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Liu X, Yang Y, Ye Z, Wang F, Zeng K, Sun Y, Huang Y, Dai L. The effect of digital interventions on attention deficit hyperactivity disorder (ADHD): A meta-analysis of randomized controlled trials. J Affect Disord 2024; 365:563-577. [PMID: 39191306 DOI: 10.1016/j.jad.2024.08.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 08/18/2024] [Accepted: 08/23/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. Individuals with ADHD often encounter heightened emotional and behavioral challenges. This study aims to conduct a meta-analysis of the efficacy of digital interventions in improving symptoms of ADHD. METHODS This study searched 6 databases for English articles from database construction until December 4, 2023. Randomized controlled trials employing digital interventions for ADHD were gathered. Following the Cochrane Collaboration criteria, Review Manager 5.3 software was utilized to evaluate the risk of bias present in the included papers. Mean differences for post-intervention and follow-up data were standardized using Stata 18.0 software. Subgroup analysis was employed to investigate the sources of heterogeneity. The study adhered to the PRISMA guidelines and was registered on the PROSPERO platform (CRD42024504134). RESULTS This review included a total of 25 randomized controlled trials (RCTs). The combined study population comprised 1780 cases. In the digital intervention groups, there was a significant decrease in overall ADHD symptoms (SMD = -0.33; 95 % CI = [-0.51, -0.16]) compared to the control groups. Furthermore, there was a significant reduction in inattention symptoms (SMD = -0.31; 95 % CI = [-0.46, -0.15]) and hyperactivity/impulsivity symptoms (SMD = -0.15; 95 % CI = [-0.29, -0.02]) within the digital intervention groups. CONCLUSION The digital interventions proved beneficial for individuals with ADHD by alleviating symptoms of ADHD, inattention, and hyperactivity/impulsivity.
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Affiliation(s)
- Xin Liu
- School of Education Research, China University of Geosciences, Wuhan, China; Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China; Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Yawen Yang
- School of Education Research, China University of Geosciences, Wuhan, China; Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China; Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Zhiyu Ye
- School of Education Research, China University of Geosciences, Wuhan, China; Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China; Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Fang Wang
- Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China; Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Kuan Zeng
- School of Education Research, China University of Geosciences, Wuhan, China; Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China; Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Ye Sun
- Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China; Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Ying Huang
- School of Education Research, China University of Geosciences, Wuhan, China; Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China; Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Lisha Dai
- School of Education Research, China University of Geosciences, Wuhan, China; Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China; Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China.
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2
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Caterfino A, Krishna S, Chen V. Novel and complementary treatment approaches in attention-deficit/hyperactivity disorder. Curr Opin Pediatr 2024; 36:562-569. [PMID: 38957089 DOI: 10.1097/mop.0000000000001378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW To provide an updated review of novel and complementary treatment approaches for children and adolescents with attention-deficit/hyperactivity disorder. RECENT FINDINGS The evidence for complementary attention-deficit/hyperactivity disorder treatments is often promising, but limited to small, unblinded studies. Recent evidence from larger, more rigorous studies reveals that most of these treatments have modest efficacy. Omega-3 polyunsaturated fatty acids, saffron, broad spectrum micronutrients, and physical exercise have potential benefits that seem to outweigh known risks. However, neurofeedback, cognitive training, and trigeminal nerve stimulation need further research to determine whether specific sub-groups of children/adolescents with attention-deficit/hyperactivity disorder would benefit long-term with their associated tolerable risks. SUMMARY There is not sufficient evidence for complementary treatments to be recommended as substitutes for first-line pharmacological and psychosocial treatment options. Nonetheless, some adjuvant therapies to currently recommended attention-deficit/hyperactivity disorder treatments can be safe. Physicians should be familiar with existing and emerging complementary treatments to help guide families.
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Affiliation(s)
- Andrew Caterfino
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
| | - Shruthi Krishna
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
| | - Victoria Chen
- Northwell, New Hyde Park
- Cohen Children's Medical Center, Queens, New York, USA
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3
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Dhanis H, Gninenko N, Morgenroth E, Potheegadoo J, Rognini G, Faivre N, Blanke O, Van De Ville D. Real-time fMRI neurofeedback modulates induced hallucinations and underlying brain mechanisms. Commun Biol 2024; 7:1120. [PMID: 39261559 PMCID: PMC11391061 DOI: 10.1038/s42003-024-06842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 09/04/2024] [Indexed: 09/13/2024] Open
Abstract
Hallucinations can occur in the healthy population, are clinically relevant and frequent symptoms in many neuropsychiatric conditions, and have been shown to mark disease progression in patients with neurodegenerative disorders where antipsychotic treatment remains challenging. Here, we combine MR-robotics capable of inducing a clinically-relevant hallucination, with real-time fMRI neurofeedback (fMRI-NF) to train healthy individuals to up-regulate a fronto-parietal brain network associated with the robotically-induced hallucination. Over three days, participants learned to modulate occurrences of and transition probabilities to this network, leading to heightened sensitivity to induced hallucinations after training. Moreover, participants who became sensitive and succeeded in fMRI-NF training, showed sustained and specific neural changes after training, characterized by increased hallucination network occurrences during induction and decreased hallucination network occurrences during a matched control condition. These data demonstrate that fMRI-NF modulates specific hallucination network dynamics and highlights the potential of fMRI-NF as a novel antipsychotic treatment in neurodegenerative disorders and schizophrenia.
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Affiliation(s)
- Herberto Dhanis
- Neuro-X Institute, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
- Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Nicolas Gninenko
- Neuro-X Institute, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
- Department of Neurology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Elenor Morgenroth
- Neuro-X Institute, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
| | - Jevita Potheegadoo
- Neuro-X Institute, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
- Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Giulio Rognini
- Neuro-X Institute, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
- Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Nathan Faivre
- Neuro-X Institute, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
- Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, Grenoble, France
| | - Olaf Blanke
- Neuro-X Institute, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland.
- Brain Mind Institute, Faculty of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland.
- Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, Switzerland.
| | - Dimitri Van De Ville
- Neuro-X Institute, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland.
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland.
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4
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Krause F, Linden DEJ, Hermans EJ. Getting stress-related disorders under control: the untapped potential of neurofeedback. Trends Neurosci 2024:S0166-2236(24)00150-4. [PMID: 39261131 DOI: 10.1016/j.tins.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 07/05/2024] [Accepted: 08/16/2024] [Indexed: 09/13/2024]
Abstract
Stress-related disorders are among the biggest global health challenges. Despite significant progress in understanding their neurocognitive basis, the promise of applying insights from fundamental research to prevention and treatment remains largely unfulfilled. We argue that neurofeedback - a method for training voluntary control over brain activity - has the potential to fill this translational gap. We provide a contemporary perspective on neurofeedback as endogenous neuromodulation that can target complex brain network dynamics, is transferable to real-world scenarios outside a laboratory or treatment facility, can be trained prospectively, and is individually adaptable. This makes neurofeedback a prime candidate for a personalized preventive neuroscience-based intervention strategy that focuses on the ecological momentary neuromodulation of stress-related brain networks in response to actual stressors in real life.
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Affiliation(s)
- Florian Krause
- Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands.
| | - David E J Linden
- Faculty of Health, Medicine and Life Sciences, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Erno J Hermans
- Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
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Dastgheib SS, Wang W, Kaufmann JM, Moratti S, Schweinberger SR. Mu-Suppression Neurofeedback Training Targeting the Mirror Neuron System: A Pilot Study. Appl Psychophysiol Biofeedback 2024; 49:457-471. [PMID: 38739182 PMCID: PMC11310260 DOI: 10.1007/s10484-024-09643-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Neurofeedback training (NFT) is a promising adjuvant intervention method. The desynchronization of mu rhythm (8-13 Hz) in the electroencephalogram (EEG) over centro-parietal areas is known as a valid indicator of mirror neuron system (MNS) activation, which has been associated with social skills. Still, the effect of neurofeedback training on the MNS requires to be well investigated. The present study examined the possible impact of NFT with a mu suppression training protocol encompassing 15 NFT sessions (45 min each) on 16 healthy neurotypical participants. In separate pre- and post-training sessions, 64-channel EEG was recorded while participants (1) observed videos with various types of movements (including complex goal-directed hand movements and social interaction scenes) and (2) performed the "Reading the Mind in the Eyes Test" (RMET). EEG source reconstruction analysis revealed statistically significant mu suppression during hand movement observation across MNS-attributed fronto-parietal areas after NFT. The frequency analysis showed no significant mu suppression after NFT, despite the fact that numerical mu suppression appeared to be visible in a majority of participants during goal-directed hand movement observation. At the behavioral level, RMET accuracy scores did not suggest an effect of NFT on the ability to interpret subtle emotional expressions, although RMET response times were reduced after NFT. In conclusion, the present study exhibited preliminary and partial evidence that mu suppression NFT can induce mu suppression in MNS-attributed areas. More powerful experimental designs and longer training may be necessary to induce substantial and consistent mu suppression, particularly while observing social scenarios.
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Affiliation(s)
- Samaneh S Dastgheib
- Department for General Psychology and Cognitive Neuroscience, Institute of Psychology, Friedrich Schiller University of Jena, Am Steiger 3/1, 07743, Jena, Germany
- Social Potential in Autism Research Unit, Friedrich Schiller University of Jena, Am Steiger 3/1, 07743, Jena, Germany
- Center for Intervention and Research On Adaptive and Maladaptive Brain Circuits Underlying, Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Germany
| | - Wenbo Wang
- Department for General Psychology and Cognitive Neuroscience, Institute of Psychology, Friedrich Schiller University of Jena, Am Steiger 3/1, 07743, Jena, Germany
- Social Potential in Autism Research Unit, Friedrich Schiller University of Jena, Am Steiger 3/1, 07743, Jena, Germany
- Center for Intervention and Research On Adaptive and Maladaptive Brain Circuits Underlying, Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Germany
| | - Jürgen M Kaufmann
- Department for General Psychology and Cognitive Neuroscience, Institute of Psychology, Friedrich Schiller University of Jena, Am Steiger 3/1, 07743, Jena, Germany
- Social Potential in Autism Research Unit, Friedrich Schiller University of Jena, Am Steiger 3/1, 07743, Jena, Germany
| | - Stephan Moratti
- Department of Experimental Psychology, Complutense University of Madrid, Madrid, Spain
| | - Stefan R Schweinberger
- Department for General Psychology and Cognitive Neuroscience, Institute of Psychology, Friedrich Schiller University of Jena, Am Steiger 3/1, 07743, Jena, Germany.
- Social Potential in Autism Research Unit, Friedrich Schiller University of Jena, Am Steiger 3/1, 07743, Jena, Germany.
- German Center for Mental Health (DZPG), Jena-Magdeburg-Halle, Germany.
