Association pour la Diffusion du Neurofeedback en France

 Le neurofeedback pour le Trouble du Déficit d'Attention avec ou sans Hyperactivité (TDA/H)

Pourcentage de praticiens de neurofeedback dynamique rapportant une amélioration d'au moins 40% concernant le Trouble du Déficit d'Attention avec ou sans Hyperactivité :

30 % au bout de 10 séances.
83 % au-delà de 20 séances.

Résultats d'un rapport indépendant effectué en 2014 par Shane Parkhill, Bsc. Eng. sous la supervision de Charlène Zietsma, Ph. D (Next Delta Consulting). Sondage réalisé auprès de plusieurs centaines de praticiens utilisant le logiciel NeurOptimal de la société Zengar Institute, totalisant près de 3 millions d'heures de séances de neurofeedback en 2014. Pour accéder au rapport complet, cliquez ici (français) ou ici (anglais).
La valeur de 40% d'amélioration est retenue comme étant un niveau d'amélioration suffisamment satisfaisant pour justifier d'entreprendre une série de séances de neurofeedback.
 

 Recherches scientifiques sur le neurofeedback et le Trouble du Déficit d'Attention avec ou sans Hyperactivité, répertoriées dans la base PubMed

PubMed est le principal moteur de recherche des publications scientifiques de biologie et de médecine. Concernant le neurofeedback, les conclusions des études publiées sont souvent prudentes par principe, un peu dépassées (cf. date de l'étude), et bien en deçà de ce qui est observé aujourd'hui sur le terrain. La technologie mise en œuvre chez les praticiens est en effet bien plus avancée que celle utilisée pour les études scientifiques de validation qui s'appuient sur des protocoles de neurofeedback déjà bien connus, donc anciens. Dans le domaine du neurofeedback, c'est la technologie qui "tire" la science officielle en avant, et non pas l'inverse.

Les sociétés qui développent les équipements de neurofeedback n'ont pas les moyens financiers des laboratoires qui produisent les médicaments, et elles ne peuvent financer ces études officielles, ce qui explique leur nombre restreint. Pour le développement et l'amélioration constante des équipements de neurofeedback, ces sociétés s'appuient plutôt sur leurs recherches internes et sur les résultats cliniques rapportés par les praticiens.

L'efficacité du neurofeedback pour le TDAH est un des domaines qui a été le plus étudié. C'est pourquoi, nous ne présentons ci-dessous que les études publiées depuis l'année 2007 (et jusqu'en avril 2014 car les études sont trop nombreuses depuis) dans la base PubMed (les plus anciennes publications ne comportant pas de résumé ont été omises). Ces 50 études résumées ci-dessous concluent en majorité en faveur du neurofeedback, à quelques exceptions près indiquées en italique :

1.	"Il n'a pas été démontré que l'entraînement au développement cognitif par [...] le neurofeedback ait amélioré l'état d'adolescents TDAH."
2.	"Six mois après l'intervention, les participants aux séances de neurofeedback ont maintenu leurs progrès significatifs [...]. Leurs symptômes de TDAH se sont améliorés plus rapidement et plus largement et les améliorations étaient toujours présentes six mois plus tard [...]. Ces résultats suggèrent que le neurofeedback est un traitement prometteur pour les enfants atteints de TDAH pour entraîner leur attention."
3.	"Les enfants qui ont reçu des séances de neurofeedback ont montré une amélioration significative par rapport au groupe de contrôle [...]. Le neurofeedback a produit une plus grande amélioration des symptômes du TDAH [...]."
4.	"Une méta-analyse sur le neurofeedback depuis 2009 a trouvé de larges tailles d'effet pour l'attention et l'impulsivité et des tailles d'effet moyennes pour l'hyperactivité. [...] les protocoles standards tels que le neurofeedback thêta/beta, SMR et SCP sont biens étudiés et ont fait la preuve de leur spécificité."
5.	"Les deux groupes [d'enfants TDA/H faisant du neurofeedback ou du biofeedback musculaire] ont montré des améliorations de comportement similaire... [...] Les résultats apportent la preuve d'effets spécifiques pour notre petit échantillon, mais seulement modérément."
6.	"Les deux études [examinées] fournissent une preuve supplémentaire de la spécificité des effets du neurofeedback pour le TDAH. [...] l'entraînement par neurofeedback [...] semble être sur le point de devenir une modalité valable et éthiquement acceptable pour le traitement des enfants TDAH."
7.	"...pour les enfants et adolescents atteint de TDA/H [...] le neurofeedback correspond aux critères de niveau 3 (efficacité possible)..."
8.	"Dans l'ensemble, les études existantes et celle-ci ne parviennent pas à démontrer les bénéfices du neurofeedback sur le fonctionnement neurocognitif pour le TDAH, peut-être à cause de la petite taille des échantillons [étudiés] ou à cause d'autres faiblesses."
9.	"Notre étude montre des effets pour les stimulants [NdT : tels que la Ritaline] mais pas pour le neurofeedback. Les effets du neurofeedback pourraient nécessiter une présélection approfondie des patients [TDAH], des séances fréquentes, une méthode d'exclusion de ceux pour qui ça ne marche pas..."
10.	"Dans les deux groupes TDAH [neurofeedback et Ritaline], une diminution similaire et significative des troubles fonctionnels fut observée... Cependant, une amélioration significative des performances scolaires fut observée uniquement dans le groupe neurofeedback. Nos résultats fournissent une nouvelle preuve de l'efficacité du neurofeedback et contribuent à élargir les possibilités d'interventions non médicamenteuses pour le TDAH."
11.	"Alors que tous les symptômes TDAH se sont améliorés au cours des séances dans les deux groupes [...] le neurofeedback EEG n'a pas été meilleurs que le neurofeedback placebo pour améliorer les symptômes du TDAH des enfants."
12.	"L'utilisation conjointe du neurofeedback et du Méthylphénidate [NdT : la Ritaline] est plus efficace que le traitement par Méthylphénidate seul."
13.	"Les résultats concernant les changements du signal EEG suite à l'entraînement de [neurofeedback], conjugués aux évaluations comportementales, aideront à élucider les mécanismes neuronaux du neurofeedback destiné à améliorer l'attention concentrée et la vigilance pour le TDAH."
14.	"Bien que plusieurs essais cliniques randomisés (ECR) montrent un bénéfice moyen à large pour le neurofeedback, il est nécessaire de réaliser un ECR en double-aveugle avec placebo pour différentier les effets spécifiques [du neurofeedback] des effets non spécifiques."
15.	"Une meilleure preuve d'efficacité par des évaluations en aveugle est nécessaire pour [...] le neurofeedback [...] avant qu'on puisse le recommander comme traitement pour les symptômes principaux du TDAH."
16.	"Les résultats [de cette étude] indiquent que [certaines] mesures pourraient avoir une utilité potentielle pour détecter des changements quantitatifs sur certains canaux EEG [suite aux séances de neurofeedback]."
17.	"La [...] combinaison de traitements bien choisis et prouvés scientifiquement (pharmacologiques et non pharmacologiques [NdT : dont le neurofeedback]) semble être recommandée d'un point de vue clinique et éthique [pour le TDAH]..."
18.	"Au cours de la thérapie [neurofeedback et comportementale], le quotient intellectuel verbal et non verbal [de l'enfant] a augmenté significativement. Ses fonctions cognitives se sont aussi améliorées... Sur le plan physiologique, des changements substantiels ont été observés après la thérapie..."
19.	"...d'autres traitements [que les traitements conventionnels] sont nécessaires [pour le TDAH]. L'un des plus prometteurs est le neurofeedback..."
20.	"Nous formulons l'hypothèse que le neurofeedback [...] a un effet sur [le sommeil] ce qui entraîne la stabilisation de la vigilance."
21.	"...la normalisation individuelle de l'activité EEG au repos et le contrôle partiel des potentiels corticaux lents s'est avérée possible dans cette région particulière du cerveau affectée par le TDAH..."
22.	"Il y a eu une amélioration significative de l'inattention et de l'hyperactivité/impulsivité [...] suite au neurofeedback... [...] Le neurofeedback SMR a entraîné des changements ERP et EEG spécifiques."
23.	"Le neurofeedback a été aussi efficace que le Méthylphénidate [NdT : la Ritaline] pour traiter les symptômes de déficit d'attention et d'hyperactivité du TDAH..."
24.	"En conclusion, le neurofeedback est une option valable pour le traitement du TDAH, mais d'autres études sont nécessaires pour guider son utilisation."
25.	"Ces dernières années, le nombre et la qualité scientifique des études sur le neurofeedback basé sur l'EEG pour le TDAH a considérablement augmenté, même si les études examinées ici ne permettent pas encore de recommander le neurofeedback comme première et unique forme de traitement."
26.	"Résultats : [pour le TDAH] les thérapies comportementales et le neurofeedback sont les plus recommandables selon ces [14] études [des traitements non pharmacologiques]."
27.	"Le neurofeedback réel ou simulé a apporté de grandes améliorations d'après les parents [d'enfants TDAH], mais le premier pas plus que le second."
28.	"...cet aspect peut être considéré comme une caractéristique fiable pour prédire la réaction [positive d'un enfant] TDAH au neurofeedback."
29.	"Les études [...] récentes ont révélé des résultats prometteurs et par conséquent le neurofeedback est en voie de devenir un complément valable au traitement multiple du TDAH."
30.	"Les études réalisées jusqu'à présent pour évaluer [le neurofeedback] signalent son efficacité clinique. [...] Les enquêtes de suivi suggèrent que les effets du traitement demeurent stables (au moins six mois)."
31.	"…la conclusion de cet examen [des études publiées] est que le neurofeedback pour les enfants TDAH peut être actuellement considéré comme 'probablement efficace'."
32.	"...le neurofeedback réduit efficacement les symptômes d'inattention selon les tests d'évaluation des parents, ainsi que les temps de réaction selon les tests neuropsychologiques."
33.	"Cette étude randomisée et controlée fournit les preuves préliminaires de l'efficacité des interventions à l'aide de l'ordinateur [par neurofeedback ou par entrainement à l'attention] pour le TDAH."
34.	"...il est prouvé par une vaste étude randomisée et controlée que le neurofeedback a des effets positifs sur la réduction des symptômes des enfants TDAH..."
35.	"Le neurofeedback modifie favorablement le paramètre [neurophysiologique] P3 ce qui est très important pour les enfants TDAH car ce paramètre reflète la vitesse de traitement de l'information ainsi que le choix d'une action appropriée et la prise de décision qui sont souvent affectés chez les enfants TDAH."
36.	"Les analyses ont montré des améliorations importantes des symptômes du TDAH [au fil des séances], mais ces changements ont été similaires pour les groupes [de neurofeedback réel ou simulé]."
37.	"Au niveau comportemental, le neurofeedback a obtenu de meilleurs résultats que le groupe de contrôle concernant les symptômes de base du TDAH... Ces résultats étaient toujours présents 6 mois plus tard. C'est pourquoi le neurofeedback peut être regardé comme cliniquement efficace pour le traitement des enfants TDAH. Au niveau neurophysiologique, [...] des effets spécifiques [du neurofeedback] ont été mis en évidence."
38.	"Les effets sur les potentiels évoqués mesurés sont étroitement corrélés à l'efficacité des séances de neurofeedback chez les enfants atteints de TDAH."
39.	"...les améliorations du comportement obtenues par des séances de neurofeedback chez des enfants TDAH étaient toujours présentes 6 mois plus tard."
40.	"Les recherches effectuées durant ces 20 dernières années semblent confirmer que 70 à 80% des patients [TDAH] obtiennent des améliorations grâce au neurofeedback."
41.	"[Après 16 séances sur des étudiants suspectés de TDAH] on n'a pas pu observer d'effet du neurofeedback sur les mesures de comportement. [...] Cependant, il se peut que la forme particulière de neurofeedback utilisée et la mise en œuvre du protocole [...] de l'étude aient diminué les effets du neurofeedback."
42.	"Sur la base des études actuellement disponibles, on ne peut tirer de conclusion ferme quant à l'efficacité du neurofeedback pour traiter le TDAH. Etant donné que le neurofeedback est de plus en plus utilisé comme traitement [NdT : en Hollande, où l'on dénombre plus de 500 praticiens], il y a un besoin urgent de recherche scientifique dans ce domaine..."
43.	"Des changements dans l'EEG, spécifiques au protocole de neurofeedback utilisé, [...] sont corrélés aux améliorations sur l'échelle allemande d'évaluation du TDAH... Ainsi, des observations différentielles sur l'EEG [selon le protocole de neurofeedback utilisé] fournissent une preuve supplémentaire que des mécanismes neuronaux distincts peuvent contribuer à des améliorations de comportement similaires chez des enfants TDAH."
44.	"...nous concluons que le neurofeedback peut être considéré comme "efficace et spécifique" pour le TDAH."
45.	"Les résultats supérieurs obtenus par une combinaison de protocoles de neurofeedback montrent l'efficacité clinique du neurofeedback pour les enfants TDAH."
46.	"Le neurofeedback réduit le ratio ondes thêta/ondes béta et conduit à une diminution significative de l'inattention et de l'hyperactivité, et il est efficace pour le traitement du TDAH chez les enfants."
47.	"Les effets du neurofeedback [sur des enfants TDAH] et la supériorité du neurofeedback sur la thérapie de groupe semblent provenir à la fois de facteurs spécifiques [du neurofeedback] et de facteurs non spécifiques."
48.	"Il existe un effet spécifique du neurofeedback SCP [sur les enfants TDAH] dû à une augmentation du contrôle cortical."
49.	"Dans les essais cliniques à grande échelle, l'efficacité du neurofeedback pour le TDAH est comparable à celle des médicaments stimulants [NdT : tels que la Ritaline]."
50.	"Les deux groupes [d'enfants TDAH ayant fait du neurofeedback] ont réussi à réguler volontairement leur activité corticale et ont amélioré leur attention et leur QI. Les parents et les enseignants ont rapporté des améliorations significatives du comportement et sur le plan cognitif. Les effets cliniques sur les deux groupes étaient toujours présents 6 mois après le traitement."

