No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Training of slow cortical potentials in attention-deficit/hyperactivity disorder: Evidence for positive behavioral and neurophysiological effects
Abstract
Learned self-control of slow cortical potentials (SCPs) may lead to behavioral improvement in attention-deficit/hyperactivity disorder (ADHD). Hence, training effects should also be reflected at the neurophysiological level.
Thirteen children with ADHD, aged 7-13 years, performed 25 SCP training sessions within 3 weeks. Before and after training, the German ADHD rating scale was completed by parents, and event-related potentials were recorded in a cued continuous performance test (CPT). For a waiting-list group of nine children with ADHD, the same testing was applied.
ADHD symptomatology was reduced by approximately 25% after SCP training. Moreover, a decrease of impulsivity errors and an increase of the contingent negative variation were observed in the CPT task.
This study provides first evidence for both positive behavioral and specific neurophysiological effects of SCP training in children with ADHD.
... This training, also called EEG frequency band (FREQ) training, addresses the tonic aspects of cortical arousal (Liechti et al., 2012). The other protocol is the training of slow cortical potentials (SCP), a type of event-related potential (ERP), and it is directed to phasic regulation of cortical excitability (Gevensleben et al., 2009;Heinrich, Gevensleben, Freisleder, Moll, & Rothenberger, 2004;Strehl et al., 2006). ...
... Previous studies have reported a decrease of behavioral problems and improved cognitive performance in ADHD children after theta/beta and SCP training (Bakhshayesh, Hänsch, Wyschkon, Rezai, & Esser, 2011;Drechsler et al., 2007;Fuchs, Birbaumer, Lutzenberger, Gruzelier, & Kaiser, 2003;Gevensleben et al., 2009Gevensleben et al., , 2010Heinrich et al., 2004;Monastra, Monastra, & George, 2002;Leins et al., 2007). Moreover, some studies have found that improvements are maintained after six months (Gevensleben et al., 2010;Leins et al., 2007), and even after two years after completing the training (Gani, Birbaumer, & Strehl, 2008). ...
... Moreover, some studies have found that improvements are maintained after six months (Gevensleben et al., 2010;Leins et al., 2007), and even after two years after completing the training (Gani, Birbaumer, & Strehl, 2008). Additionally, several studies have found certain normalization of EEG and ERP after NF training (Bakhshayesh et al., 2011;Doehnert et al., 2008;Heinrich et al., 2004;Kropotov et al., 2005;Monastra et al., 2002). Nevertheless, NF efficacy in comparison to medication, gold standard ADHD treatment, is still not well established. ...
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.
... /fnhum. . the use of commercially non-available systems "Goettinger Feedback" (GoeFi) (Heinrich et al., 2004;Drechsler et al., 2007) and "Self-regulation and Attention Management" (SAM) (Gevensleben et al., 2009b(Gevensleben et al., , 2014aStuder et al., 2014), which had been used in studies for ADHD. Thereafter, commercial systems have become available, and systems by neuroConn (neuroConn GmbH, Ilmenau, Germany) have been established as the most used (∼50% of all studies), while equipment from Though Technology (Thought Technology Ltd, Montreal) has been used in two studies (Milner et al., 2016;Morales-Quezada et al., 2019). ...
... The number of sessions ranged widely from 1 to 35 across the published studies. Eight studies employed multiple training units per session (Heinrich et al., 2004;Drechsler et al., 2007;Gevensleben et al., 2009bGevensleben et al., , 2014aStuder et al., 2014;Minder et al., 2018;Okumura et al., 2019). When considering training units instead of sessions, the median was 24 units (range: 1-35). ...
... Three studies reported that participants were doing homework in the lab or directly after training, whilst applying the regulatory strategies, under supervision of the trainer (Strehl et al., 2006a(Strehl et al., , 2017Baumeister et al., 2018). Five studies reported that parents were instructed to help the participants (Drechsler et al., 2007;Gevensleben et al., 2009bGevensleben et al., , 2014bMinder et al., 2018;Hasslinger et al., 2020), and four studies reported use of a log for the transfer exercises (Heinrich et al., 2004;Christiansen et al., 2014;Mayer et al., 2016;Albrecht et al., 2017). Transfer exercises were often introduced after having completed half of the planned sessions, and often introduced before a longer training-break. ...
Neurofeedback (NF) aims to alter neural activity by enhancing self-regulation skills. Over the past decade NF has received considerable attention as a potential intervention option for many somatic and mental conditions and ADHD in particular. However, placebo-controlled trials have demonstrated insufficient superiority of NF compared to treatment as usual and sham conditions. It has been argued that the reason for limited NF effects may be attributable to participants' challenges to self-regulate the targeted neural activity. Still, there is support of NF efficacy when only considering so-called “standard protocols,” such as Slow Cortical Potential NF training (SCP-NF). This PROSPERO registered systematic review following PRISMA criteria searched literature databases for studies applying SCP-NF protocols. Our review focus concerned the operationalization of self-regulatory success, and protocol-details that could influence the evaluation of self-regulation. Such details included; electrode placement, number of trials, length per trial, proportions of training modalities, handling of artifacts and skill-transfer into daily-life. We identified a total of 63 eligible reports published in the year 2000 or later. SCP-NF protocol-details varied considerably on most variables, except for electrode placement. However, due to the increased availability of commercial systems, there was a trend to more uniform protocol-details. Although, token-systems are popular in SCP-NF for ADHD, only half reported a performance-based component. Also, transfer exercises have become a staple part of SCP-NF. Furthermore, multiple operationalizations of regulatory success were identified, limiting comparability between studies, and perhaps usefulness of so-called transfer-exercises, which purpose is to facilitate the transfer of the self-regulatory skills into every-day life. While studies utilizing SCP as Brain-Computer-Interface mainly focused on the acquisition of successful self-regulation, clinically oriented studies often neglected this. Congruently, rates of successful regulators in clinical studies were mostly low (<50%). The relation between SCP self-regulation and behavior, and how symptoms in different disorders are affected, is complex and not fully understood. Future studies need to report self-regulation based on standardized measures, in order to facilitate both comparability and understanding of the effects on symptoms. When applied as treatment, future SCP-NF studies also need to put greater emphasis on the acquisition of self-regulation (before evaluating symptom outcomes).
Systematic review registration
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260087 , Identifier: CRD42021260087.
... Furthermore, children with ADHD showed significant improvements in inattentive symptoms after receiving 30 sessions of SCP E-NFT as compared to the children with ADHD that had underwent group sessions [17]. The overall ADHD symptoms were also improved after 25 SCP neurofeedback sessions in children with ADHD as compared to children with ADHD that were on a waiting list (Heinrich et al., 2004). Improved scores on a sustained attention task after 20 sessions beta power enhancing E-NFT (short: beta E-NFT) was found in healthy subjects as well, but only when the beta waves were changed after E-NFT [18]. ...
... In this study, large effect sizes were found for impulsivity and Applied Neuroscience And Mental Health inattention and a medium effect size for hyperactivity, therefore stating E-NFT as an efficacious and specific treatment for ADHD. However, a lot of these controlled studies showed important methodological problems [30], such as the lack of a specific control group [31,32] or missing the randomization of group assignment [20,31]. The evidence of E-NFT for the treatment of ADHD was therefore recently considered insufficient [33]. ...
... The efficacy of standard E-NFT protocols for the treatment of ADHD is in line with previous studies that found improved inattention and HI symptoms in children with ADHD after TBR and SCP E-NFT [16,31,32] and after SMR and TBR E-NFT [20]. These positive effects on attention after TBR and SMR E-NFT is also found in healthy young people [46][47][48]. ...
Electroencephalography-Neurofeedbacktraining (E-NFT) is a method to support subjects in learning to self-regulate their own brain activity. Besides that E-NFT may improve cognitive functions in healthy people, it may improve symptoms in different disorders, such as Attention Deficit and Hyperactivity Disorder (ADHD) and insomnia. The evidence of E-NFT for the treatment of attention problems in ADHD is still under debate, just as the suggested efficacy of E-NFT for reducing sleep problems in individuals suffering from insomnia and for improving attention and sleep in the general population. Therefore, this review examines the efficacy of E-NFT on attention and sleep in patients and healthy individuals. The reviewed literature provides evidence that standard E-NFT protocols may have a positive long-lasting effect on the inattention and hyperactivity/impulsivity symptoms in children with ADHD. In healthy children and young adults, E-NFT has been found to improve different aspects of attention and to reduce impulsivity. In addition, positive effects of E-NFT have been documented on sleep onset latency and on tiredness in healthy individuals. Sleep improvements have also been found in insomnia patients after standard E-NFT, although these subjective sleep improvements may likely depend on unspecific E-NFT training effects.
... Several studies have investigated the impact of SCP-NF on the CNV during a cued continuous performance task (CPT) probing attention and anticipation as well as inhibition. Heinrich, Gevensleben, Freisleder, Moll, and Rothenberger (2004) showed that SCP-NF increased the CNV amplitude while no increase was found in the waiting-list group. This CNV increase was interpreted as a neurophysiological equivalent of improved self-regulation capabilities. ...
... We hypothesized that CPT performance and attentional and preparatory neurophysiological activity to Cues are associated with symptom severity and can predict clinical outcome. We expected specific treatment effects in terms of enhanced CPT performance and Cue-P3 and CNV amplitudes following SCP-NF compared to EMG-BF (Heinrich et al., 2004;Wangler et al., 2011). ...
... Instead, a larger Cue P3 at baseline tended to predict inattention improvement rated by teachers in the SCP-NF group only. Regarding specific effects after SCP-NF, we failed to support earlier findings of increased CNV amplitude at a group level after SCP-NF training during a CPT task (Heinrich et al., 2004;Wangler et al., 2011). However, the CNV decrease at Pz and Cz interacted significantly with group, showing that the increase of the CNV negativity was associated with more clinical improvements for inattention and impulsivity symptoms rated by parents in the SCP-NF group. ...
Neurophysiological measures of preparation and attention are often atypical in ADHD. Still, replicated findings that these measures predict which patients improve after Neurofeedback (NF), reveal neurophysiological specificity, and reflect ADHD-severity are limited.
Methods
We analyzed children’s preparatory (CNV) and attentional (Cue-P3) brain activity and behavioral performance during a cued Continuous Performance Task (CPT) before and after slow cortical potential (SCP)-NF or semi-active control treatment (electromyogram biofeedback). Mixed-effects models were performed with 103 participants at baseline and 77 were assessed for pre-post comparisons focusing on clinical outcome prediction, specific neurophysiological effects of NF, and associations with ADHD-severity.
Results
Attentional and preparatory brain activity and performance were non-specifically reduced after treatment. Preparatory activity in the SCP-NF group increased with clinical improvement. Several performance and brain activity measures predicted non-specifictreatment outcome.
Conclusion
Specific neurophysiological effects after SCP-NF were limited to increased neural preparation associated with improvement on ADHD-subscales, but several performance and neurophysiological measures of attention predicted treatment outcome and reflected symptom severity in ADHD. The results may help to optimize treatment.
... The existing studies addressing the effect of NFB on ERP components in ADHD patients have used multi-session NFB interventions employing either theta/beta ratio, SCP or SMR protocols (Arns et al., 2012, Bluschke et al., 2016, Gevensleben et al., 2014, Heinrich et al., 2004, Krepel et al., 2020, Kropotov et al., 2005, Mayer et al., 2016. Consistent behavioral improvements were reported in the domain of hyperactivity, impulsivity and attention (Arns et al., 2012, Gevensleben et al., 2010, Krepel et al., 2020, Kropotov et al., 2005, Micoulaud-Franchi et al., 2014, Ryoo and Son, 2015, Van Doren et al., 2018, in parallel with an enhancement of neurophysiological responses linked to cognitive control, especially the P3 component (Arns et al., 2012, Bluschke et al., 2016, Graczyk et al., 2014, Kropotov et al., 2005, Zioga et al., 2019. ...
