Effects of a structured 20-session slow-cortical-potential-based neurofeedback program on attentional performance in children and adolescents with attention-deficit hyperactivity disorder: retrospective analysis of an open-label pilot-approach and 6-month follow-up

Abstract

ObjectiveThe aim of this approach was to conduct a structured electroencephalography-based neurofeedback training program for children and adolescents with attention-deficit hyperactivity disorder (ADHD) using slow cortical potentials with an intensive first (almost daily sessions) and second phase of training (two sessions per week) and to assess aspects of attentional performance.Patients and methodsA total of 24 young patients with ADHD participated in the 20-session training program. During phase I of training (2 weeks, 10 sessions), participants were trained on weekdays. During phase II, neurofeedback training occurred twice per week (5 weeks). The patients’ inattention problems were measured at three assessment time points before (pre, T0) and after (post, T1) the training and at a 6-month follow-up (T2); the assessments included neuropsychological tests (Alertness and Divided Attention subtests of the Test for Attentional Performance; Sustained Attention Dots and Shifting Attentional Set subtests of the Amsterdam Neuropsychological Test) and questionnaire data (inattention subscales of the so-called Fremdbeurteilungsbogen für Hyperkinetische Störungen and Child Behavior Checklist/4–18 [CBCL/4–18]). All data were analyzed retrospectively.ResultsThe mean auditive reaction time in a Divided Attention task decreased significantly from T0 to T1 (medium effect), which was persistent over time and also found for a T0–T2 comparison (larger effects). In the Sustained Attention Dots task, the mean reaction time was reduced from T0–T1 and T1–T2 (small effects), whereas in the Shifting Attentional Set task, patients were able to increase the number of trials from T1–T2 and significantly diminished the number of errors (T1–T2 & T0–T2, large effects).ConclusionFirst positive but very small effects and preliminary results regarding different parameters of attentional performance were detected in young individuals with ADHD. The limitations of the obtained preliminary data are the rather small sample size, the lack of a control group/a placebo condition and the open-label approach because of the clinical setting and retrospective analysis. The value of the current approach lies in providing pilot data for future studies involving larger samples.

How standardized are “standard protocols”? Variations in protocol and performance evaluation for slow cortical potential neurofeedback: A systematic review

“…Most of the studies using the Neuroconn systems, implemented a 2 s baseline phase, followed by an 8 s active phase. However, there were some exceptions where the active phase only lasted for 5.5 s (Albrecht et al, 2017) or 6 s (Christiansen et al, 2014). Studies using the SAM and the GoeFi-system, report 2 s baseline phase and 6 s active phase.…”

“…The frequency of training sessions varied between studies. While 3 of 4 epilepsy studies implemented daily training sessions, only 4 of 17 ADHD studies implemented daily training, including 2 studies that only used daily training during the first week (Drechsler et al, 2007;Doehnert et al, 2008;Albrecht et al, 2017). The most common frequency was 2-3 sessions per week.…”

Neurofeedback in ADHD: A qualitative study of strategy use in slow cortical potential training

“…Although there is a growing body of literature indicating that several NF protocols have beneficial effects in terms of ADHD symptom reduction and enhanced self-regulation of brain activity [34][35][36][37][38][39][40][41][42], questions remain concerning the efficacy of NF. A systematic review and meta-analysis on non-pharmacological treatment in ADHD by Sonuga-Barke et al [25] found medium size effects for the efficacy of NF on ADHD symptoms for most-proximal (i.e.…”

Individual brain regulation as learned via neurofeedback is related to affective changes in adolescents with autism spectrum disorder

“…SCP NF has been successfully applied for the treatment of ADHD in children (Drechsler et al, 2007; Strehl et al, 2017; Ute Strehl et al, 2006), adolescents (Albrecht et al, 2017) and adults (Mayer, Blume, Wyckoff, Brokmeier, & Strehl, 2016). These very slow EEG fluctuations (typically below 1 Hz) are related to the excitability threshold of the upper cortical layers, where SCP negativity corresponds to increased and SCP positivity to decreased cortical excitability (Birbaumer, Elbert, Canavan, & Rockstroh, 1990).…”

“…While reviews on the application of electroencephalography-based (EEG) NF for the treatment of attention-deficit / hyperactivity disorder (ADHD) have yielded mixed results (Arns, Heinrich, & Strehl, 2014;Sonuga-Barke et al, 2013), there is a particular recommendation for slow cortical potentials (SCPs) NF (Mayer, Wyckoff, & Strehl, 2013). SCP NF has been successfully applied for the treatment of ADHD in children (Drechsler et al, 2007;Strehl et al, 2017;Ute Strehl et al, 2006), adolescents (Albrecht et al, 2017) and adults (Mayer, Blume, Wyckoff, Brokmeier, & Strehl, 2016). These very slow EEG fluctuations (typically below 1 Hz) are related to the excitability threshold of the upper cortical layers, where SCP negativity corresponds to increased and SCP positivity to decreased cortical excitability (Birbaumer, Elbert, Canavan, & Rockstroh, 1990).…”