Brown ADD Scale Research Articles

Prevalence of ADHD in a Sample of Heroin Addicts Receiving Agonist Treatment-Study Conducted in a Public Addiction Service.

Attention-deficit/hyperactivity disorder (ADHD) is a childhood neurodevelopmental disorder that can persist into adulthood. The co-occurrence of ADHD and substance use disorders is very frequent and has received considerable attention in recent clinical/scientific investigations. However, few studies have investigated the prevalence of ADHD in heroin addicts. This study aimed to investigate the prevalence of attention-deficit/hyperactivity disorder (ADHD) in a sample of heroin addicts treated with opioid agonists and to report this clinical experience in a public service for addiction. Outpatients over 18 years old and being treated with opioid agonists for heroin addiction were enrolled. Each patient took part in a psychiatric examination and completed an ASRS (Adult ADHD Self-Report Scale) self-assessment. Subjects with positive results were called in for another psychiatric visit, and the Brown ADD scale was used as a second-level test for ADHD; furthermore, the Mini International Neuropsychiatric Interview (MINI) and Hypomania/Mania Checklist (HCL-32) were used for differential diagnoses and to assess comorbidities. In total, 111 patients were enrolled. All were followed up by the psychiatrist, who is also the author of this report and the person who formulated the diagnoses. The prevalence of ADHD in this sample was 18%. Among the 20 patients diagnosed with ADHD, 5 (25%) were female and 15 (75%) were male. The most frequent psychiatric comorbidity was major depression, found in 11 patients (55%), of which 4 presented with hypomania (bipolar disorder). In this sample, making diagnoses was very difficult. Frequently, multiple comorbidities further complicated these cases. In conclusion, the results of this study are consistent with the literature: There seems to be a significant prevalence of ADHD even among heroin addicts, and often, the diagnosis is difficult to make. We also do not know the exact effect of opioid agonist therapy on ADHD symptoms. Hypotheses have been put forward, but studies are needed.

The Quantified Behavioural Test Plus (QbTest+) in adult ADHD

The Quantified Behavioural Test Plus (QbTest+) is widely used in clinical practice to assess patients with attention-deficit hyperactivity disorder (ADHD). This study mapped its behaviour in a group of adults with ADHD. Does it signal problems with impulsivity, attention and/or activity? To what extent are patients’ self-reported problems reflected in QbTest performance? Does Qb testing foretell the future, as reflected in the patients’ and clinicians’ judgements 4 years later? We here recorded the three QbTest+ cardinals–QbActivity, QbImpulsivity and QbInattention – in 67 consecutive ADHD patients diagnosed in adulthood. Among the 54 patients who medicated as usual on the day of testing, 35 (65%) scored above the clinical cut-off (Q-score ≥ 1.25) on at least one of the QbTest+ cardinals. Out of the 13 patients who suspended medication prior to the test, 11 (85%) scored above the clinical cut-off on at least one of the Qb-variables. There were modest associations between QbTest+ cardinals and symptom self-ratings [Brown ADD scale (BADDS); Adult Self-Report Scale (ASRS)]. Forty-one patients completed a second QbTest+ approximately 4 years after the first. Performance was improved on the follow-up test and fewer patients scored in the clinical range (34%). The scores on the QbInattention cardinal at baseline correlated positively with BADDS and ASRS self-ratings at the 4-year follow-up.

Associations between early life exposure to manganese and developmental trajectories of executive functions

BACKGROUND AND AIM: Manganese (Mn) is an essential nutrient at low doses, yet high levels can be neurotoxic. Executive functions (EF) are a set of cognitive abilities critical for goal directed behavior, which develop throughout childhood and adolescence. Only few studies examined the influence of early life exposures to Mn and developmental trajectories of EF. In this study, we investigated associations between early-life Mn exposure and changes in EF throughout adolescence. METHODS: Participants (N=154. 53% females) from the Public Health Impact of Metals Exposure (PHIME) study were included in this analysis. EF were measured using the Conners ADHD Scales (ages 11-14) and Brown ADD scales (ages 17-22). Prenatal, early postnatal and childhood Mn concentrations were measured in naturally shed deciduous teeth using laser ablation-inductively coupled plasma-mass spectrometry. We used general linear models to examine associations between prenatal, postnatal, and childhood dentine Mn with the change in attention (z-scored changes over time), adjusted for sex, and age. RESULTS:Childhood dentine Mn was significantly associated with developmental changes in attention (i.e., a negative slope; β = -0.98, p = 0.0008). No significant associations with prenatal and postnatal Mn were detected. CONCLUSIONS:These results indicate that Mn exposure during childhood may protect against increased attention problems, consistent with its nutrient properties. The flatter slope for postnatal and prenatal Mn and attention suggests an absence of protection. These finding support our hypotheses that trajectories are key to understanding the role of early-life metal exposures on EF development. KEYWORDS: Heavy metals, Children's environmental health, Neurodevelopmental outcomes,

