Neurofeedback Training In Children Research Articles

Neurofeedback Training in Children with ADHD: A Systematic Review of Personalization and Methodological Features Facilitating Training Conditions.

Objective. Current research on the effectiveness of neurofeedback (NFB) in children with attention-deficit/hyperactivity disorder (ADHD) is divided. Personalized NFB (pNFB), using pre-recorded individual electroencephalogram (EEG) features, is hypothesized to provide more reliable results. Our paper reviews available evidence on pNFB effectiveness and its methodological quality. Additionally, it explores whether other methodological features implying personalization are related to successful NFB. Methods. We conducted a systematic literature review on PubMed, PSYNDEX, PsycInfo and PsycArticles until November, 30, 2023. Studies that focused on pNFB in children with ADHD were selected, deviant studies excluded. Quality ratings by independent raters using Loney's1 criteria were conducted. Pooled effect sizes for NFB effects and methodological features were calculated. Results. Three of 109 studies included personalization and were reviewed in the full-text. In two studies, theta/beta-NFB was personalized using individual alpha peak frequencies (iAPF), whereas in one study, individual beta rhythms were trained. All three studies demonstrated significant short- and long-term improvements in ADHD symptoms, as assessed by questionnaires and objective performance tests, when compared to standard protocols (SP), sham-NFB, and control conditions. Twelve of 111 studies reported methodological features consistently related to NFB effectiveness. These features, including self-control instructions, feedback animations, timing of feedback presentation, behavioral performance, pre-recorded individual ERP-components and stimulant medication dosage, can be used to personalize NFB and enhance training success. Conclusion. Personalizing NFB with iAPF appears promising based on the existing -albeit small- body of research. Future NFB studies should include iAPF and other personalized features facilitating implementation consistently associated with treatment success.

3.51 The Effect of Mobile Neurofeedback Training in Children With ADHD: A Randomized Controlled Trial

3.51 The Effect of Mobile Neurofeedback Training in Children With ADHD: A Randomized Controlled Trial

The Effect of Mobile Neurofeedback Training in Children with Attention Deficit Hyperactivity Disorder: A Randomized Controlled Trial.

: To examine the effect of mobile neurofeedback training on the clinical symptoms, attention abilities, and execution functions of children with attention deficit hyperactivity disorder (ADHD). : The participants were 74 children with ADHD aged 8-15 years who visited the Department of Child and Adolescent Psychiatry at Seoul National University Children's Hospital. The participants were randomly assigned to the mobile neurofeedback (n = 35) or control (sham; n = 39) group. Neurofeedback training was administered using a mobile app (equipped with a headset with a 2-channel electroencephalogram [EEG] sensor) for 30 min/day, 3 days/week, for 3 months. Children with ADHD were individually administered various neuropsychological tests, including the continuous performance test, Children's Color Trails Test-1 and 2, and Stroop Color and Word Tests. The effects of mobile neurofeedback were evaluated at baseline and at 3 and 6 months after treatment initiation. : Following treatment, both mobile neurofeedback-only and sham-only groups showed significant improvements in attention and response inhibition. In the visual continuous performance test, omission errors decreased to the normal range in the mobile neurofeedback-only group after training, suggesting that mobile neurofeedback effectively reduced inattention in children with ADHD. In the advanced test of attention, auditory response times decreased in the mobile neurofeedback + medication group after training, but increased in the sham+medication group. Overall, there were no significant between-group differences in other performance outcomes. : Mobile neurofeedback may have potential as an additional therapeutic option alongside medication for children with ADHD.

Neurofeedback training for children with ADHD using individual beta rhythm.

