of MainzMainz, Germany
| | - Sonja Wörz
- Institute for Medical Psychology and Behavioral Neurobiology, University of TübingenTübingen, Germany
| | - Martin Holtmann
- Landschaftsverband Westfalen-Lippe (LWL) University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University BochumHamm, Germany
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Blume F, Hudak J, Dresler T, Ehlis AC, Kühnhausen J, Renner TJ, Gawrilow C. NIRS-based neurofeedback training in a virtual reality classroom for children with attention-deficit/hyperactivity disorder: study protocol for a randomized controlled trial. Trials 2017; 18:41. [PMID: 28118856 PMCID: PMC5259870 DOI: 10.1186/s13063-016-1769-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 12/21/2016] [Indexed: 12/23/2022] Open
Abstract
Background Children with attention-deficit/hyperactivity disorder (ADHD) suffer from attention deficits, motor hyperactivity, and impulsive behaviour. These impairments are experienced at home, at school, and with friends. Functional imaging studies show that ADHD behaviour and impairments in executive functions (EFs) are mirrored by aberrant neurophysiological functioning. Moreover, several studies show that ADHD behaviour, impairments in EFs, and a lack of self-control contribute to poor school performance. Non-pharmacological interventions such as neurofeedback training (NFT), for instance, aim at improving neurophysiological and neuropsychological functioning as well as behaviour. Consequently, NFT is expected to improve school performance, EFs, and self-control in children with ADHD. Generalization of acquired self-regulation skills from laboratory to real life is crucial for a transfer to everyday situations and is hypothesized to be facilitated via training using virtual reality (VR) environments. Consequently, experiencing NFT in VR is expected to yield greater effects than training in two dimensions (2D). Methods/design Ninety children with a clinical diagnosis of ADHD will be included in the study. Participants may be medicated or unmedicated. After random assignation to one of three conditions, all participants receive 15 training sessions of either near-infrared spectroscopy (NIRS)-based NFT in VR, NIRS-based NFT in 2D, or electromyogram-based biofeedback training in VR. ADHD symptoms, self-control, EF, health-related quality of life, school performance, and motor activity measured via parent, teacher, and child reports or objectively will be assessed before and after the intervention and at a 6 months follow-up. Furthermore, we are interested in parents’ expectations about the training’s effects. Discussion This is, to our knowledge, the first study investigating the efficacy of NFT for children with ADHD in a VR compared to a 2D environment. Furthermore, this study will contribute to the discussion about the efficacy and specific and unspecific effects of NFTs in children with ADHD. In addition to commonly assessed variables such as ADHD symptoms, NIRS and behavioural data obtained in EF measures, health-related quality of life, and parents’ expectations about the intervention’s effects, this study will investigate the effects on self-control, school performance, and motor activity. Trial registration ClinicalTrials.gov, NCT02572180. Registered on 19 November 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1769-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Friederike Blume
- LEAD Graduate School & Research Network, University of Tübingen, Gartenstrasse 29, 72074, Tübingen, Germany.