Five-year outcomes of ADHD diagnosed in adulthood.

There is a dearth of long‐term follow‐up studies of adults diagnosed with ADHD. Here, the aim was to evaluate long‐term outcomes in a group of ADHD patients diagnosed in adulthood and receiving routine psychiatric health care. Adults diagnosed with any type of ADHD (n = 52) and healthy controls (n = 73) were assessed at baseline and at a 5‐year follow‐up, using Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), Brown ADD Scale (BADDS) and Adult ADHD Self‐Report Scale (ASRS). A multivariate regression method was used to identify factors predicting 5‐year outcomes, including baseline ratings, medication intensity, comorbidity, intelligence quotient (IQ), age, and sex. After 5 years, ADHD patients reported fewer and/or less severe symptoms compared to baseline, but remained at clinically significant symptom levels and with functional deficits. Baseline self‐reports of ADHD symptoms predicted their own 5‐year outcome and low baseline functioning level predicted improved global functioning at follow‐up. Factors previously reported to predict short‐term outcomes (i.e., medication, comorbidity, IQ, age, and sex) did not anticipate long‐term outcomes in present study.

Characteristics of ADHD Related to Executive Function: Differential Predictions for Creativity‐Related Traits

ABSTRACTAlthough the relationship between creativity and ADHD is uncertain, recent studies examining how dimensionally assessed characteristics of ADHD relate to creativity and divergent thinking in adults suggest an occasional positive, linear relationship between the constructs. However, the executive functions proposed to underlie characteristics of ADHD have not been examined in relation to creativity. This study was conducted to determine how different characteristics of ADHD related to executive functioning (as assessed by the Brown ADD Scales) predict different components of figural divergent thinking, intellectual risk‐taking, and creative self‐efficacy. Undergraduate engineering students (N = 60) completed the Brown ADD Scales, a figural divergent thinking task, and self‐report measures of intellectual risk‐taking and creative self‐efficacy. A series of multivariate regression models demonstrated that several components of divergent thinking (i.e., fluency, originality, and resistance to closure) were predicted by different characteristics of ADHD. Although fluency was predicted by affect only and originality was predicted by activation only, resistance to closure was predicted by activation, effort, and attention. Additionally, intellectual risk‐taking was predicted by memory, effort, and activation, whereas creative self‐efficacy was predicted by effort. The implications of these results relating to the relationship between ADHD and creativity, as well as for engineering undergraduate education are discussed.

Working Memory and Distraction: Performance Differences between College Students with and without ADHD

The goal of this study was to examine potential deficits in working memory capacity for college students that had a diagnosis of ADHD. College students with ADHD may be a particularly vulnerable group of individuals, given that success on academic work required focus and working memory for a variety of problem solving activities. Performance on these assessments involved controlled processing with simultaneous memory load. Both verbal and visual complex span tasks were used to assess working memory. Additionally, students were all administered with the Brown ADD scale in order to examine self-reported issues with distractibility. Results revealed that ADHD students performed significantly lower on the verbal complex span measure of working memory. No differences in reported inattentiveness were found. Findings were discussed in context of varying task demands in working memory and executive function measures.

