Self-management training vs. neurofeedback interventions for attention deficit hyperactivity disorder: Results of a randomized controlled treatment study

Ann-Kathrin Korfmacher, Oliver Hirsch, Mira-Lynn Chavanon, Björn Albrecht, Hanna Christiansen, Ann-Kathrin Korfmacher, Oliver Hirsch, Mira-Lynn Chavanon, Björn Albrecht, Hanna Christiansen

Abstract

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].

Keywords: attention deficit hyperactivity disorder (ADHD); children; neurofeedback training; neuropsychological test; quality of life; randomized controlled trial; self-concept; self-management training.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Korfmacher, Hirsch, Chavanon, Albrecht and Christiansen.

Figures

FIGURE 1
FIGURE 1
CONSORT flow-chart. For the current study, n = 139 children with ADHD were assessed for eligibility, of which N = 115 fulfilled inclusion criteria, gave final informed consent for participation and were randomized into groups receiving SMT (n = 58) or NF (n = 57) as the intention to treat (ITT) sample. Of these, n = 2 participants randomized into the NF group changed treatment to SMT and were excluded from modified mITT analyses. In the course of the intervention, n = 9 participants were lost in each group until follow-up (T3). Consequently, the mITT analyses comprises n = 58 children receiving SMT and n = 55 receiving NF whilst the per Protocol analyses comprises n = 49 children receiving SMT and n = 46 receiving NF that actually completed their interventions.
FIGURE 2
FIGURE 2
Changes in Conners parent- and teacher-rated and Qb-Test ADHD symptoms. This figure illustrates means and confidence intervals with p = 0.05 of ADND symptom changes from T1 to T3 from the modified intention to treat (mITT) analysis on imputed missing values. Significant improvements, that is, confidence intervals below zero as indicated by error bars, are in all of the parent-rated Conners scales (above), but in teacher ratings only in hyperactivity/impulsivity. The Qb-Test revealed improvements in particular for SMT for all ADHD symptom scores, but regarding NF only for Impulsivity. No significant differences in Δ change scores between treatments were detected except for Qb-Attention scores where SMT was superior to NF.
FIGURE 3
FIGURE 3
Changes in quality of life and self-concept. Means and confidence intervals with p = 0.05 of KINDL quality of life and self-concept scores. Significant improved quality of life was detected after SMT in self-esteem and marginally in school and family situations (p < 0.10), as well as self-concept at school whilst NF was not followed by any significant improvements. Direct comparisons between treatments revealed superiority of SMT over NF regarding quality of life in school.

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