Liste des études :

 1. Pharmacological and psychosocial treatments for adolescents with ADHD: An updated systematic review of the literature.
Sibley MH¹, Kuriyan AB², Evans SW³, Waxmonsky JG⁴, Smith BH⁵.

¹Florida International University, Miami, FL, USA. Electronic address: msibley@fiu.edu.
²Florida International University, Miami, FL, USA.
³Ohio University, Athens, OH, USA.
⁴Pennsylvania State University Milton Hershey Medical Center, Hershey, PA, USA.
⁵University of Houston, Houston, TX, USA.

Clin Psychol Rev. 2014 Apr;34(3):218-232. doi: 10.1016/j.cpr.2014.02.001. Epub 2014 Feb 27.

Abstract
Smith, Waschbusch, Willoughby, and Evans (2000) reviewed a small treatment literature on ADHD in adolescents and concluded that methylphenidate stimulant medication was a well-established treatment and behavior therapy (BT) demonstrated preliminary efficacy. This review extends and updates the findings of the prior one based on the previous 15years of research. Studies published since 1999 were identified and coded using standard criteria and effect sizes were calculated where appropriate. Highlights of the last 15years of research include an expansion of pharmacological treatment options and developmentally appropriate psychosocial treatment packages for adolescents with ADHD. Additionally, nonstimulant medications (e.g., atomoxetine) are now approved for the treatment of ADHD in adolescence. The review concludes that medication and BT produce a similar range of therapeutic effects on the symptoms of adolescents with ADHD. However, results suggest that BT may produce greater overall benefits on measures of impairment. There was no evidence that cognitive enhancement trainings, such as working memory training or neurofeedback improved the functioning of adolescents with ADHD. Whether to use medication, BT, or their combination to treat an adolescent with ADHD is complicated and we provide evidence-informed guidelines for treatment selection. The reviewed evidence does not support current American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry professional guidelines, which state that stimulant medication is the preferred treatment for adolescents with ADHD. Recommendations for assessment, practice guidelines, and future research are discussed.

Copyright © 2014 Elsevier Ltd. All rights reserved
PMID: 24632046 [PubMed - as supplied by publisher]

 2. In-school neurofeedback training for ADHD: sustained improvements from a randomized control trial.
Steiner NJ, Frenette EC, Rene KM, Brennan RT, Perrin EC.
The Floating Hospital for Children at Tufts Medical Center, Department of Pediatrics, Boston, Massachusetts.
Pediatrics. 2014 Mar;133(3):483-92. doi: 10.1542/peds.2013-2059. Epub 2014 Feb 17.

Abstract
OBJECTIVE: To evaluate sustained improvements 6 months after a 40-session, in-school computer attention training intervention using neurofeedback or cognitive training (CT) administered to 7- to 11-year-olds with attention-deficit/hyperactivity disorder (ADHD).
METHODS: One hundred four children were randomly assigned to receive neurofeedback, CT, or a control condition and were evaluated 6 months postintervention. A 3-point growth model assessed change over time across the conditions on the Conners 3-Parent Assessment Report (Conners 3-P), the Behavior Rating Inventory of Executive Function Parent Form (BRIEF), and a systematic double-blinded classroom observation (Behavioral Observation of Students in Schools). Analysis of variance assessed community-initiated changes in stimulant medication.
RESULTS: Parent response rates were 90% at the 6-month follow-up. Six months postintervention, neurofeedback participants maintained significant gains on Conners 3-P (Inattention effect size [ES] = 0.34, Executive Functioning ES = 0.25, Hyperactivity/Impulsivity ES = 0.23) and BRIEF subscales including the Global Executive Composite (ES = 0.31), which remained significantly greater than gains found among children in CT and control conditions. Children in the CT condition showed delayed improvement over immediate postintervention ratings only on Conners 3-P Executive Functioning (ES = 0.18) and 2 BRIEF subscales. At the 6-month follow-up, neurofeedback participants maintained the same stimulant medication dosage, whereas participants in both CT and control conditions showed statistically and clinically significant increases (9 mg [P = .002] and 13 mg [P < .001], respectively).
CONCLUSIONS: Neurofeedback participants made more prompt and greater improvements in ADHD symptoms, which were sustained at the 6-month follow-up, than did CT participants or those in the control group. This finding suggests that neurofeedback is a promising attention training treatment for children with ADHD.

PMID: 24534402 [PubMed - in process]

 3. Neurofeedback and cognitive attention training for children with attention-deficit hyperactivity disorder in schools.
Steiner NJ, Frenette EC, Rene KM, Brennan RT, Perrin EC.
The Floating Hospital for Children at Tufts Medical Center, Department of Pediatrics, Boston, MA; †Harvard School of Public Health, Boston, MA.
J Dev Behav Pediatr. 2014 Jan;35(1):18-27. doi: 10.1097/DBP.0000000000000009.

Abstract
OBJECTIVE: To evaluate the efficacy of 2 computer attention training systems administered in school for children with attention-deficit hyperactivity disorder (ADHD).
METHOD: Children in second and fourth grade with a diagnosis of ADHD (n = 104) were randomly assigned to neurofeedback (NF) (n = 34), cognitive training (CT) (n = 34), or control (n = 36) conditions. A 2-point growth model assessed change from pre-post intervention on parent reports (Conners 3-Parent [Conners 3-P]; Behavior Rating Inventory of Executive Function [BRIEF] rating scale), teacher reports (Swanson, Kotkin, Agler, M-Flynn and Pelham scale [SKAMP]; Conners 3-Teacher [Conners 3-T]), and systematic classroom observations (Behavioral Observation of Students in Schools [BOSS]). Paired t tests and an analysis of covariance assessed change in medication.
RESULTS: Children who received NF showed significant improvement compared with those in the control condition on the Conners 3-P Attention, Executive Functioning and Global Index, on all BRIEF summary indices, and on BOSS motor/verbal off-task behavior. Children who received CT showed no improvement compared to the control condition. Children in the NF condition showed significant improvements compared to those in the CT condition on Conners 3-P Executive Functioning, all BRIEF summary indices, SKAMP Attention, and Conners 3-T Inattention subscales. Stimulant medication dosage in methylphenidate equivalencies significantly increased for children in the CT (8.54 mg) and control (7.05 mg) conditions but not for those in the NF condition (0.29 mg).
CONCLUSION: Neurofeedback made greater improvements in ADHD symptoms compared to both the control and CT conditions. Thus, NF is a promising attention training treatment intervention for children with ADHD.

PMID: 24399101 [PubMed - in process]

 4. Evaluation of neurofeedback in ADHD: the long and winding road.
Arns M¹, Heinrich H², Strehl U³.

¹Research Institute Brainclinics, Nijmegen, The Netherlands; Utrecht University, Dept. Experimental Psychology, Utrecht, The Netherlands. Electronic address: martijn@brainclinics.com.
²Dept. of Child and Adolescent Mental Health, University Hospital of Erlangen, Erlangen, Germany; Heckscher-Klinikum, München, Germany.
³University of Tuebingen, Tuebingen, Germany.

Biol Psychol. 2014 Jan;95:108-15. doi: 10.1016/j.biopsycho.2013.11.013. Epub 2013 Dec 7.

Abstract
Among the clinical applications of neurofeedback, most research has been conducted in ADHD. As an introduction a short overview of the general history of neurofeedback will be given, while the main part of the paper deals with a review of the current state of neurofeedback in ADHD. A meta-analysis on neurofeedback from 2009 found large effect sizes for inattention and impulsivity and medium effects sizes for hyperactivity. Since 2009 several new studies, including 4 placebo-controlled studies, have been published. These latest studies are reviewed and discussed in more detail. The review focuses on studies employing (1) semi-active, (2) active, and (3) placebo-control groups. The assessment of specificity of neurofeedback treatment in ADHD is discussed and it is concluded that standard protocols such as theta/beta, SMR and slow cortical potentials neurofeedback are well investigated and have demonstrated specificity. The paper ends with an outlook on future questions and tasks. It is concluded that future controlled clinical trials should, in a next step, focus on such known protocols, and be designed along the lines of learning theory.