Comparison of Three ADHD Screening Instruments in College Students of Varying Cognitive Ability

Objective: To assess three of the better known screeners for Attention Deficit/Hyperactive Disorder (ADHD) and review the relationship between ADHD and cognitive ability. Method: The three ADHD screeners were administered to 111 college students enrolled in a college Introductory Psychology class, on whom ACT scores and total course performance were also available. As a measure of cognitive ability, the Wonderlic Personnel Test (Wonderlic, Inc., 2000) was also administered. Furthermore, self-report data were available from participants who had been diagnosed with ADHD. The three screeners were the Adult ADHD Self-Report Scale (ASRS) (Kessler et al., 2005), the Conners’ Adult ADHD Rating Scale—Self-Report: Long Version (CAARS) (Conners, Erhardt, & Sparrow, 1999), and the Brown ADD Scales (Brown, 1996). Results: The results are discussed in terms of the scales’ reliability, as well as their relationship to academic aptitude, class performance, and their ability to identify self-reported ADHD diagnoses. Conclusion: All three screeners exhibited acceptable reliability levels. Criterion validity was demonstrated by the relationship between the CAARS’s inattention subscale and self-reported cases of ADHD. Criterion validity was also seen in the relationship found between the CAARS’s hyperactivity/restlessness subscale and the total course performance even after controlling for cognitive ability. Contrary to past research cognitive ability exhibited a weak but significant relationship with a few screeners and screener subscales.

Clinical utility of ADHD symptom thresholds to assess normalization of executive function with lisdexamfetamine dimesylate treatment in adults

Objectives:This analysis assessed the relationship of various cutoff scores of the ADHD Rating Scale IV (ADHD-RS-IV) to levels of improvement in ADHD-related executive function (EF), measured by the Brown ADD Scale for Adults (BADDS), which may provide a measure of clinically meaningful EF improvement after ADHD treatment.Methods:Post hoc analysis of a 4-week, open-label, dose-optimization phase in a double-blind, placebo-controlled study of lisdexamfetamine dimesylate (LDX) in adults with ADHD. The BADDS for Adults, a validated, normed, self-report measure of EF in ADHD, provides a qualitative measure to rate treatment progress. The ADHD-RS-IV assesses current symptom status based on DSM-IV criteria. Postbaseline ADHD-RS-IV scores were categorized according to four cutoff criteria of symptom remission: (1) ADHD-RS-IV total score ≤18; (2) ADHD-RS-IV total score ≤10; (3) no ADHD-RS-IV item scored >1; and (4) ADHD-RS-IV total score ≤18 and ≤2 items per subscale with a score of 2. Sensitivity and specificity of criteria for identifying participants with optimal BADDS scores were assessed using receiver operating characteristics (ROC). Safety evaluation included treatment-emergent adverse events (TEAEs).Results:At endpoint, 85/127 participants had optimal BADDS scores. Linear ANOVA indicated limited overlap between BADDS and ADHD-RS-IV scores (r 2 = 0.20; P < 0.0001). Specificity was similar for criteria 1–4 (0.46, 0.39, 0.39, and 0.42), as were ROC (0.699, 0.776, 0.732, and 0.668). Sensitivity was high for criteria 2 and 3 (0.96, 0.92), lower for criteria 1 and 4 (0.72, 0.75). TEAEs were consistent with those of stimulants.Conclusion:Criteria 2 and 3 had satisfactorily high sensitivity, but no criteria had adequate specificity. AUC comparison indicated that criteria 2 and 3 ADHD-RS-IV thresholds may be more accurate assessments of EF normalization as measured by the BADDS. The open-label design, small sample size, and selection criteria limit the applicability of these results to a larger treatment population.Trial registration: ClinicalTrials.gov identifier: NCT00697515.

Alcohol and drug dependence in adults with attention-deficit/hyperactivity disorder: Data from Germany

Background and Objectives: The objective of the present study was to obtain information about the prevalence of addiction disorders in ADHD patients in a German study population, to compare the prevalence of addiction disorders in ADHD patients to that in the normal population according to the German Epidemiological Addiction Survey, and to determine which drugs are consumed most by ADHD patients. Participants: The sample consisted of 61 patients (average age 35.11 ± 9.33 years) from our ADHD consultation who were consecutively included in our study over a period of 12 months. Measurements: We diagnosed ADHD according to DSM-IV-R and by assessing the WURS-k, CAARS and BROWN ADD scales. For diagnosing addiction we conducted the EuropASI, the IDCL, the QOD and the FTNA. For differential diagnosis we assessed the SCL-K. Results: About half of our study population of ADHD patients were diagnosed with a dependence disorder (50.8%, n = 31). Twenty one dot three percent (n = 13) were suffering from an alcohol dependence, 13.1% (n = 8) from a substance use disorder (SUD) and 18% (n = 11) from a combination of both addictions. The drug consumed most commonly by ADHD paALCOHOL AND DRUG DEPENDENCE IN ADULTS WITH ATTENTION-DEFICIT... 151