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Himmelmeier L, Werheid K. Neurofeedback Training in Children with ADHD: A Systematic Review of Personalization and Methodological Features Facilitating Training Conditions. Clin EEG Neurosci 2024:15500594241279580. [PMID: 39211991 DOI: 10.1177/15500594241279580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Objective. Current research on the effectiveness of neurofeedback (NFB) in children with attention-deficit/hyperactivity disorder (ADHD) is divided. Personalized NFB (pNFB), using pre-recorded individual electroencephalogram (EEG) features, is hypothesized to provide more reliable results. Our paper reviews available evidence on pNFB effectiveness and its methodological quality. Additionally, it explores whether other methodological features implying personalization are related to successful NFB. Methods. We conducted a systematic literature review on PubMed, PSYNDEX, PsycInfo and PsycArticles until November, 30, 2023. Studies that focused on pNFB in children with ADHD were selected, deviant studies excluded. Quality ratings by independent raters using Loney's1 criteria were conducted. Pooled effect sizes for NFB effects and methodological features were calculated. Results. Three of 109 studies included personalization and were reviewed in the full-text. In two studies, theta/beta-NFB was personalized using individual alpha peak frequencies (iAPF), whereas in one study, individual beta rhythms were trained. All three studies demonstrated significant short- and long-term improvements in ADHD symptoms, as assessed by questionnaires and objective performance tests, when compared to standard protocols (SP), sham-NFB, and control conditions. Twelve of 111 studies reported methodological features consistently related to NFB effectiveness. These features, including self-control instructions, feedback animations, timing of feedback presentation, behavioral performance, pre-recorded individual ERP-components and stimulant medication dosage, can be used to personalize NFB and enhance training success. Conclusion. Personalizing NFB with iAPF appears promising based on the existing -albeit small- body of research. Future NFB studies should include iAPF and other personalized features facilitating implementation consistently associated with treatment success.
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Affiliation(s)
- Luisa Himmelmeier
- Clinical Neuropsychology and Psychotherapy of the Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Katja Werheid
- Clinical Neuropsychology and Psychotherapy of the Department of Psychology, Bielefeld University, Bielefeld, Germany
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7
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Hack RL, Aigner M, Musalek M, Crevenna R, Konicar L. Brain regulation training improves emotional competences in patients with alcohol use disorder. Soc Cogn Affect Neurosci 2024; 19:nsae048. [PMID: 38915188 PMCID: PMC11297497 DOI: 10.1093/scan/nsae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 05/14/2024] [Accepted: 06/22/2024] [Indexed: 06/26/2024] Open
Abstract
Alcohol use disorder (AUD) is defined as the impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences and still represents one of the biggest challenges for society regarding health conditions, social consequences, and financial costs, including the high relapse rates after traditional alcohol rehabilitation treatment. Especially, the deficient emotional competence in AUD is said to play a key role in the development of AUD and hinders the interruption of substance compulsion, often leading to a viscous circle of relapse. Although the empirical evidence of a neurophysiological basis of AUD is solid and increases even further, clinical interventions based on neurophysiology are still rare for individuals with AUD. This randomized controlled trial investigates changes in emotional competences, alcohol-related cognitions, and drinking behavior before and after an established alcohol rehabilitation treatment (control group: nCG = 29) compared to before and after an optimized, add-on neurofeedback (NF) training (experimental group: nEG = 27). Improvements on the clinical-psychological level, i.e. increases in emotional competences as well as life satisfaction, were found after the experimental electroencephalography (EEG) NF training. Neurophysiological measurements via resting-state EEG indicate decreases in low beta frequency band, while alpha and theta bands remained unaffected.
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Affiliation(s)
- Ramona L Hack
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna 1090, Austria
- Anton-Proksch-Institute, Vienna, Vienna 1230, Austria
| | - Martin Aigner
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, University Hospital Tulln, Tulln 3430, Austria
| | | | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Vienna 1090, Austria
| | - Lilian Konicar
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna 1090, Austria
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8
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Pfeiffer M, Kübler A, Hilger K. Modulation of human frontal midline theta by neurofeedback: A systematic review and quantitative meta-analysis. Neurosci Biobehav Rev 2024; 162:105696. [PMID: 38723734 DOI: 10.1016/j.neubiorev.2024.105696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/27/2024] [Accepted: 04/26/2024] [Indexed: 05/19/2024]
Abstract
Human brain activity consists of different frequency bands associated with varying functions. Oscillatory activity of frontal brain regions in the theta range (4-8 Hz) is linked to cognitive processing and can be modulated by neurofeedback - a technique where participants receive real-time feedback about their brain activity and learn to modulate it. However, criticism of this technique evolved, and high heterogeneity of study designs complicates a valid evaluation of its effectiveness. This meta-analysis provides the first systematic overview over studies attempting to modulate frontal midline theta with neurofeedback in healthy human participants. Out of 1261 articles screened, 14 studies were eligible for systematic review and 11 for quantitative meta-analyses. Studies were evaluated following the DIAD model and the PRISMA guidelines. A significant across-study effect of medium size (Hedges' g = .66; 95%-CI [-0.62, 1.73]) with substantial between-study heterogeneity (Q(16) = 167.43, p < .001) was observed and subanalysis revealed effective frontal midline theta upregulation. We discuss moderators of effect sizes and provide guidelines for future research in this dynamic field.
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Affiliation(s)
- Maria Pfeiffer
- Institute of Psychology, Department of Psychology I, Würzburg University, Marcusstr. 9-11, Würzburg D-97070, Germany
| | - Andrea Kübler
- Institute of Psychology, Department of Psychology I, Würzburg University, Marcusstr. 9-11, Würzburg D-97070, Germany
| | - Kirsten Hilger
- Institute of Psychology, Department of Psychology I, Würzburg University, Marcusstr. 9-11, Würzburg D-97070, Germany.
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Xia Z, Yang PY, Chen SL, Zhou HY, Yan C. Uncovering the power of neurofeedback: a meta-analysis of its effectiveness in treating major depressive disorders. Cereb Cortex 2024; 34:bhae252. [PMID: 38889442 DOI: 10.1093/cercor/bhae252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/25/2024] [Accepted: 06/04/2024] [Indexed: 06/20/2024] Open
Abstract
Neurofeedback, a non-invasive intervention, has been increasingly used as a potential treatment for major depressive disorders. However, the effectiveness of neurofeedback in alleviating depressive symptoms remains uncertain. To address this gap, we conducted a comprehensive meta-analysis to evaluate the efficacy of neurofeedback as a treatment for major depressive disorders. We conducted a comprehensive meta-analysis of 22 studies investigating the effects of neurofeedback interventions on depression symptoms, neurophysiological outcomes, and neuropsychological function. Our analysis included the calculation of Hedges' g effect sizes and explored various moderators like intervention settings, study designs, and demographics. Our findings revealed that neurofeedback intervention had a significant impact on depression symptoms (Hedges' g = -0.600) and neurophysiological outcomes (Hedges' g = -0.726). We also observed a moderate effect size for neurofeedback intervention on neuropsychological function (Hedges' g = -0.418). As expected, we observed that longer intervention length was associated with better outcomes for depressive symptoms (β = -4.36, P < 0.001) and neuropsychological function (β = -2.89, P = 0.003). Surprisingly, we found that shorter neurofeedback sessions were associated with improvements in neurophysiological outcomes (β = 3.34, P < 0.001). Our meta-analysis provides compelling evidence that neurofeedback holds promising potential as a non-pharmacological intervention option for effectively improving depressive symptoms, neurophysiological outcomes, and neuropsychological function in individuals with major depressive disorders.
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Affiliation(s)
- Zheng Xia
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062, China
- Shanghai Changning Mental Health Center, 299 Xiehe Road, Shanghai 200335, China
| | - Peng-Yuan Yang
- Department of Methodology and Statistics, Faculty of Behavioral and Social Sciences, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
| | - Si-Lu Chen
- Shanghai Changning Mental Health Center, 299 Xiehe Road, Shanghai 200335, China
| | - Han-Yu Zhou
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062, China
| | - Chao Yan
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, 3663 North Zhongshan Road, Shanghai 200062, China
- Shanghai Changning Mental Health Center, 299 Xiehe Road, Shanghai 200335, China
- Key Laboratory of Philosophy and Social Science of Anhui Province on Adolescent Mental Health and Crisis Intelligence Intervention, Hefei Normal University, 1688 Lianhua Road, Hefei 230601, China
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Xu J, Zhang W, Yu J, Li G, Cui J, Qi H, Zhang M, Li M, Hu Y, Wang H, Min H, Xu F, Xu X, Zhu C, Xiao Y, Zhang Y. Functional near-infrared spectroscopy-based neurofeedback training regulates time-on-task effects and enhances sustained cognitive performance. Cereb Cortex 2024; 34:bhae259. [PMID: 38904080 DOI: 10.1093/cercor/bhae259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 05/28/2024] [Accepted: 06/04/2024] [Indexed: 06/22/2024] Open
Abstract
Time-on-task effect is a common consequence of long-term cognitive demand work, which reflects reduced behavioral performance and increases the risk of accidents. Neurofeedback is a neuromodulation method that can guide individuals to regulate their brain activity and manifest as changes in related symptoms and cognitive behaviors. This study aimed to examine the effects of functional near-infrared spectroscopy-based neurofeedback training on time-on-task effects and sustained cognitive performance. A randomized, single-blind, sham-controlled study was performed: 17 participants received feedback signals of their own dorsolateral prefrontal cortex activity (neurofeedback group), and 16 participants received feedback signals of dorsolateral prefrontal cortex activity from the neurofeedback group (sham-neurofeedback group). All participants received 5 neurofeedback training sessions and completed 2 sustained cognitive tasks, including a 2-back task and a psychomotor vigilance task, to evaluate behavioral performance changes following neurofeedback training. Results showed that neurofeedback relative to the sham-neurofeedback group exhibited increased dorsolateral prefrontal cortex activation, increased accuracy in the 2-back task, and decreased mean response time in the psychomotor vigilance task after neurofeedback training. In addition, the neurofeedback group showed slower decline performance during the sustained 2-back task after neurofeedback training compared with sham-neurofeedback group. These findings demonstrate that neurofeedback training could regulate time-on-task effects on difficult task and enhance performance on sustained cognitive tasks by increasing dorsolateral prefrontal cortex activity.
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Affiliation(s)
- Jiayu Xu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
| | - Wenchao Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
| | - Juan Yu
- Department of Gastroenterology, Xijing Hospital, Air Force Medical University, Changle West Road, Xincheng District, Xi'an, Shaanxi 710032, China
| | - Guanya Li
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
| | - Jianqi Cui
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
| | - Haowen Qi
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
| | - Minmin Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
| | - Mengshan Li
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
| | - Yang Hu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
| | - Haoyi Wang
- College of Westa, Southwest University, Tiansheng Road, Beipei District, Chongqing 400715, China
| | - Huaqiao Min
- Beijing Institute of Remote Sensing Information, Anwaiwaiguan Road, Chaoyang District, Beijing 100192, China
| | - Fenggang Xu
- National Key Laboratory of Human Factors Engineering, China Astronaut Research and Training Center, Lvyuan West Road, Haidian District, Beijing 100094, China
| | - Xiaodan Xu
- National Key Laboratory of Human Factors Engineering, China Astronaut Research and Training Center, Lvyuan West Road, Haidian District, Beijing 100094, China
| | - Chaozhe Zhu
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Xinjiekouwai Street, Haidian District, Beijing 100091, China
| | - Yi Xiao
- National Key Laboratory of Human Factors Engineering, China Astronaut Research and Training Center, Lvyuan West Road, Haidian District, Beijing 100094, China
| | - Yi Zhang
- Center for Brain Imaging, School of Life Science and Technology, Xidian University & Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
- International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xifeng Road, Chang'an District, Xi'an, Shaanxi 710126, China
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11
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van der Schoot A, Wilpert J, van Horn JE. Neurofeedback and meditation technology in outpatient offender treatment: a feasibility and usability pilot study. Front Psychol 2024; 15:1354997. [PMID: 38899124 PMCID: PMC11186484 DOI: 10.3389/fpsyg.2024.1354997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction Although Cognitive Behavioral Therapy (CBT) is the most often used intervention in forensic treatment, its effectivity is not consistently supported. Interventions incorporating knowledge from neuroscience could provide for more successful intervention methods. Methods The current pilot study set out to assess the feasibility and usability of the study protocol of a 4-week neuromeditation training in adult forensic outpatients with impulse control problems. The neuromeditation training, which prompts awareness and control over brain states of restlessness with EEG neurofeedback, was offered in addition to treatment as usual (predominantly CBT). Results Eight patients completed the neuromeditation training under guidance of their therapists. Despite some emerging obstacles, overall, the training was rated sufficiently usable and feasible by patients and their therapists. Discussion The provided suggestions for improvement can be used to implement the intervention in treatment and set up future trials to study the effectiveness of neuromeditation in offender treatment.