Copyright © 2013 Elsevier B.V. All rights reserved.
PMID: 24321363 [PubMed - in process]

 5. Comparing tomographic EEG neurofeedback and EMG biofeedback in children with attention-deficit/hyperactivity disorder.
Maurizio S, Liechti MD, Heinrich H, Jäncke L, Steinhausen HC, Walitza S, Brandeis D, Drechsler R.
University of Zurich, Zurich, Switzerland.
Biol Psychol. 2014 Jan;95:31-44. doi: 10.1016/j.biopsycho.2013.10.008. Epub 2013 Nov 6.

Abstract
Two types of biofeedback (BF), tomographic electroencephalogram (EEG) neurofeedback (NF) and electromyographic biofeedback (EMG-BF), both with phasic and tonic protocols, were compared for treatment effects and specificity in attention-deficit/hyperactivity disorder (ADHD). Thirteen children with ADHD trained their brain activity in the anterior cingulate cortex (ACC), and twelve trained activity of arm muscles involved in fine motor skills. In each training session, resting state 24-channel EEG and training performances were recorded. Both groups showed similar behavioral improvements and artifact reduction in selected conditions, with no significant advantages despite medium effect sizes on primary outcomes for NF. Only the EMG-BF group, however, showed clear improvement in training regulation performance, and specific motor coordination effects. The NF group tended to present individual normalization of trained frequency bands in the ACC during rest across training. The results provide evidence for some specific effects in our small sample, albeit only to a small extent.

Copyright © 2013 Elsevier B.V. All rights reserved.
PMID: 24211870 [PubMed - in process]

 6. Neurofeedback in ADHD: further pieces of the puzzle.
Gevensleben H, Kleemeyer M, Rothenberger LG, Studer P, Flaig-Röhr A, Moll GH, Rothenberger A, Heinrich H.
Child & Adolescent Psychiatry, University Medicine Göttingen, Göttingen, Germany.
Brain Topogr. 2014 Jan;27(1):20-32. doi: 10.1007/s10548-013-0285-y. Epub 2013 Apr 6.

Abstract
Among the different neuromodulation techniques, neurofeedback (NF) is gaining increasing interest in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). In this article, a methodological framework is summarised considering the training as a neuro-behavioural treatment. Randomised controlled trials are selectively reviewed. Results from two smaller-scale studies are presented with the first study comprising a tomographic analysis over the course of a slow cortical potential (SCP) training and a correlational analysis of regulation skills and clinical outcome in children with ADHD. In the second study, ADHD-related behaviour was studied in children with tic disorder who either conducted a SCP training or a theta/low-beta (12-15 Hz) training (single-blind, randomised design). Both studies provide further evidence for the specificity of NF effects in ADHD. Based on these findings, a refined model of the mechanisms contributing to the efficacy of SCP training is developed. Despite a number of open questions concerning core mechanisms, moderators and mediators, NF (theta/beta and SCP) training seems to be on its way to become a valuable and ethically acceptable module in the treatment of children with ADHD.

PMID: 23563906 [PubMed - in process]

 7. Evidence-Based Psychosocial Treatments for Children and Adolescents with Attention-Deficit/Hyperactivity Disorder.
Evans SW, Owens JS, Bunford N.
Department of Psychology , Ohio University.
J Clin Child Adolesc Psychol. 2013 Nov 18. [Epub ahead of print]

Abstract
The purpose of this research was to update the Pelham and Fabiano ( 2008 ) review of evidence-based practices for children and adolescents with attention-deficit/hyperactivity disorder. We completed a systematic review of the literature published between 2007 and 2013 to establish levels of evidence for psychosocial treatments for these youth. Our review included the identification of relevant articles using criteria established by the Society of Clinical Child and Adolescent Psychology (see Southam-Gerow & Prinstein, in press ) using keyword searches and a review of tables of contents. We extend the conceptualization of treatment research by differentiating training interventions from behavior management and by reviewing the growing literature on training interventions. Consistent with the results of the previous review we conclude that behavioral parent training, behavioral classroom management, and behavioral peer interventions are well-established treatments. In addition, organization training met the criteria for a well-established treatment. Combined training programs met criteria for Level 2 (Probably Efficacious), neurofeedback training met criteria for Level 3 (Possibly Efficacious), and cognitive training met criteria for Level 4 (Experimental Treatments). The distinction between behavior management and training interventions provides a method for considering meaningful differences in the methods and possible mechanisms of action for treatments for these youth. Characteristics of treatments, participants, and measures, as well as the variability in methods for classifying levels of evidence for treatments, are reviewed in relation to their potential effect on outcomes and conclusions about treatments. Implications of these findings for future science and practice are discussed.

PMID: 24245813 [PubMed - as supplied by publisher]

 8. Does EEG-neurofeedback improve neurocognitive functioning in children with attention-deficit/hyperactivity disorder? A systematic review and a double-blind placebo-controlled study.
Vollebregt MA, van Dongen-Boomsma M, Buitelaar JK, Slaats-Willemse D.
Karakter University Centre for Child and Adolescent Psychiatry, Nijmegen, the Netherlands; Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
J Child Psychol Psychiatry. 2013 Oct 30. doi: 10.1111/jcpp.12143. [Epub ahead of print].

Abstract
BACKGROUND: The number of placebo-controlled randomized studies relating to EEG-neurofeedback and its effect on neurocognition in attention-deficient/hyperactivity disorder (ADHD) is limited. For this reason, a double blind, randomized, placebo-controlled study was designed to assess the effects of EEG-neurofeedback on neurocognitive functioning in children with ADHD, and a systematic review on this topic was performed.
METHODS: Forty-one children (8-15 years) with a DSM-IV-TR diagnosis of ADHD were randomly allocated to EEG-neurofeedback or placebo-neurofeedback treatment for 30 sessions, twice a week. Children were stratified by age, electrophysiological state of arousal, and medication use. Neurocognitive tests of attention, executive functioning, working memory, and time processing were administered before and after treatment. Researchers, teachers, children and their parents, with the exception of the neurofeedback-therapist, were all blind to treatment assignment. Outcome measures were the changes in neurocognitive performance before and after treatment. Clinical trial registration: www.clinicaltrials.gov: NCT00723684.
RESULTS: No significant treatment effect on any of the neurocognitive variables was found. A systematic review of the current literature also did not find any systematic beneficial effect of EEG-neurofeedback on neurocognitive functioning.
CONCLUSION: Overall, the existing literature and this study fail to support any benefit of neurofeedback on neurocognitive functioning in ADHD, possibly due to small sample sizes and other study limitations.

© 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.
PMID: 24168522 [PubMed - in process]

 9. Effects of neurofeedback versus stimulant medication in attention-deficit/hyperactivity disorder: a randomized pilot study.
Ogrim G, Hestad KA.
Østfold Hospital Trust , Neuropsychiatric Unit, Child and Adolescent Psychiatry, Fredrikstad, Norway.
J Child Adolesc Psychopharmacol. 2013 Sep;23(7):448-57. doi: 10.1089/cap.2012.0090. Epub 2013 Jun 29.

Abstract
OBJECTIVE: The purpose of this pilot study was to compare the effects of 30 sessions of neurofeedback (NF) with stimulant medication on attention-deficit/hyperactivity disorder (ADHD) patients.
METHODS: Thirty-two medication-naïve ADHD patients, ages 7-16, from a neuropsychiatric clinic, were randomized to NF (n=16) or drug treatment (n=16). Other actions, such as parent management training, information, or support in school were given as needed, with no differences between the groups. All participants were assessed before treatment on two rating scales, each with parent and teacher forms. In addition, quantitative electroencephalogram (QEEG) and event-related potentials (ERPs), which included behavioral data from a go/no go test were administered. NF training took place in the clinic over a period of 7-11 months, and was followed by a repeat of the same assessment tools. The mean time interval between pre- and postassesment was not significantly different in the two groups. The 18 symptoms of ADHD (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV)) were used as the primary outcome measure.
RESULTS: Analysis of covariance revealed a significant difference between the groups at evaluation in favor of medication, with a large effect size. This picture was confirmed by other outcome measures. The QEEG spectral power in the theta and beta bands did not change in either group. In ERP, the P3 no go component increased significantly in 8 of 12 patients who had a clinically relevant medication effect, but did not increase in the medication nonresponders or the NF group.
CONCLUSIONS: Our study supports effects for stimulants, but not for NF. Effects of NF may require thorough patient selection, frequent training sessions, a system for excluding nonresponders, and active transfer training. The P3 no go ERP component may be a marker for treatment response.

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PMID: 23808786 [PubMed - in process] PMCID: PMC3779016

 10. Neurofeedback and standard pharmacological intervention in ADHD: a randomized controlled trial with six-month follow-up.
Meisel V, Servera M, Garcia-Banda G, Cardo E, Moreno I.
Research Institute on Health Sciences (IUNICS), University of Balearic Islands (UIB), Ctra. de Valldemossa, km 7.5, 07122 Palma de Majorca, Spain. v.meisel@uib.es.
Biol Psychol. 2013 Sep;94(1):12-21. doi: 10.1016/j.biopsycho.2013.04.015. Epub 2013 May 9.

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

Copyright © 2013 Elsevier B.V. All rights reserved.
PMID: 23665196 [PubMed - indexed for MEDLINE]

 11. A randomized placebo-controlled trial of electroencephalographic (EEG) neurofeedback in children with attention-deficit/hyperactivity disorder.
van Dongen-Boomsma M, Vollebregt MA, Slaats-Willemse D, Buitelaar JK.
Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands m.vandongen-boomsma@karakter.com.
J Clin Psychiatry. 2013 Aug;74(8):821-7. doi: 10.4088/JCP.12m08321.

Abstract
OBJECTIVE: A double-blind, randomized, placebo-controlled study was designed to assess the efficacy and safety of electroencephalographic (EEG) neurofeedback in children with attention-deficit/hyperactivity disorder (ADHD). The study started in August 2008 and ended in July 2012 and was conducted at Karakter Child and Adolescent Psychiatry University Centre in Nijmegen, The Netherlands.
METHOD: Forty-one children (aged 8-15 years) with a DSM-IV-TR diagnosis of ADHD were randomly assigned to treatment with either EEG neurofeedback (n = 22) or placebo neurofeedback (n = 19) for 30 sessions, given as 2 sessions per week. The children were stratified by age, electrophysiologic state of arousal, and medication use. Everyone involved in the study, except the neurofeedback therapist and the principal investigator, was blinded to treatment assignment. The primary outcome was severity of ADHD symptoms on the ADHD Rating Scale IV, scored at baseline, during treatment, and at study end. Clinical improvement as measured by the Clinical Global Impressions-Improvement scale (CGI-I) was a secondary outcome.
RESULTS: While total ADHD symptoms improved over time in both groups (F1,39 = 26.56, P < .001), there was no significant treatment effect, ie, group × time interaction (F1,39 = 0.36, P = .554); the same was true for clinical improvement as measured by the CGI-I (P = .092). No clinically relevant side effects were observed. Among the children and their parents, guessing treatment assignment was not better than chance level (P = .224 for children, P = .643 for parents).
CONCLUSION: EEG neurofeedback was not superior to placebo neurofeedback in improving ADHD symptoms in children with ADHD.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00723684.

