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Neurofeedback in ADHD: Further Pieces of the Puzzle

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Abstract

Among the different neuromodulation techniques, neurofeedback (NF) is gaining increasing interest in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). In this article, a methodological framework is summarised considering the training as a neuro-behavioural treatment. Randomised controlled trials are selectively reviewed. Results from two smaller-scale studies are presented with the first study comprising a tomographic analysis over the course of a slow cortical potential (SCP) training and a correlational analysis of regulation skills and clinical outcome in children with ADHD. In the second study, ADHD-related behaviour was studied in children with tic disorder who either conducted a SCP training or a theta/low-beta (12–15 Hz) training (single-blind, randomised design). Both studies provide further evidence for the specificity of NF effects in ADHD. Based on these findings, a refined model of the mechanisms contributing to the efficacy of SCP training is developed. Despite a number of open questions concerning core mechanisms, moderators and mediators, NF (theta/beta and SCP) training seems to be on its way to become a valuable and ethically acceptable module in the treatment of children with ADHD.

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Notes

  1. A comprehensive review about SCPs is provided in Birbaumer et al. (1990).

  2. In a meta-analysis (Arns et al. 2009), the RCTs of Gevensleben et al. (2009a) and Bakhshayesh et al. (2011) but also earlier studies were considered. Large effect sizes for inattention and about medium effect sizes for hyperactivity/impulsivity were found.

  3. Originally, a SMR training was intended to be run. However, as a SMR training is recommended to reinforce a specific SMR spindle with duration of 0.25 s (Sherlin et al. 2011), which has not been done in our study, we decided to name the protocol 'theta/low-beta'.

References

  • Arnold LE, Lofthouse N, Hersch S, Pan X, Hurt E, Bates B, Kassouf K, Moone S, Grantier C (2012) EEG neurofeedback for ADHD: double-blind sham-controlled randomized pilot feasibility trial. J Atten Disord. doi:10.1177/1087054712446173

    Google Scholar 

  • Arns M, Kenemans JL (2012) Neurofeedback in ADHD and insomnia: vigilance stabilization through sleep spindles and circadian networks. Neurosci Biobehav Rev. doi:10.1016/j.neubiorev.2012.10.006

    PubMed  Google Scholar 

  • Arns M, de Ridder S, Strehl U, Breteler M, Coenen A (2009) Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis. Clin EEG Neurosci 40:180–189

    Article  PubMed  Google Scholar 

  • Bakhshayesh AR, Hänsch S, Wyschkon A, Rezai MJ, Esser G (2011) Neurofeedback in ADHD: a single-blind randomized controlled trial. Eur Child Adolesc Psychiatry 20(9):481–491

    Article  PubMed  Google Scholar 

  • Banaschewski T, Brandeis D (2007) Annotation: what electrical brain activity tells us about brain function that other techniques cannot tell us: a child psychiatric perspective. J Child Psychol Psychiatry 48:415–435

    Article  PubMed  Google Scholar 

  • Banaschewski T, Hollis C, Oosterlaan J, Roeyers H, Rubia K, Willcutt E, Taylor E (2005) Towards an understanding of unique and shared pathways in the psychopathophysiology of ADHD. Dev Sci 8(2):132–140

    Article  PubMed  Google Scholar 

  • Banaschewski T, Neale BM, Rothenberger A, Roessner V (2007) Comorbidity of tic disorders & ADHD: conceptual and methodological considerations. Eur Child Adolesc Psychiatry 16(Suppl 1):5–14

    Article  PubMed  Google Scholar 

  • Barry RJ, Clarke AR, Johnstone SJ (2003) A review of electrophysiology in attention deficit/hyperactivity disorder: I. Qualitative and quantitative electroencephalography. Clin Neurophysiol 114:171–183

    Article  PubMed  Google Scholar 

  • Birbaumer N, Elbert T, Canavan AG, Rockstroh B (1990) Slow potentials of the cerebral cortex and behavior. Physiol Rev 70(1):1–41

    CAS  PubMed  Google Scholar 

  • Boutron I, Moher D, Douglas G, Altman G, Schulz F, Ravaud P (2008) Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 148:295–310

    Article  PubMed  Google Scholar 

  • Chambless DL, Ollendick TH (2001) Empirically supported psychological interventions: controversies and evidence. Annu Rev Psychol 52:685–716

    Article  CAS  PubMed  Google Scholar 

  • Cohen JD (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Erlbaum, Hillsdale