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Affiliation(s)
| | - J. Wilpert
- Research Departement, De Forensische Zorgspecialisten (DFZS), Utrecht, Netherlands
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12
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Dentz A, Soelch CM, Fahim C, Torsello A, Parent V, Ponsioen A, Guay MC, Bioulac-Rogier S, Clément C, Bader M, Romo L. Non-pharmacological treatment of Attention Deficit Disorder with or without Hyperactivity (ADHD). Overview and report of the first international symposium on the non-pharmacological management of ADHD. L'ENCEPHALE 2024; 50:309-328. [PMID: 38326137 DOI: 10.1016/j.encep.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/24/2023] [Indexed: 02/09/2024]
Abstract
Attention Deficit Disorder with or without Hyperactivity (ADHD is a neurodevelopmental disorder which affects the day-to-day functioning of children and adults with this condition. Pharmacological treatment can reduce the symptoms associated with ADHD, but it has some limitations. The objective of this symposium is to determine the effects of non-pharmacological approaches on ADHD symptoms. Results indicate that the following intervention are promising approaches: cognitive behavioral therapy (CBT), mindfulness-based interventions (MBI), yoga, cognitive and metacognitive intervention, neurofeedback and parental training programs. Current research advocates multimodal approaches in conjunction with school or work accommodations integrating innovative technologies.
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Affiliation(s)
- Amélie Dentz
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland.
| | - Chantal Martin Soelch
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland
| | - Cherine Fahim
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland
| | - Alexandra Torsello
- Université de Fribourg, Département de Psychologie, rue P.A. de Faucigny 2, 1700 Fribourg, Switzerland
| | | | | | | | | | - Céline Clément
- Laboratoire Interuniversitaire des Sciences de l'Education et de la Communication (EA 2310), Université de Strasbourg, Strasbourg, France
| | - Michel Bader
- Unité de Recherche, Service de Psychiatrie de l'Enfant et de l'adolescent (SUPEA - DP CHUV), Lausanne, Switzerland
| | - Lucia Romo
- EA4430 CLIPSYD, UFR SPSE, Paris Nanterre Université, Nanterre, France
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13
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Gacek M, Smoleń T, Krzywoszański Ł, Bartecka-Śmietana A, Kulasek-Filip B, Piotrowska M, Sepielak D, Supernak K. Effects of School-Based Neurofeedback Training on Attention in Students with Autism and Intellectual Disabilities. J Autism Dev Disord 2024:10.1007/s10803-024-06400-8. [PMID: 38806749 DOI: 10.1007/s10803-024-06400-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 05/30/2024]
Abstract
In this study we aimed to assess the influence of school-based neurofeedback training on the attention of students with autism and intellectual disabilities. We assessed 24 students of a special education center who attended neurofeedback training sessions during the schoolyear; we also assessed 25 controls from the same center. We used two computer tasks to assess sustained attention in simple and cognitively demanding test situations, and we used a pen-and-paper task to assess selective attention. Each student who took part in the study was tested at the beginning and at the end of the schoolyear. Students from the experimental group significantly improved their performance in the task related to sustained attention to simple stimuli. No performance improvement related to neurofeedback treatment was observed in either sustained attention in cognitively demanding situations or selective attention. School-based neurofeedback training may improve sustained attention to simple stimuli in students with developmental disabilities.
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Affiliation(s)
- Michał Gacek
- Institute of Psychology, Jagiellonian University, ul. Ingardena 6, 30-060, Krakow, Poland.
| | - Tomasz Smoleń
- Department of Cognitive Science, Jagiellonian University, ul. Grodzka 52, 31-044, Krakow, Poland
| | - Łukasz Krzywoszański
- Institute of Psychology, The Pedagogical University of Krakow, ul. Podchorazych 2, 30-084, Krakow, Poland
| | | | - Beata Kulasek-Filip
- Special Education and Child Care Center No. 1 in Krakow, ul. Barska 45, 30-307, Krakow, Poland
| | - Maja Piotrowska
- Institute of Psychology, Jagiellonian University, ul. Ingardena 6, 30-060, Krakow, Poland
| | - Dominika Sepielak
- Institute of Psychology, Jagiellonian University, ul. Ingardena 6, 30-060, Krakow, Poland
| | - Katarzyna Supernak
- Special Education and Child Care Center No. 1 in Krakow, ul. Barska 45, 30-307, Krakow, Poland
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14
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Wider W, Mutang JA, Chua BS, Pang NTP, Jiang L, Fauzi MA, Udang LN. Mapping the evolution of neurofeedback research: a bibliometric analysis of trends and future directions. Front Hum Neurosci 2024; 18:1339444. [PMID: 38799297 PMCID: PMC11116792 DOI: 10.3389/fnhum.2024.1339444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction This study conducts a bibliometric analysis on neurofeedback research to assess its current state and potential future developments. Methods It examined 3,626 journal articles from the Web of Science (WoS) using co-citation and co-word methods. Results The co-citation analysis identified three major clusters: "Real-Time fMRI Neurofeedback and Self-Regulation of Brain Activity," "EEG Neurofeedback and Cognitive Performance Enhancement," and "Treatment of ADHD Using Neurofeedback." The co-word analysis highlighted four key clusters: "Neurofeedback in Mental Health Research," "Brain-Computer Interfaces for Stroke Rehabilitation," "Neurofeedback for ADHD in Youth," and "Neural Mechanisms of Emotion and Self-Regulation with Advanced Neuroimaging. Discussion This in-depth bibliometric study significantly enhances our understanding of the dynamic field of neurofeedback, indicating its potential in treating ADHD and improving performance. It offers non-invasive, ethical alternatives to conventional psychopharmacology and aligns with the trend toward personalized medicine, suggesting specialized solutions for mental health and rehabilitation as a growing focus in medical practice.
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Affiliation(s)
- Walton Wider
- Faculty of Business and Communications, INTI International University, Nilai, Negeri Sembilan, Malaysia
| | - Jasmine Adela Mutang
- Faculty of Psychology and Education, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Bee Seok Chua
- Faculty of Psychology and Education, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Nicholas Tze Ping Pang
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Leilei Jiang
- Faculty of Education and Liberal Arts, INTI International University, Nilai, Negeri Sembilan, Malaysia
| | - Muhammad Ashraf Fauzi
- Faculty of Industrial Management, Universiti Malaysia Pahang Al-Sultan Abdullah, Pekan, Pahang, Malaysia
| | - Lester Naces Udang
- Faculty of Liberal Arts, Shinawatra University, Pathumthani, Thailand
- College of Education, University of the Philippines, Diliman, Philippines
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15
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Mergl R, Karch S, Henl J, Meindl D, Schöpf F, Szabo SI, Hallweger P, Heiler P, Maywald M, Tschentscher N, Allgaier AK, Pogarell O. Effects of Four Different EEG-Neurofeedback Reinforcement Types in Healthy Individuals - A Pilot Study. Clin EEG Neurosci 2024; 55:305-316. [PMID: 36373604 DOI: 10.1177/15500594221138278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
EEG neurofeedback (EEG-NFB) is a promising tool for the treatment of depressive disorders. However, many methods for the presentation of neurobiological reactions are available and it is widely unknown which of these feedback options are preferrable. Moreover, the influence of motivation on NFB training success is insufficiently studied. This study analyzed the efficacy of a novel EEG protocol (FC3/Pz) based on findings for NFB in depression. The role of four feedback options (Rumination, Anxiety, Meditation Master, Moving Art) from the NFB software "Brain Assistant" and motivation in EEG-based NFB performance was studied. Regarding "Anxiety" and "Rumination" visual feedback was used to evoke emotions; reinforcement (both negative and positive operant conditioning) was continuous. Regarding "Meditation Master" visual feedback was combined with continuous positive reinforcement. Regarding "Moving Art" 20-min calm nature films with neutral character were used; both visual and auditive feedback were applied. The reinforcement was positive and continuous. 13 healthy participants completed 15 EEG sessions over four months combining simultaneous frontal (aims: reduction of theta-, alpha- and high beta-activity, increase of low and mid beta-activity) and parietal training (aims: reduction of theta-, alpha 1-, mid and high beta-activity, increase of alpha 2- and low beta-activity). We observed significantly more pronounced percentage change in the expected direction for Anxiety than Moving Art (mean difference = 3.32; p = 0.003). The association between motivation and performance was non-significant. Based on these results we conclude that feedback with both negative and positive operant conditioning and emotion evoking effects should be preferred.
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Affiliation(s)
- Roland Mergl
- Institute of Psychology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Susanne Karch
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Jennifer Henl
- Institute of Psychology, Universität der Bundeswehr München, Neubiberg, Germany
| | - Dorothea Meindl
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Felix Schöpf
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Szilard I Szabo
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Paulina Hallweger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Heiler
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Medical Practice for Neurofeedback Philipp Heiler, Munich, Germany
| | - Maximilian Maywald
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Nadja Tschentscher
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | | | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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16
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Prasad BV, Patil V, Sony KK. Neurodevelopmental Disorders: Role of Non-invasive Neuromodulation Therapies. Ann Neurosci 2024; 31:77-79. [PMID: 38694712 PMCID: PMC11060127 DOI: 10.1177/09727531241245664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Affiliation(s)
| | | | - Krishan K. Sony
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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17
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Tosti B, Corrado S, Mancone S, Di Libero T, Rodio A, Andrade A, Diotaiuti P. Integrated use of biofeedback and neurofeedback techniques in treating pathological conditions and improving performance: a narrative review. Front Neurosci 2024; 18:1358481. [PMID: 38567285 PMCID: PMC10985214 DOI: 10.3389/fnins.2024.1358481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
In recent years, the scientific community has begun tо explore the efficacy оf an integrated neurofeedback + biofeedback approach іn various conditions, both pathological and non-pathological. Although several studies have contributed valuable insights into its potential benefits, this review aims tо further investigate its effectiveness by synthesizing current findings and identifying areas for future research. Our goal іs tо provide a comprehensive overview that may highlight gaps іn the existing literature and propose directions for subsequent studies. The search for articles was conducted on the digital databases PubMed, Scopus, and Web of Science. Studies to have used the integrated neurofeedback + biofeedback approach published between 2014 and 2023 and reviews to have analyzed the efficacy of neurofeedback and biofeedback, separately, related to the same time interval and topics were selected. The search identified five studies compatible with the objectives of the review, related to several conditions: nicotine addiction, sports performance, Autism Spectrum Disorder (ASD), and Attention Deficit Hyperactivity Disorder (ADHD). The integrated neurofeedback + biofeedback approach has been shown to be effective in improving several aspects of these conditions, such as a reduction in the presence of psychiatric symptoms, anxiety, depression, and withdrawal symptoms and an increase in self-esteem in smokers; improvements in communication, imitation, social/cognitive awareness, and social behavior in ASD subjects; improvements in attention, alertness, and reaction time in sports champions; and improvements in attention and inhibitory control in ADHD subjects. Further research, characterized by greater methodological rigor, is therefore needed to determine the effectiveness of this method and the superiority, if any, of this type of training over the single administration of either. This review іs intended tо serve as a catalyst for future research, signaling promising directions for the advancement оf biofeedback and neurofeedback methodologies.
