?Es efectivo el entrenamiento en Neurofeedback para el tratamiento del TDAH? Resultados a partir de una revision sistematica.
The disorder attention deficit hyperactivity disorder (ADHD) is a behavioral disturbance with neurobiological basis, characterized by having difficulties with attention, impulsivity and hyperactivity, affecting globally between 4.1 and 5% of children and teenagers (American Psychological Association APA, 2000; Polanczyk, Lima, Horta, Bierderman & Rhode, 2007; Word Health Organization WHO, 2011). Reported prevalence rates in Colombia ranges from 3.1 % (Torres, Berbesi, Bareno & Montoya, 2010) to 15.86 % in school-age children (Cornejo et al., 2005). Figures show negatively an impact not only in the proper development but also, at the school, family and social performance (Trujillo-Orrego, Ibanez & Pineda, 2012) of this population as well as in adolescent groups.
From the neuropsychological point of view, the most studied disorders of ADHD have been related to executive-level failures, both in tests and scales measuring the effect of executive functions in daily life of patients (Shimoni Engel-Yeger & Tirosh, 2012). However, Willcutt, Doyle, Nigg, Faraone, and Pennington (2008), from a meta-analysis of 83 studies concluded that the heterogeneity of the disorder cannot generalize these executive failures in all ADHD diagnosed patients, for this reason, there have been a number of efforts to conceptualize ADHD from the formulation of different cognitive profiles associated with it.
In this line, Sonuga-Barke, Bitsakou and Thompson (2010) conducted a study to establish empirically the plausibility of an explanatory pattern from two means: one stratal fronto dorsal, which would produce a deregulation in inhibitory processes, and other in which the ventral frontostriatal circuit affect the ability to identify signs of greater latency, what would mean, difficulties to postpone greater rewards in favor of immediate rewards. The results confirm the possibility of these two models and identify a third component associated to failures in the temporal processing, probably related to alterations in the basal ganglia.
Therefore, in the development of new non-pharmacological treatments, neurofeedback (NF) has emerged as an intervention technique that is being investigated as an alternative to the attention of various neuro-psychiatric disorders. Although a great part of the published studies have focused on establishing its efficacy in the treatment of ADHD, many of these studies have used methodologies that make it difficult to extrapolate their results to clinical practice. For that reason, the importance of addressing the conceptual and methodological aspects of the use of NF in the treatment of ADHD, in order to establish possible research areas for clinical use.
As well the NF as the biofeedback, consist in a series of procedures that allow, from the acquired information and a physiological variable of interest, to modify voluntarily values on the participant (Olivares, Mendez & Bermejo, 1998). Also, it is understood as a self-regulation technique in which patients develop a voluntary control what was once thought as involuntary (Frank, Khorshid, Kiffer, Moravec & Mckee, 2010). For this purpose, The NF is supported in equipment designed in order the patient may detect the changes produced in the selected physiological responses and through operant or classical conditioning processes, he can learn to modify the values of the signal (See Figure 1); in the specific case of NF, physiological signal is used as brain waves. From this perspective, it is considered more like training than a therapy, insofar the patients play an active role and practice until developing the control skill (Frank, et al., 2010).
The participant produces a physiological signal and consequently the equipment is in charge of registering, transforming, and enlarging it in a pattern that can be presented to the participant with the aim of receiving direct information of the changes produced in the physiological signal, and thus learning how to modify it through classical conditioning and/or operant processes. (Graphic based on Carrobles & Godoy, 1987).
Among the main objectives to be achieved with the use of NF are: controlling a system of physiological responses through training, keeping controlled these responses in the absence of the feedback and generalizing and maintaining the achieved self-control (Conde & Menendez, 2002).
The NF or Biofeedback encephalographic has as a purpose that the patient, by means of operant conditioning, learns to control the brain's electrical activity, which is an unconscious physiological function, increasing the frequency of desired brainwave and deleting the unwanted one (Friel, 2007). The NF has been studied in depth, for treatments in epilepsy, anxiety , depression, and learning disorders (Fernandez et al., 2007), Asperger (Thompson, Thompson & Reid, 2010) and, there are particularly, a variety of studies related to ADHD (Masterpasqua & Healey, 2003; Heinrich, Gevensleben & Strehl, 2007; Legarda, McMahon, Othmer & Othmer, 2011; Gruzelier & Egner, 2005; Thompson & Thompson, 2005).