    Google Scholar 

  • Döpfner M, Lehmkuhl G (2000) DISYPS-KJ: Diagnostik-System für psychische Störungen im Kindes- und Hugendalter. Hans Huber, Bern

    Google Scholar 

  • Döpfner M, Schürmann S, Frölich J (2002) Therapieprogramm für kinder mit hyperkinetischem und oppositionellem problemverhalten (THOP). Beltz, Weinheim

    Google Scholar 

  • Drechsler R, Straub M, Doehnert M, Heinrich H, Steinhausen HC, Brandeis D (2007) Controlled evaluation of a neurofeedback training of slow cortical potentials in children with attention deficit/hyperactivity disorder (ADHD). Behav Brain Funct 3:35

    Article  PubMed Central  PubMed  Google Scholar 

  • El-Sayed E, Larsson JO, Persson HE, Rydelius PA (2002) Altered cortical activity in children with attention-deficit/hyperactivity disorder during attentional load task. J Am Acad Child Adolesc Psychiatry 41:811–819

    Article  PubMed  Google Scholar 

  • Faraone SV, Buitelaar J (2010) Comparing the efficacy of stimulants for ADHD in children and adolescents using meta-analysis. Eur Child Adolesc Psychiatry 19(4):353–364

    Article  PubMed  Google Scholar 

  • Freedman B (1987) Equipoise and the ethics of clinical research. N Engl J Med 317:141–145

    Article  CAS  PubMed  Google Scholar 

  • Gevensleben H, Holl B, Albrecht B, Vogel C, Schlamp D, Kratz O, Studer P, Rothenberger A, Moll GH, Heinrich H (2009a) Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. J Child Psychol Psychiatry 50:780–789

    Article  PubMed  Google Scholar 

  • Gevensleben H, Holl B, Albrecht B, Schlamp D, Kratz O, Studer P, Wangler S, Rothenberger A, Moll GH, Heinrich H (2009b) Distinct EEG effects related to neurofeedback training in children with ADHD: a randomized controlled trial. Int J Psychophysiol 74:149–157

    Article  PubMed  Google Scholar 

  • Gevensleben H, Holl B, Albrecht B, Schlamp D, Kratz O, Studer P, Rothenberger A, Moll GH, Heinrich H (2010) Neurofeedback training in children with ADHD: 6-month follow-up of a randomised controlled trial. Eur Child Adolesc Psychiatry 19(9):715–724

    Article  PubMed Central  PubMed  Google Scholar 

  • Gevensleben H, Moll GH, Rothenberger A, Heinrich H (2012) Neurofeedback in children with ADHD: validation and challenges. Expert Rev Neurother 12(4):447–460

    Article  CAS  PubMed  Google Scholar 

  • Gevensleben H, Moll GH, Rothenberger A, Heinrich H (submitted) Neurofeedback in attention-deficit/hyperactivity disorder: different models and ways of application

  • Glannon W (2013) Neuromodulation, agency and autonomy. Brain Topogr. doi:10.1007/s10548-012-0269-3

  • Goldstein AP, Shipman WG (1961) Patient expectancies, symptom reduction and aspects of the initial psychotherapeutic interview. J Clin Psychol 17:129–133

    Article  CAS  PubMed  Google Scholar 

  • Graham J, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Dittmann RW, Döpfner M, Hamilton R, Hollis C, Holtmann M, Hulpke-Wette M, Lecendreux M, Rosenthal E, Rothenberger A, Santosh P, Sergeant J, Simonoff E, Sonuga-Barke E, Wong IC, Zuddas A, Steinhausen HC, Taylor E, For the European Guidelines Group (2011) European guidelines on managing adverse effects of medication for ADHD. Eur Child Adolesc Psychiatry 20:17–37

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Heinrich H, Gevensleben H, Freisleder FJ, Moll GH, Rothenberger A (2004) Training of slow cortical potentials in ADHD: evidence for positive behavioral and neurophysiological effects. Biol Psychiatry 55(7):772–775

    Article  PubMed  Google Scholar 

  • Heinrich H, Gevensleben H, Strehl U (2007) Annotation: neurofeedback: train your brain to train behaviour. J Child Psychol Psychiatry 48(1):3–16

    Article  PubMed  Google Scholar 

  • Herbert JD, Gaudiano BA (2005) Moving from empirically supported treatment lists to practice guidelines in psychotherapy: the role of the placebo concept. J Clin Psychol 61(7):893–908