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Affiliation(s)
- Beatrice Tosti
- Department of Human Sciences, Society and Health, University of Cassino, Cassino, Lazio, Italy
| | - Stefano Corrado
- Department of Human Sciences, Society and Health, University of Cassino, Cassino, Lazio, Italy
| | - Stefania Mancone
- Department of Human Sciences, Society and Health, University of Cassino, Cassino, Lazio, Italy
| | - Tommaso Di Libero
- Department of Human Sciences, Society and Health, University of Cassino, Cassino, Lazio, Italy
| | - Angelo Rodio
- Department of Human Sciences, Society and Health, University of Cassino, Cassino, Lazio, Italy
| | - Alexandro Andrade
- Department of Physical Education, CEFID, Santa Catarina State University, Florianopolis, Santa Catarina, Brazil
| | - Pierluigi Diotaiuti
- Department of Human Sciences, Society and Health, University of Cassino, Cassino, Lazio, Italy
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18
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Tazaki M. A review: effects of neurofeedback on patients with mild cognitive impairment (MCI), and Alzheimer's disease (AD). Front Hum Neurosci 2024; 17:1331436. [PMID: 38420112 PMCID: PMC10899454 DOI: 10.3389/fnhum.2023.1331436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/29/2023] [Indexed: 03/02/2024] Open
Abstract
Neurofeedback training (NFT) is a non-invasive method and has been shown to be effective for attention deficit/hyperactivity disorder (ADHD) and various psychiatric disorders. The aim of this paper is to evaluate the effectiveness of NFT for patients with Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) or Vascular Diseases (VD), so that we searched research articles from four databases, using the keywords neurofeedback, elderly, MCI, AD, VD, and dementia. As a result, 13 articles were identified regarding the effectiveness of NFT in patients with MCI and AD. Although each study differed in study design, training protocol, electroencephalogram (EEG) electrode placement, and reward and inhibition frequency bands, all were shown to enhance memory, attention, and other cognitive abilities. Additional well-designed, randomized studies with sufficient power are needed to further confirm the effectiveness of NFT.
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Affiliation(s)
- Miyako Tazaki
- Department of Psychology, Faculty of Medicine, Toho University, Tokyo, Japan
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19
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Oh S, Choi J, Han DH, Kim E. Effects of game-based digital therapeutics on attention deficit hyperactivity disorder in children and adolescents as assessed by parents or teachers: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2024; 33:481-493. [PMID: 36862162 DOI: 10.1007/s00787-023-02174-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 02/16/2023] [Indexed: 03/03/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a childhood-onset disorder characterized by pharmacological and non-pharmacological interventions. Despite the available treatment options and prevention measures, conventional treatments have several limitations. Digital therapeutics (DTx) like EndeavorRx® is an emerging alternative to overcome these limitations. EndeavorRx® is the first FDA-approved, game-based DTx approved for the treatment of pediatric ADHD. We investigated the effects of game-based DTx in randomised controlled trials (RCTs) on children and adolescents with ADHD. In this systematic review and meta-analysis, we searched PubMed, Embase, and PsycINFO databases up to January 2022. The protocol was registered (CRD42022299866). The assessor was defined as parents and teachers. The primary outcome was differences in inattention reported by the assessor, and the secondary outcome was differences in hyperactivity and hyperactivity/impulsivity reported by the assessor and the relative comparisons between game-based DTx, medicine, and control with indirect meta-analysis. Game-based DTx improved inattention more than the control upon assessment by assessors (standard mean difference (SMD) 0.28, 95% confidence interval (CI) 0.14-0.41; SMD 0.21, 95% CI 0.03-0.39, respectively), while medication improved inattention more than game-based DTx (SMD - 0·62, 95% CI - 1·04 to - 0·20) upon assessment by the teacher. Game-based DTx improved hyperactivity/impulsivity than the control upon assessment by assessors (SMD 0.28, 95% CI 0.03-0.53; SMD 0.30, 95% CI 0.05-0.55, respectively), and medication improved hyperactivity/impulsivity significantly than game-based DTx upon assessment by the teacher. Hyperactivity has not been reported extensively. As a result, game-based DTx had a more significant effect than the control, however medication was more effective.
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Affiliation(s)
- SuA Oh
- Data Science, Evidence-Based and Clinical Research Laboratory, Department of Health, Social and Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea
| | - Jina Choi
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Doug Hyun Han
- Department of Psychiatry, College of Medicine, Chung Ang University Hospital, Seoul, 06974, Republic of Korea
| | - EunYoung Kim
- Data Science, Evidence-Based and Clinical Research Laboratory, Department of Health, Social and Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea.
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea.
- Regulatory Science, Pharmaceutical Industry, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea.
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20
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Ayoubipour S, Sho'ouri N. A Comparative Investigation of Wavelet Families for Classification of EOG Signals Related to Healthy and ADHD Children. Clin EEG Neurosci 2024; 55:11-21. [PMID: 37605610 DOI: 10.1177/15500594231192817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Based on previous research, there are differences between eye movements of people with attention-deficit hyperactivity disorder (ADHD) and of healthy people, as a result, the existence of differences regarding the electrooculogram (EOG) signals of the 2 groups exists. Thus, this study aimed to examine the recorded EOG signals of 30 ADHD children and 30 healthy children while performing an attention-related task. For this purpose, the EOG signals of these 2 groups were decomposed utilizing various wavelet functions. Afterward, features, including mean, energy, and standard deviation (SD) of approximation and detail wavelet coefficients were calculated. The Davies-Bouldin (DB) index was used for the evaluation of the feature space quality. Finally, the 2 groups were classified using one-dimensional feature vector and support vector machine (SVM). The SD of detail coefficients (db4) was selected as the most effective feature for separating the 2 groups. Statistical analysis revealed that the values of energy and SD of EOG signals' detail coefficients were significantly lower in the ADHD group in comparison with the healthy group (P<.001). These results showed that the speed of the ADHD group's eye movements was slower due to the fact that the high-frequency band activity of EOG signals in the healthy group was higher. In addition, the EOG signals were classified with a detection accuracy of 83.42 ± 3.8%. The results of this study can be applied in designing an EOG biofeedback protocol to treat or mitigate the symptoms of ADHD patients.
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Affiliation(s)
- Shahrzad Ayoubipour
- Department of Technology and Engineering, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Nasrin Sho'ouri
- Department of Technology and Engineering, Central Tehran Branch, Islamic Azad University, Tehran, Iran
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21
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Schachar RJ. Fifty years of executive control research in attention-deficit/hyperactivity disorder:What we have learned and still need to know. Neurosci Biobehav Rev 2023; 155:105461. [PMID: 37949153 DOI: 10.1016/j.neubiorev.2023.105461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
For 50 years, attention-deficit/hyperactivity disorder (ADHD) has been considered a disorder of executive control (EC), the higher-order, cognitive skills that support self-regulation, goal attainment and what we generally call "attention." This review surveys our current understanding of the nature of EC as it pertains to ADHD and considers the evidence in support of eight hypotheses that can be derived from the EC theory of ADHD. This paper provides a resource for practitioners to aid in clinical decision-making. To support theory building, I draw a parallel between the EC theory of ADHD and the common gene-common variant model of complex traits such as ADHD. The conclusion offers strategies for advancing collaborative research.
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Affiliation(s)
- Russell J Schachar
- Department of Psychiatry, The Hospital for Sick Children and University of Toronto, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G1X8, Canada.
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22
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Lee CSC, Chen TT, Gao Q, Hua C, Song R, Huang XP. The Effects of Theta/Beta-based Neurofeedback Training on Attention in Children with Attention Deficit Hyperactivity Disorder: A Systematic Review and Meta-analysis. Child Psychiatry Hum Dev 2023; 54:1577-1606. [PMID: 35471754 DOI: 10.1007/s10578-022-01361-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
Abstract
Neurofeedback training is a common treatment option for attention deficit hyperactivity disorder (ADHD). Given theta/beta-based neurofeedback (T/B NF) training targets at the electrophysiological characteristics of children with ADHD, benefits for attention may be expected. PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science were searched through December 31, 2020. Studies were evaluated with Risk of Bias tools. Within-group effects based on Pre- and Post-treatment comparisons of the Intervention Group, and Between-group effects based on the between-group differences from Pre-treatment to Post-treatment were calculated. Nineteen studies met selection criteria for systematic review, 12 of them were included in meta-analysis. Within-group effects were medium at Post-treatment and large at Follow-up. Between-group analyses revealed that T/B NF was superior to waitlist control and physical activities, but not stimulant medication. Results showed that T/B NF has benefits for attention in children with ADHD, however, cautions should be taken when interpreting the findings.
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Affiliation(s)
- Clara S C Lee
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - Ting-Ting Chen
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Qingwen Gao
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Chunzhuo Hua
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Rui Song
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Xiu-Ping Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Sun C, Xiong Z, Sun C, Liu T, Liu X, Zhang Q, Liu B, Yan S, Liu C. Placebo response in sham-acupuncture-controlled trials for migraine: A systematic review and meta-analysis. Complement Ther Clin Pract 2023; 53:101800. [PMID: 37793307 DOI: 10.1016/j.ctcp.2023.101800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/09/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
AIM To understand the placebo response of acupuncture and its effect on migraine and optimize the design of future acupuncture clinical trials on migraine treatment. METHODS Randomized controlled trials with sham acupuncture as a control in migraine treatment were searched in four English databases from inception to September 1, 2022. The primary outcome was placebo response rate. Secondary outcomes were migraine symptoms, emotional condition, and quality of life. Factors associated with placebo response were also explored. Results were combined using risk difference (RD) or standardized mean difference (SMD) and 95% confidence interval (CI) with a random effects model. RESULTS The final analysis included 21 studies involving 1177 patients. The pooled response rate of sham acupuncture was 0.34 (RD, 95% CI 0.23-0.45, I2 89.8%). The results (SMD [95% CI]) showed significant improvements in migraine symptoms (pain intensity -0.56 [-0.73 to -0.38], and episode conditions -0.55 [-0.75 to -0.35]); emotional condition (anxiety scale -0.49 [-0.90 to -0.08] and depression scale -0.21 [-0.40 to -0.03]); and quality of life on the Migraine-Specific Quality-of-Life Questionnaire (restrictive 0.78 [0.61-0.95]; preventive 0.52 [0.35-0.68]; and emotional 0.45 [0.28-0.62]) and on the Medical Outcomes Study Short-Form (physical 0.48 [0.34-0.62] and mental 0.21 [0.02-0.41]). Only acupuncture treatment frequency had a significant impact on the placebo response rate (RD 0.49 vs. 0.14; p = 0.00). CONCLUSIONS The effect sizes for placebo response of sham acupuncture varied across migraine treatment trials. Further studies should routinely consider adjusting for a more complete set of treatment factors.