... An increase of both N2 and P3 amplitudes after repetitive SMR training was also observed together with an improvement of attention, hyperactivity/impulsivity in ADHD children and adults (Arns et al., 2012), a clinical effectiveness recently replicated using individually-based qEEG training (Krepel et al., 2020). In cued-CPT tasks, multi-session training of the SCP type was consistently reported to induce an increase of the cue-related CNV amplitude, indicative of improved availability of attention resources for preparing motor response (Gevensleben et al., 2014, Heinrich et al., 2004, Mayer et al., 2016. Additionally, performance improvements were observed, such as reduction of omission errors at the CPT (Heinrich et al., 2004), RT and RT variability reduction (Gevensleben et al., 2014, Mayer et al., 2016, as well as significant attenuation of ADHD symptoms (Heinrich et al., 2004, Mayer et al., 2016. ...
... In cued-CPT tasks, multi-session training of the SCP type was consistently reported to induce an increase of the cue-related CNV amplitude, indicative of improved availability of attention resources for preparing motor response (Gevensleben et al., 2014, Heinrich et al., 2004, Mayer et al., 2016. Additionally, performance improvements were observed, such as reduction of omission errors at the CPT (Heinrich et al., 2004), RT and RT variability reduction (Gevensleben et al., 2014, Mayer et al., 2016, as well as significant attenuation of ADHD symptoms (Heinrich et al., 2004, Mayer et al., 2016. We hereby show that in adult ADHD, a single session of alpha-down-NFB positively impacted the neurocognitive processes involved in motor response (P3 correlation with RT variability), but also those related to perceptual and attentional discrimination (P3 correlation with d-prime and correct hits), which were all impaired compared to controls. ...
Objective
Event-related potentials (ERPs) are reported to be altered in relation to cognitive processing deficits in attention deficit hyperactivity disorder (ADHD). However, this evidence is mostly limited to cross-sectional data. The current study utilized neurofeedback (NFB) as a neuromodulatory tool to examine the ERP correlates of attentional and inhibitory processes in adult ADHD using a single-session, within-subject design.
Methods
We recorded high-density EEG in 25 adult ADHD patients and 22 neurotypical controls during a Go/NoGo task, before and after a 30-minute NFB session designed to down-regulate the alpha (8-12 Hz) rhythm.
Results
At baseline, ADHD patients demonstrated impaired Go/NoGo performance compared to controls, while Go-P3 amplitude inversely correlated with ADHD-associated symptomatology in childhood. Post NFB, task performance improved in both groups, significantly enhancing stimulus detectability (d-prime) and reducing reaction time variability, while increasing N1 and P3 ERP component amplitudes. Specifically for ADHD patients, the pre-to-post enhancement in Go-P3 amplitude correlated with measures of improved executive function, i.e., enhanced d-prime, reduced omission errors and reduced reaction time variability.
Conclusions
A single-session of alpha down-regulation NFB was able to reverse the abnormal neurocognitive signatures of adult ADHD during a Go/NoGo task.
Significance
The study demonstrates for the first time the beneficial neurobehavioral effect of a single NFB session in adult ADHD, and reinforces the notion that ERPs could serve as useful diagnostic/prognostic markers of executive dysfunction.
... 21 Subsequently, single and multiple case studies carried out by researchers reported a decrease of core symptoms of ADHD and improvement in neuropsychological functions (attention and response inhibition), behavioral, academic performance, and EEG measures. [22][23][24][25][26][27][28][29][30][31][32] Short-and long-term benefits of NFT were found to be positive with no adverse side effects. Children who received NFT were able to maintain the outcome after 6 months 25,29 and 2 years after completing NFT. 31 In addition, studies have proved certain normalization of EEG and ERP after NFT. ...
... Children who received NFT were able to maintain the outcome after 6 months 25,29 and 2 years after completing NFT. 31 In addition, studies have proved certain normalization of EEG and ERP after NFT. 22,27,31,33,34 NFT in ADHD is carried out using different protocols with a different rationale. Theta/beta NFT protocol is administered based on the "under-arousal hypothesis," that is, children with ADHD has elevated relative theta power and reduced relative beta power. ...
... 35,36 Another widely used NFT protocol employs slow cortical potentials (SCPs) as treatment parameter. 27,37,38 SCPs neurofeedback is different from other protocol approaches, in that changes in the polarity of the EEG are rewarded (ie, positivity vs negativity in the EEG). Researchers have hypothesized that learned self-control of SCPs may lead to behavioral improvement in ADHD. ...
Background:
Attention deficit/hyperactivity disorder (ADHD) is a highly prevalent childhood disorder with symptoms of inattention, impulsivity, and hyperactivity. EEG neurofeedback training (NFT) is a new intervention modality based on operant conditioning of brain activity, which helps reduce symptoms of ADHD in children.
Methods and procedures:
To examine the efficacy of NFT in children with ADHD, an experimental longitudinal design with pre-post comparison was adopted. A total of 30 children in the age range of 6 to 12 years diagnosed as ADHD with or without comorbid conditions were assigned to treatment group (TG; n = 15) and treatment as usual group (TAU; n = 15). TG received EEG-NFT along with routine clinical management and TAU received routine clinical management alone. Forty sessions of theta/beta NFT at the C3 scalp location, 3 to 4 sessions in a week for a period of 3.5 to 5 months were given to children in TG. Children were screened using sociodemographic data and Binet-Kamat test of intelligence. Pre-and postassessment tools were neuropsychological tests and behavioral scales. Follow-up was carried out on 8 children in TG using parent-rated behavioral measures.
Results:
Improvement was reported in TG on cognitive functions (sustained attention, verbal working memory, and response inhibition), parent- and teacher-rated behavior problems and on academic performance rated by teachers. Follow-up of children who received NFT showed sustained improvement in ADHD symptoms when assessed 6 months after receiving NFT.
Conclusion:
The present study suggests that NFT is an effective method to enhance cognitive deficits and helps reduce ADHD symptoms and behavior problems. Consequently, academic performance was found to be improved in children with ADHD. Improvement in ADHD symptoms induced by NFT were maintained at 6-month follow-up in children with ADHD.
... MNF training systems for children with ADHD are currently being developed [29]. However, neurofeedback training remains a new concept in Korea, and there is insufficient research verifying its effectiveness. ...
... Our results suggest that MNF training results in improved attention in children with ADHD, which is consistent with the findings of previous studies that have verified the effectiveness of neurofeedback training. A previous study by Heinrich et al. [29] reported that the total ARS score and the commission errors in CPT improved after neurofeedback training. Roh et al. [1] showed that neurofeedback improves attention in children with ADHD. ...
Objective:
: To examine the effect of mobile neurofeedback training on the clinical symptoms, attention abilities, and execution functions of children with attention deficit hyperactivity disorder (ADHD).
Methods:
: The participants were 74 children with ADHD aged 8-15 years who visited the Department of Child and Adolescent Psychiatry at Seoul National University Children's Hospital. The participants were randomly assigned to the mobile neurofeedback (n = 35) or control (sham; n = 39) group. Neurofeedback training was administered using a mobile app (equipped with a headset with a 2-channel electroencephalogram [EEG] sensor) for 30 min/day, 3 days/week, for 3 months. Children with ADHD were individually administered various neuropsychological tests, including the continuous performance test, Children's Color Trails Test-1 and 2, and Stroop Color and Word Tests. The effects of mobile neurofeedback were evaluated at baseline and at 3 and 6 months after treatment initiation.
Results:
: Following treatment, both mobile neurofeedback-only and sham-only groups showed significant improvements in attention and response inhibition. In the visual continuous performance test, omission errors decreased to the normal range in the mobile neurofeedback-only group after training, suggesting that mobile neurofeedback effectively reduced inattention in children with ADHD. In the advanced test of attention, auditory response times decreased in the mobile neurofeedback + medication group after training, but increased in the sham+medication group. Overall, there were no significant between-group differences in other performance outcomes.
Conclusion:
: Mobile neurofeedback may have potential as an additional therapeutic option alongside medication for children with ADHD.
... The reasons for exclusion are detailed in Additional file 3: Table S3. Finally, fourteen articles using the randomized controlled trial (RCT) design were selected for the current study [22,[33][34][35][36][37][38][39][40][41][42][43][44][45] (Table 1). The Kappa index of agreement was 1.0. ...
... Of the 12 studies that used the TB ratio as their main EEG-NF treatment protocol, two also included beta wave enhancement in their protocols (Table 1). On the other hand, two studies used the SCP protocol [42,43]. In the current meta-analysis, comparison groups consisted of TAU/ waitlist and other non-pharmaceutical interventions ( Table 1). ...
Background
The efficacy of surface electroencephalographic neurofeedback (EEG-NF) for improving attentional performance assessed by laboratory measures in patients with attention-deficit/hyperactivity disorder (ADHD) remains unclear.
Methods
Following the PRISMA guidelines, the PubMed, Embase, ClinicalKey, Cochrane CENTRAL, ScienceDirect, Web of Science, and ClinicalTrials.gov databases were systematically searched for randomized controlled trials on the efficacy of surface EEG-NF against ADHD focusing on attentional performance evaluated by laboratory measures from inception to January 2022.
Results
Fourteen eligible studies were analyzed. Of the 718 participants involved, 429 diagnosed with ADHD received EEG-NF treatment. Significant improvement in attentional performance in ADHD subjects receiving EEG-NF was noted compared to their comparators (p < 0.01). Besides, there was a significant EEG-NF-associated beneficial effect on sustained attention (Hedges’ g = 0.32, p < 0.01), whereas the impact on selective attention (p = 0.57) and working memory (p = 0.59) was limited. Moreover, protocol including beta wave enhancement was superior to that only focusing on reducing theta/beta ratio or modulation of slow cortical potential. Subgroup analyses showed that three sessions per week of EEG-NF produced the best effect, while the efficacy of surface EEG-NF was much poorer (Hedges’ g = 0.05) when only studies that blinded their participants from knowledge of treatment allocation were included. No significant difference was noted in the improvement of attentional performance 6–12 months after EEG-NF intervention (n = 3, p = 0.42).
Conclusions
Our results demonstrated the satisfactory effectiveness of surface EEG-NF for improving sustained attention, especially when beta wave enhancement was included, despite its failure to sustain a long-term effect. Further large-scale trials are warranted to support our findings.
... We deemed 21 RCTs comprising a total of 1261 participants to be eligible for inclusion in the present study (Table 1). 14,15,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] The κ coefficient was 1.0. Comparison groups included treatment as usual, wait list, electromyography (EMG)-biofeedback, computerized attention training, cognitive therapies, behavioural interventions, physical activities and sham/ placebo feedback. ...
... 7,8 In particular, the study by Lévesque and colleagues showing a large ES for therapeutic efficacy of EEG-NF did not provide data from teachers' observations. 32 Therefore, despite the lower risk 43 Arnold et al. 14 Rajabi et al. 42 Lim et al. 33 Moreno-García et al. 37 Geladé et al. 28 Minder et al. 36 Strehl et al. 40 Bihnk et al. 26 Christiansen et al. 27 Maurizio et al. 35 Steiner et al. 38 van Dongen-Boomsma et al. 41 Bakhshayesh et al. 25 Lansbergen et al. 15 Steiner et al. 39 Gevensleben et al. 29 Holtmann et al. 31 Lévesque 32 Heinrich et al. 30 Linden et al. E441 of detection bias from teachers' observations (i.e., probably blind) compared with that from parents, there may be other factors leading to discrepancies in the perception of therapeutic effects of EEG-NF among different observers. ...