    Article  PubMed  Google Scholar 

  • Hinterberger T, Veit R, Strehl U, Trevorrow T, Erb M, Kotchoubey B, Flor H, Birbaumer N (2003) Brain areas activated in fMRI during self-regulation of slow cortical potentials (SCPs). Exp Brain Res 152(1):113–122

    Article  PubMed  Google Scholar 

  • Kleemeyer M (2010) Self-regulation of slow cortical potentials in children with attention-deficit/hyperactivity disorder: a tomographic analysis over the course of a neurofeedback-training. Master Thesis, University of Bremen

  • Lansbergen MM, van Dongen-Boomsma M, Buitelaar JK, Slaats-Willemse D (2011) ADHD and EEG-neurofeedback: a double-blind randomized placebo-controlled feasibility study. J Neural Transm 118(2):275–284

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Leckman JF, Riddle MA, Hardin MT, Ort SI, Swartz KL, Stevenson J, Cohen DJ (1989) The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 28(4):566–573

    Article  CAS  PubMed  Google Scholar 

  • Leckman JF, Vaccarino FM, Kalanithi PS, Rothenberger A (2006) Annotation: tourette syndrome: a relentless drumbeat–driven by misguided brain oscillations. J Child Psychol Psychiatry 47(6):537–550

    Article  PubMed  Google Scholar 

  • Leins U, Goth G, Hinterberger T, Klinger C, Rumpf N, Strehl U (2007) Neurofeedback for children with ADHD: a comparison of SCP and theta/beta protocols. Appl Psychophysiol Biofeedback 32(2):73–88

    Article  PubMed  Google Scholar 

  • Liechti M, Maurizio S, Heinrich H, Jäncke L, Meier L, Steinhausen HC, Walitza S, Drechsler R, Brandeis D (2012) First clinical trial of tomographic neurofeedback in attention-deficit/hyperactivity disorder: evaluation of voluntary cortical control. Clin Neurophysiol 123(10):1989–2005

    Article  PubMed  Google Scholar 

  • Liechti MD, Valko L, Müller UC, Döhnert M, Drechsler R, Steinhausen HC, Brandeis D (2013) Diagnostic value of resting electroencephalogram in attention-deficit/hyperactivity disorder across the lifespan. Brain Topogr 26(1):135–151

    Article  PubMed  Google Scholar 

  • Lofthouse N, Arnold L, Hurt E (2010) A comment on Sherlin, Arns, Lubar, and Sokhadze. J Neutother 14(4):301–306

    Article  Google Scholar 

  • Loo SK, Barkley RA (2005) Clinical utility of EEG in attention deficit hyperactivity disorder. Appl Neuropsychol 12(2):64–76

    Article  PubMed  Google Scholar 

  • Messerotti Benvenuti S, Buodo G, Leone V, Palomba D (2011) Neurofeedback training for tourette syndrome: an uncontrolled single case study. Appl Psychophysiol Biofeedback 36(4):281–288

    Article  PubMed  Google Scholar 

  • Moll GH, Heinrich H, Trott GE, Wirth S, Bock N, Rothenberger A (2001) Children with comorbid attention-deficit-hyperactivity disorder and tic disorder: evidence for additive inhibitory deficits within the motor system. Ann Neurol 49(3):393–396

    Article  CAS  PubMed  Google Scholar 

  • Omer H, London P (1989) Signal and noise in psychotherapy. The role and control of non-specific factors. Br J Psychiatry 155:239–245

    Article  CAS  PubMed  Google Scholar 

  • Pascual-Marqui RD (2002) Standardized low-resolution brain electromagnetic tomography (sLORETA): technical details. Methods Find Exp Clin Pharmacol 24(Suppl D):5–12

    PubMed  Google Scholar 

  • Pelham WE Jr, Fabiano GA (2008) Evidence-based psychosocial treatments for attention-deficit/hyperactivity disorder. J Clin Child Adolesc Psychol 37(1):184–214

    Article  PubMed  Google Scholar 

  • Plotkin WB (1980) The role of attributions of responsibility in the facilitation of unusual experiential states during alpha training: an analysis of the biofeedback placebo effect. J Abnorm Psychol 89(1):67–78

    Article  CAS  PubMed  Google Scholar 

  • Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164(6):942–948

    Article  PubMed  Google Scholar 

  • Radenbach K, Wiesemann C (2010) Risiko und Belastung als Kriterien der Zulässigkeit von Forschung mit Kindern und Jugendlichen. In: Marckmann G, Niethammer D (eds) Ethische Aspekte pädiatrischer Forschung. Deutscher Ärzte-Verlag, Köln, pp 37–49

