Pathophysiology of ADHD and associated problems-starting points for NF interventions?

Björn Albrecht,Holger Gevensleben,Henrik Uebel-Von Sandersleben,Aribert Rothenberger

doi:10.3389/fnhum.2015.00359

Björn Albrecht, Holger Gevensleben + Show 2 more

Open Access

https://doi.org/10.3389/fnhum.2015.00359

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Abstract

Attention deficit hyperactivity disorder (ADHD) is characterized by severe and age-inappropriate levels of hyperactivity, impulsivity and inattention. ADHD is a heterogeneous disorder, and the majority of patients show comorbid or associated problems from other psychiatric disorders. Also, ADHD is associated with cognitive and motivational problems as well as resting-state abnormalities, associated with impaired brain activity in distinct neuronal networks. This needs to be considered in a multimodal treatment, of which neurofeedback (NF) may be a promising component. During NF, specific brain activity is fed-back using visual or auditory signals, allowing the participants to gain control over these otherwise unaware neuronal processes. NF may be used to directly improve underlying neuronal deficits, and/or to establish more general self-regulatory skills that may be used to compensate behavioral difficulties. The current manuscript describes pathophysiological characteristics of ADHD, heterogeneity of ADHD subtypes and gender differences, as well as frequently associated behavioral problems such as oppositional defiant/conduct or tic disorder. It is discussed how NF may be helpful as a treatment approach within these contexts.

Highlights

Difficulties with Inattention or Hyperactivity and Impulsivity as the core symptoms of Attention deficit Hyperactivity disorder (ADHD) are a frequent psychosocial burden
In a large multicenter randomized controlled trial of a combination of theta-beta/SCP NF training for children with ADHD, we found comparable effects for symptoms of inattention as well as hyperactivity/impulsivity (Gevensleben et al, 2014b)
In a series of neuroimaging experiments, Rubia et al showed that children with ADHD may be characterized by ‘‘cool’’ cognitive deficits like inhibition, attention and timing related to abnormal activity in inferior frontal, striatal and parietotemporal brain regions, whereas ODD/CD was associated with ‘‘hot’’ deficits in the regulation of motivation and affect resulting from dysfunctions in the paralimbic system including orbito-frontal and superiortemporal areas and the anterior cingulate cortex (ACC) as well as the limbic system (Rubia et al, 2008, 2009a,b; Rubia, 2011)

Summary

Introduction

Difficulties with Inattention or Hyperactivity and Impulsivity as the core symptoms of Attention deficit Hyperactivity disorder (ADHD) are a frequent psychosocial burden. With an early onset during childhood, ADHD is often persisting throughout life It is a heterogeneous disorder, and a challenge to treat. There are a number of studies indicating potential effectiveness of NF on ADHD symptom severity, but further evidence from randomized controlled trials using more blinded assessments is required (Arns and Strehl, 2013; Sonuga-Barke et al, 2013; Micoulaud-Franchi et al, 2014). Further double-blinding or sham feedback may diminish motivation and the belief in self-efficacy in both participants receiving sham and NF interventions, and may question an important precondition for effective trainings (Logemann et al, 2010; Gevensleben et al, 2012). Perspectives for NF interventions will be considered within these contexts

Characteristics of Attention Deficit Hyperactivity Disorder

ADHD and its Neuronal Background

Heterogeniety in ADHD

Findings

Conclusion