... It is both diagnostic and prognostic, for attention-training tasks that can improve users' attentional abilities which in turn improve BCI performances (Arns et al., 2013;Brandmeyer and Delorme, 2013;Jeunet et al., 2016;Martínez et al., 2016;Monastra et al., 2006;Rohani and Puthusserypady, 2015;Yang et al., 2017). EEG-based neurofeedback is considered a promising alternative communication and control channel for improving the cognitive skills of children with ADHD (Gevensleben et al. 2009(Gevensleben et al. , 2010Heinrich et al., 2004;L evesque et al., 2006;Qian et al., 2018;Wang et al., 2007;Vernon et al., 2004). A practical issue concerns the design of new protocols that can make BCI applications more user-friendly as well as the roles of the researcher and experimenter concerning the demystification of the BCI technology, the writing of informed-consent forms and the social presence and trust relationship with the user (Jeunet et al., 2016). ...
... Thus, BCI neurofeedback system proved to be particularly effective for ADHD (Yang et al., 2017). Neuro-feedback effects are substantial revealing a superiority of the NFT in reducing ADHD symptoms by approximately 25% after Slow Cortical Potentials, even under strict control conditions (Gevensleben et al. 2009(Gevensleben et al. , 2010Heinrich et al., 2004). Novel approaches, which use 2D/3D games in conjunction with BCI technology, provide a promising process in training attention for ADHD patients. ...
The aim of this article is to explore a paradigm shift on Brain Computer Interface (BCI) research, as well as on intervention best practices for training and rehabilitation of students with neurodevelopmental disorders. Recent studies indicate that BCI devices have positive impact on students' attention skills and working memory as well as on other skills, such as visuospatial, social, imaginative and emotional abilities. BCI applications aim to emulate humans' brain and address the appropriate understanding for each student's neurodevelopmental disorders. Studies conducted to provide knowledge about BCI-based intervention applications regarding memory, attention, visuospatial, learning, collaboration, and communication, social, creative and emotional skills are highlighted. Only non-invasive BCI type of applications are being investigated based upon representative, non-exhaustive and state-of-the-art studies within the field. This article examines the progress of BCI research so far, while different BCI paradigms are investigated. BCI-based applications could successfully regulate students' cognitive abilities when used for their training and rehabilitation. Future directions to investigate BCI-based applications for training and rehabilitation of students with neurodevelopmental disorders concerning the different populations involved are discussed.
... Studies have demonstrated promising effects on behavior, cognitive, and electrophysiological measures after SCP-NF (Christiansen, Reh, Schmidt, & Rief, 2014;Drechsler et al., 2007;Gevensleben et al., 2009;Heinrich, Gevensleben, Freisleder, Moll, & Rothenberger, 2004;Maurizio et al., 2013;Strehl et al., 2006). A recent meta-analysis failed to support NF as an effective treatment for ADHD but this result may reflect methodological weaknesses of the available studies rather than the weakness of NF as such (Cortese et al., 2016). ...
... Analysis Plan (SAP) dated and maintained by the IZKS responsible for data management, monitoring, and analysis (for details, see Holtmann et al., 2014). Sample size calculation for the primary endpoint was based on an estimation of eff ect sizes derived from the SCP-NF study by Heinrich et al., (2004) using the same outcome measure. Expecting a mean ADHD score of 1.2 at post-test 2 in the NF group and of 1.5 in controls with a common SD of 0.55 a sample size of 72 per group was required to achieve a power of 90% (α = 0.05, two-sided t-test). ...
The present thesis focused on specificity and long-term effects of slow-cortical potential neurofeedback (SCP-NF) treatment for children with ADHD in a large multicenter randomized controlled trial, on its relation to aggressive behaviors as a common comorbidity of ADHD, and on neuroimaging and psychophysiological subtypes of aggression. We assessed clinical efficacy on ADHD and comorbid aggression in comparison to a semi-active control group which controlled for unspecific effects. The role of self-regulation and learning of SCPs was systematically evaluated. Additionally, we investigated amygdala-specific activity in aggression subtypes in a large multicenter cohort, which might provide a possible putative NF target. The first two studies assessed 150 children aged 7–9 years diagnosed with ADHD which were randomized to 25 sessions of feedback of SCPs (NF) or feedback of coordination of the supraspinatus muscles (EMG). The primary outcome was the change in ADHD symptoms rated by parents four weeks and six-month after treatment end. Slow-cortical potential neurofeedback showed significant superiority over the semi-active control condition with medium effect sizes four weeks after treatment. This superiority of SCP-NF over the semi-active control group became non-significant 6 months after treatment end. However, taking together all assessments, SCP-NF showed a stable improvement with large effect sizes following treatment and EMG-BF showed worsening of symptoms one month after treatment, with subsequent remission at follow-up, leading to non-significant group differences six months after treatment end. Assessment of self-regulation showed significant ability to self-regulate slow-cortical potential when direct feedback is given and improvement of self-regulation skills indicate specificity of SCP-NF for selected subscales after training, but not at follow-up. In sum, these findings suggest shared specific and unspecific effects contributing to this clinical outcome. The third study aimed to disentangle aggression-related subtypes at a neural level. In total 177 participants (n=108 cases with aggression-related disorders and n= 69 typically developing peers), aged 8-18 years were assessed across nine sites in Europa during a well-established emotional face-matching fMRI task. Additionally, simultaneous skin conductance recordings were acquired in a subsample (n=64). Children and adolescents with aggression-related problems showed higher amygdala activity in response to negative faces compared to typically developing peers. Further, we showed distinct amygdala activity for subtypes of aggression. Callous-unemotional traits showed to moderate both central (amygdala) and peripheral (SC) responses. These findings increase insights which could be used for personalized diagnostics and treatments.
... These meta-analysis show that neurofeedback training has a positive effect on ADHD symptoms and that the effects last. Several articles investigate specific neurofeedback techniques, such as slow cortical potential training (Heinrich et al., 2004;Strehl et al., 2006), and investigate the underlying neurophysiological effects of these treatments (Gevensleben et al., 2009). These studies contribute to a better understanding of how neurofeedback alters brain function in ADHD patients to improve attention, impulsivity, and hyperactivity. ...
Introduction: This study conducts a bibliometric analysis on neurofeedback research to assess its current state and potential future developments. Methods: It examined 3,626 journal articles from the Web of Science (WoS) using co-citation and co-word methods. Results: The co-citation analysis identified three major clusters: “Real-Time fMRI Neurofeedback and Self-Regulation of Brain Activity,” “EEG Neurofeedback and Cognitive Performance Enhancement,” and “Treatment of ADHD
Using Neurofeedback.” The co-word analysis highlighted four key clusters: “Neurofeedback in Mental Health Research,” “Brain-Computer Interfaces for Stroke Rehabilitation,” “Neurofeedback for ADHD in Youth,” and “Neural Mechanisms of Emotion and Self-Regulation with Advanced Neuroimaging. Discussion: This in-depth bibliometric study significantly enhances our understanding of the dynamic field of neurofeedback, indicating its potential in treating ADHD and improving performance. It offers non-invasive, ethical alternatives to conventional psychopharmacology and aligns with the trend toward personalized medicine, suggesting specialized solutions for mental health and rehabilitation as a growing focus in medical practice.
... The total sample included 3147 children and adolescents with ADHD (75.98% boys aged 5-18 years). Forty-eight effect sizes utilized cognitive training in 15 interventions (Ackermann et al., 2018;Bigorra et al., 2016;Chacko et al., 2014;Egeland et al., 2013;Green et al., 2012;Kazemi and Mohammadi, 2019;Klingberg et al., 2005Klingberg et al., , 2002Lee et al., 2021;Muris et al., 2018;Sperafico et al., 2021;Steeger et al., 2016;Tucha et al., 2011;van der Donk et al., 2015;Van Dongen-Boomsma et al., 2014); 45 used EF-specific curriculum in 16 interventions (Gerber et al., 2012;Hannesdottir et al., 2017;Janmohammadi et al., 2019;Lan et al., 2020;Lloyd et al., 2010;Menezes et al., 2015;Miranda et al., 2013Miranda et al., , 2002Moreno-García et al., 2019;Qian et al., 2017;Smith et al., 2019;Steeger et al., 2016;Tamm et al., 2013;Vanzin et al., 2020;Wexler et al., 2021); 44 tested game-based training in 12 interventions (Azami et al., 2016;Bikic et al., 2018Bikic et al., , 2017Dovis et al., 2015;Estrada-Plana et al., 2019;Johnstone et al., 2017Johnstone et al., , 2010Jones et al., 2020;Kermani et al., 2016;Lan et al., 2020;Meyer et al., 2020;Prins et al., 2011); 24 used neurofeedback training in 13 studies (Alegria et al., 2017;Bakhshayesh et al., 2011;Dobrakowski and Łebecka, 2020;Drechsler et al., 2007;Geladé et al., 2017;Heinrich et al., 2004;Janssen et al., 2016;Lévesque et al., 2006;Maurizio et al., 2014;Moreno-García et al., 2019;Rezaei et al., 2018;Shereena et al., 2019;Wang, 2017); 26 measured physical exercise in 17 studies (Benzing and Schmidt, 2019;Bustamante et al., 2016;Chang et al., 2014;Choi et al., 2015;Faramarzi et al., 2016;Geladé et al., 2017;Janssen et al., 2016;Kadri et al., 2019;Lee et al., 2017;Memarmoghaddam et al., 2016;Pan et al., 2019Pan et al., , 2016Rezaei et al., 2018;Silva et al., 2020;Verret et al., 2012;Ziereis and Jansen, 2015); only one study (Kiani et al., 2017) focused on mindfulness practices. Intervention frequency ranged from 1 to 5 times per week, sessions lasted 8.5-120 min, number of intervention sessions ranged from 3 to 64, and total duration ranged from 105 to 7200 min. ...
Objective:
Although front-line doctors recommend medications, this kind of treatment has limited efficacy in improving executive functions (EFs) in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). This study explored the effects of non-pharmacological intervention on EFs in children and adolescents with ADHD.
Methods:
In accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines, we searched seven electronic databases: APA PsycINFO, CINAHL Complete, EMBASE, ERIC, Medline, Pubmed, and Web of Science, from inception to March 2022. Two authors independently screened studies for eligibility, extracted data, and assessed bias risk using the Physiotherapy Evidence Database scale. Our analyses included randomized controlled trials and non-randomized comparison studies of non-pharmacological interventions and assessed EFs through neurocognitive tasks in children and adolescents between 5 and 18 years.
Results:
Sixty-seven studies with 3147 participants met the inclusion criteria. The final meta-analysis included 74 independent interventions categorized into six categories: cognitive training, EF-specific curriculum, game-based training, mindfulness practice, neurofeedback training, and physical exercise. Overall, non-pharmacological interventions (combined) produced significant moderate to large effects on overall EFs in children and adolescents with ADHD (g=0.673). Physical exercise had a large positive effect on domain-specific EFs, including inhibitory control (g=0.900) and cognitive flexibility (g=1.377). Cognitive training had a large training effect on working memory (g=0.907), and an EF-specific curriculum had a small to moderate beneficial effect on planning performance (g=0.532).
Conclusion:
Non-pharmacological interventions, particularly physical exercise, cognitive training, and an EF-specific curriculum, appear to have beneficial effects on EFs in children and adolescents with ADHD.
... F. Lubar & Shouse, 1976) reported improved attention and normalized levels of arousal, together with improved grades and achievement scores for the (eight) children under treatment. Subsequent studies have reported similarly positive results, showing improvements of behaviour, attention and impulsivity (Alhambra et al., 1995;Carmody et al., 2000;Drechsler et al., 2007;Gevensleben et al., 2010;Gevensleben et al., 2009;Heinrich et al., 2004;Kaiser & Othmer, 2000;Kropotov et al., 2005;Leins et al., 2007;Linden et al., 1996;J.F. Lubar et al., 1995;J. ...