Executive function impairments in high IQ children and adolescents with ADHD

Objective: To demonstrate that high IQ children and adolescents diagnosed with ADHD tend to suffer from executive function (EF) impairments that: a) can be identified with a combination of standardized measures and normed self-report data; and b) occur more frequently in this group than in the general population. Method: From charts of 117 children and adolescents aged 6 to 17 years with high IQ ( ≥ 120) who fully met DSM-IV diagnostic criteria for ADHD, data on 8 normed measures of executive function (EF) were extracted: IQ index scores for working memory and processing speed, a standardized measure of auditory verbal memory, and 5 clusters of the Brown ADD Scale, a normed, age-graded rating scale for ADHD-related executive function impairments in daily life. Significant impairment was computed for each individual relative to age-appropriate norms for each measure and comparisons were made to base-line rates in the general population. Results: Sixty-two percent of participants were significantly impaired on at least 5 of these 8 markers of EF. Chi-square comparisons of scores from these high IQ participants were significantly different (p < 0.001) from standardization norms for each of the eight EF measures. Conclusions: High IQ children and adolescents with ADHD, despite their cognitive strengths, tend to suffer from significant impairments of executive functions that can be assessed with these measures; incidence of these impairments is significantly greater than in the general population. These results are fully consistent with data on high IQ adults diagnosed with ADHD.

Propriétés psychométriques des versions françaises des échelles d’hyperactivité de Wender (WURS) et de l’Échelle de déficit d’attention de Brown (ADD)

The objective of this work was to analyse the factorial structure of the two following instruments: (1) the Wender Utah Rating Scale (WURS) evaluates the Attention Deficit Hyperactivity Disorders (ADHD) for adults, with 25 items: the subjects describe their own childhood behaviour when they were 7 years old, (from few to very much, 0 to 4). The items are grouped in four clusters: affects and emotional problems; impulsivity and conduct disorders; impulsivity-hyperactivity; and difficulties in attention. A score of 46 or more strongly suggests diagnosis of a hyperactivity disorder during infancy; (2) Brown's (1996) Attention Deficit Disorders Scale (ADD) is a 40-item self-report. This scale is composed of a range of symptoms beyond the DSM-IV inattention criteria for ADHD. A score of 50 or more is strongly suggestive of ADD. The five clusters of this scale are: organizing and activating work; sustaining attention and concentration; sustaining energy and effort; managing affective interference; utilizing "working memory" and accessing recall. For comparative purpose, we also used the Adult Self-Report Scale (ASRS), which evaluates ADHD with six items and accepts a cut-off of four or more; the Barratt Impulsivity Scale, and the Personality Inventory Revised, essentially with the neuroticism cluster. A total of 259 adult subjects were enrolled in this study and allocated to three groups: healthy subjects, depressive patients and alcoholic patients. This study indicates that the internal consistency for the French version of the ADD and WURS scales is adequate (α=0.8-0.9). The WURS and ADD scales are not fully validated, as both sensitivity to change and concurrent validity for all groups are missing. However, these adapted versions are interesting because they facilitate the use of the questionnaires for research and clinical assessment within healthy general and clinical populations. The study confirmed the psychometric properties of the two scales evaluating ADHD: Wender's Hyperactivity Scale during childhood and Brown's Attention Deficit Disorder Scale for adults (ADD). A larger patient sample would permit clearer conclusions. Nevertheless, the obtained results are very encouraging. The ASRS has already been validated. It has shown its utility as a screening tool (well correlated with the Brown's ADD Scale) and gives us a better understanding of the nature of difficulties met by patients in terms of attention. We would like to complete this study in the short-term by increasing the patient sample size and harmonizing evaluation instruments by applying the three scales (ADD, WURS and ASRS) within the three groups. Our results support the idea that the clinical population showed an elevated presence of ADD and this disorder needs to be assessed.