| | - Justin Hudak
- LEAD Graduate School & Research Network, University of Tübingen, Gartenstrasse 29, 72074, Tübingen, Germany
| | - Thomas Dresler
- LEAD Graduate School & Research Network, University of Tübingen, Gartenstrasse 29, 72074, Tübingen, Germany.,Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstrasse 14, 72076, Tübingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, University of Tübingen, Calwerstrasse 14, 72076, Tübingen, Germany
| | - Jan Kühnhausen
- LEAD Graduate School & Research Network, University of Tübingen, Gartenstrasse 29, 72074, Tübingen, Germany.,Department of Psychology, University of Tübingen, Schleichstrasse 4, 72076, Tübingen, Germany
| | - Tobias J Renner
- LEAD Graduate School & Research Network, University of Tübingen, Gartenstrasse 29, 72074, Tübingen, Germany.,Department of Child and Adolescence Psychiatry and Psychotherapy, University of Tübingen, Osianderstrasse 14-16, 72076, Tübingen, Germany
| | - Caterina Gawrilow
- LEAD Graduate School & Research Network, University of Tübingen, Gartenstrasse 29, 72074, Tübingen, Germany.,Department of Psychology, University of Tübingen, Schleichstrasse 4, 72076, Tübingen, Germany.,Deutsches Institut für Internationale Pädagogische Forschung (DIPF), Schlossstrasse 29, 60486, Frankfurt/Main, Germany
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21
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Baumeister S, Wolf I, Holz N, Boecker-Schlier R, Adamo N, Holtmann M, Ruf M, Banaschewski T, Hohmann S, Brandeis D. Neurofeedback Training Effects on Inhibitory Brain Activation in ADHD: A Matter of Learning? Neuroscience 2016; 378:89-99. [PMID: 27659116 DOI: 10.1016/j.neuroscience.2016.09.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 08/31/2016] [Accepted: 09/12/2016] [Indexed: 12/01/2022]
Abstract
Neurofeedback training (NF) is a promising non-pharmacological treatment for ADHD that has been associated with improvement of attention-deficit/hyperactivity disorder (ADHD)-related symptoms as well as changes in electrophysiological measures. However, the functional localization of neural changes following NF compared to an active control condition, and of successful learning during training (considered to be the critical mechanism for improvement), remains largely unstudied. Children with ADHD (N=16, mean age: 11.81, SD: 1.47) were randomly assigned to either slow cortical potential (SCP, n=8) based NF or biofeedback control training (electromyogram feedback, n=8) and performed a combined Flanker/NoGo task pre- and post-training. Effects of NF, compared to the active control, and of learning in transfer trials (approximating successful transfer to everyday life) were examined with respect to clinical outcome and functional magnetic resonance imaging (fMRI) changes during inhibitory control. After 20 sessions of training, children in the NF group presented reduced ADHD symptoms and increased activation in areas associated with inhibitory control compared to baseline. Subjects who were successful learners (n=9) also showed increased activation in an extensive inhibitory network irrespective of the type of training. Activation increased in an extensive inhibitory network following NF training, and following successful learning through NF and control biofeedback. Although this study was only powered to detect large effects and clearly requires replication in larger samples, the results suggest a crucial role for learning effects in biofeedback trainings.
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Affiliation(s)
- Sarah Baumeister
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Isabella Wolf
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany; Department Neuroimaging, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Nathalie Holz
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Regina Boecker-Schlier
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Nicoletta Adamo
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Martin Holtmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany; LWL-University Hospital for Child and Adolescent Psychiatry Hamm, Ruhr-University Bochum, Bochum, Germany
| | - Matthias Ruf
- Department Neuroimaging, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - 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; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland; Neuroscience Centre Zurich, University and ETH Zurich, Zurich, Switzerland.
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22
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Ordikhani-Seyedlar M, Lebedev MA, Sorensen HBD, Puthusserypady S. Neurofeedback Therapy for Enhancing Visual Attention: State-of-the-Art and Challenges. Front Neurosci 2016; 10:352. [PMID: 27536212 PMCID: PMC4971093 DOI: 10.3389/fnins.2016.00352] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 07/12/2016] [Indexed: 11/17/2022] Open
Abstract
We have witnessed a rapid development of brain-computer interfaces (BCIs) linking the brain to external devices. BCIs can be utilized to treat neurological conditions and even to augment brain functions. BCIs offer a promising treatment for mental disorders, including disorders of attention. Here we review the current state of the art and challenges of attention-based BCIs, with a focus on visual attention. Attention-based BCIs utilize electroencephalograms (EEGs) or other recording techniques to generate neurofeedback, which patients use to improve their attention, a complex cognitive function. Although progress has been made in the studies of neural mechanisms of attention, extraction of attention-related neural signals needed for BCI operations is a difficult problem. To attain good BCI performance, it is important to select the features of neural activity that represent attentional signals. BCI decoding of attention-related activity may be hindered by the presence of different neural signals. Therefore, BCI accuracy can be improved by signal processing algorithms that dissociate signals of interest from irrelevant activities. Notwithstanding recent progress, optimal processing of attentional neural signals remains a fundamental challenge for the development of efficient therapies for disorders of attention.