... The classification of Slow Cortical Potential (SCP) signals is crucial not only for BCI but also for several other disciplines, including stroke rehabilitation [56] and neuroscience research [57][58][59]. Furthermore, SCP signals are strongly correlated with Attention Deficit Hyperactivity Disorder (ADHD) [60][61][62], and numerous studies have shown that teaching patients to modify their SCP signals dramatically raises their test results for behavior, focus, and Intelligence Quotient (IQ) [63]. ...
Brain-Computer Interface (BCI) is a promising technique because of its wide variety of applications, from treating cognition in humans to person authentication. Brain signals can be transmitted straight to a prosthetic device from the BCI system, without the need for nerve or muscle activity. For accurately identifying the transmitted signals at the prosthetic device, considering the nature of the Electroencephalography (EEG) signal, and extracting the most informative features are effective keys. In this paper, we studied the cyclostationarity of the Slow Cortical Potential (SCP) EEG signals for BCI applications, following our previous studies. Cyclostationary analysis reveals the hidden periodicity in the signal and provides a second-order statistical description in the frequency domain. We used the FFT Accumulation Method (FAM), an effective computational algorithm, to extract the features of the Spectral Correlation Function (SCF). The features are classified using SVM RBF, SVM polynomial, and K-Nearest Neighbor classifiers, and they are considered with different pre-processing. Our research indicates that the SCP EEG signal has cyclostationary properties and this idea is applied to the BCIs as well. The classification accuracy on the BCI Competition 2003 dataset Ia’s increased considerably, by spotting the intrinsic correlation between just two EEG signals.
... In fact, the preparation for a "go" stimulus following the cue stimulus generates the contingent negative variation (CNV) [25][26][27]. The CNV is an event-related potential component which has been connected to different important cognitive processes as the preparation for the arrival of an upcoming event [28], the demanding of focused attention [29] and the timing of task execution [30,31]. In the current study, both early and late ERP components were investigated, aiming to describe the differences of focusing attention on the different types of cues (directional (DS) and non-directional (nDS) stimuli). ...
Different visual stimuli can capture and shift attention into different directions. Few studies have explored differences in brain response due to directional (DS) and non-directional visual stimuli (nDS). To explore the latter, event-related potentials (ERP) and contingent negative variation (CNV) during a visuomotor task were evaluated in 19 adults. To examine the relation between task performance and ERPs, the participants were divided into faster (F) and slower (S) groups based on their reaction times (RTs). Moreover, to reveal ERP modulation within the same subject, each recording from the single participants was subdivided into F and S trials based on the specific RT. ERP latencies were analysed between conditions ((DS, nDS); (F, S subjects); (F, S trials)). Correlation was analysed between CNV and RTs. Our results reveal that the ERPs’ late components are modulated differently by DS and nDS conditions in terms of amplitude and location. Differences in ERP amplitude, location and latency, were also found according to subjects’ performance, i.e., between F and S subjects and trials. In addition, results show that the CNV slope is modulated by the directionality of the stimulus and contributes to motor performance. A better understanding of brain dynamics through ERPs could be useful to explain brain states in healthy subjects and to support diagnoses and personalized rehabilitation in patients with neurological diseases.
... The orientation of the voluntary attention involves the top-down system, since it is initiated in the medial frontal cortex and medial parietal areas 12 , and facilitates the anticipatory biasing of the system toward task relevant information 7 . One of the electroencephalographic measures related to the orientation of voluntary attention is the contingent negative variation (CNV) 13,14 . The CNV is a fronto-central slow-wave negative deflection related to motor anticipation that occurs prior to stimulus onset 10,15. ...
BACKGROUND: The fronto-central slow-wave known as the contingent negative variation (CNV) is an electroencephalographic measure related to the ability of the motor system to extract spatial-temporal regularities to produce a motor response. AIM: This study aimed to investigate the levels of electrocortical activity prior to predictable and unpredictable stimuli in a motor control task, and the association between CNV and reaction time (RT). METHOD: Seventeen participants performed a task that consisted of removing the right index finger from the space bar as fast as possible after stimulus onset. All participants practiced under both a predictable (PC) and an unpredictable (UC) context. RESULTS: Results indicated that RT under the unpredictable context was slower than under the predictable context. However, CNV levels under predictable and unpredictable contexts did not differ. CONCLUSION: The certainty of stimulus appearance in the UC may have produced effects similar to those under the PC, resulting in similar CNV levels. However, the use of this mechanism under the UC was suboptimal to motor performance.
... Fourth, different types of controls were used in the studies. In three (Bakhshayesh et al., 2011;Baumeister et al., 2018;Strehl et al., 2017) semi-active control in the form of EMG have been used; Konicar et al. (2021) used an active control group undergoing conventional treatment, that is, clinical counseling during for patients diagnosed with ASD; Schönenberg et al. (2017), Schabus et al. (2017 and Pineda et al. (2008) conducted sham-controlled studies, Heinrich et al. (2004), Dadashi et al. (2015) and Wang et al. (2016) didn't use any intervention for the control group (waiting list approach), and five studies didn't collect any data from the control group, instead comparing the performers vs non performers (Janssen et al., 2017;Lubar et al., 1995;Veilahti et al., 2021) or different types of protocols (Janssen et al., 2017;Mohagheghi et al., 2017;Plotkin & Rice, 1981;Veilahti et al., 2021) within NFB treatment group. Two studies assessed the additive effects of NFB treatment: Lee and Jung (2017) examined the potential effect of NFB for children diagnosed with ADHD beginning a medication trial first and Bink et al. (2015) studied whether NFB is of additional value to treatment as usual (TAU) for adolescents with clinical ADHD symptoms. ...
NFB has a clear potential as a recognised treatment option for ADHD, but suffers from a lack of clarity about its efficacy, still unresolved after multiple controlled trials. Comparing learners and non-learners based on the evolution of patient-level indicators during the trial serves as a ‘natural’ control, and can help elucidate the mechanisms of NFB. We present a systematic review motivated by the need to establish the state of the art of patient learning during NFB treatment in current clinical literature. One particularly striking question we would like to answer here is whether existing NFB papers study learning variability, since only individual performance differences can give us information about mechanisms of learning. The results show that very few clinical trial reports have dealt with the heterogeneity of NFB learning, nor analysed whether NFB efficacy is dependent on NFB learning, even though NFB is believed to be a treatment based on learning to perform. In this systematic review we examine not only what has been reported, but also provide a critical analysis of possible flaws or gaps in existing studies, and discuss why no generalized conclusions about NFB efficacy have yet been made. Future research should focus on finding reliable ways of identifying the performers and studying participants’ individual learning trajectories as it might enhance prognosis and the allocation of clinical resources.
... Neurofeedback training of slow cortical potentials (SCPs) is another probably effective approach. It aims at first learning to control and self-regulate certain brain activity parameters (via real-time feedback and operant principles), and as the next step utilizing this ability (by transfer) to improve everyday life functioning [e.g., (68)(69)(70)(71)(72)]. The focus of the current study is on slow-frequency shifts in the electroencephalogram (EEG) that reflect the excitation of larger cortical cell assemblies (71,73). ...
Objectives
Neurofeedback (NF) and self-management training (SMT) may be viable treatment options for patients with attention deficit hyperactivity disorder (ADHD) if they alleviate core symptoms, enhance the patients’ self-concept and improve their quality of life (QoL). Aim of the current study is evaluating both interventions accordingly and to test whether specific improvements in core symptoms lead to more general improvements in self-concept and QoL.
Methods
In a psychotherapeutic outpatient clinic in Germany, a total of N = 139 children with ADHD were screened for eligibility, of which 111 fulfilled inclusion criteria and participated in the study in accordance with the CONSORT 2010 statement. These were randomly assigned to NF vs. SMT interventions. Changes from pre- to post-intervention in core ADHD symptoms relying on parent and teacher reports (CONNERS 3) and objective tests (Qb-Test) as well as self-concept (interview with the children) and QoL assessments (using the KINDL-R self-report) were compared between patients receiving NF or SMT.
Results
Significant improvements in ADHD symptoms were achieved similarly in both treatment groups, whilst QoL and self-concept improved after SMT only.
Conclusion
This treatment study provides further evidence that SMT and NF may reduce core symptoms, but SMT may also improve patients’ self-concept and QoL and may thus in its current form be the favorable treatment option in naturalistic settings. However, several limitations of the current study implicate that further research is required before definitive conclusions and recommendations for clinical practice can be given.
Clinical trial registration
[www.clinicaltrials.gov], identifier [NCT01879644].
... In the Lubar and Lubar 27 study in children after SMR and beta wave training, all children increased SMR or beta values and decreased slow EEG activity, which was also evident in their spectral strengths regarding increased beta and decreased slow activity and improved school success. Normalization of ERP components in participants with ADHD after NFB training is also described by several other authors 28,29 . These results indicate the possibility of using SMR NFB as a therapeutic method for attention improvement. ...
Background/Aim. This study aimed to investigate the effect of sensorimotor rhythm (SMR) (12-15 Hz) neurofeedback (NFB) training on auditory cognition measured by achievement on the QuickSIN test, changes in the amplitudes and latencies of evoked potentials in auditory oddball discrimination task and changes in the spectral power of the sensorimotor rhythm. Methods. Each of 16 healthy participants aged 25-40 years (8 male) had 20 daily sessions of SMR neurofeedback training. Auditory cognitive functions and electrophysiological correlates of cognitive processing were recorded 5 times: before NFB, after 5, 10, and 20 sessions, and one month after the last session. Results. The results showed a statistically significant decrease in N200 and P300 latencies at Fz, Cz, and Pz regions, improvement on the QuickSIN test and increase in EEG SMR rhythm spectral power in Cz region as a result of NFB SMR training. No significant effect of NFB training on the amplitude of N100, N200 and P300 on Fz, Cz and Pz was found. Conclusion.The obtained results suggest that sensorimotor rhythm training (SMR) neurofeedback (NFB) affects auditory perception in terms of shorter latencies of evoked potentials and better performance on QuickSIN test.
... With respect to the etiopathogenesis of this disorder, it is still not firmly established, but the preponderance of evidence suggests that Attention Deficit Hyperactivity Disorder, is a highly heritable disorder, with abnormalities in neuroanatomy (reduced cortical volume of white and gray matter), neurochemistry (dopamine and serotonin); neurophysiology (dysfunction of frontostriatal structures), which result in electrophysiological under-excitation of the central nervous system [12]. ...
In the field of special education, and in particular, in the rehabilitation treatment of patients with Attention Deficit Hyperactivity Disorder, a multidimensional neurodevelopmental disorder characterized by a mixed pattern of inattention and hyperactivity and/or impulsivity, virtual reality integrated with neurofeedback produces an intensive neurocognitive training capable of enhancing long-term attentional capacity and, at the same time, reduce hyperactivity and/or impulsivity. Research has shown that learning enhanced by technology and, in particular, by neurofeedback combined with cognitive training based on video games produces better therapeutic effects than other common therapeutic approaches, such as conventional therapies and pharmacological proposals, as the playful component greatly increases the motivation to learn by the patient / player, providing the opportunity to live not only an immersive and fun experience, but also therapeutic in terms of symptomatic reduction.
... In this model, self-regulation, or neuro-regulation, is defined as explicit learning of controlled cognitive processes of cortical regulation evidenced by normalised shifts in EEG amplitudes [242,248,249]. Performance optimisation is evidenced by improved skill in changing the "EEG state" via self-initiated effort during task performance [243,250]. The therapist's role is to use cognitive behavioural therapy elements such as positive feedback and coaching and operant procedures as active support within treatment sessions to enhance self-efficacy and self-confidence to support neuro-regulation [244,251]. ...
