Neurofeedback for the treatment of children and adolescents with ADHD: a randomized and controlled clinical trial using parental reports

Nezla S Duric, Jørg Assmus, Doris Gundersen, Irene B Elgen, Nezla S Duric, Jørg Assmus, Doris Gundersen, Irene B Elgen

Abstract

Background: A randomized and controlled clinical study was performed to evaluate the use of neurofeedback (NF) to treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents.

Methods: The ADHD population was selected from an outpatient clinic for Child and Adolescent Mental Health in Norway. Ninety-one of the 275 children and adolescents ranging in age from 6 to 18 years (10.5 years) participated in 30 sessions of an intensive NF program. The reinforcement contingency was based on the subjects' production of cortical beta1 activity (15-18 Hz). The ADHD participants were randomized into three groups, with 30 in the NF group, 31 controls in a group that was given methylphenidate, and 30 in a group that received NF and methylphenidate. ADHD core symptoms were reported by parents using the parent form of the Clinician's Manual for Assessment by Russell A. Barkley.

Results: Ninety-one children and adolescents were effectively randomized by age, sex, intelligence and distribution of ADHD core symptoms. The parents reported significant effects of the treatments, but no significant differences between the treatment groups were observed.

Conclusions: NF was as effective as methylphenidate at treating the attentional and hyperactivity symptoms of ADHD, based on parental reports.

Trial registration: Current Controlled Trials NCT01252446.

Figures

Figure 1
Figure 1
Clinical population of children with ADHD who were invited to participate in this randomized neurofeedback trial.