Cognitive-Behaviorally-Oriented Group Rehabilitation of Adults With ADHD

Objective: Recently, novel psychological treatments for adult ADHD have been reported with promising results. However, studies about long-term treatment effects are scanty. The authors study effects of cognitive-behaviorally-oriented group rehabilitation during a 6-month follow-up. Method: Participating in the rehabilitation were 29 adults, of whom 25 were reached 3 and 6 months later. ADHD and other psychiatric symptoms were assessed with self-ratings (Brown ADD Scale for Adults, Symptom Check List—90 [SCL-90], 16 ADHD-related items of SCL-90, Beck Depression Inventory). Participants from the pretreatment period served as their own controls. Results: Participants having improvement in ADHD symptoms during treatment (n = 11) maintained most of the benefit during follow-up. They also had a decrease in other psychiatric symptoms, but this did not fully persist through the follow-up. Of all participants, 72% found their overall situation improved as compared to the pretreatment situation. Conclusion: Results suggest that cognitive-behaviorally-oriented group rehabilitation of ADHD adults might have long-term benefits.

Adults With ADHD Benefit From Cognitive—Behaviorally Oriented Group Rehabilitation

Objective: In clinical practice, a growing need exists for effective nonpharmacological treatments of adult ADHD. The authors present results from a cognitive—behaviorally oriented psychological group rehabilitation for adult ADHD. Method: A total of 29 adults with ADHD participated. Rehabilitation consisted of 10 or 11 weekly sessions. Participants were assessed with self-ratings (checklist for ADHD based on the Diagnostic and Statistical Manual of Mental Disorders , Beck Depression Inventory II, Symptom Check List-90 [SCL-90], Brown ADD Scale for Adults [BADDS]), and the ratings of their significant others (BADDS) 3 months prior to treatment, at the beginning of treatment, and at the end of treatment. Also, the Wender Utah Rating Scale questionnaire was completed prior to rehabilitation. Results: Rehabilitation resulted in reduced self-reported symptoms in 16 ADHD-related items of SCL-90, BADDS total score, and BADDS subdomains of activation and affect. Conclusion: Results suggest that cognitive—behavioral group rehabilitation can be suitable in treating adult ADHD. (J. of Att. Dis. 2008; 12(3) 218-226)

Development of a New Psychosocial Treatment for Adult ADHD

Objective: The purpose of this study was to assess the effectiveness of a new manualized group Meta-Cognitive Therapy (MCT) for adults with ADHD that extends the principles and practices of cognitive-behavioral therapy to the development of executive self-management skills. Method: Thirty adults diagnosed with ADHD completed an 8- or 12-week program designed to target impairments in time management, organization, and planning skills. Treatment efficacy was measured using pre- and posttreatment self-report standardized measures (CAARS-S:L & Brown ADD Scales). Results: General linear modeling revealed a robust significant posttreatment decline on the CAARS DSM-IV Inattentive symptom scale (p < .001) as well as improvement on the Brown ADD Scales (p < .001). Conclusion: The findings indicate that participants in the MCT program showed marked improvement with respect to core ADHD symptoms of inattention, as well as executive functioning skills, suggesting that this program has promise as a treatment for meta-cognitive deficits in adults with ADHD. (J. of Att. Dis. 2008; 11(6) 728-736)

Sleep quality in adult patients with attention deficit hyperactivity disorder (ADHD)

Sleep disorders are common in adults with attention deficit/hyperactivity disorder (ADHD). Two sleep questionnaires; the Brown ADD Scale, the Symptom-Checklist-90-R, and a self-developed symptom questionnaire were administered in this study. In a sample of 61 patients without comorbidity, current substance abuse and medication intake, sleep problems were reported more often than in healthy controls. A lack of being refreshed in the morning was very closely associated with ADHD symptomatology whereas insomnia was related to the presence of comorbidity and depressive symptoms. In the total sample (N = 120), medication intake (mainly stimulants) was not related to any of the sleep parameters. It seems important to screen adult patients with ADHD for the presence of sleep disorders, especially insomnia, restless legs syndrome, and sleep-related breathing disorders (the last in conjunction with the body mass index). Since primary sleep disorders are associated with cognitive impairment, one might expect that ADHD symptomatology may improve if comorbid sleep disorders are adequately treated in addition to the specific ADHD treatment.

