L'association
ADNF




Séances de neurofeedback



Diffusion du neurofeedback





 

  


" V o u s   n' i m a g i n e z   p a s   t o u t   c e   q u e   l e   n e u r o f e e d b a c k   p e u t   f a i r e   p o u r   v o u s ! "
 
 

Association pour la Diffusion du Neurofeedback en France

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

                                                                                                                                                                                                                                                                                                                                         

Le neurofeedback pour le TDAH sur Sky News TV
Le trouble du déficit d'attention avec hyperactivité chez l'enfant,
une situation difficile pour les parents
Si vous ne parvenez pas à lire cette vidéo, cliquez ici
(Remerciements à Sky News)

 

Pourcentage de praticiens rapportant une amélioration d'au moins 40% des symptômes chez leurs patients, concernant le Trouble du Déficit d'Attention avec ou sans Hyperactivité :

27,7 % au bout de 10 séances.
83,7% au-delà de 20 séances.

Résultats d'une étude indépendante effectuée à l'Université de Victoria (Canada) par Charlène Zietsma, Ph. D, en décembre 2008. Etude réalisée auprès de plusieurs centaines de praticiens utilisant le logiciel NeurOptimal™ de la société Zengar Institute, totalisant 1,2 millions d'heures de séances de neurofeedback. Cliquez ici pour accéder à l'étude complète (en anglais).
La valeur de 40% d'amélioration est retenue comme étant ce que l'on peut espérer de mieux grâce à la plupart des médicaments, pour la plupart des symptômes évalués dans l'étude. C'est aussi 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.

 

Le neurofeedback a fait en 2006-2008 l'objet d'une étude pour le traitement du Trouble du Déficit de l'Attention et Hyperactivité (TDAH) au Laboratoire de Neurosciences Fonctionnelles et Pathologies du CHU d'Amiens (UMR 8160, unité du CNRS). Cette étude compare les effets du neurofeedback réalisé avec le logiciel NeuroCARE® (aujourd'hui rebaptisé NeurOptimal™) et ceux de la Ritaline sur des enfants atteints de ce trouble. Elle a fait l'objet d'une publication scientifique (en anglais) consultable ici.

Quelques clés pour bien comprendre cette étude :

1) L'étude cherche à savoir pour le traitement du TDAH  a) si le neurofeedback a des effets positifs et  b) si ces effets sont équivalents à ceux de la Ritaline.

2) Pour cela, on traite un groupe d'enfants par le neurofeedback (groupe NFT) et un autre par la Ritaline (Groupe MPH=Méthylphénidate).

3) Un troisième groupe d'enfants "normaux" (non TDAH) sert de référence (Groupe Contrôle). Ce groupe permet de voir entre autre s'il est possible d'améliorer ses résultats à un test d'évaluation sans suivre aucun des 2 traitements, par apprentissage spontané au cours du premier test, auquel cas le test en question n'est pas très probant pour évaluer l'efficacité des traitements.

4) Pour évaluer les effets des traitements, on utilise des tests de comportement ("behavioral"), des tests neuropsychologiques ("neuropsychological"), et des tests pratiques ("experimental").

5) On regarde si les résultats des tests après traitement ("post-test") sont meilleurs que les résultats des tests avant traitement ("pre-test") en moyenne pour tous les enfants du groupe.

6) On mesure l'importance d'un effet obtenu (ES="Effect size") et sa signification statistique ("significant" si probabilité p<0,05 soit moins de 1 chance sur 20 [5%] que l'effet observé soit dû au hasard).

7) On compare les résultats des tests des groupes neurofeedback et Ritaline entre eux, avant et après traitement. Si un groupe obtient de meilleurs résultats qu'un autre après traitement (post-test), il faut notamment examiner si les deux groupes partaient bien sur la même ligne de départ c'est-à-dire s'ils avaient des résultats similaires au pre-test.

8) On peut aussi comparer les résultats post-test des groupes neurofeedback et Ritaline avec le groupe contrôle pour voir si les enfants sont devenus "normaux" suite au traitement. Ainsi que les résultats pre-test pour voir si selon un certain test, les enfants TDAH étaient déjà "normaux" avant traitement, auquel cas ce test n'est sans doute pas adapté à l'évaluation du TDAH.

9) Les résultats ne sont pas simples à analyser du fait de la multitude des tests utilisés. Concernant les effets positifs du neurofeedback, l'étude conclue que les résultats démontrent que le neurofeedback peut améliorer significativement plusieurs fonctions comportementales et cognitives chez les enfants TDAH. Concernant l'équivalence entre le neurofeedback et la Ritaline, l'étude conclue que ces traitements ne sont pas équivalents et que les effets obtenus par la Ritaline sont supérieurs mais que la différence n'est pas statistiquement significative.

Quelques remarques :

Cette étude est la première étude qui ait été réalisée en France pour évaluer les effets du neurofeedback. Elle représente un important travail de recherche. Mais on peut penser qu'elle aurait pu aboutir à une conclusion plus en faveur du neurofeedback que de la Ritaline pour le traitement du TDAH si une approche différente avait été utilisée.

1) La version du logiciel NeurOptimal™ (anciennement NeuroCARE®) utilisée pour cette étude date de 2005 et est maintenant très ancienne par rapport à la version actuelle qui a été largement optimisée et automatisée depuis. En outre cette version a été mise en œuvre en ne travaillant que sur la bande thêta et sur la bande béta au lieu des 8 bandes utilisées habituellement avec ce logiciel, avec réglage manuel du seuil maximum pour thêta (bande de fréquence inhibée = "inhibit") et du seuil minimum pour béta (bande de fréquence augmentée = "augment"). Ce faisant les auteurs de l'étude souhaitaient mettre en œuvre l'approche du neurofeedback traditionnel et le principe du conditionnement opérant. Ils n'ont donc pas utilisé le logiciel NeurOptimal™ au maximum de son potentiel. (Notons que le feedback étant fourni par des interruptions sonores et visuelles du film, les auteurs n'ont pas pu éviter le déclenchement de la réponse d'orientation après détection d'une turbulence, principe sur lequel s'appuie le neurofeedback NeurOptimal™ et qui n'est pas du conditionnement opérant.)