© Copyright 2013 Physicians Postgraduate Press, Inc.
PMID: 24021501 [PubMed - indexed for MEDLINE]

 12. A randomised controlled trial of combined EEG feedback and methylphenidate therapy for the treatment of ADHD.
Li L, Yang L, Zhuo CJ, Wang YF.
Institute of Mental Health, Peking University, Beijing, China; drlili@bjmu.edu.cn.
Swiss Med Wkly. 2013 Aug 22;143:w13838. doi: 10.4414/smw.2013.13838.

Abstract
PURPOSE: To evaluate the efficacy of combined methylphenidate and EEG feedback treatment for children with ADHD.
METHODS: Forty patients with ADHD were randomly assigned to the combination group (methylphenidate therapy and EEG feedback training) or control group (methylphenidate therapy and non-feedback attention training) in a 1:1 ratio using the double-blind method. These patients, who met the DSM-IV diagnostic criteria and were aged between 7 and 16 years, had obtained optimal therapeutic effects by titrating the methylphenidate dose prior to the trial. The patients were assessed using multiple parameters at baseline, after 20 treatment sessions, after 40 treatment sessions, and in 6-month follow-up studies.
RESULTS: Compared to the control group, patients in the combination group had reduced ADHD symptoms and improved in related behavioural and brain functions.
CONCLUSION: The combination of EEG feedback and methylphenidate treatment is more effective than methylphenidate alone. The combined therapy is especially suitable for children and adolescents with ADHD who insufficiently respond to single drug treatment or experience drug side effects.

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PMID: 23986461 [PubMed - in process]

 13. Neurofeedback training aimed to improve focused attention and alertness in children with ADHD: a study of relative power of EEG rhythms using custom-made software application.
Hillard B, El-Baz AS, Sears L, Tasman A, Sokhadze EM.
Department of Psychiatry & Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA.
Clin EEG Neurosci. 2013 Jul;44(3):193-202. doi: 10.1177/1550059412458262.

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

PMID: 23820311 [PubMed - indexed for MEDLINE]

 14. A proposed multisite double-blind randomized clinical trial of neurofeedback for ADHD: need, rationale, and strategy.
Kerson C; Collaborative Neurofeedback Group: Arnold LE, Arns M, Conners K, deBeus R, Hirshberg L, Kerson C, Kraemer H, Lofthouse N, Lubar J, McBurnett K, Monastra V.
ISNR Research Foundation, San Rafael, CA 94901, USA. executivedirector@isnr-researchfoundation.org.
J Atten Disord. 2013 Jul;17(5):420-36. doi: 10.1177/1087054713482580. Epub 2013 Apr 16.

Abstract
OBJECTIVE: Additional treatments with persisting benefit are needed for ADHD. Because ADHD often shows excessive theta electroencephalogram (EEG) power, low beta, and excessive theta-beta ratio (TBR), a promising treatment is neurofeedback (NF) downtraining TBR. Although several nonblind randomized clinical trials (RCTs) show a medium-large benefit for NF, a well-blinded, sham-controlled RCT is needed to differentiate specific from nonspecific effects.
METHOD: Experts in NF, ADHD, clinical trials, and statistics collaborated to design a double-blind multisite RCT.
RESULTS/CONCLUSION: At four sites, 180 children aged 7 to 10 years with rigorously diagnosed ADHD and TBR = 5 will be randomized to active TBR-NF versus sham NF of equal duration, intensity, and appearance. Sham, utilizing prerecorded EEGs with participant artifacts superimposed, will keep participants and staff blind. Treatment fidelity will be trained/monitored by acknowledged NF leaders. Multidomain assessments before, during, and after treatment (follow-up to 2 years) will also include tests of blinding and sham inertness.

PMID: 23590978 [PubMed - indexed for MEDLINE]

 15. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments.
Sonuga-Barke EJ, Brandeis D, Cortese S, Daley D, Ferrin M, Holtmann M, Stevenson J, Danckaerts M, van der Oord S, Döpfner M, Dittmann RW, Simonoff E, Zuddas A, Banaschewski T, Buitelaar J, Coghill D, Hollis C, Konofal E, Lecendreux M, Wong IC, Sergeant J; European ADHD Guidelines Group.
Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, UK. ejb3@soton.ac.uk.
Am J Psychiatry. 2013 Mar 1;170(3):275-89. doi: 10.1176/appi.ajp.2012.12070991.

Abstract
OBJECTIVE: Nonpharmacological treatments are available for attention deficit hyperactivity disorder (ADHD), although their efficacy remains uncertain. The authors undertook meta-analyses of the efficacy of dietary (restricted elimination diets, artificial food color exclusions, and free fatty acid supplementation) and psychological (cognitive training, neurofeedback, and behavioral interventions) ADHD treatments.
METHOD: Using a common systematic search and a rigorous coding and data extraction strategy across domains, the authors searched electronic databases to identify published randomized controlled trials that involved individuals who were diagnosed with ADHD (or who met a validated cutoff on a recognized rating scale) and that included an ADHD outcome.
RESULTS: Fifty-four of the 2,904 nonduplicate screened records were included in the analyses. Two different analyses were performed. When the outcome measure was based on ADHD assessments by raters closest to the therapeutic setting, all dietary (standardized mean differences=0.21-0.48) and psychological (standardized mean differences=0.40-0.64) treatments produced statistically significant effects. However, when the best probably blinded assessment was employed, effects remained significant for free fatty acid supplementation (standardized mean difference=0.16) and artificial food color exclusion (standardized mean difference=0.42) but were substantially attenuated to nonsignificant levels for other treatments.
CONCLUSIONS: Free fatty acid supplementation produced small but significant reductions in ADHD symptoms even with probably blinded assessments, although the clinical significance of these effects remains to be determined. Artificial food color exclusion produced larger effects but often in individuals selected for food sensitivities. Better evidence for efficacy from blinded assessments is required for behavioral interventions, neurofeedback, cognitive training, and restricted elimination diets before they can be supported as treatments for core ADHD symptoms.

PMID: 23360949 [PubMed - indexed for MEDLINE]

 16. Nonlinear dynamics measures applied to EEG recordings of patients with attention deficit/hyperactivity disorder: quantifying the effects of a neurofeedback treatment.
Cerquera A, Arns M, Buitrago E, Gutiérrez R, Freund J.
Faculty of Electronic and Biomedical Engineering, Antonio Nariño University, Bogota, Colombia. alexander.cerquera@uan.edu.co.
Conf Proc IEEE Eng Med Biol Soc. 2012;2012:1057-60. doi: 10.1109/EMBC.2012.6346116.

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

PMID: 23366077 [PubMed - indexed for MEDLINE]

 17. Updates on treatment of attention-deficit/hyperactivity disorder: facts, comments, and ethical considerations.
Rothenberger A, Rothenberger LG.
Child and Adolescent Psychiatry, University Medicine Göttingen, von-Siebold-Str. 5, 37075, Göttingen, Germany, arothen@gwdg.de.
Curr Treat Options Neurol. 2012 Dec;14(6):594-607. doi: 10.1007/s11940-012-0197-2.

Abstract
OPINION STATEMENT: Within the last 2 years the bulk of information on evidence based treatments in ADHD was reviewed quite intensively and new empirical studies could be added. This update reports comprehensively about actual and essential facts in the field related to brain development and sensitive periods, predictors of treatment, safety of medication, value of naturalistic studies, new drugs and complementary medicine, behavioral interventions including neurofeedback and psychosocial treatment, treatment of comorbidity, and ethical considerations including preventive aspects. The updated combination of well selected evidence based treatments (ie, pharma plus non-pharma) seems to be clinically and ethically recommended as also suggested by the European and American guidelines on ADHD.

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PMID: 22968494 [PubMed] PMCID: PMC3501189

 18. Evaluation of a neurotherapy program for a child with ADHD with Benign Partial Epilepsy with Rolandic Spikes (BPERS) using event-related potentials.
Pachalska M, Kropotov ID, Manko G, Lipowska M, Rasmus A, Lukaszewska B, Bogdanowicz M, Mirski A.
Andrzej Frycz Modrzewski Cracow University, Cracow, Poland. neuropsychologia23@o2.pl
Med Sci Monit. 2012 Nov;18(11):CS94-104.

Abstract
BACKGROUND: We hypothesized that there would be a good response to relative beta training, applied to regulate the dynamics of brain function in a patient with benign partial epilepsy with Rolandic Spikes (BPERS), associated with neuropsychiatric deficits resembling the symptoms of attention deficit-hyperactivity disorder (ADHD).
CASE REPORT: The patient, E.Z., age 9.3, was suffering from neuropsychiatric symptoms, cognitive dysfunction, especially attention deficits, and behavioral changes, rendering him unable to function independently in school and in many situations of everyday life. He was treated for epilepsy, but only slight progress was made. The patient took part in 20 sessions of relative beta training combined with behavioral training. We used standardized neuropsychological testing, as well as ERPs before the experiment and after the completion of the neurotherapy program. Neuropsychological testing at baseline showed multiple cognitive deficits. Over the course of neurotherapy, E.Z.'s verbal and non-verbal IQ increased significantly. His cognitive functions also improved, including immediate and delayed logical and visual recall on the WMS-III, maintaining attention on the WMS-III, and executive functions, but remained below norms. Physiologically, the patient showed substantial changes after neurotherapy, including fewer spikes and an increased P300 NOGO component.
CONCLUSIONS: The cognitive deficits characteristic for ADHD in a child with BPERS may be unresponsive to antiepileptic treatment, but are reversible after a carefully selected neurotherapy program, combined with antiepileptic treatment. Event Related Potentials (ERPs) in the GO/NOGO task can be used to assess functional brain changes induced by neurotherapeutical programs.

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PMID: 23111748 [PubMed - in process]

 19. Current status of neurofeedback for attention-deficit/hyperactivity disorder.
Lofthouse N, Arnold LE, Hurt E.
Department of Psychiatry, The Ohio State University, 1670 Upham Drive, Columbus, OH 43210, USA. Nicholas.Lofthouse@osumc.edu
Curr Psychiatry Rep. 2012 Oct;14(5):536-42. doi: 10.1007/s11920-012-0301-z.

Abstract
As conventional treatments offer incomplete benefit for over 33 % of children with attention-deficit/hyperactivity disorder (ADHD) and many refuse to try them, additional treatments are needed. One of the most promising is neurofeedback (NF, EEG biofeedback), which trains the brain with real-time video/audio information about its electrical activity measured from scalp electrodes. Since 2010, data from 8 randomized controlled studies of NF have been published with overall mean effect sizes of: 0.40 (all measures), 0.42 (ADHD measures), 0.56 (inattention), and 0.54 (hyperactivity/ impulsivity). Unfortunately, the benefit reported from randomized studies has not been observed in the few small blinded studies conducted. Main study strengths include randomization, evidence-based diagnostic assessments, multi-domain treatment outcomes, use of some type of blinding, and sham control conditions. Main study limitations include lack of large samples, abnormal EEG participant selection, double-blinding, and testing of blind validity and sham inertness. Most recently, a collaborative NF research group has been planning a definitive double-blind well-controlled trial.