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Affiliation(s)
- Mehdi Ordikhani-Seyedlar
- Division of Biomedical Engineering, Department of Electrical Engineering, Technical University of Denmark Lyngby, Denmark
| | - Mikhail A Lebedev
- Department of Neurobiology, Duke UniversityDurham, NC, USA; Center for Neuroengineering, Duke UniversityDurham, NC, USA
| | - Helge B D Sorensen
- Division of Biomedical Engineering, Department of Electrical Engineering, Technical University of Denmark Lyngby, Denmark
| | - Sadasivan Puthusserypady
- Division of Biomedical Engineering, Department of Electrical Engineering, Technical University of Denmark Lyngby, Denmark
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23
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Fedotchev AI, Zemlyanaya AA, Polevaya SA, Savchuk LV. [Attention deficit hyperactivity disorder and current possibilities of its treatment by the method of neurofeedback training]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:98-101. [PMID: 27437544 DOI: 10.17116/jnevro20161165198-101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article provides an overview of the literature data for the past 10 years on the prevalence, specificity of manifestations and approaches to the treatment of attention deficit hyperactivity disorder (ADHD). The current data on the nature and mechanisms of the method of neurofeedback training (NFBT), as well as the available data on the use of the method for treatment of ADHD are presented. The evaluation of the effectiveness of existing variants of the method in the treatment of ADHD is given, and promising areas for further research are identified.
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Affiliation(s)
- A I Fedotchev
- Institute of Cell Biophysics, Russian Academy of Sciences, Pushchino, Russia
| | - A A Zemlyanaya
- Federal Medical Research Center of Psychiatry and Narcology, Moscow, Russia
| | - S A Polevaya
- Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russia
| | - L V Savchuk
- Nizhny Novgorod State Medical Academy, Nizhny Novgorod, Russia
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Neurofeedback of slow cortical potentials as a treatment for adults with Attention Deficit-/Hyperactivity Disorder. Clin Neurophysiol 2016; 127:1374-1386. [DOI: 10.1016/j.clinph.2015.11.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 11/21/2022]
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Cicchese JJ, Berry SD. Hippocampal Non-Theta-Contingent Eyeblink Classical Conditioning: A Model System for Neurobiological Dysfunction. Front Psychiatry 2016; 7:1. [PMID: 26903886 PMCID: PMC4751249 DOI: 10.3389/fpsyt.2016.00001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 01/01/2016] [Indexed: 11/30/2022] Open
Abstract
Typical information processing is thought to depend on the integrity of neurobiological oscillations that may underlie coordination and timing of cells and assemblies within and between structures. The 3-7 Hz bandwidth of hippocampal theta rhythm is associated with cognitive processes essential to learning and depends on the integrity of cholinergic, GABAergic, and glutamatergic forebrain systems. Since several significant psychiatric disorders appear to result from dysfunction of medial temporal lobe (MTL) neurochemical systems, preclinical studies on animal models may be an important step in defining and treating such syndromes. Many studies have shown that the amount of hippocampal theta in the rabbit strongly predicts the acquisition rate of classical eyeblink conditioning and that impairment of this system substantially slows the rate of learning and attainment of asymptotic performance. Our lab has developed a brain-computer interface that makes eyeblink training trials contingent upon the explicit presence or absence of hippocampal theta. The behavioral benefit of theta-contingent training has been demonstrated in both delay and trace forms of the paradigm with a two- to fourfold increase in learning speed over non-theta states. The non-theta behavioral impairment is accompanied by disruption of the amplitude and synchrony of hippocampal local field potentials, multiple-unit excitation, and single-unit response patterns dependent on theta state. Our findings indicate a significant electrophysiological and behavioral impact of the pretrial state of the hippocampus that suggests an important role for this MTL system in associative learning and a significant deleterious impact in the absence of theta. Here, we focus on the impairments in the non-theta state, integrate them into current models of psychiatric disorders, and suggest how improvement in our understanding of neurobiological oscillations is critical for theories and treatment of psychiatric pathology.