The utility of self-report measures and the continuous performance test in the diagnosis of ADHD in adults.

Attention-deficit/hyperactivity disorder (ADHD) occurs in as many as 4 percent of adults yet it is often not recognized in clinical settings because the presenting symptoms may resemble those seen in other disorders or because symptoms may be masked by commonly comorbid conditions such as anxiety and depression. The purpose of this study was to examine the diagnostic utility of instruments commonly used in the assessment of adults presenting with symptoms of ADHD. We reviewed several widely used self-report and laboratory measures and empirically examined the utility of the Brown Attention-Deficit Disorder Scale for Adults (Brown ADD Scale) and the Conners Continuous Performance Test (CPT) in differentially identifying adults with ADHD and those with other Axis I disorders. Ninety-three adults who self-referred to the ADHD program for adults at a university medical center participated in the study. Of these, 44 had ADHD combined subtype (ADHD-CB), and 26 had ADHD, predominantly inattentive subtype (ADHD-IA). Thirty-three non-ADHD adults diagnosed with Axis I mood or anxiety disorders comprised an "Other Psychiatric" group. Rates of comorbid disorders, including substance abuse, in the ADHD groups were typical of those reported in the adult ADHD literature. Data on the Brown ADD Scale and on the CPT were available for subsets of 61 and 46 participants, respectively. Analyses showed that the ADHD-CB, ADHD-IA, and Other Psychiatric groups all received mean scores in the clinical range on the Brown ADD Scale, with a trend toward even higher elevations in the two ADHD groups. Among 12 CPT variables assessed for the three groups, the mean scores on only two variables for the ADHD-IA group were clinically elevated. Neither the Brown ADD Scale nor CPT scores evinced sufficient sensitivity and specificity to qualify them to assist in differential diagnosis of ADHD vis-a-vis other, predominantly internalizing, psychiatric disorders. The results indicate a need for closer examination of executive and adaptive functioning in adults with ADHD compared with those with internalizing disorders in order to identify features that could assist in differential diagnosis.

ATTENTION DEFICIT/HYPERACTIVITY DISORDER AND WORKING MEMORY IN CLINICALLY REFERRED ADULTS

A current theory of attention deficit/hyperactivity disorder (ADHD) implicates a dysfunction in working memory as a significant factor in ADHD. The Working Memory Indexes of the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III; The Psychological Corporation, 1997a) and the Wechsler Memory Scale-Third Edition (WMS-III; The Psychological Corp--oration, 1997b) were used to evaluate this theory. Seventy adults clinically diagnosed with ADHD (mean age = 25) and who were previously administered the WAIS-III and WMS-III were reviewed to determine the association between working memory and ADHD symptomology. The respondent was asked to estimate the frequency of occurrence of ADHD symptoms by completing the Brown ADD Scales (Brown, 1996). Results indicated no significant relationship between working memory and self-reported symptoms, although the Working Memory Indexes of the WAIS-III and the WMS-III were significantly correlated. Implications for current ADHD theory and suggestions for future research were discussed

A Quantitative Trait Locus Analysis of the Dopamine Transporter Gene in Adults with ADHD

Numerous lines of evidence have shown that attention deficit hyperactivity disorder (ADHD) is a highly heritable disorder, whether it is considered as a category or a dimension. We tested for an association between the dopamine transporter gene (DAT1) and ADHD considering the disorder as categorical as well as a continuous trait. Genotypes for the DAT1 variable number of tandem repeat (VNTR) alleles, along with Brown Attention Deficit Disorder Scale (BADDS) and Wender Utah Rating Scale (WURS) scores were available for 152 adult ADHD patients. In 72 of these patients DNAs from at least one parent were accessible to perform a family-based analysis (FBAT). The mean quantitative trait values of the whole sample of singleton patients were compared among the specific genotype groups using ANOVA. The family-based analysis did not reveal any association between DAT1 alleles and ADHD either when it was considered as a dichotomous trait (Z = 0.16, p = .86) or as a continuous trait (Wender Scale Z = −1.67, p = .09; Brown ADD Scale Z = 0.28, p = .77). No significant differences were detected in the mean symptom scores among the specific genotype groups. The results from our study do not support a major role for the DAT1 VNTR alleles in our sample of adult ADHD. In view of several positive reports in child ADHD, more work is required to elucidate the potential role of the DAT1 VNTR as a risk factor in ADHD.