PMID: 22890816 [PubMed - indexed for MEDLINE]

 20. Neurofeedback in ADHD and insomnia: Vigilance stabilization through sleep spindles and circadian networks.
Arns M, Kenemans JL.
Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands; Research Institute Brainclinics, Bijleveldsingel 34, 6524 AD Nijmegen, The Netherlands. Electronic address: martijn@brainclinics.com.
Neurosci Biobehav Rev. 2012 Oct 23. pii: S0149-7634(12)00173-X. doi: 10.1016/j.neubiorev.2012.10.006. [Epub ahead of print]

Abstract
In this review article an overview of the history and current status of neurofeedback for the treatment of ADHD and insomnia is provided. Recent insights suggest a central role of circadian phase delay, resulting in sleep onset insomnia (SOI) in a sub-group of ADHD patients. Chronobiological treatments, such as melatonin and early morning bright light, affect the suprachiasmatic nucleus. This nucleus has been shown to project to the noradrenergic locus coeruleus (LC) thereby explaining the vigilance stabilizing effects of such treatments in ADHD. It is hypothesized that both Sensori-Motor Rhythm (SMR) and Slow-Cortical Potential (SCP) neurofeedback impact on the sleep spindle circuitry resulting in increased sleep spindle density, normalization of SOI and thereby affect the noradrenergic LC, resulting in vigilance stabilization. After SOI is normalized, improvements on ADHD symptoms will occur with a delayed onset of effect. Therefore, clinical trials investigating new treatments in ADHD should include assessments at follow-up as their primary endpoint rather than assessments at outtake. Furthermore, an implication requiring further study is that neurofeedback could be stopped when SOI is normalized, which might result in fewer sessions.

Copyright © 2012 Elsevier Ltd. All rights reserved.
PMID: 23099283 [PubMed - as supplied by publisher]

 21. First clinical trial of tomographic neurofeedback in attention-deficit/hyperactivity disorder: evaluation of voluntary cortical control.
Liechti MD, Maurizio S, Heinrich H, Jäncke L, Meier L, Steinhausen HC, Walitza S, Drechsler R, Brandeis D.
Department of Child and Adolescent Psychiatry, University of Zürich, Zürich, Switzerland.
Clin Neurophysiol. 2012 Oct;123(10):1989-2005. doi: 10.1016/j.clinph.2012.03.016. Epub 2012 May 17.

Abstract
OBJECTIVE: Tomographic neurofeedback (tNF) training was evaluated as a treatment for attention-deficit/hyperactivity disorder (ADHD). To investigate the specificity of the treatment, outcomes were related to learning during tNF.
METHODS: Thirteen children with ADHD trained over 36 lessons to regulate their brain activity in the anterior cingulate cortex (ACC) using both theta-beta frequency and slow cortical potential (SCP) protocols. Thirty-channel electroencephalogram (EEG) was used to calculate low-resolution electromagnetic tNF and to assess the course of the training. Pre- and post-assessments included questionnaires, tests of attention, EEG recordings, and cognitive event-related potentials.
RESULTS: Despite behavioural improvement and EEG artefact reduction, only partial learning was found for ACC parameters. Successful regulation was observed only for a simple feedback variant of SCP training, but with ACC-specific effects. Over training, resting EEG analysis indicated individual frequency normalisation rather than unidirectional changes across subjects.
CONCLUSIONS: These results indicate that clinical improvement after ACC-tNF training can parallel artefact reduction without substantial learning of improved cortical control. However, individual normalisation of resting EEG activity and partial SCP control proved possible in this specific brain region affected in ADHD using tNF. Further studies are needed to clarify which critical aspects mediate region-specific learning in neurofeedback.
SIGNIFICANCE: This study is the first to systematically investigate tNF in children suffering from a psychiatric disorder .

PMID: 22608481 [PubMed - indexed for MEDLINE]

 22. The effects of QEEG-informed neurofeedback in ADHD: an open-label pilot study.
Arns M, Drinkenburg W, Leon Kenemans J.
Research Institute Brainclinics, Bijleveldsingel Nijmegen, The Netherlands. martijn@brainclinics.com
Appl Psychophysiol Biofeedback. 2012 Sep;37(3):171-80. doi: 10.1007/s10484-012-9191-4.

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

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PMID: 22446998 [PubMed - indexed for MEDLINE] PMCID: PMC3419351

 23. Neurofeedback for the treatment of children and adolescents with ADHD: a randomized and controlled clinical trial using parental reports.
Duric NS, Assmus J, Gundersen D, Elgen IB.
Department of Child and Adolescent Psychiatry, Helse Fonna Haugesund Hospital, Haugesund 5501, Norway. nezlad@gmail.com.
BMC Psychiatry. 2012 Aug 10;12:107. doi: 10.1186/1471-244X-12-107.

Abstract
BACKGROUND: A randomized and controlled clinical study was performed to evaluate the use of neurofeedback (NF) to treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents.
METHODS: The ADHD population was selected from an outpatient clinic for Child and Adolescent Mental Health in Norway. Ninety-one of the 275 children and adolescents ranging in age from 6 to 18 years (10.5 years) participated in 30 sessions of an intensive NF program. The reinforcement contingency was based on the subjects' production of cortical beta1 activity (15-18 Hz). The ADHD participants were randomized into three groups, with 30 in the NF group, 31 controls in a group that was given methylphenidate, and 30 in a group that received NF and methylphenidate. ADHD core symptoms were reported by parents using the parent form of the Clinician's Manual for Assessment by Russell A. Barkley.
RESULTS: Ninety-one children and adolescents were effectively randomized by age, sex, intelligence and distribution of ADHD core symptoms. The parents reported significant effects of the treatments, but no significant differences between the treatment groups were observed.
CONCLUSIONS: NF was as effective as methylphenidate at treating the attentional and hyperactivity symptoms of ADHD, based on parental reports.

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TRIAL REGISTRATION: Current Controlled Trials NCT01252446.
PMID: 22877086 [PubMed - indexed for MEDLINE] PMCID: PMC3441233

 24. Evidence-based information on the clinical use of neurofeedback for ADHD.
Moriyama TS, Polanczyk G, Caye A, Banaschewski T, Brandeis D, Rohde LA.
National Institute of Developmental Psychiatry for Children and Adolescents-INCT-CNPq, São Paulo, Brazil. taismoriyama@gmail.com.
Neurotherapeutics. 2012 Jul;9(3):588-98. doi: 10.1007/s13311-012-0136-7.

Abstract
Neurofeedback (NF) is a training to enhance self-regulatory capacity over brain activity patterns and consequently over brain mental states. Recent findings suggest that NF is a promising alternative for the treatment of attention-deficit/hyperactivity disorder (ADHD). We comprehensively reviewed literature searching for studies on the effectiveness and specificity of NF for the treatment of ADHD. In addition, clinically informative evidence-based data are discussed. We found 3 systematic review on the use of NF for ADHD and 6 randomized controlled trials that have not been included in these reviews. Most nonrandomized controlled trials found positive results with medium-to-large effect sizes, but the evidence for effectiveness are less robust when only randomized controlled studies are considered. The direct comparison of NF and sham-NF in 3 published studies have found no group differences, nevertheless methodological caveats, such as the quality of the training protocol used, sample size, and sample selection may have contributed to the negative results. Further data on specificity comes from electrophysiological studies reporting that NF effectively changes brain activity patterns. No safety issues have emerged from clinical trials and NF seems to be well tolerated and accepted. Follow-up studies support long-term effects of NF. Currently there is no available data to guide clinicians on the predictors of response to NF and on optimal treatment protocol. In conclusion, NF is a valid option for the treatment for ADHD, but further evidence is required to guide its use.

PMID: 22930416 [PubMed - in process] PMCID: PMC3441929 [Available on 2013/7/1]

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 25. Clinical utility of EEG in attention-deficit/hyperactivity disorder: a research update.
Loo SK, Makeig S.
Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90095, USA. sloo@mednet.ucla.edu.
Neurotherapeutics. 2012 Jul;9(3):569-87. doi: 10.1007/s13311-012-0131-z.

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

PMID: 22814935 [PubMed - in process] PMCID: PMC3441927 [Available on 2013/7/1]

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 26. Nonpharmacological Treatments for ADHD: A Meta-Analytic Review.
Hodgson K, Hutchinson AD, Denson L.
J Atten Disord. 2012 May 29. [Epub ahead of print].

Abstract
Objective: The authors replicated and expanded on Fabiano et al.'s meta-analysis of behavioral treatments for ADHD, systematically comparing the efficacy of 7 nonpharmacological interventions. Method: A total of 14 controlled treatment studies conducted post-1994-evaluating behavior modification, neurofeedback therapy, multimodal psychosocial treatment, school-based programs, working memory training, parent training, and self-monitoring-were identified, primarily by searching electronic English-language databases. The results were meta-analyzed: mean-weighted effect sizes for the treatment outcomes of 625 participants (382 treatment, 243 controls) were calculated, and moderator analyses examined contributions of gender, ADHD subtype, and treatment "dosage" to outcome. Results: Behavior modification and neurofeedback treatments were most supported by this evidence. Interventions were generally more efficacious for girls, and least efficacious for the "combined" ADHD subtype. The authors found no dose or age effects. Conclusion: Based on the small, published literature, this study supports some nonpharmacological interventions for ADHD, and indicates directions for more evaluation research into psychological treatments. (J. of Att. Dis. 2012; XX(X) 1-XX).

PMID: 22647288 [PubMed - as supplied by publisher]

 27. EEG Neurofeedback for ADHD: Double-Blind Sham-Controlled Randomized Pilot Feasibility Trial.
Arnold LE, Lofthouse N, Hersch S, Pan X, Hurt E, Bates B, Kassouf K, Moone S, Grantier C.
Atten Disord. 2012 May 22. [Epub ahead of print].

Abstract
Objective: Preparing for a definitive randomized clinical trial (RCT) of neurofeedback (NF) for ADHD, this pilot trial explored feasibility of a double-blind, sham-controlled design and adherence/palatability/relative effect of two versus three treatments/week. Method: Unmedicated 6- to 12-year-olds with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) ADHD were randomized to active NF versus sham-NF and to 2X versus 3X/week treatment frequency. Frequency switch was allowed after Treatment 24. Results: In two school years, 39 participants were recruited and 34 (87%) completed all 40 treatments. Child/parent guesses about assigned treatment were no better than chance. At Treatment 24, 38% chose 2X/week and 62% chose 3X/week. Both active NF and sham yielded large pre-post improvement on parent ratings but NF no more than sham. Conclusion: Blinding appears to work, and sham does not prevent recruitment/retention. Treatment frequency of 3X/week seems preferred over 2X/week and was as effective. A large double-blind RCT is feasible and necessary to test specific NF effectiveness. (J. of Att. Dis. 2012; XX(X) 1-XX).