    Google Scholar 

  • Roberts LW, Lauriello J, Geppert C, Keith SJ (2001) Placebos and paradoxes in psychiatric research: an ethics perspective. Biol Psychiatry 49:887–893

    Article  CAS  PubMed  Google Scholar 

  • Roessner V, Schoenefeld K, Buse J, Wanderer S, Rothenberger A (2012) Therapy of tic disorders. Z Kinder Jugendpsychiatr Psychother 40(4):217–236

    Article  PubMed  Google Scholar 

  • Ros T, Munneke MA, Ruge D, Gruzelier JH, Rothwell JC (2010) Endogenous control of waking brain rhythms induces neuroplasticity in humans. Eur J Neurosci 31(4):770–778

    Article  PubMed  Google Scholar 

  • Ros T, Théberge J, Frewen PA, Kluetsch R, Densmore M, Calhoun VD, Lanius RA (2013) Mind over chatter: plastic up-regulation of the fMRI salience network directly after EEG neurofeedback. Neuroimage 65:324–335

    Article  PubMed  Google Scholar 

  • Rothenberger A, Roessner V (2013) The phenomenology of attention-deficit/hyperactivity disorder in Tourette syndrome. In: Martino D, Leckman JF (eds) Tourette syndrome. Oxford Press, New York

    Google Scholar 

  • Sergeant JA (2005) Modeling attention-deficit/hyperactivity disorder: a critical appraisal of the cognitive-energetic model. Biol Psychiatry 57:1248–1255

    Article  PubMed  Google Scholar 

  • Sherlin LH, Arns M, Lubar J, Heinrich H, Kerson C, Strehl U, Sterman MB (2011) Neurofeedback and basic learning theory: implications for research and practice. Journal of Neurotherapy 15:292–304

    Article  Google Scholar 

  • Strehl U, Leins U, Goth G, Klinger C, Hinterberger T, Birbaumer N (2006) Self-regulation of slow cortical potentials: a new treatment for children with attention-deficit/hyperactivity disorder. Pediatrics 118(5):e1530–e1540

    Article  PubMed  Google Scholar 

  • Tansey MA (1986) A simple and a complex tic (Gilles de la Tourette’s syndrome): their response to EEG sensorimotor rhythm biofeedback training. Int J Psychophysiol 4(2):91–97

    Article  CAS  PubMed  Google Scholar 

  • Taylor E, Döpfner M, Sergeant J, Asherson P, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Rothenberger A, Sonuga-Barke E, Steinhausen HC, Zuddas A (2004) European clinical guidelines for hyperkinetic disorder: first upgrade. Eur Child Adolesc Psychiatry 13(Suppl 1):I7–I30

    PubMed  Google Scholar 

  • Wangler S, Gevensleben H, Albrecht B, Studer P, Rothenberger A, Moll GH, Heinrich H (2011) Neurofeedback in children with ADHD: specific event-related potential findings of a randomized controlled trial. Clin Neurophysiol 122(5):942–950

    Article  PubMed  Google Scholar 

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Acknowledgments

The studies included in this paper were supported by the German Research Foundation (study I, HE 4536/2, MO 726/2) and the Tourette Gesellschaft Deutschland (study II). The authors thank the participating families (particularly the children) and all colleagues and students contributing to these studies.

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Authors and Affiliations

  1. Child & Adolescent Psychiatry, University Medicine Göttingen, Göttingen, Germany

    Holger Gevensleben, Andrea Flaig-Röhr & Aribert Rothenberger

  2. Department of Child & Adolescent Mental Health, University Hospital of Erlangen, Schwabachanlage 6 + 10, 91054, Erlangen, Germany

    Maike Kleemeyer, Petra Studer, Gunther H. Moll & Hartmut Heinrich

  3. Center for Medicine, Society and Prevention, Institute for Ethics and History in Medicine, University of Tübingen, Tübingen, Germany

    Lillian Geza Rothenberger

  4. Heckscher-Klinikum, Munich, Germany

    Hartmut Heinrich

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  1. Holger Gevensleben
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  2. Maike Kleemeyer
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Correspondence to Hartmut Heinrich.

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This is one of several papers published together in Brain Topography on the “Special Topic: Clinical and Ethical Implications of Neuromodulation Techniques”.

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Gevensleben, H., Kleemeyer, M., Rothenberger, L.G. et al. Neurofeedback in ADHD: Further Pieces of the Puzzle. Brain Topogr 27, 20–32 (2014). https://doi.org/10.1007/s10548-013-0285-y

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