Abstract
ADHD is a common condition that causes suffering for those affected and economic loss for society at large. The current standard treatment for ADHD includes stimulant medications, which are not effective for all patients, may include side effects, and can be non-medically misused. Z-score neurofeedback (NFB) and heart rate variability (HRV) biofeedback are alternative treatment strategies that have been associated with Attention-Deficit/Hyperactivity Disorder (ADHD) symptom improvement. We utilized a retrospective pre-post study design to quantify the change in clients’ ADHD symptoms after combined NFB + HRV treatment (which included simultaneous z-score training at four sites). We also assessed whether relevant physiological measures changed in accordance with the protocol, which would be consistent with effective NFB + HRV training. Adults (n = 39) and children (n = 100) with Borderline or Clinical ADHD classifications by the Achenbach System of Empirically Based Assessment (ASEBA) received 30 sessions of NFB + HRV training. Measures were compared before and after treatment for the ASEBA, the Integrated Visual and Auditory Continuous Performance Test (IVA), ADHD medication use, HRV and breathing parameters, and quantitative electroencephalogram (QEEG) parameters. Average ASEBA Attention-Deficit/Hyperactive Problems score improved after treatment for adults and children (p < 0.0001), with Cohen effect sizes (dz) of −1.21 and −1.17, respectively. 87.2% of adults and 80.0% of children experienced improvements of a magnitude greater than or equal to the Minimal Clinically Important Difference. After treatment, 70.8% of adults and 52.8% of children who began in the ASEBA Clinical range, and 80.0% of adults and 63.8% of children who began in the ASEBA Borderline range, were classified in the Normal range. IVA scores also improved after treatment. Changes in HRV and breathing pattern after treatment were consistent with the protocol. QEEG parameters after treatment were closer to the age-based normative mean, which is consistent with effective z-score NFB training.
Highlights
Before and after administration of the 30-session NFB + heart rate variability (HRV) treatment protocol, clients were evaluated for Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms with the Achenbach System of Empirically Based Assessment (ASEBA) DSM-oriented symptom severity checklists, Adult SelfReport (ASR) and Child Behavioral Checklist (CBCL)
ADHD is a common condition in the United States (Bloom et al 2013; Kessler et al 2006) that causes suffering
Alternative treatment strategies are needed for individuals with ADHD for whom stimulant medications are unacceptable or ineffective
Summary
The NFB + HRV therapy sessions described in this study were performed by a private center that provides EEG NFB and Biofeedback therapies at locations in Michigan and Florida, USA. An IRB Privacy Board Waiver of Consent for retrospective studies was obtained for data analysis of clients who began a thirty-session NFB + HRV treatment program on or after February 15, 2017 that was completed by November 15, 2017, with all personal health information identifiers removed. Both before and after the 30 sessions of NFB + HRV, all clients included in this study took behavioral assessment tests, underwent a full-cap (19-electrode) QEEG assessment, completed an HRV and breathing rate assessment, and listed all current medications (including the frequency and dose taken for each drug). This information was used to compare client ADHD symptoms, performance on an objective attention task, physiological characteristics, and medication use before and after treatment
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