Abstract
In this pilot study near-infrared spectroscopy (NIRS) neurofeedback was investigated as a new method for the treatment of Attention Deficit-/Hyperactivity Disorder (ADHD). Oxygenated hemoglobin in the prefrontal cortex of children with ADHD was measured and fed back. 12 sessions of NIRS-neurofeedback were compared to the intermediate outcome after 12 sessions of EEG-neurofeedback (slow cortical potentials, SCP) and 12 sessions of EMG-feedback (muscular activity of left and right musculus supraspinatus). The task was either to increase or decrease hemodynamic activity in the prefrontal cortex (NIRS), to produce positive or negative shifts of SCP (EEG) or to increase or decrease muscular activity (EMG). In each group nine children with ADHD, aged 7–10 years, took part. Changes in parents’ ratings of ADHD symptoms were assessed before and after the 12 sessions and compared within and between groups. For the NIRS-group additional teachers’ ratings of ADHD symptoms, parents’ and teachers’ ratings of associated behavioral symptoms, childrens’ self reports on quality of life and a computer based attention task were conducted before, 4 weeks and 6 months after training. As primary outcome, ADHD symptoms decreased significantly 4 weeks and 6 months after the NIRS training, according to parents’ ratings. In teachers’ ratings of ADHD symptoms there was a significant reduction 4 weeks after the training. The performance in the computer based attention test improved significantly. Within-group comparisons after 12 sessions of NIRS-, EEG- and EMG-training revealed a significant reduction in ADHD symptoms in the NIRS-group and a trend for EEG- and EMG-groups. No significant differences for symptom reduction were found between the groups. Despite the limitations of small groups and the comparison of a completed with two uncompleted interventions, the results of this pilot study are promising. NIRS-neurofeedback could be a time-effective treatment for ADHD and an interesting new option to consider in the treatment of ADHD.
Highlights
Attention Deficit-/Hyperactivity Disorder (ADHD) is characterized by the main symptoms of inattention, hyperactivity and impulsivity, leading to deficits in social and/or academic functioning.In the model of prefrontal lobe executive functions according to Barkley (1997), a deficit in behavioral inhibition in ADHD leads to deficits in executive functions, such as working memory, and in consequence to a deficient self control
Deficits in executive functioning can be observed in children with ADHD compared to healthy controls (Martinussen et al, 2005; Willcutt et al, 2005)
near-infrared spectroscopy (NIRS)-neurofeedback working memory tasks measured with fMRI was found in children with ADHD compared to healthy controls (Dickstein et al, 2006; Paloyelis et al, 2007), as well as alterations in the prefrontal cortex (Brennan and Arnsten, 2008)
Summary
In the model of prefrontal lobe executive functions according to Barkley (1997), a deficit in behavioral inhibition in ADHD leads to deficits in executive functions, such as working memory, and in consequence to a deficient self control. Increasing behavioral inhibition should in consequence lead to an increased self control and symptom reduction. NIRS-neurofeedback working memory tasks measured with fMRI was found in children with ADHD compared to healthy controls (Dickstein et al, 2006; Paloyelis et al, 2007), as well as alterations in the prefrontal cortex (Brennan and Arnsten, 2008) (see NIRS studies below). EEG-neurofeedback has been proven to be an effective treatment for ADHD as regards to the reduction of inattention, impulsivity and hyperactivity (Arns et al, 2009)
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