Carmody, D. Journal of Neurotherapy , 4 3 Foks, M. Neurofeedback training as an educational intervention in a school setting: How the regulation of arousal states can lead to improved attention and behavior in children with special needs. Educational and Child Psychology , 22 3 Login Donate Join. About ADHD. Neurofeedback EEG Biofeedback. What is Neurofeedback The human brain emits electrical activity in waves that can be measured by a device called an electroencephalograph EEG.
The CHADD PAB is not aware of any strong clinical consensus supporting neurofeedback at this time, and the strength of the empirical evidence is a matter of debate among experts. Subjects or parents chose whether they wanted neurofeedback usually at additional cost to them , and the financial, motivational, and other family resources that would allow such a choice may well select for those who would fare better anyhow regardless of treatment.
This is a particular problem for the large study Monastra that otherwise would have been most convincing despite its lack of blinding; Lack of rigorous peer review. Further Research Needed Neurofeedback continues to be an intervention that generates much interest and attention from both researchers and consumers alike. References 1. Applied Psychophysiology and Biofeedback , 30 2 3. Applied Psychophysiology and Biofeedback , 30 2 4. First Name.
Last Name. Myndlift is a mobile neurofeedback app aimed at improving focus and attention. This type of brain training has been available only in clinics and professional settings until now, so making it available and affordable to more people is a breakthrough. Myndlift is currently in the beta phase of development. It may be available later this year. BrainTrain is a set of computerized cognitive-training systems focused on brain training and cognitive rehabilitation.
It can be used at home or provided through medical and psychological professionals. Research suggests that these products can improve memory and attention.
You must be logged in to post a comment. It appears JavaScript is disabled in your browser. Please enable JavaScript and refresh the page in order to complete this form. By Randy Kulman, Ph. Verified Updated on January 19, Play Attention Play Attention is a learning system that uses a high-tech armband to read brain signals indicative of focus or concentration.
Here, we provide an overview of the rationale and scientific evidence of the efficacy of neurofeedback in regulating the brain functions in ADHD. We also review the institutional and professional regulation of clinical neurofeedback implementations. However, the practical implementation of neurofeedback as a clinical treatment is currently not regulated. We conclude that neurofeedback based on standard protocols in ADHD should be considered as a viable treatment alternative and suggest that further research is needed to understand how specific neurofeedback protocols work.
Eventually, we emphasize the need for standard neurofeedback training for practitioners and binding standards for use in clinical practice. Similar to many of his 9-year-old school peers, Brian was put on psychostimulants after complaints of poor concentration and impulsivity that met ADHD diagnostic criteria.
Despite a remarkable improvement in his academic performance, parent and teachers noticed a reduction in appetite and weight loss after the onset of the medication. Moreover, when not under the effects of medication, inattention and impulsivity rebounded creating innumerous embarrassments to him and his family. His parents are now considering neurofeedback—a non-pharmacological and non-invasive intervention that has shown promising results in managing the ADHD symptoms in the long run and without side effects [ 1 ].
Despite being the most often applied and accepted treatments for ADHD, recent large-scale studies and meta-analyses have demonstrated limitations of psychostimulants and behavioral therapy. Thus, research and the development of non-pharmacological treatments such as neurofeedback have been recommended. We will also attempt to reconcile these seemingly discrepant research findings. Several guidelines exist for the diagnosis and treatment of children who have or are suspected of having ADHD.
Among these are international, national, and various regional guidelines for general practitioners. Additionally, there are guidelines for youth aid and youth protective services. Traditionally, the treatment of ADHD consists of pharmacotherapy, often complemented by behavioral therapy based on parent management training and mediation training for parents and teachers [ 5 ]. Additionally, classroom interventions, academic interventions, and peer-related interventions are being used as psychosocial therapeutic approaches [ 6 ].
Regarding pharmacotherapy, the administration of methylphenidate is often the method of choice e. Over the past years, the Multimodal Treatment Study of Children with ADHD and follow-up studies the so-called MTA studies have provided ample research regarding stimulant medication, behavioral treatments, their combination, and self-chosen community care. Results demonstrate that both stimulant medication and a combined treatment had a clear clinical benefit in the short term, but on the long-term group differences attenuate, as assessed after 24 months, as well as after 6 and 8 years [ 8 ].
For instance, computerized cognitive—based training approaches e. Research into this topic is still in the early stages and more controlled studies regarding the effects on ADHD core symptoms are required [ 11 ]. Another alternative treatment method for ADHD which is already more extensively studied in the past is neurofeedback. In the following paragraphs, we will i introduce neurofeedback, ii present standard protocols for ADHD, iii review the past and current evidence in the treatment of ADHD, and iv depict the current status of institutional and professional regulation of the clinical implementation of neurofeedback.
Despite the recent popularity of neuromodulation techniques, neurofeedback is for the most part still an unknown territory.
Neurofeedback is based on a brain-computer interface BCI and is implemented by a software system and a processing pipeline, altogether consisting of five elements Fig. Pre-selected brain parameters a specific frequency band or a brain potential are calculated online step 3 and translated to signals that are fed back to the user in real time step 4.