Neurofeedback training (NFT) is a noninvasive neuromodulation method for children with attention-deficit/hyperactivity disorder (ADHD). Brain rhythms, the unique pattern in electroencephalogram (EEG), are widely used as the training target. Most of current studies used a fixed frequency division of brain rhythms, which ignores the individual developmental difference of each child. In this study, we validated the feasibility of NFT using individual beta rhythm. A total of 55 children with ADHD were divided into two groups using the relative power of individual or fixed beta rhythms as the training index. ADHD rating scale (ADHD-RS) was completed before and after NFT, and the EEG and behavioral features were extracted during the training process. After intervention, the attention ability of both groups was significantly improved, showing a significant increase in beta power, a decrease in scores of ADHD-RS and an improvement in behavioral and other EEG features. The training effect was significantly better with individualized beta training, showing more improvement in ADHD-RS scores. Furthermore, the distribution of brain rhythms moved towards high frequency after intervention. This study demonstrates the effectiveness of NFT based on individual beta rhythm for the intervention of children with ADHD. When designing a NFT protocol and the corresponding data analysis process, an individualized brain rhythm division should be applied to reflect the actual brain state and to accurately evaluate the effect of NFT.

Review of Neuropsychological and Electrophysiological Correlates of Callous-unemotional Traits in Children: Implications for EEG Neurofeedback Intervention.

Conduct disorder is a significant psychiatric disorder of childhood and adolescence. The Diagnostic and Statistical Manual of Mental Disorders, fifth version (DSM-5), added the limited prosocial specifier to identify those individuals who exhibit a more severe pattern of behavior characterized by a callous and unemotional (CU) interpersonal style across multiple settings and relationships. This review has attempted to summarize the relevant research focusing on the significance of CU interpersonal style in the development of psychopathy. The primary focus was on the electrophysiological and neuropsychological correlates of CU traits and their implication on the treatment protocol using neurofeedback training for children with such traits. The source of the literature search was PubMed, which majorly uses the MEDLINE database. The keywords used included CU traits, conduct disorder, child psychopathy, empathy, electrophysiology, criminal behavior, neuropsychology, neurofeedback training, and so on. Studies from the last 15 years were considered for the review. This review revealed that children with conduct disorder and high-CU traits with a combination of reactive and proactive aggression are more likely to develop psychopathy. Evidence suggests that these children have distinct forms of electrophysiological and neuropsychological correlates. However, research in this area is still not conclusive as they yield variation in findings. Studies on the efficacy of neurofeedback training on reducing symptoms such as impulsivity, hostility, and psychopathy indicate that neurofeedback training can be a promising treatment alternative for children with severe conduct disorder.

Effect of Neurofeedback Training on Aggression and Impulsivity in Children With Attention-Deficit/Hyperactivity Disorder: A Double-Blinded Randomized Controlled Trial.

Introduction:Aggression and impulsivity are some of the behavioral symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD). Neurofeedback (NF) training has been suggested as a promising treatment in these children. This study aimed to investigate the effect of NF training on aggression and impulsivity in schoolchildren with ADHD.Methods:A total of 40 male elementary school children with ADHD (aged 11.17±0.97 years) were randomized into the NF and sham groups. The NF group received 12 NF training sessions, each taking about 60 minutes for six consecutive weeks (twice a week), based on the Hammond protocol. The subjects’ parents were questioned to evaluate the outcomes, including aggression and impulsivity, using the Buss-Perry Aggression Questionnaire (BPAQ) and Barratt Impulsiveness Scale (BIS).Results:After the intervention, in the NF group, the BPAQ score changed from 87.60±9.33 to 81±7.23 and the BIS score from 94.7±7.25 to 88.05±5.4, which were significant (P=0.001). The results indicated the large effect size of NF on aggression and impulsivity in ADHD.Conclusion:Our findings suggest NF training as a clinically applicable method for decreasing aggression and impulsivity, also support concurrent use of medication and NF training in children with ADHD.

