" 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
neurofeedback pour le Trouble du Déficit d'Attention avec ou sans
novembre 2012, l'American
Academy of Pediatrics (qui regroupe plus de 60 000 membres)
recommande le neurofeedback comme un des traitements non médicamenteux
dont l'efficacité est la mieux démontrée
scientifiquement pour le TDAH.
Le neurofeedback pour le TDAH sur Sky News TV
Le trouble du déficit d'attention avec hyperactivité
une situation difficile pour les parents Si vous ne parvenez pas à lire cette vidéo, cliquez
(Remerciements à Sky
Pourcentage de praticiens
de neurofeedback dynamique rapportant une amélioration d'au moins
40% des symptômes chez leurs patients, concernant le Trouble du
Déficit d'Attention avec ou sans Hyperactivité :
au bout de 10 séances. 83 % au-delà de 20 séances.
d'une étude indépendante effectuée en 2014 par Shane
Parkhill, Bsc. Eng. sous la supervision de Charlène Zietsma,
Ph. D (Next Delta Consulting). Etude réalisée 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. Pour accéder
à l'étude complète, cliquez ici
(français) ou ici
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
scientifiques sur le neurofeedback et le Trouble du Déficit d'Attention
avec ou sans Hyperactivité, répertoriées dans la
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 uvre 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.
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.
dynamique 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.
clés pour bien comprendre cette 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
cela, on traite un groupe d'enfants par le neurofeedback (groupe
NFT) et un autre par la Ritaline (Groupe MPH=Méthylphénidate).
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
évaluer les effets des traitements, on utilise des
tests de comportement ("behavioral"), des tests
neuropsychologiques ("neuropsychological"), et des
tests pratiques ("experimental").
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.
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).
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.
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
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.
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.
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 uvre
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 uvre 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,
sur lequel s'appuie le neurofeedback NeurOptimal et qui n'est
pas du conditionnement opérant.)
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.
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.
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
Ritaline a des effets secondaires, pas le neurofeedback NeurOptimal.
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 - n° 4, 5, 6, 13,
16, 18, 22, 35, 37, 38, 43, 44, 46, 48 et 50). 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 de façon simple*
une étude en double aveugle sur le neurofeedback car
il intègre cette option en standard. Du fait de l'automatisation
complète des séances, il est maintenant possible
avec ce logiciel de réaliser simplement 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.
janvier 2012, Geneviève Moreau a soutenu à l'Université
du Québec à Montréal une thèse
présentant les "Effets
du neurofeedback sur le fonctionnement intellectuel et les
comportements d'enfants présentant un TDAH".
Cette étude remarquable a été conduite
en double aveugle grâce à un protocole subtil
et complexe à mettre en uvre. Geneviève
Moreau mentionne qu'en 2010 Roger deBeus et David Kaiser avaient
pu aussi réaliser une étude en double aveugle
selon un mécanisme astucieux mais en partie critiquable.
D'autres tentatives de tester le neurofeedback en double aveugle
ont eu lieu, aux résultats équivoques, les expérimentateurs
ayant des difficultés à simuler le neurofeedback
de façon neutre. Le neurofeedback (mal) simulé
se révèle parfois plus efficace que le neurofeedback
réel, ce qui en fait alors un piètre placebo.
(Voir à ce sujet les études n° 11,
27 et 36 ci-dessous où les groupes supposés
placebo ont obtenu des résultats positifs supérieurs
ou identiques à ceux des groupes de neurofeedback réel.
Pour l'étude n° 8, les groupes placebo et
de neurofeedback semblent n'avoir obtenu aucun résultat.)
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) 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 :
"Il n'a pas été démontré que
l'entraînement au développement cognitif par [...]
le neurofeedback ait amélioré l'état d'adolescents
"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."
"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 [...]."
"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."
"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."
"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."
"...pour les enfants et adolescents atteint de TDA/H [...]
le neurofeedback correspond aux critères de niveau 3 (efficacité
"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."
"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..."
"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."
"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."
"L'utilisation conjointe du neurofeedback et du Méthylphénidate
[NdT : la Ritaline] est plus efficace que
le traitement par Méthylphénidate seul."
"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."
"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."
"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."
"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]."
"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]..."
"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..."
"...d'autres traitements [que les traitements conventionnels]
sont nécessaires [pour le TDAH]. L'un des plus prometteurs
est le neurofeedback..."
"Nous formulons l'hypothèse que le neurofeedback [...]
a un effet sur [le sommeil] ce qui entraîne la stabilisation
de la vigilance."
"...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..."
"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."
"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..."
"En conclusion, le neurofeedback est une option valable pour
le traitement du TDAH, mais d'autres études sont nécessaires
pour guider son utilisation."
"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."
"Résultats : [pour le TDAH] les thérapies comportementales
et le neurofeedback sont les plus recommandables selon ces 
études [des traitements non pharmacologiques]."
"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."
"...cet aspect peut être considéré comme
une caractéristique fiable pour prédire la réaction
[positive d'un enfant] TDAH au neurofeedback."
"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."
"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)."