Psychological theory and interpretation of research are key elements influencing clinical treatment development and design in Attention Deficit Hyperactivity Disorder (ADHD). Research-based treatment recommendations primarily support Cognitive Behavioural Therapy (CBT), an extension of the cognitive behavioural theory, which promotes a deficit-focused characterisation of ADHD and prioritises symptom reduction and cognitive control of self-regulation as treatment outcomes. A wide variety of approaches have developed to improve ADHD outcomes in adults, and this review aimed to map the theoretical foundations of treatment design to understand their impact. A scoping review and analysis were performed on 221 documents to compare the theoretical influences in research, treatment approach, and theoretical citations. Results showed that despite variation in the application, current treatments characterise ADHD from a single paradigm of cognitive behavioural theory. A single theoretical perspective is limiting research for effective treatments for ADHD to address ongoing issues such as accommodating context variability and heterogeneity. Research into alternative theoretical characterisations of ADHD is recommended to provide treatment design opportunities to better understand and address symptoms.
... When only these well researched and established protocols were included in meta-analysis (Cortese et al., 2016), the effects of NF on total ADHD were significant even for blinded raters (SMD = 0.36, 95% CI = 0.04-0.69). Arguably, Slow Cortical Potential NF (SCP) is the most prominent standard NF training protocol in the treatment of ADHD, with multiple trials showing improvements on both inattention and hyperactivity symptoms (Aggensteiner et al., 2019;Gevensleben et al., 2014;Heinrich et al., 2004;Strehl et al., 2017). Apart from ADHD, SCP has also demonstrated promising effects for epilepsy Tan et al., 2009) and migraine (Siniatchkin et al., 2000). ...
Neurofeedback (NF) as a treatment for Attention Deficit Hyperactivity Disorder (ADHD) has been evaluated in several trials, but the specificity and generalizability of effects remain unclear. This four-arm randomized controlled trial evaluated the efficacy of Slow Cortical Potential (SCP; standard NF protocol) and Live Z-score (LZS; non-standard NF protocol) delivered in high-frequency format (five sessions per week during five weeks), compared to Working-memory training (WMT; active comparator) and Treatment-as-usual (TAU; passive comparator). N = 202 children/adolescents aged 9 to 17 years with ADHD participated. The primary outcome measure was multi-report (self-, teacher-, and parent-report) ADHD core symptoms on the Conners-3, assessed at baseline, posttreatment, and 6-months follow-up. Data were analyzed using a linear mixed model. Between-group differences were scarce and did not show a distinct pattern. Superiority of LZS over TAU at endpoint were observed for teacher-rated measures only, while significant differences between SCP and TAU were restricted to posttreatment measurements. Contrary to our expectations, LZS outperformed SCP at endpoint for teacher-rated hyperactivity (-5.37; 95% CI: -10.14 to -0.60; p = .028; d = -.36 ) and overall ADHD symptoms (-2.20; -4.18 to -0.22; p = .030; d = -.41 ). There was no indication that either form of NF was superior to WMT. No severe adverse events were reported during the trial, whereas transient stress-related problems were quite frequent. Overall, the results from this pragmatic trial do not provide convincing support for broad implementation of NF in child and adolescent psychiatric services. Future research should try to clarify for whom and under what circumstances NF might be a viable treatment option.
... This very slow activity is characterized by a negative shift in the EEG, in anticipation of an expected event. This ERP seems to be smaller in children with ADHD, reflecting a reduction of self-regulation abilities (Heinrich, Gevensleben, Freisleder, Moll, & Rothenberger, 2004). In order to regulate this ERP Neurofeedback protocols based on the Slow Cortical Potential (SCP) are carried out. ...
ADHD is a common neurodevelopmental disorder, affecting 3-5% of the children. It refers to a variable cluster of inattention, hyperactivity and impulsivity symptoms. Neurofeedback is a rising approach to manage this disorder. This technique aims to enable subjects to learn how to modulate their own brain activity.
This thesis aimed at evaluating the effects of a new Neurofeedback training protocol in children with ADHD, exploiting a neurophysiological marker that has never been used in that context, the cortical P300 response. This event-related potential reflects selective and voluntary attention mechanisms and is affected in ADHD. A randomized controlled trial (RCT) has been performed, which entailed a blind comparison with an active control condition based on gaze and a non-blind comparison with a waiting group. This Neurofeedback training was provided through visual Brain-computer Interface (BCI) games.
We first demonstrated that typically developing children can control this kind of BCI. This first study also allowed us to build and evaluate a Template, corresponding to the evoked responses of these children, that was later used as the neurophysiological target in the Neurofeedback training group. In a second study, we further showed that typically developing children can control, using the Template, the three BCI games designed for the RCT and that these games could indeed be used to train the P300 component. Finally, the first analysis of the clinical data shows very few significant differences between the Neurofeedback group and the two control groups. Indeed, despite some differences in favor of the Neurofeedback or both training groups, most indicators showed an improvement of the symptoms regardless of the group. These results suggest that multiple factors may contribute to those changes including nonspecific ones such as time passing, the gaze training that was required in both active groups, or the care given to all children who followed some training. The unique and rich dataset that was collected in this study will continue to teach us and guide future research. Future studies, with a larger sample size and possibly targeting specific subgroups of ADHD children, will need to be carried out in order to further investigate the specific effect of such BCI training onto dimensions such as attention or impulsivity.
... Such reports include those which facilitated the sensorimotor EEG rhythm (SMR) and inhibited beta rhythmicity and those which facilitated beta EEG rhythm and inhibited theta rhythmicity [40,42,[57][58][59][60]. Another neurofeedback approach that is assumed to regulate cortical excitability and is used with positive results in the treatment of ADHD is training of Slow Cortical Potentials (SCP) [48,61]. However, in this study Infra-low Frequency (ILF) neurofeedback was used, a modern, relatively new and effective neurofeedback treatment method for mental disorders. ...
In this observational study the outcomes of an EEG-based infra-low-frequency (ILF) neurofeedback intervention on patients with attention deficit (hyperactivity) disorder (ADHD) are presented. The question is addressed whether this computer-aided treatment, which uses a brain-computer-interface to alleviate the clinical symptoms of mental disorders, is an effective non-pharmaceutical therapy for ADHD in childhood and adolescence. In a period of about 15 weeks 196 ADHD patients were treated with about 30 sessions of ILF neurofeedback in an ambulant setting. Besides regular evaluation of the severity of clinical symptoms, a continuous performance test (CPT) for parameters of attention and impulse control was conducted before and after the neurofeedback treatment. During and after the therapy, the patients did not only experience a substantial reduction in the severity of their ADHD-typical clinical symptoms, but also their performance in a continuous test procedure was significantly improved for all examined parameters of attention and impulse control, like response time, variability of reaction time, omission errors and commission errors. In a post neurofeedback intervention assessment 97% of patients reported improvement in symptoms of inattention, hyperactivity or impulsivity. Only 3% of the patients claimed no noticeable alleviation of ADHD-related symptoms. These results suggest that ILF neurofeedback is a clinically effective method that can be considered as a treatment option for ADHD and might help reducing or even avoiding psychotropic medication.
... CAEPs have been reported in autistic children(Martineau et al., 1981). Deficits of selective attention such as hyperactivity are reflected in evoked potential changes(Loiselle et al., 1980;Satterfield et al., 1987; Ciesielki et al., 1990 andHeinrich et al., 2004). ...
Abstract
Background: The term Language-based learning problems are
problems with age-appropriate reading, spelling, and/or writing. Dyslexia has
been used to refer to the specific learning problem of reading. The temporal
auditory processing deficit theory suggests that one causal deficit of language
based learning disorders (LBLP) is an impaired ability to process sounds.
Objectives: To study auditory temporal processing in children with
language based learning problems using both psychophysical and
electrophysiological tests and to assess correlations between them.
Subjects and methods: 80 child were participated in this study.
Divided into control groups formed of 30 child and study subgroups formed
of 50 child. Each subgroup was divided according to age into subgroup I (8-
10 years) and subgroup II (> 10-12 years). All participants had normal
hearing sensitivity, normal middle ear function with average intelligent. All
children were examined by using Masking Level Difference test, Gap in
Noise test, duration Pattern Sequence test, and Time Compressed speech test
at both 40% and 60% compression ratio. As well as speech auditory
brainstem response and cortical auditory evoked potentials using /da/ speech
stimulus at stimulus intensity 90 dBnHL.
Results: showed that there was significant statistical difference
between control and study subgroups in both psychophysical tests and
electrophysiological one. With children with LBLP has lower threshold for
Masking Level Difference at both 500 and 1000 Hz, prolonged absolute
threshold for Gap in Noise test, lower percentage for Duration pattern
sequence test and lower percentage at 40 %and 60% time compressed speech
test. As regards S-ABR, prolonged latency and reduced amplitude were
recorded in children with language based learning problems as well as in
cortical auditory evoked potentials latencies and amplitudes.
Conclusions: Children with LBLP have deficit in auditory temporal
processing and encoding of auditory information. Both psychophysical and
electrophysiological tests are sensitive in cases of LBLP, so they considered a
good diagnostic tests in such cases.
Keywords: Language based learning disabilities, dyslexia, MLD,
GIN, DPS, S-ABR, CAEPs.
... In this model, self-regulation, or neuroregulation, is defined as explicit learning of controlled cognitive processes of cortical regulation evidenced by normalised shifts in EEG amplitudes [230,236,237]. Performance optimisation is evidenced by improved skill in changing the "EEG state" via self-initiated effort during task performance [231,238]. The therapist's role is to use cognitive behavioural therapy elements such as positive feedback and coaching and operant procedures as active support within treatment sessions to enhance self-efficacy and self-confidence to support neuro-regulation [232,239]. ...
Psychological theory and interpretation of research are key elements influencing clinical treatment development and design in Attention Deficit Hyperactivity Disorder (ADHD). Research-based treatment recommendations primarily support Cognitive Behavioural Therapy (CBT), an extension of the cognitive behavioural theory, which promotes a deficit-focused characterisation of ADHD and prioritises symptom reduction and cognitive control of self-regulation as treatment outcomes. A wide variety of approaches have developed to improve ADHD outcomes in adults, and this review aimed to map the theoretical foundations of treatment design to understand their impact. A scoping review and analysis were performed on 221 documents to compare the theoretical influences in research, treatment approach, and theoretical citations. Results showed that despite variation in the application, current treatments characterise ADHD from a single paradigm of cognitive behavioural theory. A single theoretical perspective is limiting research for effective treatments for ADHD to address ongoing issues such as accommodating context variability and heterogeneity. Research into alternative theoretical characterisations of ADHD is recommended to provide treatment design opportunities to better understand and address symptoms.
... In the pre-training session, two functional measurements were obtained: (1) a functional localizer to determine the individual target region of interest (ROI) within the aMCC; and (2) a run of the assigned NF paradigm without receiving feedback (i.e., pre-training transfer). The functional localizer employed a continuous performance task (CPT; Heinrich et al., 2004) with the following parameters: trial length = 6,000 ms, presentation of visual stimulus (letter) = 250 ms, interstimulus interval = 5,750 ms, 80 trials, and total time = 8 min 12 s. The CPT was chosen because it is reported to elicit strong activation in the aMCC (Lütcke et al., 2009), as well as to be sensitive to NF training-related changes in this region (Gevensleben et al., 2014). ...