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Affiliation(s)
- Chengyi Sun
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Zhiyi Xiong
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Chongyang Sun
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Tinglan Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoyu Liu
- School of Acupuncture-Moxibustion and Tuina, Tianjin University of Chinese Medicine, Tianjin, China
| | - Qinhong Zhang
- Department of Tuina, Acupuncture and Moxibustion, Shenzhen Jiuwei Chinese Medicine Clinic, Shenzhen, China
| | - Baoyan Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shiyan Yan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China; International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China.
| | - Cunzhi Liu
- International Acupuncture and Moxibustion Innovation Institute, Beijing University of Chinese Medicine, Beijing, China
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24
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Rapp L, Mai-Lippold SA, Georgiou E, Pollatos O. Elevated EEG heartbeat-evoked potentials in adolescents with more ADHD symptoms. Biol Psychol 2023; 184:108698. [PMID: 37775030 DOI: 10.1016/j.biopsycho.2023.108698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023]
Abstract
INTRODUCTION Symptoms of attention deficit hyperactivity disorder (ADHD) are associated with a variety of mental abnormalities, but little is known about the perception and processing of internal signals, i.e., interoception, in individuals with ADHD symptoms. This study aimed to investigate the association between ADHD symptoms and the heartbeat-evoked potential (HEP), known as a neural correlate of automatic interoceptive processing of cardiac signals, in adolescents. METHODS HEPs of 47 healthy adolescent participants (53.2 % female) with a mean age of 14.29 years were measured during an emotional face recognition task. In addition, participants completed a self-report screening for ADHD symptoms. RESULTS ADHD symptoms were positively related to the HEP activity during the task in three of eight EEG sectors in the left hemisphere, as well as in all sectors in the right hemisphere. DISCUSSION This study is the first to demonstrate preliminary a relationship between the strength of HEP activity and ADHD symptoms in awake subjects. This finding of higher HEP amplitudes in subjects with more ADHD symptoms can be interpreted in terms of (i) increased arousal, (ii) altered neural processing of internal processes in an emotion-relevant task, and (iii) a misaligned precision-weighting process of task-irrelevant stimuli according to the predictive coding framework. These different interpretations could be reflected by previous studies showing heterogeneity of psychological deficits in individuals with ADHD symptoms. However, the generalizability to patients with diagnosed ADHD is limited due to the measurement tool for ADHD symptoms and the sample characteristics.
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Affiliation(s)
- Lorenz Rapp
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89069 Ulm, Germany.
| | - Sandra A Mai-Lippold
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89069 Ulm, Germany
| | - Eleana Georgiou
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89069 Ulm, Germany
| | - Olga Pollatos
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 47, 89069 Ulm, Germany
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Sadr-Salek S, Costa AP, Steffgen G. Psychological Treatments for Hyperactivity and Impulsivity in Children with ADHD: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1613. [PMID: 37892276 PMCID: PMC10605405 DOI: 10.3390/children10101613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Abstract
Treatment of the ADHD types (hyperactive-impulsive, inattentive, and combined) in children has rarely been studied separately, although their prognostic courses differ widely. In addition, data show that improvements in hyperactivity/impulsivity are hard to achieve. Thus, we focused on treatments tailored to hyperactivity/impulsivity. We examined meta-analyses and systematic reviews within the inter- and intra-individual treatments and found that psychoeducation and training for parents, school-based interventions, reinforcement strategies, and neurofeedback consistently showed small to moderate effect sizes in reducing hyperactivity/impulsivity in children. Conversely, emotional self-regulation, social skills, and cognitive trainings showed unsatisfactory results. In summary, we found that the quality of usual care can be surpassed when the designated interventions are purposefully combined into a multimodal treatment program.
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Affiliation(s)
- Shayan Sadr-Salek
- Service Psychologique, Solidarité Jeunes asbl—Haus 13, 48, rue Victor Hugo, L-4140 Esch-sur-Alzette, Luxembourg;
| | - Andreia P. Costa
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Campus Belval, MSH, 11 Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg;
| | - Georges Steffgen
- Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, Campus Belval, MSH, 11 Porte des Sciences, L-4366 Esch-sur-Alzette, Luxembourg;
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26
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Herrera-Morales WV, Reyes-López JV, Tuz-Castellanos KNH, Ortegón-Abud D, Ramírez-Lugo L, Santiago-Rodríguez E, Núñez-Jaramillo L. Variations in Theta/Beta Ratio and Cognitive Performance in Subpopulations of Subjects with ADHD Symptoms: Towards Neuropsychological Profiling for Patient Subgrouping. J Pers Med 2023; 13:1361. [PMID: 37763129 PMCID: PMC10533160 DOI: 10.3390/jpm13091361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
ADHD is a neurodevelopmental disorder appearing in childhood but remaining in many cases in adults. There are both pharmacological and non-pharmacological approaches to treating ADHD, but they do not have the same efficacy in all subjects. Better knowledge of the neurophysiological basis of this disorder will allow for the design of more effective treatments. Studies performing qEEG analysis in children suggest the existence of subgroups of ADHD patients with different neurophysiological traits. There are fewer studies in adults, who might have undergone plastic changes allowing them to cope with ADHD symptoms along with brain maturation. Herein, we study cognitive performance and the theta/beta ratio in young adults with ADHD symptoms. We found that subjects with ADHD symptoms and low working memory performance (n = 30) present higher theta/beta ratios than controls (n = 40) at O2 and T6 in the eyes-closed condition, as well as a tendency toward a higher theta/beta ratio at O1 and Cz. Subjects with ADHD and high working memory performance (n = 50) do not differ from the controls in their theta/beta ratios at any derivation. Our results suggest that neuropsychological profiling could be useful for patient subgrouping. Further research will allow for the distinction of neuropsychological profiles and their neurophysiological correlates, leading to a better classification of ADHD subtypes, thus improving treatment selection.
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Affiliation(s)
- Wendy Verónica Herrera-Morales
- Laboratorio de Neurofisiología, Departamento de Ciencias Médicas, División de Ciencias de la Salud, Universidad Autónoma del Estado de Quintana Roo, Chetumal 77039, Mexico; (W.V.H.-M.); (K.N.-H.T.-C.)
| | - Julián Valeriano Reyes-López
- Unidad de Neurodiagnóstico y Rehabilitación “Dr. Moisés López Gonzáles” Secretaria de Vinculación y Servicios Universitarios, Facultad de Ciencias Naturales, Universidad Autónoma de Querétaro, Querétaro 76000, Mexico;
| | - Karen Nicte-Ha Tuz-Castellanos
- Laboratorio de Neurofisiología, Departamento de Ciencias Médicas, División de Ciencias de la Salud, Universidad Autónoma del Estado de Quintana Roo, Chetumal 77039, Mexico; (W.V.H.-M.); (K.N.-H.T.-C.)
| | - Desiree Ortegón-Abud
- Universidad Santander, Montañas Rocallosas 409, Lomas de Chapultepec, Ciudad de México 11000, Mexico;
| | - Leticia Ramírez-Lugo
- División de Neurociencias, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico;
| | - Efraín Santiago-Rodríguez
- Diagnóstico, Tratamiento e Investigación Neurológica, S.C. Querétaro, Santiago de Queretaro 76177, Mexico;
| | - Luis Núñez-Jaramillo
- Laboratorio de Neurofisiología, Departamento de Ciencias Médicas, División de Ciencias de la Salud, Universidad Autónoma del Estado de Quintana Roo, Chetumal 77039, Mexico; (W.V.H.-M.); (K.N.-H.T.-C.)
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Smit D, Dapor C, Koerts J, Tucha OM, Huster RJ, Enriquez-Geppert S. Long-term improvements in executive functions after frontal-midline theta neurofeedback in a (sub)clinical group. Front Hum Neurosci 2023; 17:1163380. [PMID: 37362947 PMCID: PMC10290172 DOI: 10.3389/fnhum.2023.1163380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Impairments in executive functions (EFs) are common across disorders and can greatly affect daily functioning. Frontal-midline (FM) theta neurofeedback (NF) has been shown effective in enhancing EFs in healthy adults, prompting interest in exploring its potential as an alternative treatment for EFs in (sub)clinical samples. This study aims to determine the effects of FM theta NF on EFs in a sample of 58 adults (aged 20-60 years) with pronounced subjective EF complaints in daily life. Using a pre/post/follow-up design with a sham NF group, the present study assessed upregulation of FM theta in an eight-session individualized FM theta NF training and its immediate and long-term transfer effects on objective and subjective measures of EFs. These included behavioral performance on EF tasks assessing working memory updating (N-back task), set-shifting (Switching task), conflict monitoring (Stroop task), and response inhibition (Stop-signal task), as well as FM theta power during these tasks, and subjective EFs in daily life (BRIEF-A). The results indicate that there are only differences in FM theta self-upregulation between the NF group and sham group when non-responders are excluded from the analysis. Regarding behavioral transfer effects, NF-specific improvements are found in working memory updating reaction time (RT) and conflict monitoring RT variability at 6-month follow-up, but not immediately after the NF training. The effects on FM theta power during the EF tasks and subjective changes in EFs in daily life were not specific to the NF training. As a next step, research should identify the best predictors to stratify NF training, as well as explore ways to improve NF responsiveness, for instance by increasing neuroplasticity.
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Affiliation(s)
- Diede Smit
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, Netherlands
| | - Cecilia Dapor
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, Netherlands
| | - Oliver M. Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- Department of Psychiatry and Psychotherapy, University Medical Center Rostock, Rostock, Germany
- Department of Psychology, National University of Ireland, Maynooth, Irleand
| | - Rene J. Huster
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Stefanie Enriquez-Geppert
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, Netherlands
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Roley-Roberts ME, Pan X, Bergman R, Tan Y, Hendrix K, deBeus R, Kerson C, Arns M, Ging Jehli NR, Connor S, Schrader C, Arnold LE. For Which Children with ADHD is TBR Neurofeedback Effective? Comorbidity as a Moderator. Appl Psychophysiol Biofeedback 2023; 48:179-188. [PMID: 36526924 DOI: 10.1007/s10484-022-09575-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 12/23/2022]
Abstract
We examined psychiatric comorbidities moderation of a 2-site double-blind randomized clinical trial of theta/beta-ratio (TBR) neurofeedback (NF) for attention deficit hyperactivity disorder (ADHD). Seven-to-ten-year-olds with ADHD received either NF (n = 84) or Control (n = 58) for 38 treatments. Outcome was change in parent-/teacher-rated inattention from baseline to end-of-treatment (acute effect), and 13-month-follow-up. Seventy percent had at least one comorbidity: oppositional defiant disorder (ODD) (50%), specific phobias (27%), generalized anxiety (23%), separation anxiety (16%). Comorbidities were grouped into anxiety alone (20%), ODD alone (23%), neither (30%), or both (27%). Comorbidity (p = 0.043) moderated acute effect; those with anxiety-alone responded better to Control than to TBR NF (d = - 0.79, CI - 1.55- - 0.04), and the other groups showed a slightly better response to TBR NF than to Control (d = 0.22 ~ 0.31, CI - 0.3-0.98). At 13-months, ODD-alone group responded better to NF than Control (d = 0.74, CI 0.05-1.43). TBR NF is not indicated for ADHD with comorbid anxiety but may benefit ADHD with ODD.Clinical Trials Identifier: NCT02251743, date of registration: 09/17/2014.
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Affiliation(s)
- Michelle E Roley-Roberts
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA.
- Nisonger Center UCEDD, Ohio State University, Columbus, OH, USA.