The mentioned studies are based on findings of the electroencephalogram (EEG) in children with ADHD, which have identified a higher proportion of waves Theta / Beta, a high level of Theta waves and low level of Betha waves (Loo & Barkley, 2005; Othemer & Kaiser, 2000; Butnik, 2005), This is apparently related to the behavior of motor restlessness and lack of concentration. In addition, the EEG in children with ADHD has shown a positive correlation with the levels of cerebral perfusion associated with hypoperfusion in the frontal lobe that is related to an alteration in the rate of Theta waves (Gunkelman & Johnstone, 2005).
These results have supported the development of NF as a technique that would change the typical EEG patterns of ADHD and also improve its symptoms. While medication has been one of the most evident effective treatment, along the cognitive behavioral therapy, it has been suggested that about 20% of children do not respond adequately or have side effects that hinder their use (Diaz, 2006), that is the reason, this technique has become especially important in recent years (Baydala & Wikman, 2001, Meisel et al, 2011;. Rossiter, 2004), without presenting relevant side effects so far (Gevenselebel, et al. 2009; Henrich et al 2007; Bakhtadaze, Janelidze, & Khachapuridze, 2011).
Preliminary findings indicate that train individuals on controlling their own electrocortical activity, may have beneficial effects on reducing symptoms of ADHD (Masterpasqua & Healey, 2003; Butnik, 2005). To this purpose, it has been developed a variety of protocols, such as the Theta / Betha, which is based on increasing Betha waves while Theta waves are been decreasing. This protocol has yielded positive effects on the concentration and hyperactivity symptoms reduction (Harvard Mental Health Letter, 2010). Another protocol is based on training slow cortical potentials [Slow Cortical Potential Training] (SCP), in order to regulate the phasic cortical activity rather than the tonic.
One aspect of particular interest is the effectiveness in brainwaves modification after 20 training sessions in over 30% of patients with ADHD and the prevalence of its effects, which is estimated from one to ten years, having as a consequence the decreasing of impulsivity and hyperactivity symptoms (Fox, Tharp & Fox, 2005). In addition, several studies report a significant improvement in the levels of attention in the IQ, and the scores on the conduct scales carried out by parents and teachers (Gevensleben, Holl, Albrecht, Vogel, et al, 2009.; Gevensleben, Holl, Albrecht, Schlamp, Kratz, Studer, Wangler, et al, 2009;. Leins et al, 2007; Strehl, et al, 2005).
Although, some of these studies have been controversial due to the lack of scientific rigurosity, and limitations such as lack of control groups, small sample sizes and non-probability sampling (Harvard Mental Health Letter, 2010, Heinrich et al 2007,. Drechsler et al. 2007).
In order to obtain greater effectiveness, it is proposed to join the NF to a multimodal therapy that combines some of the following aspects: psychoeducation, medication, behavioral intervention, parent training and / or academic support, among others (Campbell, 2004; Hoekstra, 2010; Lansbergen, Dongen-Boomsma, & Buitelaar Slaats-Willemse, 2011). School and parents support have proved to be crucial in the treatment, so most studies have attempted to involve them (Pop-Jordanova, Markovska-Simoska & Zorcec, 2005, Roman, 2010).
This study aims to track and analyze the implemented advances in NF technique as an alternative treatment to ADHD, and classify the findings according the efficacy levels proposed by the Association for Applied Psychophysiology and Biofeedback, [Association for Applied Psychophysiology and Biofeedback ] (AAPB) and the Society for Neuronal Regulation in 2001.
The present work is a systematic revision, where articles related to NF and ADHD in children and adolescents from the database PubMed, Ebsco database (Psychology and Behavioral Sciences) and PsyARTICLES were taken as a unit of analysis, during a temporary margin of 11 years, between 2000 and 2011.
Firstly, the search was conducted using the terms: Neurofeedback and Attention Deficit Hyperactivity Disorder (ADHD), and a total of 88 items were found. 44 articles related to children and adolescent diagnosed with ADHD were taken, and consequently they were intervened with NF as the main technique. Finally, articles of theoretical type were discarded, having a final selection of 11 items. Thus, the inclusion criteria were:
--Empirical articles which sample made up by children and / or adolescents.
--Items selected with a sample who presented as a primary disorder ADHD, intervened with NF technique.
The information is organized into the following categories for the analysis: title, authors, country and year, sample protocol used, design, control group, results and conclusion. Finally, it was assigned to the evidence found a level of effectiveness in accordance with the established parameters by the AAPB and the Society for Neuronal Regulation, which identify five levels (Moss & Gunkelman, 2002), in order to classify the carried out studies on the issue that might lead to future research (Yucha & Gilbert, 2004). See Table 1.