Neurofeedback (NF) is a complex learning scenario, as the task consists of trying out mental strategies while processing a feedback signal that signifies activation in the brain area to be self-regulated and acts as a potential reward signal. In an attempt to dissect these subcomponents, we obtained whole-brain networks associated with efficient self-regulation in two paradigms: parallel, where the task was performed concurrently, combining feedback with strategy execution; and serial, where the task was performed consecutively, separating feedback processing from strategy execution. Twenty participants attempted to control their anterior midcingulate cortex (aMCC) using functional magnetic resonance imaging (fMRI) NF in 18 sessions over 2 weeks, using cognitive and emotional mental strategies. We analyzed whole-brain fMRI activations in the NF training runs with the largest aMCC activation for the serial and parallel paradigms. The equal length of the strategy execution and the feedback processing periods in the serial paradigm allows a description of the two task subcomponents with equal power. The resulting activation maps were spatially correlated with functionally annotated intrinsic connectivity brain maps (BMs). Brain activation in the parallel condition correlates with the basal ganglia (BG) network, the cingulo-opercular network (CON), and the frontoparietal control network (FPCN); brain activation in the serial strategy execution condition with the default mode network (DMN), the FPCN, and the visual processing network; while brain activation in the serial feedback processing condition predominantly with the CON, the DMN, and the FPCN. Additional comparisons indicate that BG activation is characteristic to the parallel paradigm, while supramarginal gyrus (SMG) and superior temporal gyrus (STG) activations are characteristic to the serial paradigm. The multifaceted view of the subcomponents allows describing the cognitive processes associated with strategy execution and feedback processing independently in the serial feedback task and as combined processes in the multitasking scenario of the conventional parallel feedback task.
... • Enhancing sensorimotor rhythm (SMR), involved in attentional processing, to reduce hypermotoric symptoms (Rossiter and Vaque, 2008). Some studies integrated this protocol and TBR in response to scientific findings that sustained attention is associated with frontal activity, along with evidence of excessive cortical slowing over central, midline and frontal regions in ADHD patients (Lubar and Lubar, 1984 • Slow Cortical Potentials (SCPs) protocol, to modify SCPs and regulate cortical excitation thresholds (Heinrich et al., 2004). ...
... In the Lubar study in children after SMR and beta wave training, all children increased SMR or beta values and decreased slow EEG activity, which was also evident in their spectral strengths regarding increased beta and decreased slow activity and improved school success 27 . Normalization of ERP components in participants with ADHD after neurofeedback training is also described by several other authors 28,29 . These results indicate the possibility of using SMR neurofeedback as therapeutic methods for attention improvement. ...
This pilot study aimed to investigate the effect of lower-beta or sensorimotor rhythm (SMR) (12-15 Hz) neurofeedback (NFB) training on amplitudes and latencies of late auditory event-related potentials (aERP) components, N100, N200, P300 in Go-No go task of auditory discrimination in 9 healthy participants aged 25-40 years (4 male). Each participant had 20 daily sessions of SMR neurofeedback training. The aERP was recorded 5 times: before NFB, after 5, 10, and 20 sessions, and one month after the last session. The results showed a statistically significant decrease in N100, N200, and P300 latencies at Fz, Cz, and Pz regions. No significant effect of NFB training on amplitude was found. The obtained results suggest that the effects of NFB exerts its effect on the processes of auditory cognition.
... The orientation of the voluntary attention involves the top-down system and is appear to be initiated by medial regions of the frontal cortex which, in turn, recruit medial parietal areas [14] facilitating the anticipated biasing of the system towards task relevant information [7]. One of the electroencephalographic measures related to the voluntary attention orientation is the contingent negative variation (CNV) [15,16]. CNV is a fronto-central slow-wave negative deflection that occurs prior to stimulus onset related to motor anticipation [11,17]. ...
The fronto-central slow-wave known as the contingent negative variation (CNV) is an electroencephalographic measure related to the ability of the motor system to extract space-temporal regularities to produce a motor response. Although well-studied in predictable settings, little is known about how the CNV behaves in an unpredictable context. Thus, this study aimed to investigate the levels of electrocortical activity prior to predictable and unpredictable stimuli in a motor control task and the association of CNV levels and motor behavior in both contexts. Seventeen participants performed a task that consisted in removing the right index finger from the space bar as fast as possible after the stimulus appearance. All participants performed under both a predictable (PC) and an unpredictable (UC) context. Although faster responses were found under the PC than under the UC, the CNV levels were not different between contexts. The results also indicated a stronger association between response quality and CNV levels under the PC than under the UC. The trial-by-trial unpredictability may have produced effects similar to those under the PC, resulting in similar CNV levels. However, the use of this mechanism under the UC was suboptimal to motor performance.
... Another issue (although perhaps not a limitaiton per se) is that the Contingent Negative Variation (CNV) was not considered in this study. The CNV was not considered because the SCP neurofeedback sample was small (n = 9) and, given that several studies have found the effect in SCP neurofeedback (Gevensleben et al., 2014;Heinrich et al., 2004) (Mayer et al., 2016), unsuitable for data analysis. Similarly, the CNV is typically extracted at more than 1000 ms after cue onset. ...
Introduction
Quantitative Electroencephalogram- (QEEG-)informed neurofeedback is a method in which standard neurofeedback protocols are assigned, based on individual EEG characteristics in order to enhance effectiveness. Thus far clinical effectiveness data have only been published in a small sample of 21 ADHD patients. Therefore, this manuscript aims to replicate this effectiveness in a new sample of 114 patients treated with QEEG-informed neurofeedback, from a large multicentric dataset and to investigate potential predictors of neurofeedback response.
Methods
A sample of 114 patients were included as a replication sample. Patients were treated with standard neurofeedback protocols (Sensori-Motor-Rhythm (SMR), Theta-Beta (TBR), or Slow Cortical Potential (SCP) neurofeedback), in combination with coaching and sleep hygiene advice. The ADHD Rating Scale (ADHD-RS) and Pittsburgh Sleep Quality Index (PSQI) were assessed at baseline, every 10th session, and at outtake. Holland Sleep Disorder Questionnaire (HSDQ) was assessed at baseline and outtake. Response was defined as ≥25% reduction (R25), ≥50% reduction (R50), and remission. Predictive analyses were focused on predicting remission status.
Results
In the current sample, response rates were 85% (R25), 70% (R50), and remission was 55% and clinical effectiveness was not significantly different from the original 2012 sample. Non-remitters exhibited significantly higher baseline hyperactivity ratings. Women who remitted had significantly shorter P300 latencies and boys who remitted had significantly lower iAPF’s.
Discussion
In the current sample, clinical effectiveness was replicated, suggesting it is possible to assign patients to a protocol based on their individual baseline QEEG to enhance signal-to-noise ratio. Furthermore, remitters had lower baseline hyperactivity scores. Likewise, female remitters had shorter P300 latencies, whereas boys who remitted have a lower iAPF. Our data suggests initial specificity in treatment allocation, yet further studies are needed to replicate the predictors of neurofeedback remission.
... [148][149][150][151] Studies using go/no-go tasks in combination with either neurofeedback or rewards/incentives have also shown them to be malleable to non-pharmacological techniques. [152][153][154][155][156][157] One aspect to be kept in mind when considering comparison and efficacy studies is that while these interventions did help normalize response speeds in ADHD individuals, the use of rewards/incentives further also increases CNV amplitudes and reduces RTV/response times in healthy adults. 158 Further as the mode of action of MPH which normalize CNV amplitudes is via the catecholaminergic pathway; the converse also applies, ie, CNV could serve as a catecholaminergic system marker. ...
Attention deficit hyperactivity disorder (ADHD) is a chronic heritable developmental delay psychiatric disorder requiring chronic management, characterized by inattention, hyperactivity, hyperkinectivity and impulsivity. Subjective clinical evaluation still remains crucial in its diagnosis. Discussed are two key aspects in the "characterizing ADHD" and on the quest for objective "pathognomonic/endophenotypic diagnostic markers of ADHD". The first aspect briefly revolves around issues related to identification of pathognomonic/endophenotypic diagnostic markers in ADHD. Issues discussed include changes in ADHD definition, remission/persistence and overlapping-symptoms cum shared-heritability with its co-morbid cross-border mental disorders. The second aspect discussed is neurobiological and EEG-based studies on ADHD. Given the neurobiological and temporal aspects of ADHD symptoms the electroencephalograph (EEG) like NeuralScan by Medeia appears as an appropriate tool. The EEGs appropriateness is further enhanced when coupled with suitable behavior/cognitive/motor/psychological tasks/paradigms yielding EEG-based markers like event-related-potential (ERPs like P3 amplitudes and latency), reaction time variability (RTV), Theta:Beta ratio (TBR) and sensorimotor rhythm (SMR). At present, these markers could potentially help in the neurobiological characterization of ADHD and either help in identifying or lay the groundwork for identifying pathognomonic and/or endophenotypic EEG-based markers enabling its diagnosis, treatment and management.
... This revised protocol was named Theta/Beta Neurofeedback (Lubar and Lubar 1984). Subsequently, a slightly different form of neurofeedback was described, called Slow Cortical Potential (SCP) neurofeedback that was shown to not only have anticonvulsive properties in epilepsy (Rockstroh et al. 1993) but also clinical effects in ADHD (Heinrich et al. 2004). SCP's are DC shifts related to positive or negative shifts in broad sheets of glial cells, representing increased activation (negativity) or decreased activation (positivity) and these very slow oscillations in the EEG associated with readiness that transfer into daily life during learning. ...
Stimulant medication and behaviour therapy are the most often applied and accepted treatments for Attention-Deficit/Hyperactivity-Disorder (ADHD). Here we explore where the non-pharmacological clinical intervention known as neurofeedback (NFB), fits on the continuum of empirically supported treatments, using standard protocols. In this quantitative review we utilized an updated and stricter version of the APA guidelines for rating ‘well-established’ treatments and focused on efficacy and effectiveness using effect-sizes (ES) and remission, with a focus on long-term effects. Efficacy and effectiveness are compared to medication and behaviour therapy using benchmark studies. Only recent systematic reviews and meta-analyses as well as multi-centre randomized controlled trials (RCT’s) will be included. Two meta-analyses confirmed significant efficacy of standard neurofeedback protocols for parent and teacher rated symptoms with a medium effect size, and sustained effects after 6–12 months. Four multicenter RCT’s demonstrated significant superiority to semi-active control groups, with medium-large effect sizes end of treatment or follow-up and remission rates of 32–47%. Effectiveness in open-label studies was confirmed, no signs of publication bias were found and no significant neurofeedback-specific side effects have been reported. Standard neurofeedback protocols in the treatment of ADHD can be concluded to be a well-established treatment with medium to large effect sizes and 32–47% remission rates and sustained effects as assessed after 6–12 months.
... In studies that use controls, the findings are mixed. Some have shown a beneficial effect of neurofeedback over control conditions: Theta/beta neurofeedback has been shown to improve reaction time in a CPT task (Bakhshayesh, Hansch, Wyschkon, Rezai, & Esser, 2011), while SCP neurofeedback decreased impulsivity errors (Heinrich, Gevensleben, Freisleder, Moll, & Rothenberger, 2004). However, there are also studies in which no difference could be found: neurofeedback and treatment as usual had similar improvements in a test of attention (Bink, van Nieuwenhuizen, Popma, Bongers, & van Boxtel, 2014); no significant differences found for attentional measures between a neurofeedback and exercise control . ...