- Department of Psychiatry, Creighton University, 7101 Newport Avenue, Suite 203, Omaha, NE, 68105, USA.
| | - Xueliang Pan
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Rachel Bergman
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Nisonger Center UCEDD, Ohio State University, Columbus, OH, USA
| | - Yubo Tan
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Kyle Hendrix
- College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Roger deBeus
- Department of Psychology, University of North Carolina at Asheville, Asheville, NC, USA
| | - Cynthia Kerson
- Department of Applied Psychophysiology, Saybrook University, Pasadena, CA, USA
- Applied Psychophysiology Education (APEd), Napa, CA, USA
| | - Martijn Arns
- Research Institute Brainclinics, Nijmegen, The Netherlands
- Deptartment Experimental Psychology, Utrecht University, Utrecht, The Netherlands
| | | | - Shea Connor
- Department of Psychology, University of North Carolina at Asheville, Asheville, NC, USA
| | - Constance Schrader
- Department of Psychology, University of North Carolina at Asheville, Asheville, NC, USA
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
- Nisonger Center UCEDD, Ohio State University, Columbus, OH, USA
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Krell J, Dolecki PK, Todd A. School-Based Neurofeedback Training for Sustained Attention. J Atten Disord 2023:10870547231168430. [PMID: 37122234 DOI: 10.1177/10870547231168430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To determine whether in situ neurofeedback training can be used as a tool to build sustained attention in the general student population and whether gains in attention translate to more effective work habits and learning skills. METHOD Students participated in attention training game-based neurofeedback in situ for a period of 35 sessions of 25 min each. The study was built as a one-group pretest-posttest quasi-experimental design. RESULTS This study supports that classroom-based neurofeedback may be an effective tool to build sustained attention and translate these gains into observable work habits and learning behaviors including planning and organization. CONCLUSION Neurofeedback has shown specificity in the treatment of Attention Deficit Hyperactivity Disorder. Published research has not, however, focused on its efficacy in developing attentional capacities in the general population. The promising results of this exploratory investigation warrant further applied research.
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Russell D, Arnold LE. Complementary and Integrative Treatments for Attention-Deficit/Hyperactivity Disorder in Youth. Child Adolesc Psychiatr Clin N Am 2023; 32:173-192. [PMID: 37147036 DOI: 10.1016/j.chc.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
First-line psychopharmacologic and psychosocial treatments for attention-deficit/hyperactivity disorder in children are effective but limited by tolerability and accessibility problems. Many complementary and integrative strategies have been investigated as alternative or adjunctive treatments for the disorder, and the literature has progressed to meta-analyses for several. Although heterogeneity of study methods and risk of bias pervades the literature, we conclude that Omega-3 supplementation, dietary restriction of artificial food colorings, and physical activity can be considered evidence-based. Additionally, meditation, yoga, and sleep hygiene are safe, partially effective, cost effective and sensible adjunctive treatment strategies.
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Affiliation(s)
- Douglas Russell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, c/o Seattle Children's Hospital, OA.5.154 PO Box 5371, Seattle, WA 98145-5005, USA.
| | - L Eugene Arnold
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, 395E McCampbell Hall, 1581 Dodd Drive, Columbus, OH 43210, USA
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Purper-Ouakil D. Editorial: Neurofeedback in Attention-Deficit/Hyperactivity Disorder: Still No Evidence of Specific Effects. J Am Acad Child Adolesc Psychiatry 2023; 62:396-397. [PMID: 36638883 DOI: 10.1016/j.jaac.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
The Neurofeedback Collaborative Group presents the results from a 25-month follow-up, randomized controlled study of theta/beta ratio (TBR) down-training electroencephalography neurofeedback (EEG-NF).1 NF is a computer-based training with real-time brain activity- contingent feedback in the form of a game with audio-visual rewards. These rewards aim to reinforce learning of neural activity patterns related to attention or behavioral control. The down-training of the TBR is considered a standard protocol of EEG-NF. The same group has previously published their findings about effects at the end of treatment and 13-month follow-up without evidence of specific NF effects on the primary outcome, a composite score of parent and teacher ratings of inattention. However, participants in the NF group had less need for medication than those in the control group.2 This randomized controlled trial has several strengths, including a sophisticated "sham NF," excellent blinding of parents and investigators, fidelity procedures, and the use of a standard protocol in a population with elevated TBR. The control group was designed to overcome some of the downsides of previous sham-NF protocols by matching the patient's artifacts on the control electroencephalogram. In their current publication, the Neurofeedback Collaborative Group focuses on the possibility of delayed therapeutic NF effects that are thought to be due to the progressive learning of brain activity control.3 These putative delayed effects and lasting benefits are essential issues in determining the utility of NF in ADHD, because previous studies with blinded or probably-blinded assessments showed no short-term differences between NF and control conditions.4 Results confirm the pre-post effect sizes of previous studies, without significant group differences at the 25-month assessment, indicated that there are no specific effects of the NF training paradigm. This is in line with another recent randomized sham-controlled trial with functional magnetic resonance imaging-NF showing no group differences either on the clinical primary outcome or on cognitive functioning in children with attention-deficit/hyperactivity disorder (ADHD).5.
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Affiliation(s)
- Diane Purper-Ouakil
- Saint Eloi Hospital, University of Montpellier, Montpellier, Hérault, France.
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Kuznetsova E, Veilahti AVP, Akhundzadeh R, Radev S, Konicar L, Cowley BU. Evaluation of Neurofeedback Learning in Patients with ADHD: A Systematic Review. Appl Psychophysiol Biofeedback 2023; 48:11-25. [PMID: 36178643 PMCID: PMC9908642 DOI: 10.1007/s10484-022-09562-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/02/2022]
Abstract
NFB has a clear potential as a recognised treatment option for ADHD, but suffers from a lack of clarity about its efficacy, still unresolved after multiple controlled trials. Comparing learners and non-learners based on the evolution of patient-level indicators during the trial serves as a 'natural' control, and can help elucidate the mechanisms of NFB. We present a systematic review motivated by the need to establish the state of the art of patient learning during NFB treatment in current clinical literature. One particularly striking question we would like to answer here is whether existing NFB papers study learning variability, since only individual performance differences can give us information about mechanisms of learning. The results show that very few clinical trial reports have dealt with the heterogeneity of NFB learning, nor analysed whether NFB efficacy is dependent on NFB learning, even though NFB is believed to be a treatment based on learning to perform. In this systematic review we examine not only what has been reported, but also provide a critical analysis of possible flaws or gaps in existing studies, and discuss why no generalized conclusions about NFB efficacy have yet been made. Future research should focus on finding reliable ways of identifying the performers and studying participants' individual learning trajectories as it might enhance prognosis and the allocation of clinical resources.
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Affiliation(s)
- Elizaveta Kuznetsova
- Faculty of Educational Sciences, University of Helsinki, PO Box 9, 00014, Helsinki, Finland.
| | | | - Ruhoollah Akhundzadeh
- Faculty of Educational Sciences, University of Helsinki, PO Box 9, 00014, Helsinki, Finland
| | - Stefan Radev
- Department of Child and Adolescence Psychiatry, Medical University of Vienna, Vienna, Austria
- Institute of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Lilian Konicar
- Department of Child and Adolescence Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Benjamin Ultan Cowley
- Faculty of Educational Sciences, University of Helsinki, PO Box 9, 00014, Helsinki, Finland
- Cognitive Science, Department of Digital Humanities, Faulty of Arts, University of Helsinki, Helsinki, Finland
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Ging-Jehli NR, Kraemer HC, Eugene Arnold L, Roley-Roberts ME, deBeus R. Cognitive markers for efficacy of neurofeedback for attention-deficit hyperactivity disorder - personalized medicine using computational psychiatry in a randomized clinical trial. J Clin Exp Neuropsychol 2023; 45:118-131. [PMID: 37157126 PMCID: PMC10515439 DOI: 10.1080/13803395.2023.2206637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/20/2023] [Accepted: 04/19/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Exploring whether cognitive components (identified by baseline cognitive testing and computational modeling) moderate clinical outcome of neurofeedback (NF) for attention-deficit hyperactivity disorder (ADHD). METHOD 142 children (aged 7-10) with ADHD were randomly assigned to either NF (n = 84) or control treatment (n = 58) in a double-blind clinical trial (NCT02251743). The NF group received live, self-controlled downtraining of electroencephalographic theta/beta ratio power. The control group received identical-appearing reinforcement from prerecorded electroencephalograms from other children. 133 (78 NF, 55 control) children had cognitive processing measured at baseline with the Integrated Visual and Auditory Continuous Performance Test (IVA2-CPT) and were included in this analysis. A diffusion decision model applied to the IVA2-CPT data quantified two latent cognitive components deficient in ADHD: drift rate and drift bias, indexing efficiency and context sensitivity of cognitive processes involving information integration. We explored whether these cognitive components moderated the improvement in parent- and teacher-rated inattention symptoms from baseline to treatment end (primary clinical outcome). RESULTS Baseline cognitive components reflecting information integration (drift rate, drift bias) moderated the improvement in inattention due to NF vs. control treatment (p = 0.006). Specifically, those with either the most or least severe deficits in these components showed more improvement in parent- and teacher-rated inattention when assigned to NF (Cohen's d = 0.59) than when assigned to control (Cohen's d = -0.21). CONCLUSIONS Pre-treatment cognitive testing with computational modeling identified children who benefitted more from neurofeedback than control treatment for ADHD.
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Affiliation(s)
- Nadja R. Ging-Jehli
- Department of Psychology, The Ohio State University,
Columbus, OH 43210, USA; Department of Cognitive, Linguistic & Psychological
Sciences, Brown University, Providence, Rhode Island
| | - Helena C. Kraemer
- Department of Psychiatry and Behavioral Sciences, Stanford
University School of Medicine, Cupertino, CA 95014, USA
| | - L. Eugene Arnold
- Department of Psychiatry and Behavioral Health, The Ohio
State University; Nisonger Center UCEDD, Columbus, OH 43210, USA
| | | | - Roger deBeus
- Department of Psychology, University of North Carolina at
Asheville, Asheville, NC 28801, USA
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Scholz L, Werle J, Philipsen A, Schulze M, Collonges J, Gensichen J. Effects and feasibility of psychological interventions to reduce inattention symptoms in adults with ADHD: a systematic review. J Ment Health 2023; 32:307-320. [PMID: 32954909 DOI: 10.1080/09638237.2020.1818189] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adult ADHD is common, highly comorbid, and restricts daily functioning. However, only a minority of patients receive appropriate treatment. AIMS Primary objective: To identify psychological interventions that diminish inattention symptoms in adults with ADHD. Secondary objective: To evaluate feasibility aspects. METHODS A search in PubMed, Cochrane Library, PsycInfo, PSYNDEX, and Eric was conducted. Interventions were grouped in: ADHD coaching, neuro feedback, cognitive training, psychoeducation, and behavioral therapy. Inattention symptoms were evaluated using standardized mean differences. Study quality was rated with the Cochrane Risk of Bias tool. Feasibility was assessed by number and time of sessions, setting, and qualification of the provider. RESULTS A total of N = 2229 results were identified, 19 randomized controlled studies were included in the analysis. Behavioral therapy showed effects on inattention symptoms [SMD: 0.44-1.71] when compared to inactive controls. In terms of feasibility, longer interventions did not outperform shorter ones and individual sessions were not superior to group sessions. No effects were given for neuro feedback, cognitive training, and psychoeducation in comparison to controls. CONCLUSION For adults with ADHD behavioral therapy seems an effective intervention to reduce inattention symptoms. In terms of feasibility, brief interventions may be valuable for a primary care setting.
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Affiliation(s)
- Lisanne Scholz
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Jana Werle
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | | | - Jochen Gensichen
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Munich, Germany
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Previously Marzena Szkodo MOR, Micai M, Caruso A, Fulceri F, Fazio M, Scattoni ML. Technologies to support the diagnosis and/or treatment of neurodevelopmental disorders: A systematic review. Neurosci Biobehav Rev 2023; 145:105021. [PMID: 36581169 DOI: 10.1016/j.neubiorev.2022.105021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/13/2022] [Accepted: 12/23/2022] [Indexed: 12/27/2022]
Abstract
In recent years, there has been a great interest in utilizing technology in mental health research. The rapid technological development has encouraged researchers to apply technology as a part of a diagnostic process or treatment of Neurodevelopmental Disorders (NDDs). With the large number of studies being published comes an urgent need to inform clinicians and researchers about the latest advances in this field. Here, we methodically explore and summarize findings from studies published between August 2019 and February 2022. A search strategy led to the identification of 4108 records from PubMed and APA PsycInfo databases. 221 quantitative studies were included, covering a wide range of technologies used for diagnosis and/or treatment of NDDs, with the biggest focus on Autism Spectrum Disorder (ASD). The most popular technologies included machine learning, functional magnetic resonance imaging, electroencephalogram, magnetic resonance imaging, and neurofeedback. The results of the review indicate that technology-based diagnosis and intervention for NDD population is promising. However, given a high risk of bias of many studies, more high-quality research is needed.
