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

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          Abstract

          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 material

          The online version of this article (doi:10.1007/s00702-010-0524-2) contains supplementary material, which is available to authorized users.

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          The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies.

          Stephen V Faraone, Joseph Biederman, Eric Mick (2006)
          This study examined the persistence of attention deficit hyperactivity disorder (ADHD) into adulthood. We analyzed data from published follow-up studies of ADHD. To be included in the analysis, these additional studies had to meet the following criteria: the study included a control group and it was clear from the methods if the diagnosis of ADHD included subjects who did not meet full criteria but showed residual and impairing signs of the disorder. We used a meta-analysis regression model to separately assess the syndromatic and symptomatic persistence of ADHD. When we define only those meeting full criteria for ADHD as having 'persistent ADHD', the rate of persistence is low, approximately 15% at age 25 years. But when we include cases consistent with DSM-IV's definition of ADHD in partial remission, the rate of persistence is much higher, approximately 65%. Our results show that estimates of ADHD's persistence rely heavily on how one defines persistence. Yet, regardless of definition, our analyses show that evidence for ADHD lessens with age. More work is needed to determine if this reflects true remission of ADHD symptoms or is due to the developmental insensitivity of diagnostic criteria for the disorder.
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            The Worldwide Prevalence of ADHD: A Systematic Review and Metaregression Analysis

            Guilherme Polanczyk (2007)
            Article 0 comments Cited 208 times – based on 0 reviews     Review now
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              3-year follow-up of the NIMH MTA study.

              Peter S Jensen, L Eugene Arnold, James M. Swanson … (2007)
              In the intent-to-treat analysis of the Multimodal Treatment Study of Children With ADHD (MTA), the effects of medication management (MedMgt), behavior therapy (Beh), their combination (Comb), and usual community care (CC) differed at 14 and 24 months due to superiority of treatments that used the MTA medication algorithm (Comb+MedMgt) over those that did not (Beh+CC). This report examines 36-month outcomes, 2 years after treatment by the study ended. For primary outcome measures (attention-deficit/hyperactivity disorder [ADHD] and oppositional defiant disorder [ODD] symptoms, social skills, reading scores, impairment, and diagnostic status), mixed-effects regression models and orthogonal contrasts examined 36-month outcomes. At 3 years, 485 of the original 579 subjects (83.8%) participated in the follow-up, now at ages 10 to 13 years, (mean 11.9 years). In contrast to the significant advantage of MedMgt+Comb over Beh+CC for ADHD symptoms at 14 and 24 months, treatment groups did not differ significantly on any measure at 36 months. The percentage of children taking medication >50% of the time changed between 14 and 36 months across the initial treatment groups: Beh significantly increased (14% to 45%), MedMed+Comb significantly decreased (91% to 71%), and CC remained constant (60%-62%). Regardless of their treatment use changes, all of the groups showed symptom improvement over baseline. Notably, initial symptom severity, sex (male), comorbidity, public assistance, and parental psychopathology (ADHD) did not moderate children's 36-month treatment responses, but these factors predicted worse outcomes over 36 months, regardless of original treatment assignment. By 36 months, the earlier advantage of having had 14 months of the medication algorithm was no longer apparent, possibly due to age-related decline in ADHD symptoms, changes in medication management intensity, starting or stopping medications altogether, or other factors not yet evaluated.
              Article 0 comments Cited 120 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                : +31-628114833 , +31-243540561 , mariekelansbergen@hotmail.com
                Journal
                Journal ID (nlm-ta): J Neural Transm
                Title: Journal of Neural Transmission
                Publisher: Springer Vienna (Vienna )
                ISSN (Print): 0300-9564
                ISSN (Electronic): 1435-1463
                Publication date (Electronic): 17 December 2010
                Publication date PMC-release: 17 December 2010
                Publication date (Print): February 2011
                Volume: 118
                Issue: 2
                Pages: 275-284
                Affiliations
                [1 ]Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
                [2 ]Karakter University Centre for Child and Adolescent Psychiatry, Nijmegen, The Netherlands
                [3 ]Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
                Article
                Publisher ID: 524
                DOI: 10.1007/s00702-010-0524-2
                PMC ID: 3051071
                PubMed ID: 21165661
                SO-VID: 092beaeb-6f45-40a5-98f7-c89e28f057e0
                Copyright © © The Author(s) 2010
                History
                Date received : 20 July 2010
                Date accepted : 31 October 2010
                Categories
                Subject: Biological Child and Adolescent Psychiatry - Original Article
                Custom metadata
                issue-copyright-statement © Springer-Verlag 2011

                ScienceOpen disciplines: Neurosciences
                Keywords: electroencephalogram (eeg),eeg-neurofeedback,feasibility,safety,attention-deficit/hyperactivity disorder (adhd),randomized controlled trial (rct)
                Data availability:
                ScienceOpen disciplines: Neurosciences
                Keywords: electroencephalogram (eeg), eeg-neurofeedback, feasibility, safety, attention-deficit/hyperactivity disorder (adhd), randomized controlled trial (rct)

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