EL15-2 Usefulness of neurofeedback training for children with ADHD: Focusing on prediction of effectiveness

EL15-2 Usefulness of neurofeedback training for children with ADHD: Focusing on prediction of effectiveness

Designing a Successful Neurofeedback Training for Children with Autism Spectrum Disorder

Abstract. The goal of this article was to highlight important issues that have to be considered when designing an electroencephalography (EEG)-based neurofeedback training for children with Autism Spectrum Disorder and to provide practical advice for a successful implementation. Autism is a heterogeneous and complex disorder, which leads to a broad and varied profile of symptoms as well as to huge individual differences between the affected children. This is why the neurofeedback training protocol has to be individually designed based on the specific symptoms as well as in consideration of the existing theories about aberrant brain activity, and why it then needs to be evaluated empirically. Furthermore, neurofeedback training has to be optimized individually regarding the specific control signal, feedback and practical implementations in order to lead to the desired improvements.

EEG Neurofeedback Training in Children With Attention Deficit/Hyperactivity Disorder: A Cognitive and Behavioral Outcome Study

Attention deficit/hyperactivity disorder (ADHD) is a highly prevalent childhood disorder with symptoms of inattention, impulsivity, and hyperactivity. EEG neurofeedback training (NFT) is a new intervention modality based on operant conditioning of brain activity, which helps reduce symptoms of ADHD in children. To examine the efficacy of NFT in children with ADHD, an experimental longitudinal design with pre-post comparison was adopted. A total of 30 children in the age range of 6 to 12 years diagnosed as ADHD with or without comorbid conditions were assigned to treatment group (TG; n = 15) and treatment as usual group (TAU; n = 15). TG received EEG-NFT along with routine clinical management and TAU received routine clinical management alone. Forty sessions of theta/beta NFT at the C3 scalp location, 3 to 4 sessions in a week for a period of 3.5 to 5 months were given to children in TG. Children were screened using sociodemographic data and Binet-Kamat test of intelligence. Pre-and postassessment tools were neuropsychological tests and behavioral scales. Follow-up was carried out on 8 children in TG using parent-rated behavioral measures. Improvement was reported in TG on cognitive functions (sustained attention, verbal working memory, and response inhibition), parent- and teacher-rated behavior problems and on academic performance rated by teachers. Follow-up of children who received NFT showed sustained improvement in ADHD symptoms when assessed 6 months after receiving NFT. The present study suggests that NFT is an effective method to enhance cognitive deficits and helps reduce ADHD symptoms and behavior problems. Consequently, academic performance was found to be improved in children with ADHD. Improvement in ADHD symptoms induced by NFT were maintained at 6-month follow-up in children with ADHD.

Predictive factors of success in neurofeedback training for children with ADHD

ABSTRACTIntroduction: Neurofeedback (NF) training aims the enhancement of self-regulation over brain activities. While it is largely recognized as an effective treatment for attention deficit hyperactivity disorder (ADHD), the existence of non-learners has also been reported. The present study explored pre-training assessment indices that could predict learners prior to NF training. Methods: Twenty-two children with ADHD participated in slow cortical potential (SCP) NF training and completed pre- and post-training assessments. Participants were classified into learners or non-learners based on their progress in the SCP regulation, and pre-training indices that differentiate the two groups were examined by decision tree analysis. Results and Discussion: The learner rate in NF training was 45.5%. Learners were predicted by pre-training cognitive and neurophysiological measures regarding Stroop tasks, which suggested relatively intact executive function as their characteristics. Given that NF training is not universally effective for children with ADHD, further studies are necessary to establish application criteria.

Positive effects of neurofeedback on autism symptoms correlate with brain activation during imitation and observation.