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Affiliation(s)
| | - Martina Micai
- Research Coordination and Support Service, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Angela Caruso
- Research Coordination and Support Service, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Francesca Fulceri
- Research Coordination and Support Service, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
| | - Maria Fazio
- Department of Mathematics, Computer Science, Physics and Earth Sciences (MIFT), University of Messina, Viale F. Stagno d'Alcontres, 31, 98166 Messina, Italy.
| | - Maria Luisa Scattoni
- Research Coordination and Support Service, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy.
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Lim CG, Soh CP, Lim SSY, Fung DSS, Guan C, Lee TS. Home-based brain-computer interface attention training program for attention deficit hyperactivity disorder: a feasibility trial. Child Adolesc Psychiatry Ment Health 2023; 17:15. [PMID: 36698168 PMCID: PMC9878772 DOI: 10.1186/s13034-022-00539-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 11/29/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a prevalent child neurodevelopmental disorder that is treated in clinics and in schools. Previous trials suggested that our brain-computer interface (BCI)-based attention training program could improve ADHD symptoms. We have since developed a tablet version of the training program which can be paired with wireless EEG headsets. In this trial, we investigated the feasibility of delivering this tablet-based BCI intervention at home. METHODS Twenty children diagnosed with ADHD, who did not receive any medication for the preceding month, were randomised to receive the 8-week tablet-based BCI intervention either in the clinic or at home. Those in the home intervention group received instructions before commencing the program and got reminders if they were lagging on the training sessions. The ADHD Rating Scale was completed by a blinded clinician at baseline and at week 8. Adverse events were monitored during any contact with the child throughout the trial and at week 8. RESULTS Children in both groups could complete the tablet-based intervention easily on their own with minimal support from the clinic therapist or their parents (at home). The intervention was safe with few reported adverse effects. Clinician-rated inattentive symptoms on the ADHD-Rating Scale reduced by 3.2 (SD 6.20) and 3.9 (SD 5.08) for the home-based and clinic-based groups respectively, suggesting that home-based intervention was comparable to clinic-based intervention. CONCLUSIONS This trial demonstrated that the tablet version of our BCI-based attention training program can be safely delivered to children in the comfort of their own home. Trial registration This trial is registered at clinicaltrials.gov as NCT01344044.
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Affiliation(s)
- Choon Guan Lim
- Department of Developmental Psychiatry, Institute of Mental Health, 10, Buangkok View, Singapore, 539747, Singapore.
| | - Chui Pin Soh
- grid.414752.10000 0004 0469 9592Department of Developmental Psychiatry, Institute of Mental Health, 10, Buangkok View, Singapore, 539747 Singapore
| | - Shernice Shi Yun Lim
- grid.414752.10000 0004 0469 9592Department of Developmental Psychiatry, Institute of Mental Health, 10, Buangkok View, Singapore, 539747 Singapore
| | - Daniel Shuen Sheng Fung
- grid.414752.10000 0004 0469 9592Department of Developmental Psychiatry, Institute of Mental Health, 10, Buangkok View, Singapore, 539747 Singapore
| | - Cuntai Guan
- grid.59025.3b0000 0001 2224 0361School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Tih-Shih Lee
- grid.428397.30000 0004 0385 0924Neuroscience and Behavioral Disorders Program, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
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Adhia DB, Mani R, Mathew J, O'Leary F, Smith M, Vanneste S, De Ridder D. Exploring electroencephalographic infraslow neurofeedback treatment for chronic low back pain: a double-blinded safety and feasibility randomized placebo-controlled trial. Sci Rep 2023; 13:1177. [PMID: 36670176 PMCID: PMC9860016 DOI: 10.1038/s41598-023-28344-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Chronic low back pain (CLBP) is a disabling condition worldwide. In CLBP, neuroimaging studies demonstrate abnormal activities in cortical areas responsible for pain modulation, emotional, and sensory components of pain experience [i.e., pregenual and dorsal anterior cingulate cortex (pgACC, dACC), and somatosensory cortex (SSC), respectively]. This pilot study, conducted in a university setting, evaluated the feasibility, safety, and acceptability of a novel electroencephalography-based infraslow-neurofeedback (EEG ISF-NF) technique for retraining activities in pgACC, dACC and SSC and explored its effects on pain and disability. Participants with CLBP (n = 60), recruited between July'20 to March'21, received 12 sessions of either: ISF-NF targeting pgACC, dACC + SSC, a ratio of pgACC*2/dACC + SSC, or Placebo-NF. Descriptive statistics demonstrated that ISF-NF training is feasible [recruitment rate (7 participants/month), dropouts (25%; 20-27%), and adherence (80%; 73-88%)], safe (no adverse events reported), and was moderate to highly acceptable [Mean ± SD: 7.8 ± 2.0 (pgACC), 7.5 ± 2.7 (dACC + SCC), 8.2 ± 1.9 (Ratio), and 7.7 ± 1.5 (Placebo)]. ISF-NF targeting pgACC demonstrated the most favourable clinical outcomes, with a higher proportion of participants exhibiting a clinically meaningful reduction in pain severity [53%; MD (95% CI): - 1.9 (- 2.7, - 1.0)], interference [80%; MD (95% CI): - 2.3 (- 3.5, - 1.2)], and disability [73%; MD (95% CI): - 4.5 (- 6.1, - 2.9)] at 1-month follow-up. ISF-NF training is a feasible, safe, and an acceptable treatment approach for CLBP.
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Affiliation(s)
- Divya Bharatkumar Adhia
- Department of Surgical Sciences, Otago Medical School, University of Otago, PO BOX 56, Dunedin, 9054, New Zealand. .,Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand. .,Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.
| | - Ramakrishnan Mani
- Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand.,Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Jerin Mathew
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Dunedin, New Zealand
| | - Finella O'Leary
- Department of Surgical Sciences, Otago Medical School, University of Otago, PO BOX 56, Dunedin, 9054, New Zealand
| | - Mark Smith
- Neurofeedback Therapy Services of New York, New York, NY, USA
| | - Sven Vanneste
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Dirk De Ridder
- Department of Surgical Sciences, Otago Medical School, University of Otago, PO BOX 56, Dunedin, 9054, New Zealand.,Pain@Otago Research Theme, University of Otago, Dunedin, New Zealand
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Kerick SE, Asbee J, Spangler DP, Brooks JB, Garcia JO, Parsons TD, Bannerjee N, Robucci R. Neural and behavioral adaptations to frontal theta neurofeedback training: A proof of concept study. PLoS One 2023; 18:e0283418. [PMID: 36952490 PMCID: PMC10035884 DOI: 10.1371/journal.pone.0283418] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/08/2023] [Indexed: 03/25/2023] Open
Abstract
Previous neurofeedback research has shown training-related frontal theta increases and performance improvements on some executive tasks in real feedback versus sham control groups. However, typical sham control groups receive false or non-contingent feedback, making it difficult to know whether observed differences between groups are associated with accurate contingent feedback or other cognitive mechanisms (motivation, control strategies, attentional engagement, fatigue, etc.). To address this question, we investigated differences between two frontal theta training groups, each receiving accurate contingent feedback, but with different top-down goals: (1) increase and (2) alternate increase/decrease. We hypothesized that the increase group would exhibit greater increases in frontal theta compared to the alternate group, which would exhibit lower frontal theta during down- versus up-modulation blocks over sessions. We also hypothesized that the alternate group would exhibit greater performance improvements on a Go-NoGo shooting task requiring alterations in behavioral activation and inhibition, as the alternate group would be trained with greater task specificity, suggesting that receiving accurate contingent feedback may be the more salient learning mechanism underlying frontal theta neurofeedback training gains. Thirty young healthy volunteers were randomly assigned to increase or alternate groups. Training consisted of an orientation session, five neurofeedback training sessions (six blocks of six 30-s trials of FCz theta modulation (4-7 Hz) separated by 10-s rest intervals), and six Go-NoGo testing sessions (four blocks of 90 trials in both Low and High time-stress conditions). Multilevel modeling revealed greater frontal theta increases in the alternate group over training sessions. Further, Go-NoGo task performance increased at a greater rate in the increase group (accuracy and reaction time, but not commission errors). Overall, these results reject our hypotheses and suggest that changes in frontal theta and performance outcomes were not explained by reinforcement learning afforded by accurate contingent feedback. We discuss our findings in terms of alternative conceptual and methodological considerations, as well as limitations of this research.
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Affiliation(s)
- Scott E Kerick
- U.S. Combat Capabilities Development Command, Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, United States of America
| | - Justin Asbee
- The Institute for Integrative & Innovative Research, University of Arkansas, Fayetteville, AR, United States of America
| | - Derek P Spangler
- U.S. Combat Capabilities Development Command, Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, United States of America
- Department of Biobehavioral Health, Penn State University, University Park, PA, United States of America
| | - Justin B Brooks
- U.S. Combat Capabilities Development Command, Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, United States of America
- D-Prime, Washington, DC, United States of America
- Department of Computer Science and Electrical Engineering, University of Maryland at Baltimore County, Baltimore, MD, United States of America
| | - Javier O Garcia
- U.S. Combat Capabilities Development Command, Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD, United States of America
| | - Thomas D Parsons
- Computational Neuropsychology and Simulation (CNS) Laboratory, Edson College, Arizona State University, Phoenix, AZ, United States of America
| | - Nilanjan Bannerjee
- Department of Computer Science and Electrical Engineering, University of Maryland at Baltimore County, Baltimore, MD, United States of America
| | - Ryan Robucci
- Department of Computer Science and Electrical Engineering, University of Maryland at Baltimore County, Baltimore, MD, United States of America
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Voetterl H, van Wingen G, Michelini G, Griffiths KR, Gordon E, DeBeus R, Korgaonkar MS, Loo SK, Palmer D, Breteler R, Denys D, Arnold LE, du Jour P, van Ruth R, Jansen J, van Dijk H, Arns M. Brainmarker-I Differentially Predicts Remission to Various Attention-Deficit/Hyperactivity Disorder Treatments: A Discovery, Transfer, and Blinded Validation Study. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:52-60. [PMID: 35240343 DOI: 10.1016/j.bpsc.2022.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder is characterized by neurobiological heterogeneity, possibly explaining why not all patients benefit from a given treatment. As a means to select the right treatment (stratification), biomarkers may aid in personalizing treatment prescription, thereby increasing remission rates. METHODS The biomarker in this study was developed in a heterogeneous clinical sample (N = 4249) and first applied to two large transfer datasets, a priori stratifying young males (<18 years) with a higher individual alpha peak frequency (iAPF) to methylphenidate (N = 336) and those with a lower iAPF to multimodal neurofeedback complemented with sleep coaching (N = 136). Blinded, out-of-sample validations were conducted in two independent samples. In addition, the association between iAPF and response to guanfacine and atomoxetine was explored. RESULTS Retrospective stratification in the transfer datasets resulted in a predicted gain in normalized remission of 17% to 30%. Blinded out-of-sample validations for methylphenidate (n = 41) and multimodal neurofeedback (n = 71) corroborated these findings, yielding a predicted gain in stratified normalized remission of 36% and 29%, respectively. CONCLUSIONS This study introduces a clinically interpretable and actionable biomarker based on the iAPF assessed during resting-state electroencephalography. Our findings suggest that acknowledging neurobiological heterogeneity can inform stratification of patients to their individual best treatment and enhance remission rates.