" la conclusion de cet examen [des études publiées]
est que le neurofeedback pour les enfants TDAH peut être actuellement
considéré comme 'probablement efficace'."
"...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."
"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."
"...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..."
"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."
"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]."
"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."
"Les effets sur les potentiels évoqués mesurés
sont étroitement corrélés à l'efficacité
des séances de neurofeedback chez les enfants atteints de
"...les améliorations du comportement obtenues par des
séances de neurofeedback chez des enfants TDAH étaient
toujours présentes 6 mois plus tard."
"Les recherches effectuées durant ces 20 dernières
années semblent confirmer que 70 à 80% des patients
[TDAH] obtiennent des améliorations grâce au neurofeedback."
"[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 uvre du protocole [...] de l'étude aient
diminué les effets du neurofeedback."
"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..."
"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."
"...nous concluons que le neurofeedback peut être considéré
comme "efficace et spécifique" pour le TDAH."
"Les résultats supérieurs obtenus par une combinaison
de protocoles de neurofeedback montrent l'efficacité clinique
du neurofeedback pour les enfants TDAH."
"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."
"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."
"Il existe un effet spécifique du neurofeedback SCP
[sur les enfants TDAH] dû à une augmentation du contrôle
"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]."
"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 :
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: firstname.lastname@example.org. 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.
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.
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.
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
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 <
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.
[PubMed - in process]
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,
J Dev Behav Pediatr. 2014 Jan;35(1):18-27. doi:
OBJECTIVE: To evaluate the efficacy of 2 computer attention training systems
administered in school for children with attention-deficit hyperactivity
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
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.
[PubMed - in process]
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: email@example.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.
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.
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.
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.
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,
Brain Topogr. 2014 Jan;27(1):20-32. doi: 10.1007/s10548-013-0285-y.
Epub 2013 Apr 6.
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.
[PubMed - in process]
Evidence-Based Psychosocial Treatments for Children and Adolescents with
Evans SW, Owens JS, Bunford N.
Department of Psychology , Ohio University.
J Clin Child Adolesc Psychol. 2013 Nov 18. [Epub
ahead of print]
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.
[PubMed - as supplied by publisher]
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].
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
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.
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.
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.
[PubMed - in process] PMCID: PMC3779016
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.
Biol Psychol. 2013 Sep;94(1):12-21. doi: 10.1016/j.biopsycho.2013.04.015.
Epub 2013 May 9.
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.
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 firstname.lastname@example.org.
J Clin Psychiatry. 2013 Aug;74(8):821-7. doi: 10.4088/JCP.12m08321.
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,
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.
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; email@example.com.
Swiss Med Wkly. 2013 Aug 22;143:w13838. doi: 10.4414/smw.2013.13838.
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
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.
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:
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.
[PubMed - indexed for MEDLINE]
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. firstname.lastname@example.org.
J Atten Disord. 2013 Jul;17(5):420-36. doi: 10.1177/1087054713482580.
Epub 2013 Apr 16.
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
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.
[PubMed - indexed for MEDLINE]
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
Developmental Brain-Behaviour Laboratory, Department of Psychology, University
of Southampton, UK. email@example.com.
Am J Psychiatry. 2013 Mar 1;170(3):275-89. doi:
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.
Nonlinear dynamics measures applied to EEG recordings of patients with
attention deficit/hyperactivity disorder: quantifying the effects of a
Cerquera A, Arns M, Buitrago E, Gutiérrez R, Freund J.
Faculty of Electronic and Biomedical Engineering, Antonio Nariño
University, Bogota, Colombia. firstname.lastname@example.org.
Conf Proc IEEE Eng Med Biol Soc. 2012;2012:1057-60.
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.
[PubMed - indexed for MEDLINE]
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, email@example.com.
Curr Treat Options Neurol. 2012 Dec;14(6):594-607.
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.
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. firstname.lastname@example.org
Med Sci Monit. 2012 Nov;18(11):CS94-104.
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
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
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:
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.
[PubMed - indexed for MEDLINE]
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: email@example.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]
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.
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,
Clin Neurophysiol. 2012 Oct;123(10):1989-2005. doi:
10.1016/j.clinph.2012.03.016. Epub 2012 May 17.
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
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
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
SIGNIFICANCE: This study is the first to systematically investigate tNF
in children suffering from a psychiatric disorder .
[PubMed - indexed for MEDLINE]
The effects of QEEG-informed neurofeedback in ADHD: an open-label pilot
Arns M, Drinkenburg W, Leon Kenemans J.
Research Institute Brainclinics, Bijleveldsingel Nijmegen, The Netherlands.
Appl Psychophysiol Biofeedback. 2012 Sep;37(3):171-80.
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.
[PubMed - indexed for MEDLINE] PMCID: PMC3419351
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. firstname.lastname@example.org.
BMC Psychiatry. 2012 Aug 10;12:107. doi: 10.1186/1471-244X-12-107.
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
Current Controlled Trials NCT01252446.
PMID: 22877086 [PubMed - indexed for MEDLINE] PMCID: PMC3441233
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. email@example.com.
Neurotherapeutics. 2012 Jul;9(3):588-98. doi: 10.1007/s13311-012-0136-7.
