AD/HD
Research Papers
Showing 6 of 9Benefits of a 12-Week Non-Drug “Brain Fitness Program” for Patients with Attention-Deficit/Hyperactive Disorder, Post-Concussion Syndrome, or Memory Loss
Background: Non-pharmacologic interventions can potentially improve cognitive function, sleep, and/or mood in patients with attention-deficit/hyperactive disorder (ADHD), post-concussion syndrome (PCS), or memory loss. Objective: We evaluated the benefits of a brain rehabilitation program in an outpatient neurology practice that consists of targeted cognitive training, lifestyle coaching, and electroencephalography (EEG)-based neurofeedback, twice weekly (90 minutes each), for 12 weeks. Methods: 223 child and adult patients were included: 71 patients with ADHD, 88 with PCS, and 64 with memory loss (mild cognitive impairment or subjective cognitive decline). Patients underwent a complete neurocognitive evaluation, including tests for Verbal Memory, Complex Attention, Processing Speed, Executive Functioning, and Neurocognition Index. They completed questionnaires about sleep, mood, diet, exercise, anxiety levels, and depression—as well as underwent quantitative EEG—at the beginning and the end of the program. Results: Pre-post test score comparison demonstrated that all patient subgroups experienced statistically significant improvements on most measures, especially the PCS subgroup, which experienced significant score improvement on all measures tested (p≤0.0011; dz≥0.36). After completing the program, 60% to 90% of patients scored higher on cognitive tests and reported having fewer cognitive and emotional symptoms. The largest effect size for pre-post score change was improved executive functioning in all subgroups (ADHD dz= 0.86; PCS dz= 0.83; memory dz= 1.09). Conclusion: This study demonstrates that a multimodal brain rehabilitation program can have benefits for patients with ADHD, PCS, or memory loss and supports further clinical trials in this field.
View Full Paper →Neurofeedback, Self-Regulation, and Brain Imaging: Clinical Science and Fad in the Service of Mental Disorders
Neurofeedback draws on multiple techniques that propel both healthy and patient populations to self-regulate neural activity. Since the 1970s, numerous accounts have promoted electroencephalography-neurofeedback as a viable treatment for a host of mental disorders. Today, while the number of health care providers referring patients to neurofeedback practitioners increases steadily, substantial methodological and conceptual caveats continue to pervade empirical reports. And yet, nascent imaging technologies (e.g., real-time functional magnetic resonance imaging) and increasingly rigorous protocols are paving the road towards more effective applications and a better scientific understanding of the underlying mechanisms. Here, we outline common neurofeedback methods, illuminate the tenuous state of the evidence, and sketch out future directions to further unravel the potential merits of this contentious therapeutic prospect.
View Full Paper →What is Neurofeedback: An Update
Written to educate both professionals and the general public, this article provides an update and overview of the field of neurofeedback (EEG biofeedback). The process of assessment and neurofeedback training is explained. Then, areas in which neurofeedback is being used as a treatment are identified and a survey of research findings is presented. Potential risks, side effects, and adverse reactions are cited and guidelines provided for selecting a legitimately qualified practitioner.
View Full Paper →Altered spontaneous low frequency brain activity in Attention Deficit/Hyperactivity Disorder
Background: Resting brain activity appears altered in Attention Deficit/Hyperactivity Disorder (ADHD). The default mode interference hypothesis (Sonuga-Barke and Castellanos, 2007) postulates that patterns of spontaneous very low frequency brain activity, typical of the resting brain, cause attention lapses in ADHD when they remain unattenuated following the transition from rest to active task performance. Here we test this hypothesis using DC-EEG. Methods: DC-EEG recordings of very low frequency brain activity (< 1.5 Hz) were compared for 16 male children with ADHD and 16 healthy controls during both rest and active task performance (two choice reaction time task). Results: A previously identified very low frequency resting network of electrodes was replicated. At rest ADHD children showed less EEG power in very low frequency bands (i.e., .02–.2 Hz). They also showed less attenuation of power at these frequency bands during rest-to-task transition. Reduced attenuation was associated with a number of measures of performance. Discussion: We confirmed the existence of altered very low frequency brain activity in ADHD. ADHD children may have deficits both in maintaining a resting brain when needed and ‘protecting’ an active brain from the intrusion of resting state brain activity.