Autism has been characterized by atypical task-related brain activation and functional connections, coinciding with deficits in sociocommunicative abilities. However, evidence of the brain's experience-dependent plasticity suggests that abnormal activity patterns may be reversed with treatment. In particular, neurofeedback training (NFT), an intervention based on operant conditioning resulting in self-regulation of brain electrical oscillations, has shown increasing promise in addressing abnormalities in brain function and behavior. We examined the effects of ≥20h of sensorimotor mu-rhythm-based NFT in children with high-functioning autism spectrum disorders (ASD) and a matched control group of typically developing children (ages 8-17). During a functional magnetic resonance imaging imitation and observation task, the ASD group showed increased activation in regions of the human mirror neuron system following the NFT, as part of a significant interaction between group (ASD vs. controls) and training (pre- vs. post-training). These changes were positively correlated with behavioral improvements in the ASD participants, indicating that mu-rhythm NFT may be beneficial to individuals with ASD.

Game-based combined cognitive and neurofeedback training using Focus Pocus reduces symptom severity in children with diagnosed AD/HD and subclinical AD/HD

Previous studies report reductions in symptom severity after combined working memory (WM) and inhibitory control (IC) training in children with AD/HD. Based on theoretical accounts of the role of arousal/attention modulation problems in AD/HD, the current study examined the efficacy of combined WM, IC, and neurofeedback training in children with AD/HD and subclinical AD/HD. Using a randomized waitlist control design, 85 children were randomly allocated to a training or waitlist condition and completed pre- and post-training assessments of overt behavior, trained and untrained cognitive task performance, and resting and task-related EEG activity. The training group completed twenty-five sessions of training using Focus Pocus software at home over a 7 to 8-week period. Trainees improved at the trained tasks, while enjoyment and engagement declined across sessions. After training, AD/HD symptom severity was reduced in the AD/HD and subclinical groups according to parents, and in the former group only according to blinded teachers and significant-others. There were minor improvements in two of six near-transfer tasks, and evidence of far-transfer of training effects in four of five far-transfer tasks. Frontal region changes indicated normalization of atypical EEG features with reduced delta and increased alpha activity. It is concluded that technology developments provide an interesting a vehicle for delivering interventions and that, while further research is needed, combined WM, IC, and neurofeedback training can reduce AD/HD symptom severity in children with AD/HD and may also be beneficial to children with subclinical AD/HD.

NIRS-based neurofeedback training in a virtual reality classroom for children with attention-deficit/hyperactivity disorder: study protocol for a randomized controlled trial

BackgroundChildren with attention-deficit/hyperactivity disorder (ADHD) suffer from attention deficits, motor hyperactivity, and impulsive behaviour. These impairments are experienced at home, at school, and with friends. Functional imaging studies show that ADHD behaviour and impairments in executive functions (EFs) are mirrored by aberrant neurophysiological functioning. Moreover, several studies show that ADHD behaviour, impairments in EFs, and a lack of self-control contribute to poor school performance. Non-pharmacological interventions such as neurofeedback training (NFT), for instance, aim at improving neurophysiological and neuropsychological functioning as well as behaviour. Consequently, NFT is expected to improve school performance, EFs, and self-control in children with ADHD. Generalization of acquired self-regulation skills from laboratory to real life is crucial for a transfer to everyday situations and is hypothesized to be facilitated via training using virtual reality (VR) environments. Consequently, experiencing NFT in VR is expected to yield greater effects than training in two dimensions (2D).Methods/designNinety children with a clinical diagnosis of ADHD will be included in the study. Participants may be medicated or unmedicated. After random assignation to one of three conditions, all participants receive 15 training sessions of either near-infrared spectroscopy (NIRS)-based NFT in VR, NIRS-based NFT in 2D, or electromyogram-based biofeedback training in VR. ADHD symptoms, self-control, EF, health-related quality of life, school performance, and motor activity measured via parent, teacher, and child reports or objectively will be assessed before and after the intervention and at a 6 months follow-up. Furthermore, we are interested in parents’ expectations about the training’s effects.DiscussionThis is, to our knowledge, the first study investigating the efficacy of NFT for children with ADHD in a VR compared to a 2D environment. Furthermore, this study will contribute to the discussion about the efficacy and specific and unspecific effects of NFTs in children with ADHD. In addition to commonly assessed variables such as ADHD symptoms, NIRS and behavioural data obtained in EF measures, health-related quality of life, and parents’ expectations about the intervention’s effects, this study will investigate the effects on self-control, school performance, and motor activity.Trial registrationClinicalTrials.gov, NCT02572180. Registered on 19 November 2015.