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Affiliation(s)
- Joseph J Cicchese
- Department of Psychology, Center for Neuroscience, Miami University , Oxford, OH , USA
| | - Stephen D Berry
- Department of Psychology, Center for Neuroscience, Miami University , Oxford, OH , USA
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26
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Mayer K, Wyckoff SN, Fallgatter AJ, Ehlis AC, Strehl U. Neurofeedback as a nonpharmacological treatment for adults with attention-deficit/hyperactivity disorder (ADHD): study protocol for a randomized controlled trial. Trials 2015; 16:174. [PMID: 25928870 PMCID: PMC4433028 DOI: 10.1186/s13063-015-0683-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/26/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Neurofeedback has been applied effectively in various areas, especially in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). This study protocol is designed to investigate the effect of slow cortical potential (SCP) feedback and a new form of neurofeedback using near-infrared spectroscopy (NIRS) on symptomatology and neurophysiological parameters in an adult ADHD population. A comparison of SCP and NIRS feedback therapy methods has not been previously conducted and may yield valuable findings about alternative treatments for adult ADHD. METHODS/DESIGN The outcome of both neurofeedback techniques will be assessed over 30 treatment sessions and after a 6-month follow-up period, and then will be compared to a nonspecific biofeedback treatment. Furthermore, to investigate if treatment effects in this proof-of-principle study can be predicted by specific neurophysiological baseline parameters, regression models will be applied. Finally, a comparison with healthy controls will be conducted to evaluate deviant pretraining neurophysiological parameters, stability of assessment measures, and treatment outcome. DISCUSSION To date, an investigation and comparison of SCP and NIRS feedback training to an active control has not been conducted; therefore, we hope to gain valuable insights in effects and differences of these types of treatment for ADHD in adults. TRIAL REGISTRATION This study is registered with the German Registry of Clinical Trials: DRKS00006767 , date of registration: 8 October 2014.
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Affiliation(s)
- Kerstin Mayer
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Silcherstrasse 5, 72076, Tübingen, Germany.
| | - Sarah Nicole Wyckoff
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Silcherstrasse 5, 72076, Tübingen, Germany.
- Sense Labs, Mesa, AZ, 1918 N. Higley Rd, 85205, Mesa, AZ, USA.
| | - Andreas J Fallgatter
- Department for Psychiatry and Psychotherapy, University of Tübingen, Osianderstr. 24, 72076, Tübingen, Germany.
- LEAD Graduate School, University of Tübingen, 72074, Tübingen, Germany.
- CIN Excellence Cluster, University of Tübingen, 72076, Tübingen, Germany.
| | - Ann-Christine Ehlis
- Department for Psychiatry and Psychotherapy, University of Tübingen, Osianderstr. 24, 72076, Tübingen, Germany.
| | - Ute Strehl
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Silcherstrasse 5, 72076, Tübingen, Germany.