Thus, selected features of brain activity are made perceivable for the participant. Through this feedback, the participant step 5 can learn to self-regulate his own brain activity to directly alter the underlying neural mechanism of cognition and behavior. Overview neurofeedback: neurofeedback pipeline and three areas of neurofeedback application.
The pipeline includes the five most important processing steps and parts of a neurofeedback system. It has been proposed that neurofeedback is based on principles of operant conditioning and procedural skills learning.
Nowadays, neurofeedback is used in three ways: i as a therapeutic tool to normalize deviating brain activity and treat neurocognitive disorders, ii as a so-called peak performance training to enhance cognitive performance in healthy participants, and iii as an experimental method to investigate the causal role of neural oscillations in cognition and behavior. More precisely, the neurofeedback research is dominated by two streams: clinical research and neuroscientific inspired research, which is mainly based on recent methodological and technical innovations, as well as on an increasing knowledge about the neural correlates of behavior and cognition.
Historically, neurofeedback dates back to the initial discovery of the human electroencephalogram EEG by Hans Berger. Only 6 years after this breakthrough, two French researchers—Gustave Durup and Alfred Fessard—first reported that the EEG alpha rhythm could be subject to classical conditioning [ 19 ], which is thought to be one of the basic premises of neurofeedback.
In this study, they had participants press a button, which would switch the lights on and off, and use subvocal verbal commands when pressing the button, e. After five sessions, the subject was able to voluntarily suppress alpha activity, while the lights were off a condition where normally synchronous alpha would be present. Despite these early developments, it was only in the s that these same principles were applied more systematically, and the first clinical implications were described in the literature.
These developments were motivated by the discovery of the anticonvulsant effects of sensori-motor rhythm SMR neurofeedback in cats [ 22 ] and subsequently humans [ 23 ]. The presumed role of SMR modulation on motor behavior was followed by the first demonstrations of the positive effects of SMR neurofeedback in hyperkinetic disorder [ 24 ].
Recent randomized controlled trials suggest that 30 to 40 sessions of TBR neurofeedback were as effective as methylphenidate in reducing inattentive and hyperactivity symptoms and were even associated with superior post-treatment academic performance [ 31 , 32 ].
It has been proposed that the effects of TBR neurofeedback on ADHD might be explained by the learned self-regulation of attention [ 33 ] as evidenced by enhanced amplitude of endogenous evoked-related potentials such as the P [ 34 ].
However, more neuroscientific evidence is needed to determine the specific mechanisms by which TBR neurofeedback might impact cognitive functioning in ADHD. SMR neurofeedback training over the sensori-motor strip predominantly in the central right hemispheric region was first applied to ADHD children by Lubar and colleagues [ 24 , 35 ], based on the functional association of the sensori-motor rhythm with behavioral inhibition and the promising results in reducing cortical excitability in epileptics obtained by Sterman, MacDonald, and Stone [ 36 ].
However, the two protocols might achieve the same results through distinct mechanisms. A mediation analysis revealed that this normalized sleep mid-treatment was responsible for the improved inattention post-treatment.
The improvements in ADHD symptoms following SMR training might hence be the result of the vigilance stabilization mediated by the regulation of the locus coeruleus noradrenergic system of which activation has been shown to impact the sleep spindle circuitry [ 38 ].
This explanation seems to be in line with previous indications that patients with ADHD present delays in SOL [ 39 ] and that SMR training increases sleep spindle density and improves sleep quality in healthy adults [ 40 ]. SCP neurofeedback is based on the learned self-regulation of cortical activation and inhibition which are associated with the electrical negativation and positivation of slow cortical electrical deflections respectively.
These periodical shifts from electrical positivity to negativity have been described as a phasic tuning mechanism in the regulation of attention [ 43 ] as shown by the enhanced reaction time, stimulus detection, and short-term memory during the negative shift phase [ 44 ].
Since SCP, of which the CNV is an example, are closely associated with preparatory motor responses with a maximal topographic representation in the motor areas, the vertex is usually the site of choice for training. In the case of ADHD, the therapeutic focus is on promoting an increase in the firing probabilities of the underlying cortical areas i.
Another difference relative to frequency neurofeedback is that in SCP neurofeedback the learning trials are higher in number and considerably shorter in duration. Interestingly, it has been hypothesized that SCP might also be associated with improvements in sleep.
The generation of slow oscillations, in particular negative slow direct current, shifts training during SCP neurofeedback, might exert control over the sleep spindle circuit and therefore facilitate the transition from wakefulness to sleep [ 45 ]. As with any emerging new treatments, knowledge of technical aspects of the treatment, proper standards, and education are crucial for appropriately evaluating the merits and pitfalls of neurofeedback.
Neurofeedback can differentially impact brain functioning depending on the kind protocol and implementation the same way as different pharmacological treatments do e. As an illustration, neurofeedback treatments such as the earlier mentioned SMR, TBR, and SCP neurofeedback are well-investigated and effective in the treatment of ADHD while other approaches such as posterior alpha enhancement have been found to be not effective for a review, see [ 3 ]. Blinded ratings have usually lower effects sizes than ratings by people most-proximal to the child and therefore least blinded e.
0コメント