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Neurofeedback in ADHD: Further Pieces of the Puzzle

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Abstract

Among the different neuromodulation techniques, neurofeedback (NF) is gaining increasing interest in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). In this article, a methodological framework is summarised considering the training as a neuro-behavioural treatment. Randomised controlled trials are selectively reviewed. Results from two smaller-scale studies are presented with the first study comprising a tomographic analysis over the course of a slow cortical potential (SCP) training and a correlational analysis of regulation skills and clinical outcome in children with ADHD. In the second study, ADHD-related behaviour was studied in children with tic disorder who either conducted a SCP training or a theta/low-beta (12–15 Hz) training (single-blind, randomised design). Both studies provide further evidence for the specificity of NF effects in ADHD. Based on these findings, a refined model of the mechanisms contributing to the efficacy of SCP training is developed. Despite a number of open questions concerning core mechanisms, moderators and mediators, NF (theta/beta and SCP) training seems to be on its way to become a valuable and ethically acceptable module in the treatment of children with ADHD.

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Notes

  1. A comprehensive review about SCPs is provided in Birbaumer et al. (1990).

  2. In a meta-analysis (Arns et al. 2009), the RCTs of Gevensleben et al. (2009a) and Bakhshayesh et al. (2011) but also earlier studies were considered. Large effect sizes for inattention and about medium effect sizes for hyperactivity/impulsivity were found.

  3. Originally, a SMR training was intended to be run. However, as a SMR training is recommended to reinforce a specific SMR spindle with duration of 0.25 s (Sherlin et al. 2011), which has not been done in our study, we decided to name the protocol 'theta/low-beta'.

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Acknowledgments

The studies included in this paper were supported by the German Research Foundation (study I, HE 4536/2, MO 726/2) and the Tourette Gesellschaft Deutschland (study II). The authors thank the participating families (particularly the children) and all colleagues and students contributing to these studies.

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Authors and Affiliations

  1. Child & Adolescent Psychiatry, University Medicine Göttingen, Göttingen, Germany

    Holger Gevensleben, Andrea Flaig-Röhr & Aribert Rothenberger

  2. Department of Child & Adolescent Mental Health, University Hospital of Erlangen, Schwabachanlage 6 + 10, 91054, Erlangen, Germany

    Maike Kleemeyer, Petra Studer, Gunther H. Moll & Hartmut Heinrich

  3. Center for Medicine, Society and Prevention, Institute for Ethics and History in Medicine, University of Tübingen, Tübingen, Germany

    Lillian Geza Rothenberger

  4. Heckscher-Klinikum, Munich, Germany

    Hartmut Heinrich

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  1. Holger Gevensleben
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  2. Maike Kleemeyer
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Correspondence to Hartmut Heinrich.

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This is one of several papers published together in Brain Topography on the “Special Topic: Clinical and Ethical Implications of Neuromodulation Techniques”.

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Gevensleben, H., Kleemeyer, M., Rothenberger, L.G. et al. Neurofeedback in ADHD: Further Pieces of the Puzzle. Brain Topogr 27, 20–32 (2014). https://doi.org/10.1007/s10548-013-0285-y

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