Mixed-Effects Modeling of Neurofeedback Self-Regulation Performance: Moderators for Learning in Children with ADHD.

Agnieszka Zuberer,Franziska Minder,Daniel Brandeis,Renate Drechsler

doi:10.1155/2018/2464310

Abstract

Introduction Neurofeedback (NF) has gained increasing popularity as a training method for children and adults with attention deficit hyperactivity disorder (ADHD). However, it is unclear to what extent children learn to regulate their brain activity and in what way NF learning may be affected by subject- and treatment-related factors. Methods In total, 48 subjects with ADHD (age 8.5–16.5 years; 16 subjects on methylphenidate (MPH)) underwent 15 double training sessions of NF in either a clinical or a school setting. Four mixed-effects models were employed to analyze learning: training within-sessions, across-sessions, with continuous feedback, and with transfer in which performance feedback is delayed. Results Age and MPH affected the NF performance in all models. Cross-session learning in the feedback condition was mainly moderated by age and MPH, whereas NF learning in the transfer condition was mainly boosted by MPH. Apart from IQ and task types, other subject-related or treatment-related effects were unrelated to NF learning. Conclusion This first study analyzing moderators of NF learning in ADHD with a mixed-effects modeling approach shows that NF performance is moderated differentially by effects of age and MPH depending on the training task and time window. Future studies may benefit from using this approach to analyze NF learning and NF specificity. The trial name Neurofeedback and Computerized Cognitive Training in Different Settings for Children and Adolescents With ADHD is registered with NCT02358941.

Highlights

Neurofeedback (NF) has gained increasing popularity as a training method for children and adults with attention deficit hyperactivity disorder (ADHD)
This paper addresses the lack of NF studies in ADHD that map learning in NF and control for both treatment-related effects, such as setting and time frequency, and subjectrelated effects, such as IQ and stimulants
It appears that the self-regulation of brain activity in the feedback condition is positively associated with both maturation and intake of stimulants

Summary

Introduction

Neurofeedback (NF) has gained increasing popularity as a training method for children and adults with attention deficit hyperactivity disorder (ADHD). Four mixed-effects models were employed to analyze learning: training within-sessions, across-sessions, with continuous feedback, and with transfer in which performance feedback is delayed. This first study analyzing moderators of NF learning in ADHD with a mixed-effects modeling approach shows that NF performance is moderated differentially by effects of age and MPH depending on the training task and time window. Neurofeedback (NF) is a training method by which real-time feedback of brain activity, typically an EEG parameter, is delivered to the subject to promote voluntary control of brain activity. SCP training targets the phasic regulation of cortical excitability by learning to generate negative and positive shifts of cortical activity. According to Birbaumer’s threshold regulation model of cortical excitation [1], negative and positive SCPs are associated with an activated (i.e., more attentive) or deactivated (less attentive/more relaxed) state, respectively

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