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Zuberer A, Brandeis D, Drechsler R. Are treatment effects of neurofeedback training in children with ADHD related to the successful regulation of brain activity? A review on the learning of regulation of brain activity and a contribution to the discussion on specificity. Front Hum Neurosci 2015; 9:135. [PMID: 25870550 PMCID: PMC4376076 DOI: 10.3389/fnhum.2015.00135] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/27/2015] [Indexed: 11/17/2022] Open
Abstract
While issues of efficacy and specificity are crucial for the future of neurofeedback training, there may be alternative designs and control analyses to circumvent the methodological and ethical problems associated with double-blind placebo studies. Surprisingly, most NF studies do not report the most immediate result of their NF training, i.e., whether or not children with ADHD gain control over their brain activity during the training sessions. For the investigation of specificity, however, it seems essential to analyze the learning and adaptation processes that take place in the course of the training and to relate improvements in self-regulated brain activity across training sessions to behavioral, neuropsychological and electrophysiological outcomes. To this aim, a review of studies on neurofeedback training with ADHD patients which include the analysis of learning across training sessions or relate training performance to outcome is presented. Methods on how to evaluate and quantify learning of EEG regulation over time are discussed. “Non-learning” has been reported in a small number of ADHD-studies, but has not been a focus of general methodological discussion so far. For this reason, selected results from the brain-computer interface (BCI) research on the so-called “brain-computer illiteracy”, the inability to gain control over one’s brain activity, are also included. It is concluded that in the discussion on specificity, more attention should be devoted to the analysis of EEG regulation performance in the course of the training and its impact on clinical outcome. It is necessary to improve the knowledge on characteristic cross-session and within-session learning trajectories in ADHD and to provide the best conditions for learning.
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Affiliation(s)
- Agnieszka Zuberer
- Department of Child and Adolescent Psychiatry, University of Zurich Zurich, Switzerland
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry, University of Zurich Zurich, Switzerland ; Neuroscience Center Zurich, University of Zurich and ETH Zurich Zurich, Switzerland ; Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/ Heidelberg University Mannheim, Germany ; Center for Integrative Human Physiology, University of Zurich Zurich, Switzerland
| | - Renate Drechsler
- Department of Child and Adolescent Psychiatry, University of Zurich Zurich, Switzerland
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Marx AM, Ehlis AC, Furdea A, Holtmann M, Banaschewski T, Brandeis D, Rothenberger A, Gevensleben H, Freitag CM, Fuchsenberger Y, Fallgatter AJ, Strehl U. Near-infrared spectroscopy (NIRS) neurofeedback as a treatment for children with attention deficit hyperactivity disorder (ADHD)-a pilot study. Front Hum Neurosci 2015; 8:1038. [PMID: 25610390 PMCID: PMC4285751 DOI: 10.3389/fnhum.2014.01038] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/11/2014] [Indexed: 11/13/2022] Open
Abstract
In this pilot study near-infrared spectroscopy (NIRS) neurofeedback was investigated as a new method for the treatment of Attention Deficit-/Hyperactivity Disorder (ADHD). Oxygenated hemoglobin in the prefrontal cortex of children with ADHD was measured and fed back. 12 sessions of NIRS-neurofeedback were compared to the intermediate outcome after 12 sessions of EEG-neurofeedback (slow cortical potentials, SCP) and 12 sessions of EMG-feedback (muscular activity of left and right musculus supraspinatus). The task was either to increase or decrease hemodynamic activity in the prefrontal cortex (NIRS), to produce positive or negative shifts of SCP (EEG) or to increase or decrease muscular activity (EMG). In each group nine children with ADHD, aged 7-10 years, took part. Changes in parents' ratings of ADHD symptoms were assessed before and after the 12 sessions and compared within and between groups. For the NIRS-group additional teachers' ratings of ADHD symptoms, parents' and teachers' ratings of associated behavioral symptoms, childrens' self reports on quality of life and a computer based attention task were conducted before, 4 weeks and 6 months after training. As primary outcome, ADHD symptoms decreased significantly 4 weeks and 6 months after the NIRS training, according to parents' ratings. In teachers' ratings of ADHD symptoms there was a significant reduction 4 weeks after the training. The performance in the computer based attention test improved significantly. Within-group comparisons after 12 sessions of NIRS-, EEG- and EMG-training revealed a significant reduction in ADHD symptoms in the NIRS-group and a trend for EEG- and EMG-groups. No significant differences for symptom reduction were found between the groups. Despite the limitations of small groups and the comparison of a completed with two uncompleted interventions, the results of this pilot study are promising. NIRS-neurofeedback could be a time-effective treatment for ADHD and an interesting new option to consider in the treatment of ADHD.