Regarding knowledge production between 2000 and 2011 about the NF and ADHD in children and adolescents, a reduced volume of articles was recorded in the databases. Lack of studies in Latin America is evident and most of the articles from this region are review articles.
Eight of the research articles are studies carried out in Germany (Gevensleben, Holl, Albretch, Vogel, et al., 2009; Leins et al., 2007; Gevensleben et al., 2010; Gevensleben, Holl, Albretch, Schlamp, et al., 2009; Strehl et al., 2005; Wangler, et al., 2011; Bakhshayesh, Hansch, Wyschkon, Rezai & Esser, 2011; Fuchs, Birbaumer, Lutzenberger, Gruzelier & Kaiser, 2003), it corresponds to a 73% of the total analyzed volume that fulfills with the inclusion criteria. The other 27% was divided among Switzerland (Drechsler et al., 2007), Macedonia (Pop-Jordanova et al., 2005) and the Netherlands (Lansbergen et al., 2011) with an article each one.
The studies of Gevensleben et al. (2010); Wangler et al. (2011) y Gevensleben, Holl, Albretch, Schlamp, Kratz, Studer, Wangler, et al. (2009), took final samples from a group of 102 children from Gevensleben, Holl, Albretch, Vogel, et al. (2009) work. Sharing the demography characteristics of this sample, in a way that children and adolescents with comorbid emotional disorders, tics or dyslexia were excluded. On the other hand, Leins et al. (2007) did not exclude participants with psychiatric or neurologic disorders different from Lansbergen, et al. (2011) who did excluded from their study any type of comorbid disorder. On the contrary, Drechsler et al. (2007), had samples without any comorbid disorder or any known neurological damage. While Strehl et al. (2005), similarly than Bakhshayesh et al. (2011), involved participants in this etereo group, with no additional neurological disorders. Finally, the studies of Fuchs et al. (2003) and Pop-Jordanova et al. (2005) did not specify if the comorbid neurological or psychiatric disorders are part of the inclusion criteria.
Secondly, the IQ was part of the initial evaluation, and in several studies those participants who presented a IQ higher than 80 were considered as inclusion criteria (Bakhshayesh et al., 2011; Drechsler et al., 2007; Fuchs et al., 2003; Lansbergen et al., 2011; Leins et al., 2007; Strehl et al., 2005).
Similarly, there were some differences with regard to the inclusion or not of children and adolescents with medication or alternative treatment. In the studies of Gevensleben, Holl, Albrecht, Vogel, et al. (2009); Gevensleben, et al. (2010); Wangler et al. (2011) and Gevensleben, Holl, Albrecht, Schlamp, Kratz, Studer, Wangler, et al. (2009), participants should not be under medication or attending psychotherapy for at least six weeks prior to the study. Meanwhile, in the study of Fuchs et al. (2003) the sample should not be linked to any treatment before or during the study. In contrast, the studies of Lansbergen et al. (2011), Drechsler et al. (2007) and Bakhshayesh et al. (2011) did not exclude children and adolescents who were under medication at the time of the study, provided the dose was controlled without any variation along the study. The mentioned above, is based on the concept that the NF should be part of a multimodal therapy. Finally, Pop-Jordanova et al. (2005) did not specify this criterion.
Protocols of NF used
The protocols of NF used in the studies were Training Theta / Beta and training called Slow Cortical Potential Training (SCP), being used in 73% of the studies analyzed. Some studies have only worked with SCP (Drechsler et al, 2007; Strehl et al, 2005) and a study with the Theta / Beta training (Bakhshayesh et al, 2011). However, some studies have used both protocols either using them in separate blocks to a single group (Wangler et al, 2011; Gevensleben et al, 2010; Gevensleben, Holl, Albrecht, Schlamp et al, 2009; Gevensleben, Holl, Albrecht, Vogel, et al., 2009) or selecting one for each experimental group (Leins et al., 2007). Another protocol widely used is the Rhythm Sensory Motor, which was practiced in 27% [Sensorimotor Rhythm (SMR)] (Fuchs et al, 2003; Lansbergen et al, 2011; Pop-Jordanova et al., 2005). On the other hand, Lansbergen et al. (2011) propose another training way on NF, in which NF individual protocols were used, based on visual inspection and comparison who researchers conducted between the initial EEG of children evaluated and the quantitative electroencephalogram (QEEG) of the NeuroGuide database that contains records of 625 healthy children with electrophysiological heterogeneity.