Optical-imaging-based neurofeedback to enhance therapeutic intervention in adolescents with autism: methodology and initial data

Impaired facial processing may contribute to social dysfunction in certain individuals with autism spectrum disorder (ASD). Prior studies show that electroencephalogram-based and functional magnetic resonance imaging-based neurofeedback might help some individuals with ASD learn to modulate regional brain activity and thus reduce symptoms. Here, we report for the first time the feasibility of employing functional near-infrared spectroscopy (fNIRS)-based neurofeedback training in children with ASD. We developed a method to study physiological self-regulation of oxy-hemoglobin using real-time feedback. The paradigm is illustrated with initial data from four subjects who engaged in a facial-identity recognition training program during which an implicit reinforcement was given based on the participant's brain activity and behavioral performance. Two participants had a confirmed diagnosis of ASD, and the other two were typically developing (TD). One participant with ASD and one TD participant received real-feedback (real-FB) during the training, whereas the other two received sham-feedback (sham-FB). After five training sessions, the subjects who received real-FB showed more improvement in facial recognition performance compared with those receiving sham-FB, particularly in the participant with ASD. These results suggest fNIRS-based neurofeedback could enhance therapeutic intervention in children with ASD.

Relative Power of Specific EEG Bands and Their Ratios during Neurofeedback Training in Children with Autism Spectrum Disorder.

Neurofeedback is a mode of treatment that is potentially useful for improving self-regulation skills in persons with autism spectrum disorder. We proposed that operant conditioning of EEG in neurofeedback mode can be accompanied by changes in the relative power of EEG bands. However, the details on the change of the relative power of EEG bands during neurofeedback training course in autism are not yet well explored. In this study, we analyzed the EEG recordings of children diagnosed with autism and enrolled in a prefrontal neurofeedback treatment course. The protocol used in this training was aimed at increasing the ability to focus attention, and the procedure represented the wide band EEG amplitude suppression training along with upregulation of the relative power of gamma activity. Quantitative EEG analysis was completed for each session of neurofeedback using wavelet transform to determine the relative power of gamma and theta/beta ratio, and further to detect the statistical changes within and between sessions. We found a linear decrease of theta/beta ratio and a liner increase of relative power of gamma activity over 18 weekly sessions of neurofeedback in 18 high functioning children with autism. The study indicates that neurofeedback is an effective method for altering EEG characteristics associated with the autism spectrum disorder. Also, it provides information about specific changes of EEG activities and details the correlation between changes of EEG and neurofeedback indexes during the course of neurofeedback. This pilot study contributes to the development of more effective approaches to EEG data analysis during prefrontal neurofeedback training in autism.

Effect of the Theta-Beta Neurofeedback Protocol as a Function of Subtype in Children Diagnosed with Attention Deficit Hyperactivity Disorder

AbstractNeurofeedback is a neuronal self-regulation technique that teaches people to modulate their brain frequencies using visual and auditory reinforcements presented on a computer screen. To assess the effect of neurofeedback training in children with ADHD as far as improved attention and impulse control, and analyze whether or not there are differences between the inattentive and hyperactive subtypes. Fifty children diagnosed with ADHD participated in the study: 14 comprised the control group, and 36 the experimental group (16 with the inattentive ADHD subtype, 20 with the hyperactive ADHD subtype). Attention and impulse control were assessed using the Integrated Visual Auditory CPT (IVA/CPT). Results indicated that the predominantly inattentive group showed significant differences on the Control Scale (p = .023, d = 1.31) and the Attention Scale (p < .01, d = 1.89) of the IVA/CPT; meanwhile the predominantly hyperactive group showed significant improvement on the Control Scale (p = .016, d = 1.21). The control group exhibited no significant differences on either of the two scales (p > .5). In terms of theta/beta ratio, no significant differences were detected (p = .10) between ADHD subtypes. The findings suggest that neurofeedback training using the theta/beta protocol was more effective in the predominantly inattentive subset of individuals with ADHD.