PMID: 22617866 [PubMed - as supplied by publisher]

 28. Which attention-deficit/hyperactivity disorder children will be improved through neurofeedback therapy? A graph theoretical approach to neocortex neuronal network of ADHD.
Ahmadlou M, Rostami R, Sadeghi V.
Atieh Comprehensive Center for Nerve and Psych Disorders, Tehran, Iran. mehranahmadlou@gmail.com
Neurosci Lett. 2012 May 10;516(1):156-60. doi: 10.1016/j.neulet.2012.03.087. Epub 2012 Apr 5.

Abstract
Neurofeedback training is increasingly used for ADHD treatment. However some ADHD patients are not treated through the long-time neurofeedback trainings with common protocols. In this paper a new graph theoretical approach is presented for EEG-based prediction of ADHD patients' responses to a common neurofeedback training: rewarding SMR activity (12-15 Hz) with inhibiting theta activity (4-8 Hz) and beta2 activity (18-25 Hz). Eyes closed EEGs of two groups before and after neurofeedback training were studied: ADHD patients with (15 children) and without (15 children) positive response to neurofeedback training. Employing a recent method to measure synchronization, fuzzy synchronization likelihood, functional connectivity graphs of the patients' brains were constructed in the full-band EEGs and 6 common EEG sub-bands produced by wavelet decomposition. Then, efficiencies of the brain networks in synchronizability and high speed information transmission were computed based on mean path length of the graphs, before and after neurofeedback training. The results were analyzed by ANOVA and showed synchronizability of the neocortex activity network at beta band in ADHDs with positive response is obviously less than that of ADHDs resistant to neurofeedback therapy, before treatment. The accuracy of linear discriminant analysis (LDA) in distinguishing these patients based on this feature is so high (84.2%) that this feature can be considered as reliable characteristics for prediction of responses of ADHDs to the neurofeedback trainings. Also difference between flexibility of the neocortex in beta band before and after treatment is obviously larger in the ADHDs with positive response in comparison to those with negative response which may be a neurophysiologic reason for dissatisfaction of the last group to the neurofeedback therapy.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
PMID: 22503723 [PubMed - indexed for MEDLINE]

 29. Neurofeedback in children with ADHD: validation and challenges.
Gevensleben H, Rothenberger A, Moll GH, Heinrich H.
Child & Adolescent Psychiatry, University of Göttingen, v. Siebold-Str. 5, D-37075 Göttingen, Germany. hgevens@gwdg.de
Expert Rev Neurother. 2012 Apr;12(4):447-60. doi: 10.1586/ern.12.22.

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

PMID: 22449216 [PubMed - indexed for MEDLINE]

 30. [The usage of neurofeedback in children with ADHD: the method and its evaluation].
Gevensleben H, Moll GH, Rothenberger A, Heinrich H. [Article in German]
Kinder- und Jugendpsychiatrie, Universitätsmedizin Göttingen.
Prax Kinderpsychol Kinderpsychiatr. 2011;60(8):666-76.

Abstract
Neurofeedback is a computer-based behavior training, which is gaining increasing interest in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). This article gives an introduction to neurofeedback and summarizes the state of research, discussing inter alia methodical aspects (e. g., requirements to a control training). Evaluation studies conducted so far indicate clinical efficacy. For example, neurofeedback training was superior to a computerized attention training in a randomized controlled trial (medium effect size). Follow-up investigations suggest that treatment effects remain stable (at least six months). At the clinical level, comparable improvements could be obtained for the neurofeedback protocols theta/beta training and training of slow cortical potentials. Neurophysiological findings document different mechanisms of theta/beta training and slow cortical potential training. Future studies should further elucidate the specificity of training effects related to the kind of training and certain disorders and address how to optimize and individualize neurofeedback training.

PMID: 22145423 [PubMed - indexed for MEDLINE]

 31. A Review of Neurofeedback Treatment for Pediatric ADHD.
Lofthouse N, Arnold LE, Hersch S, Hurt E, Debeus R.
The Ohio State University, Columbus, USA.
J Atten Disord. 2011 Nov 16. [Epub ahead of print]

Abstract
Objective: The aim of this paper was to review all randomized published trials and unpublished conference presentations on the neurofeedback (NF) treatment of pediatric ADHD, and their relevance, strengths, and limitations. Method: Via PsychInfo and Medline searches and contacts with NF researchers 14 studies were identified and reviewed. Results: The majority were conducted from 1994 to 2010, with 5- to 15-year-olds, usually male and White with the combined type of ADHD. Most studies used theta/beta NF with a unipolar-electrode placement at Cz and demonstrated, where reported, an overall ADHD mean effect size of d = 0.69, a medium effect. Main study strengths, within some studies, include use of randomization, treatment control conditions, Diagnostic and Statistical Manual of Mental Disorders criteria, evidence-based assessment of ADHD, standard treatment outcome measures, multidomain assessment, and, for some studies, moderate sample size, some type of blind and the identification of medication as a concomitant treatment. Main study limitations (and directions for future research) include the lack of adequate blinding of participants, raters and NF trainers, a sham-NF/blinded control treatment condition, posttreatment follow-up, generalizability, specific details about delivery of NF, identification and control of comorbidity, and the identification, measurement, and control of concomitant treatments and potential side effects. Conclusion: Based on the results and methodologies of published studies, this review concludes that NF for pediatric ADHD can be currently considered as "probably efficacious". (J. of Att. Dis. 2011; XX(X) 1-XX).

PMID: 22090396 [PubMed - as supplied by publisher]

 32. Neurofeedback in ADHD: a single-blind randomized controlled trial.
Bakhshayesh AR, Hänsch S, Wyschkon A, Rezai MJ, Esser G.
Department of Psychology, Faculty of Humanities, Yazd University, Yazd, Iran.
Eur Child Adolesc Psychiatry. 2011 Aug 13. [Epub ahead of print]

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

PMID: 21842168 [PubMed - as supplied by publisher]

 33. Computer-based attention training in the schools for children with attention deficit/hyperactivity disorder: a preliminary trial.
Steiner NJ, Sheldrick RC, Gotthelf D, Perrin EC.
Floating Hospital for Children, Boston, MA, USA. nsteiner@tuftsmedicalcenter.org
Clin Pediatr (Phila). 2011 Jul;50(7):615-22. Epub 2011 May 10.

Abstract
Objective. This study examined the efficacy of 2 computer-based training systems to teach children with attention deficit/hyperactivity disorder (ADHD) to attend more effectively. Design/methods. A total of 41 children with ADHD from 2 middle schools were randomly assigned to receive 2 sessions a week at school of either neurofeedback (NF) or attention training through a standard computer format (SCF), either immediately or after a 6-month wait (waitlist control group). Parents, children, and teachers completed questionnaires pre- and postintervention. Results. Primary parents in the NF condition reported significant (P < .05) change on Conners's Rating Scales-Revised (CRS-R) and Behavior Assessment Scales for Children (BASC) subscales; and in the SCF condition, they reported significant (P < .05) change on the CRS-R Inattention scale and ADHD index, the BASC Attention Problems Scale, and on the Behavioral Rating Inventory of Executive Functioning (BRIEF). Conclusion. This randomized control trial provides preliminary evidence of the effectiveness of computer-based interventions for ADHD and supports the feasibility of offering them in a school setting.

PMID: 21561933 [PubMed - in process]

 34. Complementary medicine for children and young people who have attention deficit hyperactivity disorder.
Skokauskas N, McNicholas F, Masaud T, Frodl T.
Department of Psychiatry, Trinity College, Ireland. N_Skokauskas@yahoo.com.
Curr Opin Psychiatry. 2011 Jul;24(4):291-300.

Abstract
PURPOSE OF REVIEW: Despite effectiveness of medication in treating children and young people who have attention deficit hyperactivity disorder (ADHD), concerns about the effects of medication on children's developing brains, adverse side-effects, possibility of long-term use, and compliance issues have all contributed to the continuing search for alternative therapies. This article reviews the latest scientific evidence of the effectiveness and safety of these treatments in ADHD.
RECENT FINDINGS: Although there is evidence from a large randomized controlled study that neurofeedback has positive effects on reducing children's symptoms of ADHD, most recent randomized controlled trials have generally yielded negative results. Some positive results exist from a pilot study of repetitive transcranial magnetic stimulation. However, the sample size was far too small to enable any conclusions to be drawn about the evidence. Findings from the recent randomized controlled trials of supplements of essential fatty acids in children who have ADHD clearly demonstrated lack of superiority compared with placebo.
SUMMARY: Notwithstanding efforts made to increase the scientific rigor of previous studies, more recent studies have generally been unsuccessful in demonstrating adequate treatment effects of complementary medicine on children who have ADHD. Currently, there is no proof that complementary medicine provides a better alternative for children who have ADHD than treatments that are currently available within multimodal therapy.

PMID: 21602686 [PubMed - in process]

 35. Changes in cognitive evoked potentials during non pharmacological treatment in children with attention deficit/hyperactivity disorder.
Bakhtadze SZ, Dzhanelidze MT, Khachapuridze NS.
S. Khechinashvili Univeristy Clinic, Tbilisi, Georgia.
Georgian Med News. 2011 Mar;(192):47-57.

Abstract
Attention deficit/hyperactivity disorder (ADHD) is one of the most widely spread condition of school aged children affecting 5% of children of this age. The unified consensus of the precise diagnosis of this condition is still absent. This fact encourages the researchers to seek the alternative neurometric tools which will help the clinicians in diagnosis making process of ADHD. The neurophysiologic approaches especially event-related potentials (ERPs) are mostly important from this point of view. The later response of ERPs (P3) reflects the most important parts of executive functioning frequently affected in ADHD children - the process of mental effortfullness to select the appropriate behavior and decision making. Besides the diagnosis the treatment of ADHD is also the point of concern of neurologists and neurophyschologists. In recent years EEG biofeedback (Neurofeedback-NF) have become the alternative treatment as in some cases pharmacological drugs are non effective. The positive impact of NF was based on improvement detected by various questionnaires which are less valid but its effectiveness on ERPs parameters is still unknown. Thus we aimed to study the changes of ERPs after NF therapy.
METHODS: We have studied 93 children with ADHD of combined subtype (ADHDcom) without any kind of pharmacological treatment. Age range 9-12 years. The children were divided into two subgroups: The first ADHDcom-1 (48 children) were children where NF treatment was carried out and the second subgroup of ADHDcom-2 (45 children) were non treated children.
RESULTS: We have observed statistically significant improvement of parameters of later response like P3 in ADHD-1 compared with ADHD-2 whereas NF was non effective for earlier component like N1.
CONCLUSIONS: NF can positively affect on the P3 parameters which is very important in ADHD children as P3 reflects the speed of information processing as well as selection of appropriate action and decision making which are frequently affected in ADHD children.

PMID: 21525539 [PubMed - indexed for MEDLINE]

 36. ADHD and EEG-neurofeedback: a double-blind randomized placebo-controlled feasibility study.
Lansbergen MM, van Dongen-Boomsma M, Buitelaar JK, Slaats-Willemse D.
Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, mariekelansbergen@hotmail.com.
J Neural Transm. 2011 Feb;118(2):275-84. Epub 2010 Dec 17.

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

See complete free article.