This dissertation is concerned with the assessment of two current available methods of enhancing attentional abilities in children and adolescents: neurofeedback and ambient light exposition. Study 1 investigated the short term effects of neurofeedback in children with attention deficit hyperactivity disorder (ADHD) in a two session format. It was found that attentional resources, reflected by suppression of the theta wave, were able to be influenced after only two neurofeedback sessions. This finding was also found to be variant among the participants, leading to distinctions in this early phase of training as ‘good’ or ‘poor’ regulators, reflective of potentially different endophenotypes of ADHD. Study 2 was a meta-analysis assessing the long-term symptomatic effects of neurofeedback training in children and adolescents with ADHD, in which assessments were conducted pre-, post- and follow-up (two months to two years) to training. Here it was found that neurofeedback training was superior to non-active controls for both inattention and hyperactivity/impulsivity at post- and follow-up training. Neurofeedback was found to be inferior to active controls (medication, self management training) at post training, but then comparable at follow-up time points. These results support the use of neurofeedback for the long term therapeutic improvement of ADHD symptoms. Study 3 investigated the effect of red vs. blue light exposition in healthy adolescents in a laboratory setting. Blue light exposition was found to improve attention (as measured by reduced reaction time variability and improved arithmetic performance) in this demographic, while red evening light exposition was found to slightly improve sleep quality, which can in turn affect attentional abilities. Together these three studies provide evidence that attentional abilities can be influenced in children and adolescents in clinical settings. Additionally, they support that different endophenotypes of ADHD should be considered when choosing a neurofeedback protocol and that light exposition could be additionally used as either an additive treatment or an independent therapy.
... Prior studies have noted the relationship between neurophysiological processes and therapy response to medication, as well as nonmedication therapies (e.g. Banaschewski and Brandeis, 2007;atomox- etine: Yamamuro et al., 2016a;stimulants: Ogrim et al., 2016; neurofeedback and methylphenidate: Janssen et al., 2016a, b; slow-cortical potentials neurofeedback: Heinrich et al., 2004), indicating that ERPs might be useful as objective diagnostic add-ons that are easy to assess in a non-invasive way to predict and track therapy outcome. The current meta-analysis suggests to (further) explicitly test the predictive value of later ERPs as neuromarkers in a personalized medicine framework (we are aware of a few already published, as well as ongoing studies using EEG/ERPs to predict response to different therapeutic interventions; e.g. ...
The current meta-analysis summarizes relevant literature on earlier (P100, N100, P200, N200, ERN/Ne) versus later (P300, Pe, CNV) cognitive Event-Related Potential (ERP) differences between children, adolescents, and adults with Attention-Deficit/Hyperactivity Disorder (ADHD) and without ADHD (non-ADHD). Furthermore, the heterogeneity in previous research is addressed by analyzing potentially relevant demographic and methodological moderators (age group, IQ, medication, comorbidity, task, cognitive function, modality, inter-stimulus-interval, number of electrodes). Via database search 52 relevant articles were identified including n = 1576 ADHD and n = 1794 non-ADHD. Using multilevel-models, pooled effect sizes were calculated. For earlier components, individuals with ADHD showed shorter Go-P100-latencies than non-ADHD. For later ERPs, individuals with ADHD showed smaller Cue-P300-amplitudes, longer Go-P300-latencies, smaller NoGo-P300-amplitudes, longer NoGo-P300-latencies, smaller CNV-amplitudes, and smaller Pe-amplitudes. The substantial heterogeneity identified for most of the ERP components could be explained by the demographic and methodological moderators of interest. This meta-analysis identified relevant moderate group differences (-0.32<d<-0.57), mainly regarding later cognitive ERPs. Nevertheless, results are characterized by substantial heterogeneity and the moderate effect sizes (d<0.6) limit the use for clinical application.
This study aimed to investigate the effectiveness of a treatment program using computerized neuro-feedback in improving attention for children with attention deficit hyperactivity disorder (ADHD). To achieve the aim of the study, the computerized neurofeedback program was applied to (56) children diagnosed with (ADHD), aged between (7-11) years. They were distributed into four groups: the first group was subjected to combined intervention (neurofeedback & pharmacological treatment), the second group was subjected to (neurofeedback only), while the third group was exposed to the intervention using (pharmacological treatment only), and the fourth group was (not exposed to any intervention). Test of Variables of Attention (T. O. V. A) was applied pre and post intervention. Results indicated that the first group (combined) outperformed the other groups on Test of Variables of Attention. Similar results were shown between the second group (with neurofeedback) and the third group (with pharmacological treatment). The results indicated that the therapeutic intervention using computerized neurofeedback improved attention and reduced other symptoms of the disorder. In light of the results, the study recommended that computerized neurofeedback could be applied in psychiatric clinics, special needs centers, and schools as an accompanying or alternative treatment intervention for medication for subjects with ADHD. Keywords: Neurofeedback, Attention-Deficit/Hyperactivity Disorder (ADHD), Test of Variables of Attention (T.O.V.A), Treatment program.
Dieses Kapitel beschäftigt sich mit dem Neurofeedbacktraining der langsamen kortikalen Potentiale bei der ADHS. Zunächst wird auf die neurophysiologischen und lerntheoretischen Grundlagen eingegangen. Nachfolgend wird der Ablauf des Trainings praktisch und anschaulich dargestellt. Es wird beschrieben, was die Trainingsaufgabe ist, wie die einzelnen Sitzungen aufgebaut sind und wie der Transfer in den Alltag erfolgt. Des Weiteren werden die Therapiephasen, der therapeutische Prozess und das Therapeutenverhalten erläutert. Abschließend werden die empirischen Befunde hinsichtlich Wirksamkeit und Wirkweise vorgestellt.
Kapitola sa zaoberá transdisciplinárnym prepájaním poznatkov v multiprofesionálnych tímoch ambulantnej zdravotnej starostlivosti a spoločným interdisciplinárnym vzdelávaním, v rámci ktorého sa okrem medicíny odporúča potrebné inkorporovať aj poznatky z iných súvisiacich odborov (biológia, fyzika, matematika, filozofia, psychológia, pedagogika a podobne) v záujme komplexnej viacdimenzionálnej zdravotnej starostlivosti o pacienta. Súčasťou článku je aj náplň medzinárodného vzdelávacieho študijného programu zahŕňajúceho spomínané prvky multiprofesionálneho vzdelávania.
Objective
Possible beneficial effects of neurofeedback in improving ADHD functional outcomes have been increasingly reported. This meta-analysis aimed to evaluate the relationship between neurofeedback and executive functioning in children with ADHD.
Methods
PubMed, EMBASE, EBSCO, Web of Science, and Cochrane databases were searched to identify studies reporting the effects of neurofeedback on executive functioning, including response inhibition, sustained attention, and working memory, assessed by neuropsychological tests. Only randomized controlled studies of children aged 5 to 18 years were included using a random-effects model.
Results
Ten studies were included. The effects of neurofeedback were not found on three domains of executive functions. A meta-regression analysis revealed a trend of numbers of neurofeedback sessions positively associated with response inhibition ( p = .06).
Conclusion
Results did not show the benefits of neurofeedback on executive functions assessed by neuropsychological tests. Future studies should focus on standard neurofeedback protocols, the intensity of intervention, and neuropsychological outcomes.
So far, several methods have been developed to treat attention deficit disorder symptoms or enhance attention performance and concentration. The most common method is medicinal therapy. Recently, new nonmedicinal therapeutic and rehabilitation techniques have been proposed. Some of these methods are used in clinics or are prescribed as home use. Some others are still being studied and researched despite their positive effects. In this chapter, some of the most famous clinical and nonclinical methods and their features are briefly introduced.
Paying attention to incoming stimuli follows with the activation of various neural resources, such as some brain regions and neurotransmitters. In this chapter, the functional anatomy of the brain regions and networks involved in the human attention control system is explained, and the roles of different neurotransmitters are discussed. The dynamics of the involved neural system are also described from electrophysiological aspects.
Attention Deficit Hyperactivity Disorder (ADHD) often manifests during childhood, and typically impacts children from the age of four to fifteen. There is a lack of optimum levels of catecholamine's like dopamine and norepinephrine present. Psychostimulants such as methylphenidate and phenethylamine, modulate these catecholamine's, which are the primary treatment option for ADHD in children. These drugs remain the treatment of choice, but their long-term effect and safety is still under scrutiny. Non-pharmaceutical treatment options for this complex disorder may be of benefit in this population, with fewer side effects, whose incidence is 8-12% of children worldwide. This preliminary review of the literature is guided by two questions: 1) How electroencephalogram-neurofeedback (EEG-NF) reduces inattention, hyperactivity, and impulsivity in children diagnosed with ADHD and 2) what are some of the limitations of this treatment modality. Hypovolemia of PFC is detected in ADHD and it is associated with the symptoms of inattention. Several studies in this review have suggested that NF training produced microstructural changes in the gray and white matter of the cerebral cortex. Increases in alpha wave and reduction in beta wave brain function are often found on the electroencephalogram in ADHD. Electroencephalogram-neurofeedback (EEG-NF) provides a continuous feedback. The study participants showed improved attention, cognitive functions, reduced distractibility, and improvement in IQ. This treatment modality utilizes operant conditioning and trained children to gain control of their cortical functions. This paper explores the impact of NF on ADHD symptoms, it also provides a brief overview of neuroanatomy and neurotransmitters of this disorder, electroencephalogram, the even related potential, biomarkers of EEG, side effects of medical regimens, and limitations of NF.
Auffälligkeiten im Kleinkind-, Kindes und Jugendalter können wie bei Säuglingen strukturelle aber auch funktionelle Ursachen haben. Entsprechend ist das therapeutische Vorgehen. Bei vielen Erkrankungen kann die Manualmedizin nur begleitend wirksam sein, wie viele Erkrankungen im Kopf-, Gesichts-, Wirbelsäulenbereich sowie zentralnervöse Krankheiten zeigen. An über 50 Beispielen wird die Vorgehensweise beschrieben.
Langsame Potenziale (SCP) steuern die Verschaltung der Netzwerke des Gehirns. Diese verbinden und lösen sich wieder voneinander, je nach den Anforderungen, die gerade gestellt werden. Werden in bestimmten Netzwerken des Gehirns nur wenige langsame Potenziale produziert, dann hat das einen Einfluss auf die Effizienz dieser Netzwerke. Wie effektiv wir mit uns selbst und mit der Welt zurechtzukommen, ist abhängig von der reibungslosen Funktion der langsamen Potenziale.
Background:
The classification of the slow cortical potential (SCP) signals plays a key role in a variety of research areas, including disease diagnostics, human-machine interaction, and education. The widely used classification methods, which combine multiple kinds of features, can be unsuitable in practical applications due to their low robustness to scenario changes.
New method:
A flexible concave-convex (C-C) feature is reported. The C-C feature is extracted by two steps: (1) the low-frequency node coefficients of the SCP signals are first extracted using wavelet packet decomposition; (2) then the underlying trend of the low-frequency node coefficients is estimated using third-order polynomial fitting, and the feature is constructed using the minimum and maximum second derivative values of the trend curve as |ymin| - ymax where y is the second derivative value.
Results:
Experimental results on real datasets reveal that our method with the single C-C feature exhibits high average classification accuracies (92.5% and 84.9% on the BCI competition II dataset Ia and the TJU dataset). The accuracy can be further improved (94.5% and 85.9%) by adding the commonly used mean voltage feature and using the naive Bayesian classifier, indicating the flexibility and scalability of the proposed method.
Comparison with existing methods:
The proposed C-C feature based method outperforms state-of-the-art (SOTA) multi-feature classification method from the perspective of classification accuracy.
Conclusions:
The effectiveness of the C-C feature for SCP classification is validated. The proposed feature will represent a useful contribution to the SCP classification, balancing the strengths of traditional features and the proposed one.
The aim of present study is to examine the effect of neurofeedback training on attentional processes in two groups of healthy adult participants. During the experiment, participants in the experimental group were required to complete two puzzles displayed on the computer screen while having neu-rofeedback training. During this procedure, performance on the puzzles was based on participants’ brain activity that was recorded from the Cz area. Moreover, before and after completion of seven neurofeedback sessions, Stroop task was used to measure selective attention performance. Results for the Stroop task showed that although there was a significant reaction time difference before and after the neurofeedback training, there was no significant main effect of group (experimental vs. control group). Furthermore, the reaction time to complete the puzzles across the sessions did not differ significantly between the experimental and the control group. Improving the training program by increasing the number of training sessions and employing a more attention-demanding task in the training sessions might have resulted in an expected effect of neurofeedback.
