Neurofeedback (NF) is a form of behavioural training aimed at developing skills for selfregulation

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Brent Harrington
7 years ago
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1 Neurofeedback for ADHD Neurofeedback (NF) is a form of behavioural training aimed at developing skills for selfregulation of brain activity. In NF training, self-regulation of specific aspects of electrical brain activity is acquired by means of immediate feedback and positive reinforcement. Measures representing these neurophysiological patterns are converted into visual or acoustic signals which are continuously fed back in real-time. Changes that are made in the desired direction are rewarded, i.e. positively reinforced. Neurofeedback training can be run as a kind of computer game and is thus principally attractive for children. Studies revealed paradigm-specific effects on e.g. attention and memory processes and performance improvements in real-life conditions, in healthy subjects as well as in patients. In several studies it was shown that children with attention-deficit hyperactivity disorder (ADHD) improved behavioural and cognitive variables after frequency (e.g. theta / beta) training or SCP training. We provide neurofeedback for children with ADHD and Tic/Tourette disorder. Our Studies Actually we are running three distinct trials examining different aspects of the efficacy and specificity of Neurofeedback in ADHD and Tic-/Tourette disorder.

2 1.) Comparison of neurofeedback and computerised attention skills training in children with attention-deficit/ hyperactivity disorder (ADHD). Trial registry: (supported by the Deutsche Forschungsgemeinschaft; DFG; RO 698/4) In a randomized controlled trial encompassing 102 children with ADHD we documented clinical efficacy of NF. A combined NF (18 units of theta/beta frequency band training preceded or followed by 18 units of training of slow cortical potentials (SCP) was compared to 2 x 18 units of a computerised attention skills training, not encompassing neuroregulation. According to parents and teachers ratings children of the NF group showed larger behavioural (clinical) improvements than those of the control group. Due to comparable settings and demands for NF and AST training, superiority of NF was ascribed to specific factors of the NF treatment first and foremost. In order to learn more about neurophysiological mechanisms underlying behavioural changes of NF training in children with ADHD, we also study the impact of theta / beta and SCP training on the spontaneous EEG and ERP measures. The combined NF training was accompanied by a reduction of theta activity. Protocol-specific EEG changes (theta/beta training: decrease of posterior-midline theta activity; SCP training: increase of central-midline alpha activity) were associated with a decrease of the hyperactivity/impulsivity subscale of the German ADHD rating scale. Related EEG-based predictors were obtained. Thus differential EEG patterns for theta / beta and SCP training provide further evidence that specific effects contribute to behavioural improvements in children with ADHD. In cooperation with the Max-Planck-Insititute for Biophysical Chemistry, distinct effects of NF-protocols in healthy adults will be evaluated using functional MRI.

3 2.) Neurofeedback in children with attention-deficit/hyperactivity disorder (ADHD) - a controlled multicenter study of a non-pharmacological treatment approach (supported by the Deutsche Forschungsgemeinschaft: HO 2503/4-1) The aim of this investigation is to examine the efficacy of SCP-Neurofeedback in childhood ADHD in a prospective, randomized, controlled study, assessing its effectiveness in comparison to an unspecific peripheral biofeedback treatment (muscular relaxation) with an identical setting. After a six-month delay, a follow-up examination will be conducted focusing on the long-term effects. Children will be randomly assigned to one of the two groups: Neurofeedback or EMGbiofeedback. Both interventions will be administered in addition to treatment as usual (TAU). TAU may comprise pharmacotherapy with psychostimulants (short or long acting), e.g. methylphenidate and amphetamine salts, and atomoxetine. To assess the unique effects of the interventions, their stability over time and the need of further pharmacotherapy, medication will be washed out after the intervention phase in both groups. Medication will be readministered in the case of symptom relapse. Children will attend an average of 25 sessions of Neurofeedback training in 3 months. Each session is expected to last ~60 minutes. This will include time needed for electrode montage as well as 4 x 10 minute feedback segments. The training protocol reinforces increasing negativation and positivation compared to the baseline. The very last 10 sessions are followed each by short transfer exercises: the children will be instructed to use the stragies of self regulation while doing their homework. TAU will be provided as outlined above. To control for the degree of researcher-participant interaction, as well as non-specific motivational

4 effects of the feedback-setting, children assigned to the EMG group will attend an average of 25 sessions of peripheral electromyographic biofeedback (muscular relaxation at different regions of the body). Duration of sessions, surface of the feedback device, reinforcement and transfer exercises will be identical to the Neurofeedback-setting. TAU will be provided as outlined above. It is planned to enrol a total number of 160 patients into the trial. Efficacy will be evaluated on the behavioral, neuropsychological and neurophysiological level.

5 3.) Specific effects of two different neurofeedback protocols in Children with Tic- /Tourette disorder a summer camp evaluation study (supported by the Deutsche Tourette Gesellschaft Deutschland e. V.) To enhance self regulation capability in view of a reduction of tic frequency, 48 children with tic-/tourette disorder participate in a neurofeedback training (two weeks vacation camp). Two different treatment protocols (training of slow cortical potentials vs. sensorimotor rhythm) will be compared due to efficacy and specific effects, using measures of EEG (coherence) and event-related potentials (ERP) to elucidate the mechanisms underlying the treatment. Evaluation of treatment effects will be conducted on behavioral level (behavioral monitoring during sessions, patients and parents questionnaires), neurophysiological level (EEG coherence, ERP) and neuropsychological level (test performance: executive functions). Our results might not only provide evidence for the effectiveness of neurofeedback as an additional treatment option for tic disorders but will also elucidate neurophysiological mechanisms underlying neurofeedback treatment and neurophysiological selfregulation strategies.

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