PMID: 21165661 [PubMed - in process]

 37. [Neurofeedback training in children with ADHD: behavioral and neurophysiological effects].
Gevensleben H, Moll GH, Heinrich H. [Article in German]
Kinder- und Jugendpsychiatrie, Universitätsmedizin Göttingen.
Z Kinder Jugendpsychiatr Psychother. 2010 Nov;38(6):409-19; quiz 419-20.

Abstract
In a multicentre randomised controlled trial, we evaluated the clinical efficacy of neurofeedback (NF) training in children with ADHD and investigated the mechanisms underlying a successful training. We used an attention skills training, coupled with the training setting and demands made upon participants, as the control condition. At the behavioural level, NF was superior to the control group concerning core ADHD symptomatology as well as associated domains. For the primary outcome measure (improvement in the FBB-HKS total score), the effect size was .60. The same pattern of results was obtained at the 6-month follow-up. Thus, NF may be seen as a clinically effective module in the treatment of children with ADHD. At the neurophysiological level (EEG, ERPs), specific effects for the two NF protocols, theta/beta training, and training of slow cortical potentials were demonstrated. For example, for theta/beta training, a decrease of theta activity in the EEG was associated with a reduction of ADHD symptomatology. SCP training was accompanied inter alia by an increase in the contingent negative variation in the attention network test; thus, children were able to allocate more resources for preparation. EEG- and ERP-based predictors were also found. The present article reviewed the findings of the original papers related to the trial and outlines future research topics.

PMID: 21128217 [PubMed - indexed for MEDLINE]

 38. Neurofeedback in children with ADHD: Specific event-related potential findings of a randomized controlled trial.
Wangler S, Gevensleben H, Albrecht B, Studer P, Rothenberger A, Moll GH, Heinrich H.
Dept. of Child and Adolescent Mental Health, University of Erlangen-Nürnberg, Schwabachanlage 6+10, D-91054 Erlangen, Germany.
Clin Neurophysiol. 2010 Sep 13. [Epub ahead of print].

Abstract
OBJECTIVE: In a randomized controlled trial, we could demonstrate clinical efficacy of neurofeedback (NF) training for children with ADHD (Gevensleben et al., 2009a). The present investigation aimed at learning more about the neuronal mechanisms of NF training.
METHODS: Children with ADHD either completed a NF training or a computerized attention skills training (ratio 3:2). NF training consisted of one block of theta/beta training and one block of slow cortical potential (SCP) training, each comprising 18 training units. At three times (pre-training, between the two training blocks and at post-training), event-related potentials (ERP) were recorded during the Attention Network Test. ERP analysis focused on the P3, reflecting inter alia attentional resources for stimulus evaluation, and the contingent negative variation (CNV), primarily related to cognitive preparation.
RESULTS: After NF training, an increase of the CNV in cue trials could be observed, which was specific for the SCP training. A larger pre-training CNV was associated with a larger reduction of ADHD symptomatology for SCP training.
CONCLUSIONS: CNV effects reflect neuronal circuits underlying resource allocation during cognitive preparation. These distinct ERP effects are closely related to a successful NF training in children with ADHD. In future studies, neurophysiological recordings could help to optimize and individualize NF training.
SIGNIFICANCE: The findings contribute to a better understanding of the mechanisms underlying NF training in children with ADHD.

Copyright © 2010 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.
PMID: 20843737 [PubMed - as supplied by publisher]

 39. Neurofeedback training in children with ADHD: 6-month follow-up of a randomised controlled trial.
Gevensleben H, Holl B, Albrecht B, Schlamp D, Kratz O, Studer P, Rothenberger A, Moll GH, Heinrich H.
Child and Adolescent Psychiatry, University of Göttingen, v.Siebold-Str. 5, Göttingen, Germany.
Eur Child Adolesc Psychiatry. 2010 Sep;19(9):715-24. Epub 2010 May 25.

Abstract
Neurofeedback (NF) could help to improve attentional and self-management capabilities in children with attention-deficit/hyperactivity disorder (ADHD). In a randomised controlled trial, NF training was found to be superior to a computerised attention skills training (AST) (Gevensleben et al. in J Child Psychol Psychiatry 50(7):780-789, 2009). In the present paper, treatment effects at 6-month follow-up were studied. 94 children with ADHD, aged 8-12 years, completed either 36 sessions of NF training (n = 59) or a computerised AST (n = 35). Pre-training, post-training and follow-up assessment encompassed several behaviour rating scales (e.g., the German ADHD rating scale, FBB-HKS) completed by parents. Follow-up information was analysed in 61 children (ca. 65%) on a per-protocol basis. 17 children (of 33 dropouts) had started a medication after the end of the training or early in the follow-up period. Improvements in the NF group (n = 38) at follow-up were superior to those of the control group (n = 23) and comparable to the effects at the end of the training. For the FBB-HKS total score (primary outcome measure), a medium effect size of 0.71 was obtained at follow-up. A reduction of at least 25% in the primary outcome measure (responder criterion) was observed in 50% of the children in the NF group. In conclusion, behavioural improvements induced by NF training in children with ADHD were maintained at a 6-month follow-up. Though treatment effects appear to be limited, the results confirm the notion that NF is a clinically efficacious module in the treatment of children with ADHD.

PMID: 20499120 [PubMed - indexed for MEDLINE]

 40. [Neurofeedback as ADDH therapy].
Stjernholm O. [Article in Danish]
Højderyggens Psykologkontor, 8766 Nørre Snede, Denmark. olestj@os.dk
Ugeskr Laeger. 2010 Aug 16;172(33):2221-5.

Abstract
The article is a review of the past two decades of research on Attention Deficit Hyperactive Disorder (ADHD) and the documented effect of training with EEG biofeedback, often called neurofeedback. Research during the past twenty years seems to confirm that 70-80% of patients benefit from neurofeedback training. Research from the last ten years, using control groups, comparison between different kinds of treatment and psychometric testing, has to some degree confirmed the early findings. Due to the lack of placebo studies or studies comprising false feedback, neurofeedback can only be characterized as probably effective.

PMID: 20727288 [PubMed - indexed for MEDLINE]

 41. The effectiveness of EEG-feedback on attention, impulsivity and EEG: a sham feedback controlled study.
Logemann HN, Lansbergen MM, Van Os TW, Böcker KB, Kenemans JL.
Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands. H.N.A.Logemann@uu.nl
Neurosci Lett. 2010 Jul 19;479(1):49-53. Epub 2010 May 15.

Abstract
EEG-feedback, also called neurofeedback, is a training procedure aimed at altering brain activity, and is used as a treatment for disorders like Attention Deficit/Hyperactivity Disorder (ADHD). Studies have reported positive effects of neurofeedback on attention and other dependent variables. However, double-blind studies including a sham neurofeedback control group are lacking. The inclusion of such group is crucial to control for unspecific effects. The current work presents a sham-controlled, double-blind evaluation. The hypothesis was that neurofeedback enhances attention and decreases impulsive behavior. Participants (n=27) were students selected on relatively high scores on impulsivity/inattention questionnaires (Barrat Impulsivity Scale and Broadbent CFQ). They were assigned to a neurofeedback treatment or a sham group. (sham)Neurofeedback training was planned for 15 weeks consisting of a total of 30 sessions, each lasting 22 min. Before and after 16 sessions (i.e., interim analyses), qEEG was recorded and impulsivity and inattention was assessed using a stop signal task and reversed continuous performance task and two questionnaires. Results of the interim analyses showed that participants were blind with respect to group inclusion, but no trend towards an effect of neurofeedback on behavioral measures was observed. Therefore in line with ethical guidelines the experiment was ceased. These results implicate a possible lack of effect of neurofeedback when one accounts for non-specific effects. However, the specific form of feedback and application of the sham-controlled double-blind design may have diminished the effect of neurofeedback.

Copyright 2010 Elsevier Ireland Ltd. All rights reserved.
PMID: 20478360 [PubMed - indexed for MEDLINE]

 42. [Neurofeedback and attention deficit hyperactivity disorder: what is it and is it working?].
Van As J, Hummelen JW, Buitelaar JK. [Article in Dutch]
jvas@centrummaliebaan.nl
Tijdschr Psychiatr. 2010;52(1):41-50. Comment in Tijdschr Psychiatr. 2010;52(4):277-8; author reply 278-9.

Abstract
BACKGROUND:
Neurofeedback (NF) is a method of treatment that is being used increasingly in the Netherlands, particularly in psychological practices. Many psychiatric and somatic symptoms are currently being treated with the help of NF. In particular, NF is being used more and more to treat attention deficit hyperactivity disorder (ADHD). Despite its growing popularity, NF is still a relatively unknown treatment method in psychiatric practices.
AIM: To investigate the scientific evidence for treating adhd with NF.
METHOD: We searched the literature for reports on controlled trials that investigated the effectiveness of NF on ADHD.
RESULTS: Six controlled trials were located. The studies reported that NF had a positive effect on adhd, but all the studies were marred by methodological shortcomings.
CONCLUSION: On the basis of currently available research results, no firm conclusion can be drawn about the effectiveness of treating adhd by means of NF. In view of the fact that NF is being used more and more as a method of treatment, there is an urgent need for scientific research in this field to be well planned and carefully executed.

PMID: 20054796 [PubMed - indexed for MEDLINE] Free Article (in Dutch)

 43. Distinct EEG effects related to neurofeedback training in children with ADHD: a randomized controlled trial.
Gevensleben H, Holl B, Albrecht B, Schlamp D, Kratz O, Studer P, Wangler S, Rothenberger A, Moll GH, Heinrich H.
Child and Adolescent Psychiatry, University of Göttingen, v.Siebold-Str. 5, D-37075 Göttingen, Germany.
Int J Psychophysiol. 2009 Nov;74(2):149-57. Epub 2009 Aug 25.

Abstract
In a randomized controlled trial, neurofeedback (NF) training was found to be superior to a computerised attention skills training concerning the reduction of ADHD symptomatology (Gevensleben et al., 2009). The aims of this investigation were to assess the impact of different NF protocols (theta/beta training and training of slow cortical potentials, SCPs) on the resting EEG and the association between distinct EEG measures and behavioral improvements. In 72 (of initially 102) children with ADHD, aged 8-12, EEG changes after either a NF training (n=46) or the control training (n=26) could be studied. The combined NF training consisted of one block of theta/beta training and one block of SCP training, each block comprising 18 units of 50 minutes (balanced order). Spontaneous EEG was recorded in a two-minute resting condition before the start of the training, between the two training blocks and after the end of the training. Activity in the different EEG frequency bands was analyzed. In contrast to the control condition, the combined NF training was accompanied by a reduction of theta activity. Protocol-specific EEG changes (theta/beta training: decrease of posterior-midline theta activity; SCP training: increase of central-midline alpha activity) were associated with improvements in the German ADHD rating scale. Related EEG-based predictors were obtained. Thus, differential EEG patterns for theta/beta and SCP training provide further evidence that distinct neuronal mechanisms may contribute to similar behavioral improvements in children with ADHD.

PMID: 19712709 [PubMed - indexed for MEDLINE]

 44. Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis.
Arns M, de Ridder S, Strehl U, Breteler M, Coenen A.
Brainclinics Diagnostics, Nijmegen, The Netherlands. martijn@brainclinics.com
Clin EEG Neurosci. 2009 Jul;40(3):180-9.