Contingent negative variation (CNV) and evoked potentials were recorded during the continuous performance test in 20 children (aged 7 to 12) with attention deficit/hyperactivity disorder (ADHD) and in 19 age-matched healthy children. A series of letters were displayed every 2.1 s and a button had to be pressed whenever the letter O was followed by an X. Children were also given neuropsychological tests and questionnaires assessing anxiety and depression. Unlike ADHD children, healthy children showed a more pronounced CNV after the cue – the letter O – than after the distractors. At Fz, CNV negativity was significantly correlated with IQ and executive function. Control children also exhibited a higher parietal N375 post S1 – likely to be associated with letter processing – and a higher N550 amplitude at Fz than ADHD children post S1 and S2; both groups showed a higher N550 amplitude whenever X followed non-O or O was followed by non-X. This component appears to be involved in decision-making processes regarding the initiation or inhibition of movement. ADHD children had a faster reaction time but made more errors of omission and commission. Results suggest that ADHD children show deficits in both stimulus processing and response execution.
Attention deficit hyperactivity disorder (ADHD) comprises a deficit in behavioral inhibition. A theoretical model is constructed that links inhibition to 4 executive neuropsychological functions that appear to depend on it for their effective execution: (a) working memory, (b) self-regulation of affect-motivation-arousal, (c) internalization of speech, and (d) reconstitution (behavioral analysis and synthesis). Extended to ADHD, the model predicts that ADHD should be associated with secondary impairments in these 4 executive abilities and the motor control they afford. The author reviews evidence for each of these domains of functioning and finds it to be strongest for deficits in behavioral inhibition, working memory, regulation of motivation, and motor control in those with ADHD. Although the model is promising as a potential theory of self-control and ADHD, far more research is required to evaluate its merits and the many predictions it makes about ADHD.
Most of the problems in learning disabled (LD) and hyperkinetic (HK) children arise from their deficiency in attending selectively and/or in sustaining attention. This conclusion is based on experimental studies, psychological tests, neurological soft signs (John 1977), and electrophysiological investigations. Various electrophysiological indices point at impaired attentional processes in these children, for example smaller amplitudes of event-related potential (ERP) components that are related to attention such as N2 and P3 (Lovrich and Stamm 1983; Loiselle et al. 1980; Stamm et al. 1982) or P2-N2 amplitudes with longer latencies (Grünewald-Zuberbier and Grünewald 1982). Lubar et al. (1987) reported that the P3 component was found to have a somewhat higher amplitude for gifted children (IQ > 130) than for “normal controls” but was clearly reduced in amplitude for LD children, these differences being most pronounced for a semantic task. In a continuous performance test, Lutzenberger et al. (1986) found error rates and reduction of the P3 amplitude to be similar in children with attentional problems (identified by their school teachers) and children diagnosed by child psychiatrists as hyperactive (without overt neurological deficits). Furthermore, ERPs in anticipation of signaled or self-induced responses were found to be smaller in children with poor ability to concentrate as compared with well concentrating children.
Currently, children and adolescents with an excess of hyperactive, inattentive, and impulsive behavior are diagnosed as Attention-Deficit/ Hyperactivity Disorder (ADHD; see the Diagnostic and Statistical Manual of Mental Disorders {DSM-IV}, American Psychiatric Association, 1994, and chapter 1, this volume).
The P300 event-related brain potential (ERP) has been used to study normal aging as well as patient populations with a variety of neurologic and psychiatric disorders. The P300 has demonstrated reasonable success as a means to assess disturbances in cognitive function, and its clinical utility has been enhanced by the identification of factors that contribute to the variability of ERP measurements. In this article, the neuropsychological theory of P300 is reviewed, ways in which this brain potential can be used as a measure of cognitive efficiency are defined, and methodologic issues that must be considered for successful clinical ERP applications are outlined. This approach is then extended to specific recommendations concerning the technical and practical aspects of P300 recording, so that a well-defined normative database can be developed for evaluating individual patients. When appropriate procedures are used, the P300 can provide a highly useful means to quantify human cognitive capability.
The present study aimed at investigating to what extent the regulation of excitability in cortical networks, as indicated by surface-negative slow cortical potentials (SCPs), is impaired in epileptic patients and to what extent training of SCP self-regulation by means of biofeedback and instrumental learning procedures might affect seizure frequency. Twenty-five patients suffering from drug-refractory epilepsies (complex focal, grand mal, and absence type of seizures) participated in 28 1-h sessions of feedback and instrumental conditioning of their SCPs. Subjects' EEGs were obtained from the vertex. Depending on discriminative stimuli DC shifts towards increased or suppressed negativity relative to the pre-trial baseline were demonstrated by on-line visual feedback during intervals of 8 s each; each session comprised 110 trials. While performance on the SCP self-regulation task was initially below normal (as compared to healthy subjects), significant increases in SCP control were achieved by the patients across the 28 training sessions. In 18 patients at least 1-year follow-up data are available. Changes in seizure frequency were related to transfer of SCP control with six of the patients becoming seizure-free. Age affected the ability to acquire SCP control and its impact on seizure frequency.
Twenty sessions of biofeedback training were carried out with 12 drug-resistant patients with focal epilepsy who learned to produce either negative or positive shifts of their slow cortical potentials (SCPs) at vertex. Feedback trials were interspersed with transfer trials in which only a discriminative stimulus (signalizing whether positivity or negativity was required) was presented, without feedback signal. Patients were able to differentiate significantly between the conditions of cortical positivity and cortical negativity, with larger differentiation scores being obtained in feedback trials than in transfer trials. The amplitude of positivity generated in the positivity condition increased linearly across sessions both in feedback and in transfer trials. The largest negativity was produced in the 5th session; after this, more transient negativities were generated, whose amplitude decreased towards the end of trial. The mean severity of seizures, estimated as the frequency of seizures weighted by their subjective 'strength', decreased significantly after training as compared to the pre-training phase. The data suggest that (1) patients could learn to achieve a state of cortical disfacilitation and (2) with progressed learning, they became less motivated for (or afraid of) producing considerable negative shifts, since extensive negativity may reflect cortical over-excitation and therefore be associated with early signs of seizures. The inability of producing cortical negativity is however not necessarily a bad predictor.
A new method of slow cortical potential (SCP) biofeedback is described, in which subjects were presented with a sequence of two alternating tones. Subjects learned to adjust their SCPs with the 4-s rhythm of presented tones by producing directed SCP changes only in certain inter-tone intervals. Specifically, they learned to simultaneously produce two EEG signals: 1) positive or negative SCP shift at vertex, and 2) SCP asymmetry between the right and the left central area. After one training session, 13 healthy participants were able to differentiate significantly between the negativity and the positivity conditions; this differentiation was achieved within less than 300 ms after the discriminative signal, i.e. much faster than in previous studies employing traditional SCP biofeedback technique. However, these participants did not produce a significant hemispheric asymmetry in the first session. In the second experiment, five subjects participated in prolonged training (6 to 17 sessions). Highly significant control of SCP asymmetry over the precentral cortex was attained in four out of five participants. Advantages and disadvantages of the new method as compared with the "classical" SCP biofeedback technique are discussed.
A total of 11 children with attention deficit disorder (ADD) and nine control children performed a continuous performance test (CPT) of the A-X type with concurrent neuroelectric brain mapping to assess preparatory processing, purportedly mediated by the frontal lobes. This cued CPT task proved to be a highly specific task. The groups could be clearly differentiated both at the behavioral and electrophysiological level. ADD children detected fewer signals and made more false alarms. There were no major group differences in topographical distribution of the event-related potential microstates, but ADD children displayed reduced global field power (GFP) in an early CNV/P3 microstate to cues. This indicated that impaired orienting to cues, rather than impaired executive target processing, determines the initial processing stages in ADD. In comparison with data from the same task run in Utrecht, the same orienting deficit in clinically diagnosed ADHD children was demonstrated. Low resolution electromagnetic tomography (LORETA) estimated posterior sources underlying these orienting processes and the orienting deficit. This argued against frontal lobe involvement at this stage and suggested involvement of a posterior attention system.
For children with attention-deficit-hyperactivity disorder (ADHD) or tic disorder (TD), we recently reported deficient inhibitory mechanisms within the motor system by using transcranial magnetic stimulation. These deficits--stated as reduced intracortical inhibition in ADHD and shortened cortical silent period in TD--could be seen as neurophysiological correlates of motor hyperactivity and tics, respectively. To investigate neurophysiological aspects of comorbidity, we measured motor system excitability for the first time also in children with combined ADHD and TD. The findings of a reduced intracortical inhibition as well as a shortened cortical silent period in these comorbid children provide evidence for additive effects at the level of motor system excitability.
To evaluate the impact of psychopathological comorbidity with oppositional defiant/conduct disorder (ODD/CD) on brain electrical correlates in children with attention deficit hyperactivity disorder (ADHD) and to study the pathophysiological background of comorbidity of ADHD+ODD/CD.
Event-related potentials (ERPs) were recorded during a cued continuous performance test (CPT-A-X) in children (aged 8 to 14 years) with ICD-10 diagnoses of either hyperkinetic disorder (HD; n = 15), hyperkinetic conduct disorder (HCD; n = 16), or ODD/CD (n = 15) and normal children (n = 18). HD/HCD diagnoses in all children were fully concordant with the DSM-IV diagnosis of ADHD-combined type. ERP-microstates, i.e., time segments with stable brain electrical map topography were identified by adaptive segmentation. Their characteristic parameters and behavioral measures were further analyzed.
Children with HD but not comorbid children showed slower and more variable reaction times compared to control children. Children with HD and ODD/CD-only but not comorbid children displayed reduced P3a amplitudes to cues and certain distractors (distractor-X) linked to attentional orienting. Correspondingly, global field power of the cue-CNV microstate related to anticipation and preparation was reduced in HD but not in HCD. Topographical alterations of the HD occurred already in the cue-P2/N2 microstate. In sum, the comorbid group was less deviant than both the HD-group and the ODD/CD-group.
The findings suggest that HD children (ADHD-combined type without ODD/CD) suffer from a more general deficit (e.g., suboptimal energetical state regulation) including deficits of attentional orienting and response preparation than just a responseinhibitory deficit, backing the hypothesis of an involvement of a dysregulation of the central noradrenergic networks. The results contradict the hypothesis that ADHD+ODD/CD represents an additive co-occurrence of ADHD and ODD/CD and strongly suggest that it represents a separate pathological entity as considered in the ICD-10 classification system, which differs from both HD and ODD/CD-only.
- H Heinrich
H. Heinrich et al
BIOL PSYCHIATRY 2004;55:772–775 775
Information processing and energetic factors in attention-deficit/hyperactivity disorder
- J A Sergeant
- J Oosterlaan
- J J Van Der Meere
Sergeant JA, Oosterlaan J, Van der Meere JJ (1999): Information processing
and energetic factors in attention-deficit/hyperactivity disorder. In:
Quay HC, Hogan A, editors. Handbook of Disruptive Behavior Disorders.
New York: Plenum Press, 75-104.
Children with comorbid attention-deficit-hyperactivity disorder and tic disorder.
- Moll G.H
- Heinrich H
- Trott G.E
- Wirth S
- Bock N
- Rothenberger A
Diagnostic and Statistical Manual of Mental Disorders
American Psychiatric Association (1994): Diagnostic and Statistical Manual of
Mental Disorders. 4th ed. Washington, DC: American Psychiatric Press.
Children with comorbid attention-deficit-hyperactivity disorder and tic disorder
- Moll
Information processing and energetic factors in attention-deficit/hyperactivity disorder
- Sergeant