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Affiliation(s)
- Anna-Maria Marx
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tuebingen Tuebingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, Psychophysiology and Optical Imaging, University of Tuebingen Tuebingen, Germany
| | - Adrian Furdea
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tuebingen Tuebingen, Germany
| | - Martin Holtmann
- LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr-University Bochum Hamm, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim of the University of Heidelberg Mannheim, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim of the University of Heidelberg Mannheim, Germany ; Department of Child and Adolescent Psychiatry, University of Zuerich Zuerich, Switzerland
| | - Aribert Rothenberger
- Clinic for Child and Adolescent Psychiatry, University Medical Center of Goettingen Goettingen, Germany
| | - Holger Gevensleben
- Clinic for Child and Adolescent Psychiatry, University Medical Center of Goettingen Goettingen, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe-University Frankfurt am Main Frankfurt am Main, Germany
| | - Yvonne Fuchsenberger
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe-University Frankfurt am Main Frankfurt am Main, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, Psychophysiology and Optical Imaging, University of Tuebingen Tuebingen, Germany
| | - Ute Strehl
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tuebingen Tuebingen, Germany
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Gevensleben H, Albrecht B, Lütcke H, Auer T, Dewiputri WI, Schweizer R, Moll G, Heinrich H, Rothenberger A. Neurofeedback of slow cortical potentials: neural mechanisms and feasibility of a placebo-controlled design in healthy adults. Front Hum Neurosci 2014; 8:990. [PMID: 25566020 PMCID: PMC4263073 DOI: 10.3389/fnhum.2014.00990] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/20/2014] [Indexed: 11/13/2022] Open
Abstract
To elucidate basic mechanisms underlying neurofeedback we investigated neural mechanisms of training of slow cortical potentials (SCPs) by considering EEG- and fMRI. Additionally, we analyzed the feasibility of a double-blind, placebo-controlled design in NF research based on regulation performance during treatment sessions and self-assessment of the participants. Twenty healthy adults participated in 16 sessions of SCPs training: 9 participants received regular SCP training, 11 participants received sham feedback. At three time points (pre, intermediate, post) fMRI and EEG/ERP-measurements were conducted during a continuous performance test (CPT). Performance-data during the sessions (regulation performance) in the treatment group and the placebo group were analyzed. Analysis of EEG-activity revealed in the SCP group a strong enhancement of the CNV (electrode Cz) at the intermediate assessment, followed by a decrease back to baseline at the post-treatment assessment. In contrast, in the placebo group a continuous but smaller increase of the CNV could be obtained from pre to post assessment. The increase of the CNV in the SCP group at intermediate testing was superior to the enhancement in the placebo group. The changes of the CNV were accompanied by a continuous improvement in the test performance of the CPT from pre to intermediate to post assessment comparable in both groups. The change of the CNV in the SCP group is interpreted as an indicator of neural plasticity and efficiency while an increase of the CNV in the placebo group might reflect learning and improved timing due to the frequent task repetition. In the fMRI analysis evidence was obtained for neuronal plasticity. After regular SCP neurofeedback activation in the posterior parietal cortex decreased from the pre- to the intermediate measurement and increased again in the post measurement, inversely following the U-shaped increase and decrease of the tCNV EEG amplitude in the SCP-trained group. Furthermore, we found a localized increase of activity in the anterior cingulate cortex (ACC). Analyses of the estimation of treatment assignment by the participants indicate feasibility of blinding. Participants could not assess treatment assignment confidently. Participants of the SCP-group improved regulation capability during treatment sessions (in contrast to the participants of the placebo-group), although regulation capability appeared to be instable, presumably due to diminished confidence in the training (SCP- or sham-training). Our results indicate that SCP training in healthy adults might lead to functional changes in neuronal circuits serving cognitive preparation even after a limited number of sessions.
