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Applied Psychophysiology and Biofeedback

, Volume 32, Issue 2, pp 73–88 | Cite as

Neurofeedback for Children with ADHD: A Comparison of SCP and Theta/Beta Protocols

  • Ulrike LeinsEmail author
  • Gabriella Goth
  • Thilo Hinterberger
  • Christoph Klinger
  • Nicola Rumpf
  • Ute Strehl
Original Paper

Abstract

Behavioral and cognitive improvements in children with ADHD have been consistently reported after neurofeedback-treatment. However, neurofeedback has not been commonly accepted as a treatment for ADHD. This study addresses previous methodological shortcomings while comparing a neurofeedback-training of Theta-Beta frequencies and training of slow cortical potentials (SCPs). The study aimed at answering (a) whether patients were able to demonstrate learning of cortical self-regulation, (b) if treatment leads to an improvement in cognition and behavior and (c) if the two experimental groups differ in cognitive and behavioral outcome variables. SCP participants were trained to produce positive and negative SCP-shifts while the Theta/Beta participants were trained to suppress Theta (4–8 Hz) while increasing Beta (12–20 Hz). Participants were blind to group assignment. Assessment included potentially confounding variables. Each group was comprised of 19 children with ADHD (aged 8–13 years). The treatment procedure consisted of three phases of 10 sessions each. Both groups were able to intentionally regulate cortical activity and improved in attention and IQ. Parents and teachers reported significant behavioral and cognitive improvements. Clinical effects for both groups remained stable six months after treatment. Groups did not differ in behavioural or cognitive outcome.

Keywords

ADHD Neurofeedback Slow cortical potentials Theta-Beta Self-regulation 

Notes

Acknowledgments

This study was supported by the Förderprogramm der Medizinischen Fakultät Tübingen zur Angewandten Klinischen Forschung (AKF-Programm) and the Deutsche Forschungsgemeinschaft (DFG).

References

  1. Alhambra, M. A., Fowler, T. P., & Alhambra, A. A. (1995). EEG Biofeedback: A new treatment option for ADD/ADHD. Journal of Neurotherapy, 2, 39–43.CrossRefGoogle Scholar
  2. Barbaresi, W., Katusic, S., Colligan, R., Weaver, A., Pankratz, V., Mrazek, D., et al. (2004). How common is attention-deficit/hyperactivity disorder? Towards resolution of the controversy: results from a population-based study. Acta Paediatrica, 445, 55–59.Google Scholar
  3. Barbaresi, W. J., Katusic, S. K., Colligan, R. C., Pankratz, S., Weaver, A. L., Weber, K. J., et al. (2002). How common is attention-deficit/hyperactivity disorder? Archives of Pediatrics and Adolescent Medicine, 156, 217–224.PubMedGoogle Scholar
  4. Beelmann, A., & Schneider, N. (2003). Wirksamkeit von Psychotherapie bei Kindern und Jugendlichen. Eine Übersicht und Meta-Analyse zum Bestand und zu Ergebnissen der deutschsprachigen Effektivitätsforschung. Zeitschrift für Klinische Psychologie und Psychotherapie, 32, 129–143.CrossRefGoogle Scholar
  5. Bortz, J., & Döring, N. (1995). Forschungsmethoden und evaluation für sozialwissenschaftler (2nd ed.). Berlin, Heidelberg: Springer.Google Scholar
  6. Bruner, J. S. (1957). On perceptual readiness. Psychological Review, 64, 123–152.PubMedCrossRefGoogle Scholar
  7. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
  8. Conners, C. K. (1997). Conner’ rating scales—revised; technical manual. North Tonawande, N.Y.: Multi-Health Systems.Google Scholar
  9. Conners, C. K. (2002). Forty years of methylphenidate treatment in attention-deficit/hyperactivity disorder. Journal of Attention Disorders, 6, 17–30.Google Scholar
  10. Döpfner, M., & Lehmkuhl, G. (2002). Evidenzbasierte Therapie von Kindern und Jugendlichen mit Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS). Prax Kinderpsychol Kinderpsychiat, 51, 419–440.Google Scholar
  11. Eyberg, S. M., & Pincus D. (1999). Eyberg child behavior inventory & sutter-eyberg student behavior inventory—Revised. Odessa, FL: Psychological Assessment Ressources.Google Scholar
  12. Fuchs, T., Birbaumer, N., Lutzenberger, W., Gruzelier, J. H., & Kaiser, J. (2003). Neurofeedback treatment for attention-deficit/ hyperactivity disorder in children: A comparison with methylphenidate. Applied Psychophysiology and Biofeedback, 28, 1–12.PubMedCrossRefGoogle Scholar
  13. Goldman, L. S., Genel, M., Bezman, R. J., & Slanetz, P. J. (1998). Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Journal of the American Medical Association, 279, 1100–1107.PubMedCrossRefGoogle Scholar
  14. Heinrich, H. (2004). Training of slow cortical potentials in ADHD: Evidence for positive behavioral and neurophysiological effects. Biological Psychiatry, 55, 772–775.PubMedCrossRefGoogle Scholar
  15. Higgins, E. T., & Rholes, W. S. (1977). Category accessibility and impression formation. Journal of Experimental Social Psychology, 13, 141–154.CrossRefGoogle Scholar
  16. Hinterberger, T., Kotchoubey, B., Kaiser, J., Kübler, A., Neumann, N., Perelmouter, J., et al. (2000). Anwendungen der Selbstkontrolle langsamer kortikaler Potentiale. Verhaltenstherapie, 10, 219–227.CrossRefGoogle Scholar
  17. Hinterberger, T., Neumann, N., Pham, M., Kubler, A., Grether, A., Hofmayer, N., et al. (2004). A multimodal brain-based feedback and communication system. Experimental Brain Research, 154, 521–526.CrossRefGoogle Scholar
  18. Johnstone, S. J., Barry, R. J., & Anderson, J. W (2001). Topographic distribution and developmental time course of auditory event-related potentials in two subtypes of attention-deficit hyperactivity disorder. International Journal of Psychophysiology, 42, 73–94.PubMedCrossRefGoogle Scholar
  19. Kotchoubey, B., Blankenhorn, V., Fröscher, W., Strehl, U., & Birbaumer, N. (1997). Stability of cortical self-regulation in epilepsy patients. Neuroreport, 8, 1867–1870.PubMedCrossRefGoogle Scholar
  20. Kotchoubey, B., Strehl, U., Uhlmann, C., Holzapfel, S., König, M., Fröscher, W., et al. (2001). Modification of slow cortical potentials in patients with refractory epilepsy. Epilepsia, 42, 406–416.PubMedCrossRefGoogle Scholar
  21. Rossiter, T. R., & La Vaque, T. J. (1995). A comparison of EEG biofeedback and psychostimulants in treating attention deficit hyperactivity disorder. Journal of Neurotherapy, 1, 48–59.CrossRefGoogle Scholar
  22. Lubar, J. F., & Shouse, M. N. (1976). EEG and behavioral changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR). A preliminary report. Biofeedback and Self-Regulation, 1, 293–306.PubMedCrossRefGoogle Scholar
  23. Lubar, J. F., Swartwood, M. O., Swartwood, J. N., & O’Donnell, P. H. (1995). Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in TOVA scores, behavioral ratings and WISCR performance. Biofeedback and Self- Regulation, 20, 83–99.PubMedCrossRefGoogle Scholar
  24. Lubar, J. O., & Lubar, J. F. (1984). Electroencephalographic biofeedback of SMR and Beta for treatment of attention deficit disorders in a clinical setting. Biofeedback and Self-Regulation, 9, 1–23.PubMedCrossRefGoogle Scholar
  25. Mann, C. A., Lubar, J. F., Zimmerman, A. W., Miller, C. A., & Muenchen, R. A. (1992). Quantitative analysis of EEG in boys with ADHD: controlled study with clinical implications. Pediatric Neurology, 8, 30–36.PubMedCrossRefGoogle Scholar
  26. Miller, Y. (2000). Erziehung von Kindern im Kindergartenalter. Erziehungsverhalten und Kompetenzüberzeugungen von Eltern und der Zusammenhang zu kindlichen Verhaltensstörungen. Doktorarbeit an der TU Braunschweig. (un pub).Google Scholar
  27. Monastra, V. J., Linden, M., VanDeusen, P., Green, G., Wing, W., Phillips, A., et al. (1999). Assessing attention deficit hyperactivity disorder via quantitative electrencephalography. Neurophysiology, 13, 424–433.Google Scholar
  28. Monastra, V. J., & Lubar, J. F. L. M. (2001). The development of a quantitative electroencephalographic scanning process for attention deficit—Hyperactivity disorder reliability and validity studies. Neuropsychology, 15, 136–144.PubMedCrossRefGoogle Scholar
  29. Monastra, V. J., Monastra, D. M., & George, S. (2002). The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary smptoms of attention-deficit/Hyperactivity disorder. Applied Psychophysiology and Biofeedback, 27, 231–249.PubMedCrossRefGoogle Scholar
  30. Monastra, V. J., Lynn, S., Linden, M., Lubar, J. F., Gruzelier, J., & La Vaque, T. J. (2005). Electroencephalographic biofeedback in the treatment of attention-deficit/Hyperactivity disorder. Applied Psychophysiology and Biofeedback, 30, 95–114.PubMedCrossRefGoogle Scholar
  31. MTA Cooperative Group. (2004). National institute of mental health multimodal treatment study of ADHD follow-up: Changes in effectiveness and growth after the end of treatment. Pediatrics, 113, 762–769.CrossRefGoogle Scholar
  32. Neumann, N., Hinterberger, T., Kaiser, J., Leins, U., Birbaumer, N., & Kübler, A. (2004). Automatic processing of self-regulation of slow cortical potentials: evidence from brain-computer communication in paralyzed patients. Clinical Neurophysiology, 115, 628–635.PubMedCrossRefGoogle Scholar
  33. Othmer, S., Othmer, S. F., & Clifford, S. M. (1991). EEG biofeedback training for attention deficit disorder, specific learning disabilities, and associated conduct problems. EEG Spectrum (http://www.eegspectrum.com/Applications/ADHD-ADD/).Google Scholar
  34. Ramirez, P. M., Desantis, D., & Opler, L. A. (2001). EEG biofeedback treatment of ADD. A viable alternative to traditional medical intervention? Annals of the New York Academy of Science, 931, 342–358.CrossRefGoogle Scholar
  35. Rockstroh, B., Elbert, T., Canavan, A., Lutzenberger, W., & Birbaumer, N. (1989). Slow cortical potentials and behavior. Baltimore, München, Wien: Urban & Schwarzenberg.Google Scholar
  36. Rockstroh, B., Elbert, T., Lutzenberger, W., & Birbaumer, N. (1990). Biofeedback: Evaluation and therapy in children with attentional dysfunctions. In A. Rothenberger (Ed.), Brain and behavior in child psychiatry (pp. 345–355). Berlin: Springer.Google Scholar
  37. Satterfield, J. H., Schell, A. M., & Nicholas, T. (1994). Preferential neural processing of attended stimuli in attention-deficit hyperactivity disorder and normal boys. Psychophysiology, 31, 1–10.PubMedCrossRefGoogle Scholar
  38. Schachter, M., Pham, B., King, J., Langford, S., & Moher, D. (2001). How efficacious and safe ist short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolsecents? A meta-analysis. Canadian Medical Association, 165, 1475–1488.Google Scholar
  39. Shouse, M. N., & Lubar, J. F. (1979). Operant conditioning of EEG rhythms and ritalin in the treatment of hyperkinesis. Biofeedback and Self- Regulation, 4, 299–312.PubMedCrossRefGoogle Scholar
  40. Spencer, T. J., Biederman, J., Wilens, T. E., & Faraone, S. V. (2002). Novel treatments for ADHD in children. Journal of Clinical Psychiatry, 63, 16–22.PubMedGoogle Scholar
  41. Spencer, T., Biederman, J., Wilens, T., Harding, M., O’Donnell, D., & Griffin, S. (1996). Pharmacotherapy of attention-deficit hyperactivity disorder across the life. Journal of the American Academy of Child and Adolescent, 35, 409–432.CrossRefGoogle Scholar
  42. Strehl, U., Leins, U., Goth, G., Klinger, C., & Birbaumer, N. (2006). Physiological regulation of slow cortical potentials—a new treatment for children for ADHD. Pediatrics.Google Scholar
  43. Tansey, M. A., & Bruner, R. L. (1983). EMG and EEG biofeedback training in the treatment of a 10-year-old hyperactive boy with a developmental reading disorder. Biofeedback and Self- Regulation, 8, 25–37.PubMedCrossRefGoogle Scholar
  44. Tewes, U., Rossmann, P., & Schallberger, U. (1999). Hamburg wechsler intelligenztest für kinder—Dritte Auflage (HAWIK III). Bern: Huber.Google Scholar
  45. Thompson, L., & Thompson, M. (1998). Neurofeedback combined with training in meta cognitive strategies: Effectiveness in students with ADD. Applied Psychophysiology and Biofeedback, 23, 243–263.PubMedCrossRefGoogle Scholar
  46. Vernon, D., Frick, A., & Gruzelier, J. (2004). Neurofeedback as a treatment for ADHD: A methodological review with implications for future research. Journal of Neurotherapy, 8, 53–82.CrossRefGoogle Scholar
  47. Wagner, K. D. (2002). Management of treatment refractory attention-deficit/hyperacitivity disorder in children and adolescents. Psychopharmacology-Bulletin, 36, 130–142.PubMedGoogle Scholar
  48. Zimmermann, P., & Fimm, B. (1997). Testbatterie zur aufmerksamkeitsprüfung (TAP), Version 1.7. Herzogenrath: PsyTest.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Ulrike Leins
    • 1
    Email author
  • Gabriella Goth
    • 2
  • Thilo Hinterberger
    • 2
  • Christoph Klinger
    • 2
  • Nicola Rumpf
    • 2
  • Ute Strehl
    • 2
  1. 1.Department of Psychiatry and PsychotherapyUniversity Hospital of TübingenTübingenGermany
  2. 2.Institute of Medical Psychology and Behavioral NeurobiologyUniversity of TübingenTübingenGermany

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