All studies, except those by Leins, et al. (2007), Pop-Jordanova et al. (2005) and Strehl et al. (2005), used this methodological strategy, in order to compare the effectiveness of NF with other interventions. These interventions included training on attention skills, electromyography biofeedback training or cognitive behavioral therapy, among others.
Reported main findings
In relation to NF training, regardless of the protocol used, it was found that ADHD symptoms were reduced in all studies, especially in those related to inattention (Bakhshayesh et al., 2011) and self-regulation (Drechsler et al., 2007; Leins et al, 2007). Considering the baselines of psychometric tests and neuropsychological, an improvement in reaction time on the tests was found, as well as in parent and teachers' ratings, and in some cases IQ increasing was presented (Pop-Jordanova et al. 2005; Gevensleben, Holl, Albrecht, Vogel, et al, 2009;. Gevensleben, Holl, Albrecht, Schlamp, et al, 2009; Leins et al, 2007; Strehl et al., 2005).
Referring to Theta / Betha training, a positive impact can be observed, so through this the Theta / Beta tax was reduced (Bakhshayesh et al., 2011) or the presence of theta waves are decreased and Betha waves are increased (Gevensleben, Holl, Albrecht, Vogel, et al, 2009; Gevensleben, Holl, Albrecht, Schlamp, et al, 2009,.. Leins et al, 2007), which was associated with significant reductions in reported symptoms of ADHD.
With respect to the training results with SCP, positive results were found in several studies. An increase in the central midline of the alpha activity was correlated with an improvement in the level of ADHD (Gevensleben, et al., 2010), as well as an increase in the specific CNV (Contingent Negative Variation) to the SCP was associated with a reduction of ADHD symptoms (Wangler et al., 2011) and a learning response in the negative regulation of SCP (Strehl et al., 2005). However, Drechsler et al. (2007) found that less than a half of the participants who received SCP training were able to differentiate their cortical activation in transfer trials Drechsler et al. (2007), so that the effects could not be fully attributed to the electrophysiology training.
Additionally, training with SMR protocol, succeeded in reducing ADHD symptoms in all studies in which it was used (Pop-Jordanova et al, 2005; Lansbergen et al, 2011; Fuchs et al, 2003.). See Table 2.
In table 3 are included the main criteria considered by AAPB and the Neuronal Regulation Society, to defined the efficacy levels in studies with NF.
Discussion and Conclusions
According to the review of the factors that determine the efficacy level of the NF as an alternative for the ADHD treatment, it is determined that the selected studies present efficacy levels between II and IV (see Table 3), which suggests that the NF would be an effective technique for controlling some of the symptoms of ADHD.
In the same table it can be seen that there are three studies classified in level IV, which suggests that it is a really effective technique. However, according to the proposed classification by the AAPB and the Society for Neuronal Regulation, in order to consider the highest level of efficacy, it is necessary that such studies are conducted by independent groups, but this is not the case, so the three classified studies as level IV, were performed in the same research center. Additionally, there are several factors that deserve to be into consideration.
Furthermore, other mediating variables such as parental and school support have proved to be decisive (Pop-Jordanova et al., 2005). The sample size and the timing and type of measurement are still a limitation in many studies. Hence, the importance of having a baseline of register of EEG and a post NF, in order to know and control fluctuations waves (Vernon, 2005; Dempster & Vernon, 2009).
Based on levels of efficacy, three studies of this type of classification were found. Monastra et al., (2005) assigned to the EEG biofeedback a level of "probable efficacy" as a treatment for ADHD and explained, that in spite of 75% of patients from published studies reported significant clinical improvement, further studies would be necessary with random and controlled groups to provide a better estimate percentage of real patients.
Arns, M. de Ridder, S. Strehl, U. Breteler, M. & Coenen, A. (2009) exposed in a meta-analysis, that the ADHD treatment using the NF technique, improves behavior in open trials with medium sizes of compared samples with active or passive controlled groups. It was concluded that treatment with NF can be ranked in level 5 of efficacy: Effective and specific.
However, a study based on the random presentation of electroencephalographic changes published in 2013, in which a placebo training protocol was used, indicates that there were not statistically significant differences obtained with the group under training with NF (Vollebregt Dongen-Boomsma, Buitelaar Slaats-Willemse, 2013).
Secondly, it is important to differentiate between effectiveness and efficacy. Rossiter (2004) explains that effectiveness studies place a greater emphasis to external validity, while efficacy studies are focused on the internal validity.