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Affiliation(s)
- Holger Gevensleben
- Child and Adolescent Psychiatry, University Medical Center (UMG) Göttingen, Germany
| | - Björn Albrecht
- Child and Adolescent Psychiatry, University Medical Center (UMG) Göttingen, Germany
| | - Henry Lütcke
- Biomedizinische NMR Forschungs GmbH, MPI for Biophysical Chemistry Göttingen, Germany ; Scientific IT Services, ETH Zürich Zürich, Switzerland
| | - Tibor Auer
- Biomedizinische NMR Forschungs GmbH, MPI for Biophysical Chemistry Göttingen, Germany ; 3MRC Cognition and Brain Sciences Unit, University Cambridge Cambridge, UK
| | - Wan Ilma Dewiputri
- Biomedizinische NMR Forschungs GmbH, MPI for Biophysical Chemistry Göttingen, Germany ; Department of Neuroscience, School of Medical Sciences, Universiti Sains Malaysia Pulau Pinang, Malaysia
| | - Renate Schweizer
- Biomedizinische NMR Forschungs GmbH, MPI for Biophysical Chemistry Göttingen, Germany
| | - Gunther Moll
- Department of Child and Adolescent Mental Health, University Hospital of Erlangen Erlangen, Germany
| | - Hartmut Heinrich
- Department of Child and Adolescent Mental Health, University Hospital of Erlangen Erlangen, Germany ; kbo-Heckscher-Klinikum Munich, Germany
| | - Aribert Rothenberger
- Child and Adolescent Psychiatry, University Medical Center (UMG) Göttingen, Germany
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30
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Gevensleben H, Moll GH, Rothenberger A, Heinrich H. Neurofeedback in attention-deficit/hyperactivity disorder - different models, different ways of application. Front Hum Neurosci 2014; 8:846. [PMID: 25374528 PMCID: PMC4204462 DOI: 10.3389/fnhum.2014.00846] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 10/02/2014] [Indexed: 11/22/2022] Open
Abstract
In children with attention-deficit/hyperactivity disorder (ADHD), different neurofeedback (NF) protocols have been applied, with the most prominent differentiation between EEG frequency-band (e.g., theta/beta) training and training of slow cortical potentials (SCPs). However, beyond distinctions between such basic NF variables, there are also competing assumptions about mechanisms of action (e.g., acquisition of regulation capability, generalization to daily life behavior). In the present article, we provide a framework for NF models and suppose two hypothetical models, which we call “conditioning-and-repairing model” and “skill-acquisition model,” reflecting extreme poles within this framework. We argue that the underlying model has an impact not only on how NF is applied but also on the selection of evaluation strategies and suggest using evaluation strategies beyond beaten paths of pharmacological research. Reflecting available studies, we address to what extent different views are supported by empirical data. We hypothesize that different models may hold true depending on the processes and behaviors to be addressed by a certain NF protocol. For example, the skill-acquisition model is supported by recent findings as an adequate explanatory framework for the mechanisms of action of SCP training in ADHD. In conclusion, evaluation and interpretation of NF trials in ADHD should be based on the underlying model and the way training is applied, which, in turn, should be stated explicitly in study reports.