Neurofeedback for AD/HD: A Ratio Feedback Case Study and Tutorial

Introduction. The case study of a 13-year-old AD/HD male treated with neurofeedback is the subject matter for a tutorial on Ratio feedback. Method. Neurofeedback was conducted at C3 (increase 15 to 18 Hz, decrease 2 to 10 Hz) and C4 (increase 12 to 15 Hz, decrease 2 to 7 Hz). Protocols provided visual and auditory feedback based on the ratio of slow wave activity to be suppressed divided by fast wave activity to be enhanced (Ratio feedback). Results. The patient demonstrated marked improvement in processing speed and variability on the Test of variables of Attention-Auditory, a 19-point increase in IQ on the Kaufman Brief Intelligence Test, significant behavioral improvement based on parental (Behavior Assessment System for Children) and patient (Brown ADD Scale) reports, and a 7.5 grade equivalent increase in reading scores (Kaufman Test of Educational Achievement-Brief Form). At the 17-month follow-up parent questionnaires indicated that the patient’s behavioral gains had been maintained or were slightly improved. EEG data showed significant declines in the C4/SMR Ratio (10*2 to 7 Hz/12 to 15 Hz) and 2 to 7 Hz amplitude, a tendency toward an increase in 12 to 15 Hz amplitude, a significant increase in 8 to 11 Hz amplitude, and a decline in 22 to 30 Hz amplitude. Beta activity (15 to 18 Hz) was unchanged. An unexpected finding was that C3/Beta (10*2 to 10 Hz/15 to 18 Hz) and C4/SMR protocols had similar effects on the EEG even though they targeted different bands to enhance and suppress. It appears that suppression of slow wave activity (2 to 7 Hz) may be the active component in both Ratio protocols and that fast wave enhancement either plays a minor (12 to 15 Hz) or no role (15 to 18 Hz). Discussion. The findings cast doubt on the assumption that the C3/Beta and C4/SMR protocols have unique effects on EEG activity. Nevertheless, they may have differential effects on brain functions related to the training sites employed. It would be useful to analyze EEG changes in successfully treated individual AD/HD patients as a first step toward understanding the effects of various treatment protocols. What the protocols are intended to do, and the actual effects on the EEG may be different. If there are active components common to the various AD/HD treatment protocols reported in the literature, this is one way of beginning to recognize them. Brain maps collected before, during, and at the conclusion of treatment would enhance our understanding of treatment effects of various neurofeedback protocols, lead to more focused and productive research, and ultimately facilitate the development of more efficient treatment paradigms.

Validity of the Brown ADD scales: an investigation in a predominantly inattentive ADHD adolescent sample with and without reading disabilities.

The Brown ADD Scale for Adolescents is widely used in clinical settings, yet, no published studies have investigated divergent and concurrent validity and specificity and sensitivity to inattentive ADHD symptomatology. Ninety-eight participants (13 to 16 years) were classified as ADHD/I and/or reading disabled (RD) using Kiddie Schedule for Affective Disorder and Schizophrenia (K-SADS), Conners' Rating Scales (CRS-R), and Ontario Child Health Study Scales (OCHSS), WRAT3, and WRMT-R. The results were: 29 ADHD/I; 12 RD, 16 ADHD/I with RD; and, 41 controls. The RD group was included to evaluate specificity. The Brown was administered but not used in classification. The ADHD groups scored higher on the Brown subscales compared with the other two groups. The recommended cutoffs resulted in high rates of false negatives but few false positives; this suggests good specificity but poor sensitivity. There were moderate correlations among the Brown, CRS-R, and OCHSS. The Brown can be useful in screening out ADHD; however, its low sensitivity precludes its usefulness in diagnosing ADHD.