In this line, Pine (2009) argues that until the effects are not replicated convincingly, and there are no more results to compare the efficacy of different trials, the NF should not be recommended as an alternate treatment for ADHD. Although, the carried out researches presented some findings in favor the use of NF techniques in ADHD treatment, it cannot be recommended yet, as a unique treatment option. In spite of the multiple factors involved in the disorder and heterogeneity of neuropsychological patterns reported, it is suggested their use as a suitable complement, when it is focused on effective parenting patterns oriented in developing skills that allow dealing with children and adolescents and providing support at the school. Interventions that promote the recognition of the impairment and provide strategies of environmental type are generally favorable and could be an ideal complement to the work with the NF techniques. Its use does not appear to be incompatible with the pharmacological support, though it is not established yet, whether the combination of these two strategies could be better than the particular use of the drug.
Finally, in order to do for further studies, it is important to consider the control level of the variables and select broader samples, as well as to provide a proper diagnosis and establish groups of participants according to neuropsychological performance patterns. In that way, some patients might obtain greater benefit from the use of NF, due to the circuits that could have been affected rather than the technique itself.
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Received: February 3-2014 Revised: April 4-2014 Accepted: April 30-2014
Juana Gaviria Loaiza (1), Liliana Calderon-Delgado (2), Mauricio Barrera-Valencia (3)
(1,2) Universidad CES, (3) Universidad de Antioquia, Medellin, Colombia
(1) Psicologa, Universidad CES. Estudiante de Doctorado en Desarrollo Humano y Estudios Familiares, Universidad de Delaware, E.U.
(2) Psicologa, Especialista en Salud Mental del Nino y del Adolescente, Universidad CES, Doctora en Psicologia con Orientacion en Neurociencia Cognitiva Aplicada. Docente e investigadora, Universidad CES, Medellin, Colombia. firstname.lastname@example.org
(3) Psicologo. Magister en Neuropsicologia, Universidad De San Buenaventura, sede Medellin. Doctor en Psicologia con Orientacion en Neurociencia Cognitiva Aplicada. Coordinador Linea de Neurodesarrollo y Neuropsicologia Grupo de Investigacion en Psicologia Cognitiva, Universidad de Antioquia.
Table 1. Efficacy ratings for Neurofeedback studies, according to AAPB and the Society for Neuronal Regulation Level Type of Description efficacy Level 1 No It only has anecdotal reports and case empirical studies support Level 2 Possible At least one study with enough statistical efficacy power with well-defined outcome measures, but without a random assignment to a condition of internal control for the study Level 3 Probable Multiple observational studies, clinical efficacy trials, controlled studies on the waiting list and responses in the inter-and intra-subject studies demonstrating efficacy Level 4 Efficacy a. Compared to an untreated control group, alternative treatment group or placebo control group using random assignment, the treatment to be investigated is significantly superior to the control condition or the investigated treatment is equivalent to a previously established treatment of efficacy. b. Studies are conducted in a population treated for a specific problem and the inclusion criteria are drafted in a reliable way, and defined operationally. c. The study uses specific, clear and valid outcome measures. d. Data are subject to a proper analysis result. e. The diagnosis and treatment variables, as well as procedures, are defined in a clear way that allows replication of the study by independent investigators. f. The superiority or equivalence of the investigated subject has been shown at least in two independent research areas. Level 5 Effective The investigated treatment showed to be and statistically superior to medication or specific treatment, in at least two independent fields of research. Table 2. Training protocols in NF, study design and main conclusions reported in the selected papers. Country Study Authors and year Sample Neuro-feedback Wangler Germany 102 in children et al. 2011 children with ADHD: with Specific ADHD event-related aged 8 potential to 12 findings of years. a randomized controlled trial Neuro-feedback Bakhshayesh, Germany 35 in ADHD: a Hansch, 2011 children single-blind Wyschkon-Rezai, with randomized & Esser. ADHD, controlled aged 6 trial to 14 years. Neuro-feedback Gevensleben, Germany 61 training in Holl, 2010 children children Albretch, with with ADHD: Schlamp, ADHD, 6-month et al. aged 8 follow-up to 12 of a years randomized controlled trial Distinct Gevensleben, Germany 102 EEG effects Holl, 2009 children related to Albretch, (72 at neuro-feedback Schlamp, the training in Kratz, end) children Studer, aged 8 with ADHD: Wangler, to 12 A randomized et al. years, controlled with trial ADHD Is Gevensleben, Germany 102 Neuro-feedback Holl, 2009 children an efficacious Albretch, (94 at treatment Vogel, et the for ADHD? al. end) A randomized with controlled ADHD, clinical trial aged 8 to 12 years Neuro-feedback Leins et Germany 38 for Children al. 2007 children with ADHD: with A Comparison ADHD of SCP and aged 8 Theta/Beta to 13 Protocols years. Self-regulation Strehl et Germany 23 of Slow al. 2005 children Cortical with Potentials: ADHD A New between Treatment 8 and for Children 13 years With old. Attention- Deficit/ Hyperactivity Disorder Neuro-feedback Fuchs, Germany 34 Treatment for Birbaumer, 2003 children Attention- Lutzenberger, aged 8 Deficit/ Gruzelier to 12 Hyperactivity & Kaiser. with Disorder in ADHD Children: A Comparison with Methylphenidate Neurofeedback Pop-Jordanova, Macedonia 12 treatment Markovska- 2005 children of children Simoska aged 7 with & Zorcec. to 13 Attention years Deficit with Hyperactivity ADHD Disorder Controlled Drechsler, Switzerland, 30 evaluation Straub, 2007 children of a Doehnert with neurofeedback ADHD training of Heinrich, aged 9 slow Steinhausen, to 13 cortical & years. potentials Brandeis. in children with Attention Deficit/ Hyperactivity Disorder (ADHD) ADHD and EEG- Lansbergen, Netherlands 14 neurofeedback: Dongen-Boomsma, 2011 children a double-blind Buitelaar with randomized & Slaats- ADHD between placebo- Willemse. 8 and 15 controlled years old. feasibility study Neuro-feedback Control Study Protocol Design group Neuro-feedback 36 ERP pre, 28 in children Theta/Betha during and children with ADHD: training post-training with Specific sessions ADHD event-related and SCP With potential control Protocol findings of group and 36 AST a randomized random sessions controlled group trial assignment Neuro-feedback 30 Psycophysiological, 17 in ADHD: a Theta/Betha neuropsycological children single-blind training and with randomized sessions psychometric ADHD. controlled measurement trial pre- and post-training. Protocol With Elecromyo- control graphy group and biofeedback random training. group assignment Neuro-feedback The Follow-up 23 training in children study children children completed with with ADHD: 36 sessions ADHD 6-month of with follow-up Theta/Betha previous of a training training randomized and SCP in on AST. controlled a previous trial phase of the study. Distinct 36 EEG pre, 26 EEG effects sessions during and children related to of post-training. with neuro-feedback Theta/Betha ADHD training in training children and SCP Protocol with ADHD: 36 AST A randomized sessions. controlled trial Is 36 Psychometric 35 Neuro-feedback sessions measurement children an efficacious of pre and with treatment Theta/Betha post-training. ADHD. for ADHD? training A randomized and SCP With Protocol controlled control clinical trial group and 36 AST random sessions. group assignment Neuro-feedback 30 Psychometric Absent for Children sessions measurement with ADHD: of pre, A Comparison Theta/Betha post-training of SCP and training, and follow-up. Theta/Beta or 30 Protocols sessions Random of SCP group training. assignment Self-regulation 30 SCP Psychometric Absent of Slow sessions. and Cortical neurologic Potentials: evaluation A New pre and Treatment post-treatment. for Children With Attention- Deficit/ Hyperactivity Disorder Neuro-feedback 36 Neuropsyco- 12 Treatment for sessions logical and children Attention- of psychometric with Deficit/ Neurocybernetics measurement ADHD Hyperactivity EEG pre- and Disorder in Biofeedback post-treatment, Children: A System or training. Protocol Comparison C4 and Intentional Treatment with SMR were assignment with Methylphenidate used in to groups methyl- hyperactive according phenidate children to choice of (10 to 60 and C3 en parents. mg daily). beta1 was Control used in group predominantly missing inattentive due to ethical children. considerations. Neurofeedback 40 Neuropsycological Absent treatment Biograph/ measurement of children ProComp pre and with 2.0 post-treatment. Attention sessions Deficit and EEG Hyperactivity ratings Disorder SMR Controlled SCP Scales and 13 evaluation training neuropsycholofical children of a assessment with neurofeedback pre and ADHD. training of post-training. slow cortical Protocol potentials Group in children cognitive- with behavioral Attention therapy Deficit/ Hyperactivity Disorder (ADHD) ADHD and EEG- 30 Theta Clinical 6 children neurofeedback: supression neuropsycho- with a double-blind SMR logical, ADHD. randomized sessions. pre and placebo- Individual post-training. Protocol controlled NF Placebo feasibility protocols Control feedback study group and random group assignment Study Results Conclusions Neuro-feedback In both groups, The effects of CNV in children there were an reflect on the with ADHD: improvement in underlying neural Specific the test circuits to the event-related performance and a sources of potential decrease in the assigned resources findings of p300 component, in the cognitive a randomized possibly due to the preparation, controlled adaptation to the related to a trial attention test. successful NF training in children After the NF with ADHD. A training, there was neuropsychological an increase in the assessment is CNV specific for suggested to SCP. A greater optimize and pre-training in CNV individualize NF was associated training. with a decreased in the ADHD symptoms in the SCP training. Neuro-feedback The Theta/Betha It is important to in ADHD: a rate and the EMG discuss if the single-blind levels were therapeutic randomized reduced in the alliance may result controlled groups. The by itself in trial parents reported changes in important cerebral activity reductions in primary symptoms The behavior of ADHD and the contingencies, inattention self-efficacy, improvements relaxation, the were greater in the structured learning NF group, in which environment, an improvement routines, among was also noticed in others factors, the reaction time should be taken at the into account. neuropsychological assessment. Neuro-feedback 50% of the sample Improvement in training in responds to the behavior related children follow-up, versus a with NF training with ADHD: 30.4% in the was remained for 6-month control group. six months and follow-up being higher than of a the control group. randomized controlled The NF may be trial considered effective in the ADHD treatment. Distinct A reduction in Theta and Betha EEG effects Theta activity in differential related to the EEG was patterns in EEG, neuro-feedback evident in the NF show the neural training in trained group. mechanisms that children Also, an increased could cause with ADHD: in the alfa activity improvements in A randomized central midline, behavior on controlled which was children with trial correlated with an ADHD. improvement in the ADHD scale. Is 51% of the Combination of Neuro-feedback experimental protocols in NF an efficacious groups responds training has an treatment to the treatment effective effect in for ADHD? (Theta waves children with A randomized decrease) ADHD, however controlled compared with a more studies are clinical trial 2% in the control needed. group. According to parents and teachers, there was an improvement in behavior. Neuro-feedback Intentional NF training has a for Children regulation of positive and with ADHD: cortical activity in lasting effect. A Comparison both groups, of SCP and improving Limitations: Lack Theta/Beta attention and IQ. of control group, Protocols Parents and sample size, teachers also control of reported important nonspecific effects. improvements in behavior and cognitive level. Clinical effects were maintained during six months posterior to the treatment and the groups did not differ from each other. Self-regulation The children Evidence supports of Slow learned how to a SCP efficacy level Cortical regulate the 2. Future research Potentials: negative SCP. An should control A New improvement in medication, Treatment attention, behavior nonspecific effects for Children and IQ score was and subtypes, in With observed. Changes order to know if Attention- remained the six SCP is an Deficit/ months after. alternative Hyperactivity treatment to Disorder ADHD. Limitation: Sample size Neuro-feedback Both treatments A greater sample Treatment for reduced the ADHD size is necessary to Attention- symptoms. determine Deficit/ equivalence Hyperactivity There were between groups, Disorder in improvements in because both led Children: A d2 and TOVA. No to significant Comparison significant improvement in with differences in many variables, Methylphenidate Conners or although the Weschler results equivalence test were found was not significant between groups. for all dependent variables. Changes in electroencephalo- graphic bands were not monitored after NF training. Neurofeedback Increase in Betha NF is a good treatment waves activity and choice to ADHD of children decrease in Theta treatment. with waves. Attention Cooperation of Deficit Improvement in parents and Hyperactivity school grades, teachers is Disorder social adaptation essential. and self-esteem was observed. ADHD symptoms were reduced. Controlled Both groups Improvement in evaluation showed behavior may be of a improvement in related to NF, neurofeedback the especially at a training of neuropsychological regulated level, slow assessment. but the found cortical advantage in potentials Less than half of parents and in children the NF participants teacher's scale in with were able to the NF groups Attention differentiate their cannot be Deficit/ cortical activity on explained by Hyperactivity transference trials, electrophysiologic Disorder so the effects al mechanisms in (ADHD) cannot be the entire group, completely however, it can be attributed to the influenced by electrophysiologic mediated variables al training. such as parental support. ADHD and EEG- Changes were Improvements neurofeedback: similar in both after NF could be a double-blind groups, with a attributed to randomized significantly nonspecific effects placebo- decreasing in such as time controlled ADHD symptoms. spent, given feasibility attention, study therapeutic interaction or expectations, rather than the ability to have self-control cerebral activity The sample size was limited. It is possible to conduct a rigorous study controlled by placebo feedback. * Considered Absent group because there were two groups, each one with a different protocol Neurofeedback: untrained or alternative treatment Table 3. Efficacy levels evaluation in the selected studies, based in the criteria of the AAPB and the Neuronal Regulation Society Specific, clear and valid The sample measurement, is specific with A control to a exclusion group is particular and included clinical inclusion in the Study condition criteria design. Neurofeedback in Yes Appropriate Yes children with ADHD: Specific event-related potential findings of a randomized controlled trial Neurofeedback in Yes Yes Yes ADHD: a single- blind randomized controlled trial Neurofeedback Yes Yes Yes training in children with ADHD: 6-month follow-up of a randomised controlled trial Is Neurofeedback Yes Yes Yes an efficacious treatment for ADHD? A randomized controlled clinical trial Distinct EEG Yes Yes Yes effects related to neurofeedback training in children with ADHD: A randomized controlled trial Neurofeedback for Yes Yes No Children with ADHD: A Comparison of SCP and Theta/Beta Protocols Self-regulation of Yes Yes No Slow Cortical Potentials: A New Treatment for Children With Attention Deficit/ Hyperactivity Disorder Neurofeedback Yes Yes Yes Treatment for Attention-Deficit /Hyperactivity Disorder in Children: A Comparison between Methylphenidate Neurofeedback Yes Yes No treatment of children with Attention Deficit Hyperactivity Disorder, and a Controlled Yes Yes Yes evaluation of a neurofeedback training of slow cortical potentials in children with Attention Deficit/Hyperactivity Disorder (ADHD) ADHD and Yes Yes Yes EEG-neurofeedback: a double-blind randomized placebo-controlled feasibility study Results compared Intra and with inter Random established individuals participant efficacy statistical Study assignment treatments analysis. Neurofeedback in Yes Partially Yes children with ADHD: Specific event-related potential findings of a randomized controlled trial Neurofeedback in Yes No Yes ADHD: a single- blind randomized controlled trial Neurofeedback Yes Appropriate Yes training in children with ADHD: 6-month follow-up of a randomised controlled trial Is Neurofeedback Yes Appropriate Yes an efficacious treatment for ADHD? A randomized controlled clinical trial Distinct EEG Yes Appropriate Yes effects related to neurofeedback training in children with ADHD: A randomized controlled trial Neurofeedback for Yes * No Yes Children with ADHD: A Comparison of SCP and Theta/Beta Protocols Self-regulation of No No Yes Slow Cortical Potentials: A New Treatment for Children With Attention Deficit/ Hyperactivity Disorder Neurofeedback No Yes Yes Treatment for Attention-Deficit /Hyperactivity Disorder in Children: A Comparison between Methylphenidate Neurofeedback No No Yes treatment of children with Attention Deficit Hyperactivity Disorder, and a Controlled Partially Yes Yes evaluation of a neurofeedback training of slow cortical potentials in children with Attention Deficit/Hyperactivity Disorder (ADHD) ADHD and Yes No** Yes EEG-neurofeedback: a double-blind randomized placebo-controlled feasibility study The information given by the paper allows to replicate Efficacy Study the study levels Neurofeedback in Yes III children with ADHD: Specific event-related potential findings of a randomized controlled trial Neurofeedback in Yes III ADHD: a single- blind randomized controlled trial Neurofeedback Yes IV training in children with ADHD: 6-month follow-up of a randomised controlled trial Is Neurofeedback Yes IV an efficacious treatment for ADHD? A randomized controlled clinical trial Distinct EEG Yes IV effects related to neurofeedback training in children with ADHD: A randomized controlled trial Neurofeedback for Partially II Children with ADHD: A Comparison of SCP and Theta/Beta Protocols Self-regulation of Partially II Slow Cortical Potentials: A New Treatment for Children With Attention Deficit/ Hyperactivity Disorder Neurofeedback Yes III Treatment for Attention-Deficit /Hyperactivity Disorder in Children: A Comparison between Methylphenidate Neurofeedback Yes II treatment of children with Attention Deficit Hyperactivity Disorder, and a Controlled Yes III evaluation of a neurofeedback training of slow cortical potentials in children with Attention Deficit/Hyperactivity Disorder (ADHD) ADHD and Yes IV EEG-neurofeedback: a double-blind randomized placebo-controlled feasibility study * Participants were randomly assigned to two different experimental conditions with no control group ** In this study the control group used a placebo neurofeedback protocol
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|Title Annotation:||Original Research Article|
|Author:||Gaviria Loaiza, Juana; Calderon-Delgado, Liliana; Barrera-Valencia, Mauricio|
|Publication:||Revista CES Psicologia|
|Date:||Jan 1, 2014|
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