Are treatment effects of neurofeedback training in children with ADHD related to the successful regulation of brain activity? A review on the learning of regulation of brain activity and a contribution to the discussion on specificity.

While issues of efficacy and specificity are crucial for the future of neurofeedback training, there may be alternative designs and control analyses to circumvent the methodological and ethical problems associated with double-blind placebo studies. Surprisingly, most NF studies do not report the most immediate result of their NF training, i.e., whether or not children with ADHD gain control over their brain activity during the training sessions. For the investigation of specificity, however, it seems essential to analyze the learning and adaptation processes that take place in the course of the training and to relate improvements in self-regulated brain activity across training sessions to behavioral, neuropsychological and electrophysiological outcomes. To this aim, a review of studies on neurofeedback training with ADHD patients which include the analysis of learning across training sessions or relate training performance to outcome is presented. Methods on how to evaluate and quantify learning of EEG regulation over time are discussed. “Non-learning” has been reported in a small number of ADHD-studies, but has not been a focus of general methodological discussion so far. For this reason, selected results from the brain-computer interface (BCI) research on the so-called “brain-computer illiteracy”, the inability to gain control over one’s brain activity, are also included. It is concluded that in the discussion on specificity, more attention should be devoted to the analysis of EEG regulation performance in the course of the training and its impact on clinical outcome. It is necessary to improve the knowledge on characteristic cross-session and within-session learning trajectories in ADHD and to provide the best conditions for learning.

A randomised control investigation of combined cognitive and neurofeedback training for children with AD/HD

Event Abstract Back to Event A randomised control investigation of combined cognitive and neurofeedback training for children with AD/HD Stuart J. Johnstone1*, Steven Roodenrys1, Kirsten Johnson1 and Rebecca Bonfield1 1 University of Wollongong, School of Psychology, Australia Objectives: There is increasing evidence that working memory and inhibitory control training can lead to behavioural improvement in children with Attention-Deficit/Hyperactivity Disorder (AD/HD). State-regulation theories of AD/HD suggest that an inability to adjust energetic state level, and consequent executive functioning issues, are at the core of the disorder. Accordingly, the present study examined the efficacy of a combined cognitive and neurofeedback training program for children with AD/HD using a randomised control design. Methods: The final sample consisted of 80 children aged 7-12 years, 40 in the training and 40 in the waitlist (WL) condition. Training consisted of cognitive and neurofeedback tasks and took place in the childrens' home, with participants required to complete between 20 and 25 sessions over a 6-8 week period. Outcomes examined included questionnaires assessing AD/HD symptom severity and frequency, performance on a digit span and counting span task, and EEG topography and power during several basic EEG tasks including resting eyes-open and eyes-closed. Results: Compared to the WL condition, children in the training condition showed significant reductions in AD/HD symptoms overall and specifically for the hyperactivity/impulsivity symptom of AD/HD. EEG power showed typical AD/HD topographical differences at Time 1, while post-training there was evidence of a directional trend towards EEG normalisation for children in the training condition. Conclusions: Overall the results provide support for the efficacy of a combined cognitive and neurofeedback training program for children with AD/HD. Acknowledgements The authors thank the parents and children who participated in this study. Keywords: ADHD, Neurofeedback Training, EEG, Inhibition (Psychology), working memory training Conference: ASP2015 - 25th Annual Conference of the Australasian Society for Psychophysiology, Sydney, Australia, 2 Dec - 4 Dec, 2015. Presentation Type: Poster Presentation Topic: Psychophysiology Citation: Johnstone SJ, Roodenrys S, Johnson K and Bonfield R (2015). A randomised control investigation of combined cognitive and neurofeedback training for children with AD/HD. Conference Abstract: ASP2015 - 25th Annual Conference of the Australasian Society for Psychophysiology. doi: 10.3389/conf.fnhum.2015.219.00022 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 11 Oct 2015; Published Online: 30 Nov 2015. * Correspondence: Dr. Stuart J Johnstone, University of Wollongong, School of Psychology, Wollongong, NSW, 2522, Australia, sjohnsto@uow.edu.au Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Stuart J Johnstone Steven Roodenrys Kirsten Johnson Rebecca Bonfield Google Stuart J Johnstone Steven Roodenrys Kirsten Johnson Rebecca Bonfield Google Scholar Stuart J Johnstone Steven Roodenrys Kirsten Johnson Rebecca Bonfield PubMed Stuart J Johnstone Steven Roodenrys Kirsten Johnson Rebecca Bonfield Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