References

    1. Monastra VJ, Lynn S, Linden M, Lubar JF, Gruzelier J, LaVaque TJ. Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder. Appl Psychophysiol Biofeedback. 2005;30(2):95–114. doi: 10.1007/s10484-005-4305-x.
    1. Barkley RA. Attention-deficit hyperactivity disorder: A handbood for diagnosis and treatment (2nd ed.) Guilford Press, New York; 1998.
    1. Safren SA, Sprich S, Mimiaga MJ, Surman C, Knouse L, Groves M, Otto MW. Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. JAMA. 2010;304(8):875–880. doi: 10.1001/jama.2010.1192.
    1. Zwi M, Jones H, Thorgaard C, York A, Dennis JA. Parent training interventions for Attention Deficit Hyperactivity Disorder (ADHD) in children aged 5 to 18 years. Cochrane Database Syst Rev. 2011;12 CD003018.
    1. Langberg JM, Arnold LE, Flowers AM, Epstein JN, Altaye M, Hinshaw SP, Swanson JM, Kotkin R, Simpson S, Molina BS. et al.Parent-reported homework problems in the MTA study: evidence for sustained improvement with behavioral treatment. J Clin Child Adolesc Psychol. 2010;39(2):220–233. doi: 10.1080/15374410903532700.
    1. Reeves G, Anthony B. Multimodal treatments versus pharmacotherapy alone in children with psychiatric disorders: implications of access, effectiveness, and contextual treatment. Paediatr Drugs. 2009;11(3):165–169. doi: 10.2165/00148581-200911030-00002.
    1. Barbaresi WJ, Katusic SK, Colligan RC, Pankratz VS, Weaver AL, Weber KJ, Mrazek DA, Jacobsen SJ. How common is attention-deficit/hyperactivity disorder? Incidence in a population-based birth cohort in Rochester, Minn. Arch Pediatr Adolesc Med. 2002;156(3):217–224.
    1. Barbaresi W, Katusic S, Colligan R, Weaver A, Pankratz V, Mrazek D, Jacobsen S. How common is attention-deficit/hyperactivity disorder? Towards resolution of the controversy: results from a population-based study. Acta Paediatr Suppl. 2004;93(445):55–59.
    1. Wagner KD. Management of treatment refractory attention-deficit/hyperactivity disorder in children and adolescents. Psychopharmacol Bull. 2002;36(1):130–142.
    1. Jensen PS, Arnold LE, Swanson JM, Vitiello B, Abikoff HB, Greenhill LL, Hechtman L, Hinshaw SP, Pelham WE, Wells KC. et al.3-year follow-up of the NIMH MTA study. J Am Acad Child Adolesc Psychiatry. 2007;46(8):989–1002. doi: 10.1097/CHI.0b013e3180686d48.
    1. Monastra VJ, Monastra DM, George S. The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder. Appl Psychophysiol Biofeedback. 2002;27(4):231–249. doi: 10.1023/A:1021018700609.
    1. Monastra VJ. EEG and neurofeedback findingsin ADHD:AN empirical response. The ADHD Report. 2004;12:5–8.
    1. Fox DJ, Tharp DF, Fox LC. Neurofeedback: an alternative and efficacious treatment for Attention Deficit Hyperactivity Disorder. Appl Psychophysiol Biofeedback. 2005;30(4):365–373. doi: 10.1007/s10484-005-8422-3.
    1. Arns M, de Ridder S, Strehl U, Breteler M, Coenen A. Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis. Clin EEG Neurosci. 2009;40(3):180–189. doi: 10.1177/155005940904000311.
    1. Lubar JO, Lubar JF. Electroencephalographic biofeedback of SMR and beta for treatment of attention deficit disorders in a clinical setting. Biofeedback Self Regul. 1984;9(1):1–23. doi: 10.1007/BF00998842.
    1. Bakhshayesh AR, Hansch S, Wyschkon A, Rezai MJ, Esser G. Neurofeedback in ADHD: a single-blind randomized controlled trial. Eur Child Adolesc Psychiatry. 2011.
    1. Rossiter T. The effectiveness of neurofeedback and stimulant drugs in treating AD/HD: part II. Replication. Appl Psychophysiol Biofeedback. 2004;29(4):233–243. doi: 10.1007/s10484-004-0383-4.
    1. Friel PN. EEG biofeedback in the treatment of attention deficit hyperactivity disorder. Altern Med Rev. 2007;12(2):146–151.
    1. Othmer SF. Interhemispheric EEG training. J Neurotherapy. 2005;9:87–96. doi: 10.1300/J184v09n02_08.
    1. Lubar J. Quantitative Electroencephalographic Analysis (QEEG) Databases for Neurotherapy: Description,Validation, and Application. Haworth Medical Press. 2004.
    1. Lubar JF, Lubar JO. Neurofeedback Assessment and Treatment for Attention Deficit/Hyperactivity DisordersIntroduction to Quantitative EEG and Neurofeedback. Academic Press, New York; 1999. pp. 103–141.
    1. Egner T, Zech TF, Gruzelier JH. The effects of neurofeedback training on the spectral topography of the electroencephalogram. Clin Neurophysiol. 2004;115(11):2452–2460. doi: 10.1016/j.clinph.2004.05.033.
    1. Leins U, Hinterberger T, Kaller S, Schober F, Weber C, Strehl U. Neurofeedback for children with ADHD: a comparison of SCP- and theta/beta-protocols. Prax Kinderpsychol Kinderpsychiatr. 2006;55(5):384–407.
    1. Kaiser DA, Othmer SF. Effect of Neurofeedback on Variables of Attention in a Large Multi-Center Trial. Journal of Neurotherapy. 2000;4(1):5–15. doi: 10.1300/J184v04n01_02.
    1. Barkley AR. Continuing concerns about EEG biofeedback/neurofeedback. ADHD Report. 1993.
    1. Loo SK, Barkley RA. Clinical utility of EEG in attention deficit hyperactivity disorder. Appl Neuropsychol. 2005;12(2):64–76. doi: 10.1207/s15324826an1202_2.
    1. Stjernholm O. Neurofeedback as ADDH therapy. Ugeskr Laeger. 2010;172(33):2221–2225.
    1. Gevensleben H, Holl B, Albrecht B, Vogel C, Schlamp D, Kratz O, Studer P, Rothenberger A, Moll GH, Heinrich H. Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. J Child Psychol Psychiatry. 2009;50(7):780–789. doi: 10.1111/j.1469-7610.2008.02033.x.
    1. Spencer TJ, Biederman J, Wilens TE, Faraone SV. Novel treatments for attention-deficit/hyperactivity disorder in children. J Clin Psychiatry. 2002;63(Suppl 12):16–22.
    1. Fuchs T, Birbaumer N, Lutzenberger W, Gruzelier JH, Kaiser J. Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: a comparison with methylphenidate. Appl Psychophysiol Biofeedback. 2003;28(1):1–12. doi: 10.1023/A:1022353731579.
    1. Kropotov JD, Grin-Yatsenko VA, Ponomarev VA, Chutko LS, Yakovenko EA, Nikishena IS. ERPs correlates of EEG relative beta training in ADHD children. Int J Psychophysiol. 2005;55(1):23–34. doi: 10.1016/j.ijpsycho.2004.05.011.
    1. Linden M, Habib T, Radojevic V. A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback Self Regul. 1996;21(1):35–49. doi: 10.1007/BF02214148.
    1. Logemann HN, Lansbergen MM, Van Os TW, Bocker KB, Kenemans JL. The effectiveness of EEG-feedback on attention, impulsivity and EEG: a sham feedback controlled study. Neurosci Lett. 2010;479(1):49–53. doi: 10.1016/j.neulet.2010.05.026.
    1. Duric NS, Elgen I. Norwegian Children and Adolescents with ADHD – A Retrospective Clinical Study: Subtypes and Comorbid Conditions and Aspects of Cognitive Performance and Social Skills. Adolescent Psychiatry. 2011;1:349–354. doi: 10.2174/2210677411101040349.
    1. Duric NS, Elgen I. Characteristics of Norwegian children suffering from ADHD symptoms: ADHD and primary health care. Psychiatry Res. 2011;188(3):402–405. doi: 10.1016/j.psychres.2011.05.008.
    1. Wechsler D, Corporation P. Wechsler intelligence scale for children. Psychological Corporation New York, New York; 1949.
    1. Wechsler D. Manual for the Wechsler Intelligence Scale for Children. Psychological Corporation, New York; 1949.
    1. Barkley RA. Defiant Children: Second Edition: A Clinician's Manual for Assessment and Parent Training. Guilford Press. 1997.
    1. Lubar J. Quantitative Electroencephalographic Analysis (QEEG) Databases for Neurotherapy:Description,Validation, and Application. Haworth Medical Press, New York; 2004.
    1. Technology T. .
    1. Barkley RA. Defiant Children: Second Edition: A Clinician's Manual for Assessment and Parent Training. Guilford Press, New York; 1997.
    1. Morris SB, DeShon RP. Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychol Methods. 2002;7(1):105–125.
    1. Kaiser DA, Othmer O. Effect of Neurofeedback on Variables of Attention in a Large Multi-Center Trial. J Neurotherapy: Investig Neuromodulation, Neurofeedback Appl Neuroscience. 2000;4(1):5–15.
    1. Thompson L, Thompson M. Neurofeedback combined with training in metacognitive strategies: effectiveness in students with ADD. Appl Psychophysiol Biofeedback. 1998;23(4):243–263. doi: 10.1023/A:1022213731956.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe