Standardized neurofeedback (NF) protocols have been extensively evaluated in attention-deficit/hyperactivity disorder (ADHD). However, such protocols do not account for the large EEG heterogeneity in ADHD. Thus, individualized approaches have been suggested to improve the clinical outcome. In this direction, an open-label pilot study was designed to evaluate a NF protocol of relative upper alpha power enhancement in fronto-central sites. Upper alpha band was individually determined using the alpha peak frequency as an anchor point. 20 ADHD children underwent 18 training sessions. Clinical and neurophysiological variables were measured pre- and post-training. EEG was recorded pre- and post-training, and pre- and post-training trials within each session, in both eyes closed resting state and eyes open task-related activity. A power EEG analysis assessed long-term and within-session effects, in the trained parameter and in all the sensors in the (1–30) Hz spectral range. Learning curves over sessions were assessed as well. Parents rated a clinical improvement in children regarding inattention and hyperactivity/impulsivity. Neurophysiological tests showed an improvement in working memory, concentration and impulsivity (decreased number of commission errors in a continuous performance test). Relative and absolute upper alpha power showed long-term enhancement in task-related activity, and a positive learning curve over sessions. The analysis of within-session effects showed a power decrease (“rebound” effect) in task-related activity, with no significant effects during training trials. We conclude that the enhancement of the individual upper alpha power is effective in improving several measures of clinical outcome and cognitive performance in ADHD. This is the first NF study evaluating such a protocol in ADHD. A controlled evaluation seems warranted due to the positive results obtained in the current study.
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American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Press.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Arns, M., Gunkelman, J., Breteler, M., & Spronk, D. (2008). EEG phenotypes predict treatment outcome to stimulants in children with ADHD. Journal of Integrative Neuroscience, 7(03), 421–438.
Arns, M., de Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: A meta-analysis. Clinical EEG and Neuroscience, 40(3), 180–189.
Arns, M., Drinkenburg, W., & Kenemans, J. L. (2012). The effects of QEEG-informed neurofeedback in ADHD: An open-label pilot study. Applied Psychophysiology and Biofeedback, 37(3), 171–180.
Arns, M., Conners, C. K., & Kraemer, H. C. (2013). A decade of EEG theta/beta ratio research in ADHD: A meta-analysis. Journal of Attention Disorders, 17(5), 374–383.
Arns, M., Heinrich, H., & Strehl, U. (2014). Evaluation of neurofeedback in ADHD: The long and winding road. Biological Psychology, 95(0):108–115. (Society of Applied Neuroscience) Special issue on Neurofeedback.
Barachant, A., Bonnet, S., Congedo, M., & Jutten, C. (2012). Multiclass brain-computer interface classification by Riemannian geometry. IEEE Transactions on Biomedical Engineering, 59(4), 920–928.
Barachant, A., Andreev, A., & Congedo, M. (2013). The Riemannian Potato: An automatic and adaptive artifact detection method for online experiments using Riemannian geometry. In Proceedings of TOBI workshop IV, pp. 19–20.
Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65.
Barry, R. J., Clarke, A. R., & Johnstone, S. J. (2003). A review of electrophysiology in attention-deficit/hyperactivity disorder: I. Qualitative and quantitative electroencephalography. Clinical Neurophysiology, 114(2), 171–183.
Brickenkamp, R., & Zillmer, E. (1998). The d2 test of attention. Seattle, WA: Hogrefe & Huber Publishers.
Castellanos, F. X., & Tannock, R. (2002). Neuroscience of attention-deficit/hyperactivity disorder: The search for endophenotypes. Nature Reviews Neuroscience, 3(8), 617–628.
Clarke, A. R., Barry, R. J., McCarthy, R., & Selikowitz, M. (2001). EEG-defined subtypes of children with attention-deficit/hyperactivity disorder. Clinical Neurophysiology, 112(11), 2098–2105.
Clarke, A. R., Barry, R. J., Dupuy, F. E., McCarthy, R., Selikowitz, M., & Johnstone, S. J. (2013). Excess beta activity in the EEG of children with attention-deficit/hyperactivity disorder: A disorder of arousal? International Journal of Psychophysiology, 89(3), 314–319.
Conners, C. K., & Staff, M. (2000). Conners’ continuous performance test II (CPT II V. 5). North Tonawanda, NY: Multi-Health Systems Inc.
Conners, C. K., Sitarenios, G., Parker, J. D., & Epstein, J. N. (1998). The revised Conners’ Parent Rating Scale (CPRS-R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26(4), 257–268.
Escolano, C., Aguilar, M., & Minguez, J. (2011). EEG-based upper alpha neurofeedback training improves working memory performance. In: International conference of the IEEE Engineering in Medicine and Biology Society (EMBC), Boston (USA), pp. 2327–2330.
Faraone, S. V., Biederman, J., & Mick, E. (2006). The age-dependent decline of attention deficit hyperactivity disorder: A meta-analysis of follow-up studies. Psychological Medicine, 36(2), 159–166.
Freunberger, R., Werkle-Bergner, M., Griesmayr, B., Lindenberger, U., & Klimesch, W. (2011). Brain oscillatory correlates of working memory constraints. Brain Research, 1375, 93–102.
Graham, J., Banaschewski, T., Buitelaar, J., Coghill, D., Danckaerts, M., Dittmann, R., et al. (2011). European guidelines on managing adverse effects of medication for ADHD. European Child & Adolescent Psychiatry, 20(1), 17–37.
Gruzelier, J. H. (2013). EEG-neurofeedback for optimising performance. I: A review of cognitive and affective outcome in healthy participants. Neuroscience & Biobehavioral Reviews, 44, 124–141.
Hanslmayr, S., Sauseng, P., Doppelmayr, M., Schabus, M., & Klimesch, W. (2005). Increasing individual upper alpha power by neurofeedback improves cognitive performance in human subjects. Applied Psychophysiology and Biofeedback, 30, 1–10.
Heinrich, H., Gevensleben, H., & Strehl, U. (2007). Annotation: Neurofeedback-train your brain to train behaviour. Journal of Child Psychology and Psychiatry, 48(1), 3–16.
Holmes, A. P., Blair, R., Watson, G., & Ford, I. (1996). Nonparametric analysis of statistic images from functional mapping experiments. Journal of Cerebral Blood Flow & Metabolism, 16(1), 7–22.
Hyvarinen, A. (1999). Fast and robust fixed-point algorithms for independent component analysis. IEEE Transactions on Neural Networks, 10(3), 626–634.
Klimesch, W. (1999). EEG alpha and theta oscillations reflect cognitive and memory performance: A review and analysis. Brain Research Reviews, 29(2–3), 169–195.
Klimesch, W., Sauseng, P., & Hanslmayr, S. (2007). EEG alpha oscillations: The inhibition-timing hypothesis. Brain research reviews, 53(1), 63–88.
Kluetsch, R., Ros, T., Théberge, J., Frewen, P., Calhoun, V., Schmahl, C., et al. (2013). Plastic modulation of PTSD resting-state networks and subjective wellbeing by EEG neurofeedback. Acta Psychiatrica Scandinavica, 130(2), 123–136.
Lansbergen, M. M., Arns, M., van Dongen-Boomsma, M., Spronk, D., & Buitelaar, J. K. (2011a). The increase in theta/beta ratio on resting-state EEG in boys with attention-deficit/hyperactivity disorder is mediated by slow alpha peak frequency. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 35(1), 47–52.
Lansbergen, M. M., van Dongen-Boomsma, M., Buitelaar, J. K., & Slaats-Willemse, D. (2011b). ADHD and EEG-neurofeedback: A double-blind randomized placebo-controlled feasibility study. Journal of Neural Transmission, 118(2), 275–284.
Lee, T. W., Girolami, M., & Sejnowski, T. J. (1999). Independent component analysis using an extended infomax algorithm for mixed subgaussian and supergaussian sources. Neural Computation, 11(2), 417–441.
Logemann, H. N., Lansbergen, M. M., Van Os, T. W., Böcker, K. B., & Kenemans, J. L. (2010). The effectiveness of EEG-feedback on attention, impulsivity and EEG: A sham feedback controlled study. Neuroscience letters, 479(1), 49–53.
Loo, S. K., & Makeig, S. (2012). Clinical utility of EEG in attention-deficit/hyperactivity disorder: A research update. Neurotherapeutics, 9(3), 569–587.
Lubar, J. F., & Shouse, M. N. (1976). EEG and behavioral changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR). Biofeedback and Self-Regulation, 1(3), 293–306.
Maris, E., & Oostenveld, R. (2007). Nonparametric statistical testing of EEG- and MEG-data. Journal of Neuroscience Methods, 164(1), 177–190.
Martinussen, R., Hayden, J., Hogg-Johnson, S., & Tannock, R. (2005). A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 44(4), 377–384.
Molina, B. S., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., et al. (2009). The MTA at 8 years: Prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Academy of Child & Adolescent Psychiatry, 48(5), 484–500.
Monastra, V. J., Lynn, S., Linden, M., Lubar, J. F., Gruzelier, J., & La Vaque, T. J. (2006). Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder. Journal of Neurotherapy, 9(4), 5–34.
Nan, W., Rodrigues, J. P., Ma, J., Qu, X., Wan, F., Mak, P. I., et al. (2012). Individual alpha neurofeedback training effect on short term memory. International Journal of Psychophysiology, 86(1), 83–87.
Nichols, T. E., & Holmes, A. P. (2002). Nonparametric permutation tests for functional neuroimaging: A primer with examples. Human brain mapping, 15(1), 1–25.
Pesarin, F. (2001). Multivariate permutation tests: With applications in biostatistics (Vol. 240). New York, NY: Wiley.
Pfurtscheller, G., & Lopes da Silva, F. H. (1999). Event-related EEG/MEG synchronization and desynchronization: Basic principles. Clinical Neurophysiology, 110(11), 1842–1857.
Polanczyk, G., de Lima, M., Horta, B., Biederman, J., & Rohde, L. (2007). The worldwide prevalence of ADHD: A systematic review and metaregression analysis. American Journal of Psychiatry, 164(6), 942–948.
Reynolds, C. R., & Kamphaus, R. W. (2004). Behavior Assessment System for Children. Circle Pines, MN: AGS Publishing.
Ros, T., Munneke, M., Parkinson, L., & Gruzelier, J. (2014). Neurofeedback facilitation of implicit motor learning. Biological Psychology 95(0):54–58. SAN (Society of Applied Neuroscience) Special issue on Neurofeedback.
Sauseng, P., Klimesch, W., Heise, K. F., Gruber, W. R., Holz, E., Karim, A., et al. (2009). Brain oscillatory substrates of visual short-term memory capacity. Current Biology, 19(21), 1846–1852.
Snyder, S. M., & Hall, J. R. (2006). A meta-analysis of quantitative EEG power associated with attention-deficit hyperactivity disorder. Journal of Clinical Neurophysiology, 23(5), 441–456.
Sterman, M. B. (2000). Basic concepts and clinical findings in the treatment of seizure disorders with EEG operant conditioning. Clinical Electroencephalography, 31(1), 45–55.
Wang, G. J., Volkow, N. D., Wigal, T., Kollins, S. H., Newcorn, J. H., Telang, F., et al. (2013). Long-term stimulant treatment affects brain dopamine transporter level in patients with attention deficit hyperactive disorder. PloS One, 8(5), e63,023.
Wechsler, D. (2003). Wechsler intelligence scale for children-4th edition (WISC-IV). San Antonio, TX: The Psychological Corporation.
Zoefel, B., Huster, R. J., & Herrmann, C. S. (2011). Neurofeedback training of the upper alpha frequency band in EEG improves cognitive performance. NeuroImage, 54(2), 1427–1431.
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Escolano, C., Navarro-Gil, M., Garcia-Campayo, J. et al. The Effects of Individual Upper Alpha Neurofeedback in ADHD: An Open-Label Pilot Study. Appl Psychophysiol Biofeedback 39, 193–202 (2014). https://doi.org/10.1007/s10484-014-9257-6
- Individual upper alpha
- Cognitive performance