View Full Paper →Functional Neuroanatomy and the Rationale for Using EEG Biofeedback for Clients with Asperger’s Syndrome
This paper reviews the symptoms of Asperger’s Syndrome (AS), a disorder along the autism continuum, and highlights research findings with an emphasis on brain differences. Existing theories concerning AS are described, including theory of mind (Hill and Frith in Phil Trans Royal Soc Lond, Bull 358:281–289, 2003), mirror neuron system (Ramachandran and Oberman in Sci Am 295(5):62–69, 2006), and Porges’ (Ann N Y Acad Sci 1008:31–47, 2003, The neurobiology of autism, Johns Hopkins University Press, Baltimore, 2004) polyvagal theory. (A second paper, Outcomes using EEG Biofeedback Training in Clients with Asperger’s Syndrome, summarizes clinical outcomes obtained with more than 150 clients.) Patterns seen with QEEG assessment are then presented. Single channel assessment at the vertex (CZ) reveals patterns similar to those found in Attention-Deficit/Hyperactivity Disorder. Using 19-channel data, significant differences (z-scores > 2) were found in the amplitude of both slow waves (excess theta and/or alpha) and fast waves (beta) at various locations. Differences from the norm were most often found in mirror neuron areas (frontal, temporal and temporal-parietal). There were also differences in coherence patterns, as compared to a normative database (Neuroguide). Low Resolution Electromagnetic Tomography Analysis (Pascual-Marqui et al. in Methods Find Exp Clin Pharmacol 24C:91–95, 2002) suggested the source of the abnormal activity was most often the anterior cingulate. Other areas involved included the amygdala, uncus, insula, hippocampal gyrus, parahippocampal gyrus, fusiform gyrus, and the orbito-frontal and/or ventromedial areas of the prefrontal cortex. Correspondence between symptoms and the functions of the areas found to have abnormalities is evident and those observations are used to develop a rationale for using EEG biofeedback, called neurofeedback (NFB), intervention. NFB training is targeted to improve symptoms that include difficulty reading and mirroring emotions, poor attention to the outside world, poor self-regulation skills, and anxiety. Porges’ polyvagal theory is used to emphasize the need to integrate NFB with biofeedback (BFB), particularly heart rate variability training. We term this emerging understanding the Systems Theory of Neural Synergy. The name underscores the fact that NFB and BFB influence dynamic circuits and emphasizes that, no matter where we enter the nervous system with an intervention, it will seek its own new balance and equilibrium.
View Full Paper →The Effectiveness of Neurofeedback and Stimulant Drugs in Treating AD/HD: Part I. Review of Methodological Issues
The paper examines major criticisms of AD/HD (Attention Deficit/Hyperactivity Disorder) neurofeedback research using T. R. Rossiter and T. J. La Vaque (1995) as an exemplar and discusses relevant aspects of research methodology. J. Lohr, S. Meunier, L. Parker, and J. P. Kline (2001), D. A. Waschbusch and G. P. Hill (2001), and J. P. Kline, C. N. Brann, and B. R. Loney (2002) criticized Rossiter and La Vaque for (1) using an active treatment control; (2) nonrandom assignment of patients; (3) provision of collateral treatments; (4) using nonstandardized and invalid assessment instruments; (5) providing artifact contaminated EEG feedback; and (6) conducting multiple non-alpha protected t tests. The criticisms, except those related to statistical analysis, are invalid or are not supported as presented by the authors. They are based on the critics' unsubstantiated opinions; require redefining Rossiter and La Vaque as an efficacy rather than an effectiveness study; or reflect a lack of familiarity with the research literature. However, there are broader issues to be considered. Specifically, what research methodology is appropriate for studies evaluating the effectiveness of neurofeedback and who should make that determination? The uncritical acceptance and implementation of models developed for psychotherapy, pharmacology, or medical research is premature and ill-advised. Neurofeedback researchers should develop models that are appropriate to the technology, treatment paradigms, and goals of neurofeedback outcome studies. They need to explain the rationale for their research methodology and defend their choices.
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