Slow cortical potential neurofeedback in attention deficit hyperactivity disorder: Is there neurophysiological evidence for specific effects?

Department of Child and Adolescent Psychiatry, University of Zurich, Neumuensterallee 9, 8032, Zurich, Switzerland.
Journal of Neural Transmission (Impact Factor: 2.4). 10/2008; 115(10):1445-56. DOI: 10.1007/s00702-008-0104-x
Source: PubMed


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.

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    • "We defined our categorization according to earlier approaches (Strehl et al., 2006; Drechsler et al., 2007; Doehnert et al., 2008; Studer et al., 2014) described above, and the assumption that creating a high differentiation between positivation and negativation during the transfer condition is the highest level of self-regulation skill that can be reached. In contrast to other studies that compared increase of regulation ability over the course of the training, we decided that it is most important to show this ability at the end of training. "
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    ABSTRACT: Objective: Attention Deficit-/Hyperactivity Disorder (ADHD) has been treated successfully in children with neurofeedback (NF). In this study, for the first time NF is investigated in adults with ADHD. To answer the question of specificity the relationship between treatment outcome and self-regulation ability is assessed. Methods: Twenty-four participants underwent 30 sessions of slow cortical potential NF. Measurements of ADHD and comorbid symptoms, as well as neurophysiological data (reaction time (RT) and RT variability (RTV) and contingent negative variation (CNV)) were performed before and after treatment, and again six months after sessions were completed. Participants were categorized into self-regulation learners and non-learners. Results: Significant improvements on all symptom scales were observed with medium to large effect sizes after treatment and six months post treatment. RT and RTV decreased significantly and there was a trend for an increased CNV. Half of the participants successfully learned to regulate their brain activity. In the long-term, symptoms in the group of learners improved more than in non-learners with large effect sizes. Conclusion: NF is effective in treating adult ADHD long-term. The impact of self-regulation ability and possible unspecific effects still require further investigation. Significance: This study is the first to investigate the effects of NF in adults with ADHD, relating clinical outcome to self-regulation performance.
    No preview · Article · Nov 2015 · Clinical Neurophysiology
    • "2.4.1. Cued continuous performance test with flankers (CPT-OX; Doehnert et al., 2008; McLoughlin, et al., 2010): The task consisted of 400 black letters, Including cue letter 'O', target letter 'X' and distractors 'H', 'B', 'C', 'D', 'E', 'F', 'G', 'J' and 'L'. "
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    ABSTRACT: Attention-deficit/hyperactivity disorder (ADHD) is associated with cognitive performance and functional brain changes that are sensitive to task conditions, indicating a role for dynamic impairments rather than stable cognitive deficits. Prominent hypotheses consistent with this observation are a failure to optimise brain arousal or activation states. Here we investigate cortical activation during different conditions. Using a sample of 41 non-comorbid adults with ADHD and 48 controls, we examine quantitative EEG activity during a resting state, a cued continuous performance test with flankers (CPT-OX) and the Sustained Attention to Response Task (SART). We further investigate the effects of methylphenidate in a subsample of 21 ADHD cases. Control participants showed a task-related increase in theta activity when engaged in cognitive tasks, primarily in frontal and parietal regions, which was absent in participants with ADHD. Treatment with methylphenidate resulted in normalisation of the resting state to task activation pattern. These findings suggest that ADHD in adults is associated with insufficient allocation of neuronal resources required for normal cortical activation commensurate with task demands. Further work is required to clarify the causal role of the deficit in cortical activation and provide a clearer understanding of the mechanisms involved.
    No preview · Article · Nov 2014 · European Neuropsychopharmacology
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    • "In children with ADHD, increased CNV amplitudes after SCP training compared to a waiting-list group had also been reported previously (Heinrich et al., 2004). Even though in a study by Doehnert et al. (2008) in children with ADHD a decrease in CNV amplitudes was observed after both SCP training and group therapy, this decrease was less pronounced in those children who successfully learned SCP self-regulation. Also in adults with ADHD, preliminary results after 15 SCP sessions indicated a trend toward a CNV amplitude increase (Mayer et al., 2012a,b). "
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    ABSTRACT: Neurofeedback (NF) is being successfully applied, among others, in children with ADHD and as a peak performance training in healthy subjects. However, the neuronal mechanisms mediating a successful NF training have not yet been sufficiently uncovered for both theta/beta (T/B), and slow cortical potential (SCP) training, two protocols established in NF in ADHD. In the present randomized controlled investigation in adults without a clinical diagnosis (n = 59), the specificity of the effects of these two NF protocols on attentional processes, and motor system excitability were to be examined, focusing on the underlying neuronal mechanisms. NF training consisted of 10 double sessions, and self-regulation skills were analyzed. Pre- and post-training assessments encompassed performance and event-related potential measures during an attention task, and motor system excitability assessed by transcranial magnetic stimulation. Some NF protocol specific effects have been obtained. However, due to the limited sample size medium effects didn’t reach the level of significance. Self-regulation abilities during negativity trials of the SCP training were associated with increased contingent negative variation amplitudes, indicating improved resource allocation during cognitive preparation. Theta/beta training was associated with increased response speed and decreased target-P3 amplitudes after successful theta/beta regulation suggested reduced attentional resources necessary for stimulus evaluation. Motor system excitability effects after theta/beta training paralleled the effects of methylphenidate. Overall, our results are limited by the non-sufficiently acquired self-regulation skills, but some specific effects between good and poor learners could be described. Future studies with larger sample sizes and sufficient acquisition of self-regulation skills are needed to further evaluate the protocol specific effects on attention and motor system excitability reported.
    Full-text · Article · Jul 2014 · Frontiers in Human Neuroscience
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