2) Les enfants TDAH ont reçu 24 séances de neurofeedback. Ce nombre de séance est adapté pour des séances effectuées avec le logiciel NeurOptimal™. En neurofeedback plus traditionnel, à la façon dont a été utilisé NeuroCARE® avec tous les automatismes débrayés, le nombre de séances habituel pour le TDAH est d'environ 40. L'expérience acquise par les praticiens permet de penser qu'avec 40 séances au lieu de 24, ou sans débrayer les automatismes de NeurOptimal™, les effets obtenus auraient été aussi importants qu'avec la Ritaline et que ces deux traitements auraient pu être considérés comme équivalents.

3) L'étude n'évalue pas la présence possible de contraintes externes habituellement connues pour freiner les effets du neurofeedback. Concernant des enfants TDAH, on pourrait notamment recenser certains problèmes organiques (thyroïde, asthme, apnée du sommeil...), la prise de certains médicaments (benzodiazépines...) ou de cannabis, une alimentation déséquilibrée (sucre...), un contexte psychologique particulièrement difficile, et le nombre d'heures quotidiennes passées devant la télévision, tous ces points étant connus pour pouvoir diminuer l'efficacité des séances.

4) L'étude n'évalue pas les effets à long terme du traitement. Or on sait que les effets du neurofeedback perdurent au-delà des séances, contrairement à ceux de la Ritaline qui cessent à l'arrêt du traitement.

5) La Ritaline a des effets secondaires, pas le neurofeedback NeurOptimal™.

Pour conclure, notons que les effets spécifiques du neurofeedback ne sont pas évalués dans cette étude (même s'ils l'ont été dans d'autres études présentées ci-dessous - réf. 6, 8, 9, 14, 15, 17, 19 et 21). On ne peut exclure ici a priori que les effets obtenus par le neurofeedback soient dus à un effet placebo lié par exemple au soin apporté à l'enfant par le praticien, à l'aspect enthousiasmant de cette technologie pour le praticien, l'enfant et ses parents, etc. Seule une étude en double aveugle permettrait d'évacuer totalement cette possibilité. Le logiciel NeurOptimal™ est le seul qui permette aujourd'hui de conduire une étude en double aveugle sur le neurofeedback. Du fait de l'automatisation complète des séances, il est en effet possible de réaliser des séances de neurofeedback réel ou simulé à l'insu du patient et du praticien et de comparer les résultats selon le type de séance donné. Cette étude en double aveugle n'a pas encore été entreprise à ce jour.

 

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 les plus récentes, publiées depuis l'année 2007 dans la base PubMed (les publications ne comportant pas de résumé ont été omises). Ces 21 études résumées ci-dessous concluent :

 1.

"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)."
 
 2.

"…la conclusion de cet examen [des études publiées] est que le neurofeedback pour les enfants TDAH peut être actuellement considéré comme "probablement efficace"."
 
 3.

"...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."
 
 4.

"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."
 
 5.

"Bien qu'il soit prouvé par une vaste étude randomisée et controlée que le neurofeedback a des effets positifs sur la réduction des symptômes des enfants TDAH, les études randomisées et controlées les plus récentes ont généralement donné des résultats négatifs [?]."
 
 6.

"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."
 
 7.

"...une étude en double aveugle [sur les effets du neurofeedback] pourrait n'être pas faisable car l'utilisation de seuils de récompense ajustés automatiquement pourrait être moins efficace que des seuils de récompense ajustés manuellement."
 
 8.

"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."
 
 9.

"Les effets sur les potentiels évoqués mesurés sont étroitement corrélés à l'efficacité des séances de neurofeedback chez les enfants atteints de TDAH."
 
 10.

"...les améliorations du comportement obtenues par des séances de neurofeedback chez des enfants TDAH étaient toujours présentes 6 mois plus tard."
 
 11.

"Les recherches effectuées durant ces 20 dernières années semblent confirmer que 70 à 80% des patients [TDAH] obtiennent des améliorations grâce au neurofeedback."
 
 12.

"[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."
 
 13.

"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..."
 
 14.

"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."
 
 15.

"...nous concluons que le neurofeedback peut être considéré comme "efficace et spécifique" pour le TDAH."
 
 16.

"Les résultats supérieurs obtenus par une combinaison de protocoles de neurofeedback montrent l'efficacité clinique du neurofeedback pour les enfants TDAH."
 
 17.

"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."
 
 18.

"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."
 
 19.

"Il existe un effet spécifique du neurofeedback SCP [sur les enfants TDAH] dû à une augmentation du contrôle cortical."
 
 20.

"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]."
 
 21.

"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. [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]

 2. 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]

 3. 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]

 4. 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]

 5. 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]

 6. 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]

 7. 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.

PMID: 21165661 [PubMed - in process]

 8. [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]

 9. 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]

 10. 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]

 11. [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]

 12. 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]

 13. [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)

 14. 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]

 15. 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]

 16. 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]

 17. [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]

 18. 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]

 19. 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

 20. 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.

See complete free article.

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

 21. 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]

Pour la liste complète des études concernant le neurofeedback répertoriées dans la base PubMed, cliquez ici.

[Haut]