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Affiliation(s)
- Holger Gevensleben
- Child and Adolescent Psychiatry, University Medical Center Göttingen Göttingen, Germany
| | - Gunther H Moll
- Department of Child and Adolescent Mental Health, University Hospital of Erlangen Erlangen, Germany
| | - Aribert Rothenberger
- Child and Adolescent Psychiatry, University Medical Center Göttingen Göttingen, Germany
| | - Hartmut Heinrich
- Department of Child and Adolescent Mental Health, University Hospital of Erlangen Erlangen, Germany ; Heckscher-Klinikum München, Germany
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Marx AM, Ehlis AC, Furdea A, Holtmann M, Banaschewski T, Brandeis D, Rothenberger A, Gevensleben H, Freitag CM, Fuchsenberger Y, Fallgatter AJ, Strehl U. Near-infrared spectroscopy (NIRS) neurofeedback as a treatment for children with attention deficit hyperactivity disorder (ADHD)-a pilot study. Front Hum Neurosci 2014. [PMID: 25610390 DOI: 10.3389/fnhum.2014.0103810.3389/fnhum.2014.01038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
In this pilot study near-infrared spectroscopy (NIRS) neurofeedback was investigated as a new method for the treatment of Attention Deficit-/Hyperactivity Disorder (ADHD). Oxygenated hemoglobin in the prefrontal cortex of children with ADHD was measured and fed back. 12 sessions of NIRS-neurofeedback were compared to the intermediate outcome after 12 sessions of EEG-neurofeedback (slow cortical potentials, SCP) and 12 sessions of EMG-feedback (muscular activity of left and right musculus supraspinatus). The task was either to increase or decrease hemodynamic activity in the prefrontal cortex (NIRS), to produce positive or negative shifts of SCP (EEG) or to increase or decrease muscular activity (EMG). In each group nine children with ADHD, aged 7-10 years, took part. Changes in parents' ratings of ADHD symptoms were assessed before and after the 12 sessions and compared within and between groups. For the NIRS-group additional teachers' ratings of ADHD symptoms, parents' and teachers' ratings of associated behavioral symptoms, childrens' self reports on quality of life and a computer based attention task were conducted before, 4 weeks and 6 months after training. As primary outcome, ADHD symptoms decreased significantly 4 weeks and 6 months after the NIRS training, according to parents' ratings. In teachers' ratings of ADHD symptoms there was a significant reduction 4 weeks after the training. The performance in the computer based attention test improved significantly. Within-group comparisons after 12 sessions of NIRS-, EEG- and EMG-training revealed a significant reduction in ADHD symptoms in the NIRS-group and a trend for EEG- and EMG-groups. No significant differences for symptom reduction were found between the groups. Despite the limitations of small groups and the comparison of a completed with two uncompleted interventions, the results of this pilot study are promising. NIRS-neurofeedback could be a time-effective treatment for ADHD and an interesting new option to consider in the treatment of ADHD.
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Affiliation(s)
- Anna-Maria Marx
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tuebingen Tuebingen, Germany
| | - Ann-Christine Ehlis
- Department of Psychiatry and Psychotherapy, Psychophysiology and Optical Imaging, University of Tuebingen Tuebingen, Germany
| | - Adrian Furdea
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tuebingen Tuebingen, Germany
| | - Martin Holtmann
- LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr-University Bochum Hamm, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim of the University of Heidelberg Mannheim, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim of the University of Heidelberg Mannheim, Germany ; Department of Child and Adolescent Psychiatry, University of Zuerich Zuerich, Switzerland
| | - Aribert Rothenberger
- Clinic for Child and Adolescent Psychiatry, University Medical Center of Goettingen Goettingen, Germany
| | - Holger Gevensleben
- Clinic for Child and Adolescent Psychiatry, University Medical Center of Goettingen Goettingen, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe-University Frankfurt am Main Frankfurt am Main, Germany
| | - Yvonne Fuchsenberger
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe-University Frankfurt am Main Frankfurt am Main, Germany
| | - Andreas J Fallgatter
- Department of Psychiatry and Psychotherapy, Psychophysiology and Optical Imaging, University of Tuebingen Tuebingen, Germany
| | - Ute Strehl
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tuebingen Tuebingen, Germany
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