Abstract
Neurofeedback is widely applied as non-pharmacological intervention aimed at reducing symptoms of ADHD, even though efficacy has not been unequivocally established. Neuronal changes during the neurofeedback intervention that resemble learning can provide crucial evidence for the feasibility and specificity of this intervention. A total of 38 children (aged between 7 and 13 years) with a DSM-IV-TR diagnosis of ADHD, completed on average 29 sessions of theta (4–8 Hz)/beta (13–20 Hz) neurofeedback training. Dependent variables included training-related measures as well as theta and beta power during baseline and training runs for each session. Learning effects were analyzed both within and between sessions. To further specify findings, individual learning curves were explored and correlated with behavioral changes in ADHD symptoms. Over the course of the training, there was a linear increase in participants’ mean training level, highest obtained training level and the number of earned credits (range b = 0.059, −0.750, p < 0.001). Theta remained unchanged over the course of the training, while beta activity increased linearly within training sessions (b = 0.004, 95% CI = [0.0013–0.0067], p = 0.005) and over the course of the intervention (b = 0.0052, 95% CI = [0.0039–0.0065], p < 0.001). In contrast to the group analyses, significant individual learning curves were found for both theta and beta over the course of the intervention in 39 and 53%, respectively. Individual learning curves were not significantly correlated with behavioral changes. This study shows that children with ADHD can gain control over EEG states during neurofeedback, although a lack of behavioral correlates may indicate insufficient transfer to daily functioning, or to confounding reinforcement of electromyographic activity. Clinical Trials Registration: This trial is registered at the US National Institutes of Health (ClinicalTrials.gov, ref. no: NCT01363544); https://clinicaltrials.gov/show/NCT01363544.
Highlights
This study shows that children with Attention deficit hyperactivity disorder (ADHD) can gain control over EEG states during neurofeedback, a lack of behavioral correlates may indicate insufficient transfer to daily functioning, or to confounding reinforcement of electromyographic activity
Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric disorder that is characterized by a persistent pattern of inattentive and/or hyperactive and impulsive behavior that interferes with normal social, academic or occupational functioning [1, 2]
Theta/beta neurofeedback is aimed at altering brain activity using operant conditioning principles with the goal to improve behavior and neurocognitive functioning in children with ADHD
Summary
Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric disorder that is characterized by a persistent pattern of inattentive and/or hyperactive and impulsive behavior that interferes with normal social, academic or occupational functioning [1, 2]. The most commonly applied intervention for ADHD is treatment with stimulant medication. Parents may be reluctant to agree with stimulant treatment for their child [6]. This situation urges the need for effective alternatives to pharmacological interventions. Few alternative interventions prove efficacious when only probably blinded results are considered [7], which might indicate a considerable contribution of non-specific effects to the positive outcomes reported for alternative interventions. Research into working mechanisms of alternative interventions may help to distinguish effective from non-effective treatment elements, which may contribute to improving and developing nonpharmacological interventions for children with ADHD
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