Slow cortical potential neurofeedback and self-management training in outpatient care for children with ADHD: study protocol and first preliminary results of a randomized controlled trial

Abstract

Background: Treatment for children with attention deficit/hyperactivity disorder (ADHD) today is predominantly pharmacological. While it is the most common treatment, it might not always be the most appropriate one. Moreover, long term effects remain unclear. Behavior therapy (BT) and non-pharmacological treatments such as neurofeedback (NF) are promising alternatives, though there are no routine outpatient care/effectiveness studies yet that have included children with medication or changes in medication.Methods/design: This paper presents the protocol of a randomized controlled trial to compare the effectiveness of a Slow Cortical Potential (SCP) NF protocol with self-management (SM) in a high frequent outpatient care setting. Both groups (NF/SM) receive a total of 30 high frequent therapy sessions. Additionally, 6 sessions are reserved for comorbid problems. The primary outcome measure is the reduction of ADHD core symptoms according to parent and teacher ratings.Preliminary Results: Untill now 58 children were included in the study (48 males), with a mean age of 8.42 (1.34) years, and a mean IQ of 110 (13.37). Conners-3 parent and teacher ratings were used to estimate core symptom change. Since the study is still ongoing, and children are in different study stages, pre-post and follow-up results are not yet available for all children included. Preliminary results suggest overall good pre-post effects, though. For parent and teacher ratings an ANOVA with repeated measures yielded overall satisfying pre-post effects (η2 0.175–0.513). Differences between groups (NF vs. SM) could not yet be established (p = 0.81).Discussion: This is the first randomized controlled trial to test the effectiveness of a NF protocol in a high frequent outpatient care setting that does not exclude children on or with changes in medication. First preliminary results show positive effects. The rationale for the trial, the design, and the strengths and limitations of the study are discussed.Trial registration: This trial is registered in www.clinicaltrials.gov as NCT01879644.

Sustained effects of neurofeedback in ADHD: a systematic review and meta-analysis

“… For neurofeedback (NF) protocols, frequency bands and feedback electrodes are listed. Parent ratings were considered (except for Bink et al [ 26 ] which used self-reports) SCP slow cortical potential, SMR sensorimotor rhythm, MPH methylphenidate, PA physical activity, FBB-HKS German ADHD rating scale for parents, ADHD RS-IV ADHD Rating Scale-IV, Conners Conners questionnaire subscale, Conners DSM DSM subscale within the Conners questionnaire; SWAN strengths and weaknesses of ADHD symptoms and Normal Behavior Scale, NR not reported a For more study details see Table S-4 b Unpublished data from Christiansen et al [ 40 ] …”

Neurofeedback Therapy for Enhancing Visual Attention: State-of-the-Art and Challenges

“…A good understanding of neurophysiology of attention is required to extract attentional signals from neural recordings and dissociate them from the other ongoing activities in the brain (Sanei and Chambers, 2008 ). Notwithstanding these difficulties, visual-attention based BCI systems have been already developed and applied to ADHD (Christiansen et al, 2014 ; Heinrich et al, 2014 ; Holtmann et al, 2014a , b ; Micoulaud-Franchi et al, 2014 ; Steiner et al, 2014b ). In this article, we cover the current state of the art and future challenges in this research.…”

Efficacy of Neurofeedback Versus Pharmacological Support in Subjects with ADHD

“…Second, a protocol to reduce hypermotoric symptoms and enhance sensorimotor rhythm (SMR), which is sometimes used in addition to the previous theta-beta protocol (Monastra et al 2005;Russell-Chapin et al 2013). Third, based on the electrophysiologic evidence of altered slow cortical potentials (SCPs) in ADHD, other protocol has emerged, which is aimed at modifying SCPs in order to regulate cortical excitation thresholds (Christiansen et al 2014). Among the varieties of NF protocols, the classic theta-beta procedure is one of the best scientifically evaluated (Zuberer et al 2015) and will therefore be the focus of the present study.…”