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.
[PubMed - in process] PMCID: PMC3441929 [Available on 2013/7/1]
Clinical utility of EEG in attention-deficit/hyperactivity disorder: a
Loo SK, Makeig S.
Department of Psychiatry and Biobehavioral Sciences, University of California
Los Angeles, Los Angeles, CA 90095, USA. firstname.lastname@example.org.
Neurotherapeutics. 2012 Jul;9(3):569-87. doi: 10.1007/s13311-012-0131-z.
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.
[PubMed - in process] PMCID: PMC3441927 [Available on 2013/7/1]
Nonpharmacological Treatments for ADHD: A Meta-Analytic Review.
Hodgson K, Hutchinson AD, Denson L.
J Atten Disord. 2012 May 29. [Epub ahead
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).
[PubMed - as supplied by publisher]
EEG Neurofeedback for ADHD: Double-Blind Sham-Controlled Randomized Pilot
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].
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).
[PubMed - as supplied by publisher]
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.
Neurosci Lett. 2012 May 10;516(1):156-60. doi: 10.1016/j.neulet.2012.03.087.
Epub 2012 Apr 5.
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.
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. email@example.com
Expert Rev Neurother. 2012 Apr;12(4):447-60. doi:
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.
[PubMed - indexed for MEDLINE]
[The usage of neurofeedback in children with ADHD: the method and its
Gevensleben H, Moll GH, Rothenberger A, Heinrich H. [Article in German]
Kinder- und Jugendpsychiatrie, Universitätsmedizin Göttingen.
Prax Kinderpsychol Kinderpsychiatr. 2011;60(8):666-76.
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
[PubMed - indexed for MEDLINE]
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]
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).
[PubMed - as supplied by publisher]
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,
Eur Child Adolesc Psychiatry. 2011 Aug 13. [Epub
ahead of print]
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.
[PubMed - as supplied by publisher]
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. firstname.lastname@example.org
Clin Pediatr (Phila). 2011 Jul;50(7):615-22. Epub
2011 May 10.
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.
[PubMed - in process]
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.
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.
[PubMed - in process]
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.
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.
[PubMed - indexed for MEDLINE]
ADHD and EEG-neurofeedback: a double-blind randomized placebo-controlled
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,
J Neural Transm. 2011 Feb;118(2):275-84. Epub 2010
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.
[Neurofeedback training in children with ADHD: behavioral and neurophysiological
Gevensleben H, Moll GH, Heinrich H. [Article in German]
Kinder- und Jugendpsychiatrie, Universitätsmedizin Göttingen.
Z Kinder Jugendpsychiatr Psychother. 2010 Nov;38(6):409-19;
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.
[PubMed - indexed for MEDLINE]
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,
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].
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
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.
Neurofeedback training in children with ADHD: 6-month follow-up of a randomised
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.
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.
[PubMed - indexed for MEDLINE]
[Neurofeedback as ADDH therapy].
Stjernholm O. [Article in Danish]
Højderyggens Psykologkontor, 8766 Nørre Snede, Denmark.
Ugeskr Laeger. 2010 Aug 16;172(33):2221-5.
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.
[PubMed - indexed for MEDLINE]
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
Neurosci Lett. 2010 Jul 19;479(1):49-53. Epub 2010
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.
2010 Elsevier Ireland Ltd. All rights reserved.
PMID: 20478360 [PubMed - indexed for MEDLINE]
[Neurofeedback and attention deficit hyperactivity disorder: what is it
and is it working?].
Van As J, Hummelen JW, Buitelaar JK. [Article in Dutch]
Tijdschr Psychiatr. 2010;52(1):41-50. Comment in
Tijdschr Psychiatr. 2010;52(4):277-8; author reply 278-9.
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
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.
[PubMed - indexed for MEDLINE] Free Article (in Dutch)
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.
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.
[PubMed - indexed for MEDLINE]
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. email@example.com
Clin EEG Neurosci. 2009 Jul;40(3):180-9.
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.
[PubMed - indexed for MEDLINE]
Is neurofeedback an efficacious treatment for ADHD? A randomised controlled
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.
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
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.
[PubMed - indexed for MEDLINE]
[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. firstname.lastname@example.org
Zhongguo Dang Dai Er Ke Za Zhi. 2008 Dec;10(6):726-7.
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.
[PubMed - indexed for MEDLINE]
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.
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.
[PubMed - indexed for MEDLINE]
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
Department of Child and Adolescent Psychiatry, University of Zurich, Switzerland.
Behav Brain Funct. 2007 Jul 26;3:35.
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.
EEG biofeedback in the treatment of attention deficit hyperactivity disorder.
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.
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.
[PubMed - indexed for MEDLINE] Free Article
Neurofeedback for children with ADHD: a comparison of SCP and Theta/Beta
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.email@example.com
Appl Psychophysiol Biofeedback. 2007 Jun;32(2):73-88.
Epub 2007 Mar 14.
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.
[PubMed - indexed for MEDLINE]
Pour la liste complète
des études concernant le neurofeedback répertoriées
dans la base PubMed, cliquez ici.