Abstract
Since the first reports of neurofeedback treatment in Attention Deficit Hyperactivity Disorder (ADHD) in 1976, many studies have investigated the effects of neurofeedback on different symptoms of ADHD such as inattention, impulsivity and hyperactivity. This technique is also used by many practitioners, but the question as to the evidence-based level of this treatment is still unclear. In this study selected research on neurofeedback treatment for ADHD was collected and a meta-analysis was performed. Both prospective controlled studies and studies employing a pre- and post-design found large effect sizes (ES) for neurofeedback on impulsivity and inattention and a medium ES for hyperactivity. Randomized studies demonstrated a lower ES for hyperactivity suggesting that hyperactivity is probably most sensitive to nonspecific treatment factors. Due to the inclusion of some very recent and sound methodological studies in this meta-analysis, potential confounding factors such as small studies, lack of randomization in previous studies and a lack of adequate control groups have been addressed, and the clinical effects of neurofeedback in the treatment of ADHD can be regarded as clinically meaningful. Three randomized studies have employed a semi-active control group which can be regarded as a credible sham control providing an equal level of cognitive training and client-therapist interaction. Therefore, in line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude that neurofeedback treatment for ADHD can be considered "Efficacious and Specific" (Level 5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.

PMID: 19715181 [PubMed - indexed for MEDLINE]

 45. Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial.
Gevensleben H, Holl B, Albrecht B, Vogel C, Schlamp D, Kratz O, Studer P, Rothenberger A, Moll GH, Heinrich H.
Child & Adolescent Psychiatry, University of Göttingen, Germany
J Child Psychol Psychiatry. 2009 Jul;50(7):780-9. Epub 2009 Jan 12. comment in J Child Psychol Psychiatry. 2009 Jul;50(7):767-8.

Abstract
BACKGROUND: For children with attention deficit/hyperactivity disorder (ADHD), a reduction of inattention, impulsivity and hyperactivity by neurofeedback (NF) has been reported in several studies. But so far, unspecific training effects have not been adequately controlled for and/or studies do not provide sufficient statistical power. To overcome these methodological shortcomings we evaluated the clinical efficacy of neurofeedback in children with ADHD in a multisite randomised controlled study using a computerised attention skills training as a control condition.
METHODS: 102 children with ADHD, aged 8 to 12 years, participated in the study. Children performed either 36 sessions of NF training or a computerised attention skills training within two blocks of about four weeks each (randomised group assignment). The combined NF treatment consisted of one block of theta/beta training and one block of slow cortical potential (SCP) training. Pre-training, intermediate and post-training assessment encompassed several behaviour rating scales (e.g., the German ADHD rating scale, FBB-HKS) completed by parents and teachers. Evaluation ('placebo') scales were applied to control for parental expectations and satisfaction with the treatment.
RESULTS: For parent and teacher ratings, improvements in the NF group were superior to those of the control group. For the parent-rated FBB-HKS total score (primary outcome measure), the effect size was .60. Comparable effects were obtained for the two NF protocols (theta/beta training, SCP training). Parental attitude towards the treatment did not differ between NF and control group.
CONCLUSIONS: Superiority of the combined NF training indicates clinical efficacy of NF in children with ADHD. Future studies should further address the specificity of effects and how to optimise the benefit of NF as treatment module for ADHD.

PMID: 19207632 [PubMed - indexed for MEDLINE]

 46. [Electroencephalographic biofeedback for the treatment of attention deficit hyperactivity disorder in children].
Hou JH, Zhang Y, Xu C. [Article in Chinese]
Department of Pediatrics, Nantong First People's Hospital, Nantong, Jiangsu, 226001, China. hongj65@126.com
Zhongguo Dang Dai Er Ke Za Zhi. 2008 Dec;10(6):726-7.

Abstract
OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is a common behavioral disorder in children. When the children fulfill cognition tasks, brain theta wave activity increases and beta wave activity weakens. This study aimed to explore the efficacy of electroencephalographic (EEG) biofeedback therapy for ADHD in children by assessing the changes of the ratio of brain theta to beta waves and the integrated visual and auditory continuous performance test (IVA-CPT).
METHODS: EEG biofeedback therapy was performed in 30 children with ADHD. The ratio of brain theta to beta waves was measured before and after therapy. IVA-CPT was used to assess the effectiveness of biofeedback therapy.
RESULTS: After two courses of treatment, the mean ratio of brain theta to beta waves in the 30 children with ADHD was significantly reduced from 12.32+/-4.35 (before treatment) to 6.54+/-1.27 (p<0.01). IVA-CPT demonstrated that the values of six indexes measured, including integrate reaction control quotient, integrate attention quotient, auditory and visual reaction control quotients, auditory and visual attention control quotients, were significantly increased after biofeedback therapy (p<0.01).
CONCLUSIONS: EEG biofeedback can reduce the ratio of brain theta to beta waves and lead to significant decreases in inattention and hyperactivity and it is effective for treatment of ADHD in children.

PMID: 19102840 [PubMed - indexed for MEDLINE]

 47. Slow cortical potential neurofeedback in attention deficit hyperactivity disorder: is there neurophysiological evidence for specific effects?.
Doehnert M, Brandeis D, Straub M, Steinhausen HC, Drechsler R.
Department of Child and Adolescent Psychiatry, University of Zurich, Neumuensterallee 9, 8032, Zurich, Switzerland.
J Neural Transm. 2008 Oct;115(10):1445-56. Epub 2008 Sep 2.

Abstract
This study compared changes in quantitative EEG (QEEG) and CNV (contingent negative variation) of children suffering from ADHD treated by SCP (slow cortical potential) neurofeedback (NF) with the effects of group therapy (GT) to separate specific from non-specific neurophysiological effects of NF. Twenty-six children (age: 11.1 +/- 1.15 years) diagnosed as having ADHD were assigned to NF (N = 14) or GT (N = 12) training groups. QEEG measures at rest, CNV and behavioral ratings were acquired before and after the trainings and statistically analyzed. For children with ADHD-combined type in the NF group, treatment effects indicated a tendency toward improvement of selected QEEG markers. We could not find the expected improvement of CNV, but CNV reduction was less pronounced in good NF performers. QEEG changes were associated with some behavioral scales. Analyses of subgroups suggested specific influences of SCP training on brain functions. To conclude, SCP neurofeedback improves only selected attentional brain functions as measurable with QEEG at rest or CNV mapping. Effects of neurofeedback including the advantage of NF over GT seem mediated by both specific and non-specific factors.

PMID: 18762860 [PubMed - indexed for MEDLINE]

 48. Controlled evaluation of a neurofeedback training of slow cortical potentials in children with Attention Deficit/Hyperactivity Disorder (ADHD).
Drechsler R, Straub M, Doehnert M, Heinrich H, Steinhausen HC, Brandeis D.
Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland. renate.drechsler@kjpd.uzh.ch.
Behav Brain Funct. 2007 Jul 26;3:35.

Abstract
BACKGROUND: Although several promising studies on neurofeedback training in Attention Deficit/Hyperactivity Disorder (ADHD) have been performed in recent years, the specificity of positive treatment effects continues to be challenged.
METHODS: To evaluate the specificity of a neurofeedback training of slow cortical potentials, a twofold strategy was pursued: First, the efficacy of neurofeedback training was compared to a group training program for children with ADHD. Secondly, the extent of improvements observed in the neurofeedback group in relation to successful regulation of cortical activation was examined. Parents and teachers rated children's behaviour and executive functions before and after treatment. In addition, children underwent neuropsychological testing before and after training.
RESULTS: According to parents' and teachers' ratings, children of the neurofeedback training group improved more than children who had participated in a group therapy program, particularly in attention and cognition related domains. On neuropsychological measures children of both groups showed similar improvements. However, only about half of the neurofeedback group learned to regulate cortical activation during a transfer condition without direct feedback. Behavioural improvements of this subgroup were moderately related to neurofeedback training performance, whereas effective parental support accounted better for some advantages of neurofeedback training compared to group therapy according to parents' and teachers' ratings.
CONCLUSION: There is a specific training effect of neurofeedback of slow cortical potentials due to enhanced cortical control. However, non-specific factors, such as parental support, may also contribute to the positive behavioural effects induced by the neurofeedback training.

See complete free article.

PMID: 17655749 [PubMed - in process] PMCID: PMC1988816 Free PMC Article

 49. EEG biofeedback in the treatment of attention deficit hyperactivity disorder.
Friel PN.
Washington State Toxicology Laboratory, Forensic Laboratory Services Bureau Suit 360, 2203 Airport Way South, Seattle, WA 98134, USA. Pat.Friel@wsp.wa.gov
Altern Med Rev. 2007 Jun;12(2):146-51.

Abstract
Electroencephalogram (EEG) biofeedback, also known as neurofeedback, is a promising alternative treatment for patients with attention deficit/hyperactivity disorder (AD/HD). EEG biofeedback therapy rewards scalp EEG frequencies that are associated with relaxed attention, and suppresses frequencies associated with under- or over-arousal. In large-scale clinical trials, the efficacy of EEG biofeedback for AD/HD is comparable to that of stimulant medications. Many different EEG biofeedback protocols for AD/HD are available. Single-channel protocols developed by Lubar and interhemispheric protocols developed by the Othmers are widely practiced and supported by large-scale clinical studies.

PMID: 17604459 [PubMed - indexed for MEDLINE] Free Article

 50. Neurofeedback for children with ADHD: a comparison of SCP and Theta/Beta protocols.
Leins U, Goth G, Hinterberger T, Klinger C, Rumpf N, Strehl U.
Department of Psychiatry and Psychotherapy, University Hospital of Tübingen, Osianderstrasse 24, 72076, Tübingen, Germany. Ulrike.leins@med.uni-tuebingen.de
Appl Psychophysiol Biofeedback. 2007 Jun;32(2):73-88. Epub 2007 Mar 14.

Abstract
Behavioral and cognitive improvements in children with ADHD have been consistently reported after neurofeedback-treatment. However, neurofeedback has not been commonly accepted as a treatment for ADHD. This study addresses previous methodological shortcomings while comparing a neurofeedback-training of Theta-Beta frequencies and training of slow cortical potentials (SCPs). The study aimed at answering (a) whether patients were able to demonstrate learning of cortical self-regulation, (b) if treatment leads to an improvement in cognition and behavior and (c) if the two experimental groups differ in cognitive and behavioral outcome variables. SCP participants were trained to produce positive and negative SCP-shifts while the Theta/Beta participants were trained to suppress Theta (4-8 Hz) while increasing Beta (12-20 Hz). Participants were blind to group assignment. Assessment included potentially confounding variables. Each group was comprised of 19 children with ADHD (aged 8-13 years). The treatment procedure consisted of three phases of 10 sessions each. Both groups were able to intentionally regulate cortical activity and improved in attention and IQ. Parents and teachers reported significant behavioral and cognitive improvements. Clinical effects for both groups remained stable six months after treatment. Groups did not differ in behavioural or cognitive outcome.

PMID: 17356905 [PubMed - indexed for MEDLINE]

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