Brain activity assessed by electroencephalography (EEG) has been demonstrated to respond to conditioning techniques. The concept of modulating this activity has been called EEG biofeedback, more recently neurofeedback, and is based on operant learning principles. Technological advancements have significantly enhanced the ease and affordability of recording and analyzing brain activity. Thus, properly trained practitioners can implement these conditioning strategies in their practice. Recent research indicating evidenced-based efficacy has made this technique a more viable option for clinical intervention. The objective of this article is to highlight the learning principles that have provided the fundamentals of this neuromodulatory approach. In addition, it is recommended that future applications in clinical work, research, and development adhere to these principles.

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Attention deficit hyperactivity disorder (ADHD) is a developmental psychiatric disorder thought to affect approximately 5 to 10% of school-age children, of whom 30 to 65% continue to exhibit symptoms into adulthood. The prevalence of ADHD in adults is also an estimated 4%, second only to depression. Across studies there appear to be significant network dysfunctions involved in ADHD. Typically the foci of interest in ADHD included the insular cortices, frontal lobes, basal ganglia, and cerebellum. More recently, attention has been directed to the default network of the brain and its functional integrity in ADHD with focus on the precuneus and parietal lobes and interactions with medial prefrontal cortices. Functional magnetic resonance imaging (fMRI) measures neurovascular coupling as measured by the blood oxygenated level dependent signal (BOLD). Electroencephalogram (EEG) measures brain electrical information. Because fMRI is an indirect measure of neuronal activity and EEG is a direct measure, combining the results from these two imaging modalities under the same task conditions may provide a more complete story as to the what (EEG) and where (fMRI) activity exists. This article discusses the benefits of using standardized low resolution electromagnetic tomography (sLORETA) analysis of the EEG as compared to fMRI. The goal of the study, the data from which we use for our justification, was to discover the functional differences in ADHD and non-ADHD brains with different brain imaging modalities. We hoped to elucidate functional connectivity patterns by interpreting the data acquired with the EEG using sLORETA and the data acquired with the fMRI scans. We further hoped to find correlation with the sLORETA and fMRI interpretations so as to confirm that EEG is an adequate stand-alone methodology to evaluate ADHD. Participants included 6 ADHD and 7 non-ADHD subjects. They were initially interviewed by phone and administered the Connors Rating Scale and the Mini International Neuropsychiatric Interview to determine accuracy of symptom reporting and to rule out psychological comorbidities. Exclusion criteria consisted of previous head trauma, recent drug or alcohol abuse (14 days), or neurological syndromes. We recorded sequential 19-channel EEG and fMRI during the eyes-open and eyes-closed states and while performing the Stroop test. The QEEG results were evaluated with comparison to a normative database and with sLORETA analysis.Functional connectivity was assessed using the seed-based approach in sLORETA. The fMRI results were evaluated using Brain Voyager TM and other neuroimaging software packages. sLORETA and fMRI data identify a region in medial Brodmann Area (BA) 10 of the default network. Furthermore, regional frontal differences extend to medial BA 32 with more emphasis to left prefrontal. sLORETA determines there is less current source density at BA 10 in the ADHD participants than controls. sLORETA is adequate in localizing the sources of the EEG in the default network as contrasted with fMRI. It is impor...

At four sites, 180 children aged 7 to 10 years with rigorously diagnosed ADHD and TBR ≥ 5 will be randomized to active TBR-NF versus sham NF of equal duration, intensity, and appearance. Sham, utilizing prerecorded EEGs with participant artifacts superimposed, will keep participants and staff blind. Treatment fidelity will be trained/monitored by acknowledged NF leaders. Multidomain assessments before, during, and after treatment (follow-up to 2 years) will also include tests of blinding and sham inertness.

Introduction. Twenty-eight anxious adults were assessed for frontal lobe alpha asymmetry, a brain state associated with depression and anxiety. Fifteen of the 28 exhibited significant asymmetry and 12 agreed to participate in a biofeedback program addressed at reducing frontal alpha asymmetry. Method. The program consisted of earlobe temperature biofeedback (ETB) and two forms of neurofeedback, alpha suppression and alpha symmetry training. Individuals were instructed to warm their right earlobe for six sessions, and half succeeded, though success was not required to advance to the next stage of training. For subsequent EEG training, two anterior sites were selected on the basis of poor alpha coherence. Individuals were trained to reduce alpha magnitude at these sites by 10% for 30 min or more, which took from 6 to 16 sessions to achieve. Once successful with alpha suppression, individuals were trained to improve alpha symmetry between the sites by 15% for 30 min or more. Results. This feat took 8 to 32 sessions to achieve, and eventually all eight individuals were able to reduce alpha asymmetry. The State-Trait Anxiety Inventory (STAI) was used to measured anxiety levels after each training type and both state and trait scores significantly improved by a 6-month follow-up. Conclusion. Participants also completed a daily shortened version of the STAI, which indicated that anxiety improved after neurofeedback but not after ETB.