ADHD and EEG-neurofeedback: a double-blind randomized placebo-controlled feasibility study

Electroencephalography (EEG)-neurofeedback has been shown to offer therapeutic benefits to patients with attention-deficit/hyperactivity disorder (ADHD) in several, mostly uncontrolled studies. This pilot study is designed to test the feasibility and safety of using a double-blind placebo feedback-controlled design and to explore the initial efficacy of individualized EEG-neurofeedback training in children with ADHD. Fourteen children (8–15 years) with ADHD defined according to the DSM-IV-TR criteria were randomly allocated to 30 sessions of EEG-neurofeedback (n = 8) or placebo feedback (n = 6). Safety measures (adverse events and sleep problems), ADHD symptoms and global improvement were monitored. With respect to feasibility, all children completed the study and attended all study visits and training sessions. No significant adverse effects or sleep problems were reported. Regarding the expectancy, 75% of children and their parent(s) in the active neurofeedback group and 50% of children and their parent(s) in the placebo feedback group thought they received placebo feedback training. Analyses revealed significant improvements of ADHD symptoms over time, but changes were similar for both groups. This pilot study shows that it is feasible to conduct a rigorous placebo-controlled trial to investigate the efficacy of neurofeedback training in children with ADHD. However, a double-blind design may not be feasible since using automatic adjusted reward thresholds may not work as effective as manually adjusted reward thresholds. Additionally, implementation of active learning strategies may be an important factor for the efficacy of EEG-neurofeedback training. Based on the results of this pilot study, changes are made in the design of the ongoing study.Electronic supplementary materialThe online version of this article (doi:10.1007/s00702-010-0524-2) contains supplementary material, which is available to authorized users.

Neurofeedback in children with ADHD: Specific event-related potential findings of a randomized controlled trial

Objective In a randomized controlled trial, we could demonstrate clinical efficacy of neurofeedback (NF) training for children with ADHD ( Gevensleben et al., 2009a). The present investigation aimed at learning more about the neuronal mechanisms of NF training. Methods Children with ADHD either completed a NF training or a computerized attention skills training (ratio 3:2). NF training consisted of one block of theta/beta training and one block of slow cortical potential (SCP) training, each comprising 18 training units. At three times (pre-training, between the two training blocks and at post-training), event-related potentials (ERP) were recorded during the Attention Network Test. ERP analysis focused on the P3, reflecting inter alia attentional resources for stimulus evaluation, and the contingent negative variation (CNV), primarily related to cognitive preparation. Results After NF training, an increase of the CNV in cue trials could be observed, which was specific for the SCP training. A larger pre-training CNV was associated with a larger reduction of ADHD symptomatology for SCP training. Conclusions CNV effects reflect neuronal circuits underlying resource allocation during cognitive preparation. These distinct ERP effects are closely related to a successful NF training in children with ADHD. In future studies, neurophysiological recordings could help to optimize and individualize NF training. Significance The findings contribute to a better understanding of the mechanisms underlying NF training in children with ADHD.