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Affiliation(s)
- Helena Voetterl
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands; Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Giorgia Michelini
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles, California; Department of Biological & Experimental Psychology, Queen Mary University of London, London, United Kingdom
| | - Kristi R Griffiths
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Roger DeBeus
- Department of Psychology, University of North Carolina at Asheville, Asheville, North Carolina
| | - Mayuresh S Korgaonkar
- Brain Dynamics Centre, Westmead Institute for Medical Research, The University of Sydney, Sydney, New South Wales, Australia; School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sandra K Loo
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute for Neuroscience & Human Behavior, University of California Los Angeles, Los Angeles, California
| | | | - Rien Breteler
- Department of Clinical Psychology, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - L Eugene Arnold
- Department of Psychiatry & Behavioral Health, Nisonger Center, Ohio State University, Columbus, Ohio
| | | | | | - Jeanine Jansen
- Open Mind Neuroscience, Eindhoven, the Netherlands; Eindhovens Psychologisch Instituut, Eindhoven, the Netherlands
| | - Hanneke van Dijk
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands; Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Martijn Arns
- Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, the Netherlands; Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
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Chiu HJ, Sun CK, Fan HY, Tzang RF, Wang MY, Cheng YC, Cheng YS, Yeh PY, Chung W. Surface electroencephalographic neurofeedback improves sustained attention in ADHD: a meta-analysis of randomized controlled trials. Child Adolesc Psychiatry Ment Health 2022; 16:104. [PMID: 36536438 PMCID: PMC9764556 DOI: 10.1186/s13034-022-00543-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The efficacy of surface electroencephalographic neurofeedback (EEG-NF) for improving attentional performance assessed by laboratory measures in patients with attention-deficit/hyperactivity disorder (ADHD) remains unclear. METHODS Following the PRISMA guidelines, the PubMed, Embase, ClinicalKey, Cochrane CENTRAL, ScienceDirect, Web of Science, and ClinicalTrials.gov databases were systematically searched for randomized controlled trials on the efficacy of surface EEG-NF against ADHD focusing on attentional performance evaluated by laboratory measures from inception to January 2022. RESULTS Fourteen eligible studies were analyzed. Of the 718 participants involved, 429 diagnosed with ADHD received EEG-NF treatment. Significant improvement in attentional performance in ADHD subjects receiving EEG-NF was noted compared to their comparators (p < 0.01). Besides, there was a significant EEG-NF-associated beneficial effect on sustained attention (Hedges' g = 0.32, p < 0.01), whereas the impact on selective attention (p = 0.57) and working memory (p = 0.59) was limited. Moreover, protocol including beta wave enhancement was superior to that only focusing on reducing theta/beta ratio or modulation of slow cortical potential. Subgroup analyses showed that three sessions per week of EEG-NF produced the best effect, while the efficacy of surface EEG-NF was much poorer (Hedges' g = 0.05) when only studies that blinded their participants from knowledge of treatment allocation were included. No significant difference was noted in the improvement of attentional performance 6-12 months after EEG-NF intervention (n = 3, p = 0.42). CONCLUSIONS Our results demonstrated the satisfactory effectiveness of surface EEG-NF for improving sustained attention, especially when beta wave enhancement was included, despite its failure to sustain a long-term effect. Further large-scale trials are warranted to support our findings.
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Affiliation(s)
- Hsien-Jane Chiu
- Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hsin-Yi Fan
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, No. 509, Fengping 1St Rd., Daliao Dist, Kaohsiung, Taiwan
| | - Ruu-Fen Tzang
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ming-Yu Wang
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Ying-Chih Cheng
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Shian Cheng
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, No. 509, Fengping 1St Rd., Daliao Dist, Kaohsiung, Taiwan.
| | - Pin-Yang Yeh
- Department of Psychology, College of Medical and Health Science, Asia University, 500, Lioufeng Rd., Wufeng, Taichung, 41354, Taiwan.
| | - Weilun Chung
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, No. 509, Fengping 1St Rd., Daliao Dist, Kaohsiung, Taiwan.
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Hao Z, He C, Ziqian Y, Haotian L, Xiaoli L. Neurofeedback training for children with ADHD using individual beta rhythm. Cogn Neurodyn 2022; 16:1323-1333. [PMID: 36408061 PMCID: PMC9666577 DOI: 10.1007/s11571-022-09798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022] Open
Abstract
Neurofeedback training (NFT) is a noninvasive neuromodulation method for children with attention-deficit/hyperactivity disorder (ADHD). Brain rhythms, the unique pattern in electroencephalogram (EEG), are widely used as the training target. Most of current studies used a fixed frequency division of brain rhythms, which ignores the individual developmental difference of each child. In this study, we validated the feasibility of NFT using individual beta rhythm. A total of 55 children with ADHD were divided into two groups using the relative power of individual or fixed beta rhythms as the training index. ADHD rating scale (ADHD-RS) was completed before and after NFT, and the EEG and behavioral features were extracted during the training process. After intervention, the attention ability of both groups was significantly improved, showing a significant increase in beta power, a decrease in scores of ADHD-RS and an improvement in behavioral and other EEG features. The training effect was significantly better with individualized beta training, showing more improvement in ADHD-RS scores. Furthermore, the distribution of brain rhythms moved towards high frequency after intervention. This study demonstrates the effectiveness of NFT based on individual beta rhythm for the intervention of children with ADHD. When designing a NFT protocol and the corresponding data analysis process, an individualized brain rhythm division should be applied to reflect the actual brain state and to accurately evaluate the effect of NFT.
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Affiliation(s)
- Zhang Hao
- The State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875 China
| | - Chen He
- The State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875 China
- School of Systems Science, Beijing Normal University, Beijing, 100875 China
| | - Yuan Ziqian
- The State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875 China
| | - Liao Haotian
- The State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875 China
| | - Li Xiaoli
- The State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, 100875 China
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Cervantes JA, López S, Molina J, López F, Perales-Tejeda M, Carmona-Frausto J. CogniDron-EEG: A system based on a brain-computer interface and a drone for cognitive training. COGN SYST RES 2022. [DOI: 10.1016/j.cogsys.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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Lin FL, Sun CK, Cheng YS, Wang MY, Chung W, Tzang RF, Chiu HJ, Cheng YC, Tu KY. Additive effects of EEG neurofeedback on medications for ADHD: a systematic review and meta-analysis. Sci Rep 2022; 12:20401. [PMID: 36437272 PMCID: PMC9701807 DOI: 10.1038/s41598-022-23015-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/21/2022] [Indexed: 11/29/2022] Open
Abstract
To elucidate possible additive effects of electroencephalogram-based neurofeedback (EEG-NF) on medications against the core symptoms of attention-deficit/hyperactivity disorder (ADHD), randomized controlled trials (RCTs) were retrieved from electronic databases including PubMed, EMBASE, ClinicalKey, Cochrane CENTRAL, ScienceDirect, and ClinicalTrials.gov from inception to March 2022. The primary outcomes were changes in ADHD symptoms (i.e., global, inattention, hyperactivity/impulsivity) assessed with validated rating scales, while secondary outcome was all-cause discontinuation rate. Meta-analysis of five RCTs involving 305 participants [Median age = 9.285 years (range 8.6-11.05)] with a median follow-up of 12 weeks showed additive effects of EEG-NF on medications from parents' observations against ADHD global symptoms (Hedges' g = 0.2898, 95%CI [0.0238; 0.5557]) and inattention symptoms (Hedges' g = 0.3274, 95%CI [0.0493; 0.6055]). However, additive effects failed to sustain six months after EEG-NF intervention. Besides, there was no difference in improvement of hyperactivity/impulsivity from parents' observation, attentional performance, and all-cause discontinuation rate between the two groups. Our results supported additional benefits of combining EEG-NF with medications compared to medication alone in treating global symptoms and symptoms of inattention in ADHD patients. Nevertheless, given a lack of evidence showing a correlation between underlying physiological changes and small effect sizes in our preliminary results, further studies are warranted to support our findings.
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Affiliation(s)
- Feng-Li Lin
- Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan City, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yu-Shian Cheng
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Ming Yu Wang
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, China
- Department of Health Services Administration, China Medical University, Hsinchu, China
| | - Weilun Chung
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan
| | - Ruu-Fen Tzang
- Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hsien-Jane Chiu
- Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan City, Taiwan
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ying-Chih Cheng
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, China.
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Kun-Yu Tu
- Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan.
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The Effects of Different Theta and Beta Neurofeedback Training Protocols on Cognitive Control in ADHD. JOURNAL OF COGNITIVE ENHANCEMENT 2022; 6:463-477. [PMID: 36373033 PMCID: PMC9638270 DOI: 10.1007/s41465-022-00255-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
Neurofeedback (NF) is an important treatment for attention deficit/hyperactivity disorder (ADHD). In ADHD, cognitive control deficits pose considerable problems to patients. However, NF protocols are not yet optimized to enhance cognitive control alongside with clinical symptoms, partly because they are not driven by basic cognitive neuroscience. In this study, we evaluated different EEG theta and/or beta frequency band NF protocols designed to enhance cognitive control. Participants were n = 157 children and adolescents, n = 129 of them were patients with ADHD (n = 28 typically developing (TD) controls). Patients with ADHD were divided into five groups in the order of referral, with four of them taking part in different NF protocols systematically varying theta and beta power. The fifth ADHD group and the TD group did not undergo NF. All NF protocols resulted in reductions of ADHD symptoms. Importantly, only when beta frequencies were enhanced during NF (without any theta regulation or in combination with theta upregulation), consistent enhancing effects in both response inhibition and conflict control were achieved. The theta/beta NF protocol most widely used in clinical settings revealed comparatively limited effects. Enhancements in beta band activity are key when aiming to improve cognitive control functions in ADHD. This calls for a change in the use of theta/beta NF protocols and shows that protocols differing from the current clinical standard are effective in enhancing important facets of cognitive control in ADHD. Further studies need to examine regulation data within the neurofeedback sessions to provide more information about the mechanisms underlying the observed effects.
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Michelini G, Norman LJ, Shaw P, Loo SK. Treatment biomarkers for ADHD: Taking stock and moving forward. Transl Psychiatry 2022; 12:444. [PMID: 36224169 PMCID: PMC9556670 DOI: 10.1038/s41398-022-02207-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 11/09/2022] Open
Abstract
The development of treatment biomarkers for psychiatric disorders has been challenging, particularly for heterogeneous neurodevelopmental conditions such as attention-deficit/hyperactivity disorder (ADHD). Promising findings are also rarely translated into clinical practice, especially with regard to treatment decisions and development of novel treatments. Despite this slow progress, the available neuroimaging, electrophysiological (EEG) and genetic literature provides a solid foundation for biomarker discovery. This article gives an updated review of promising treatment biomarkers for ADHD which may enhance personalized medicine and novel treatment development. The available literature points to promising pre-treatment profiles predicting efficacy of various pharmacological and non-pharmacological treatments for ADHD. These candidate predictive biomarkers, particularly those based on low-cost and non-invasive EEG assessments, show promise for the future stratification of patients to specific treatments. Studies with repeated biomarker assessments further show that different treatments produce distinct changes in brain profiles, which track treatment-related clinical improvements. These candidate monitoring/response biomarkers may aid future monitoring of treatment effects and point to mechanistic targets for novel treatments, such as neurotherapies. Nevertheless, existing research does not support any immediate clinical applications of treatment biomarkers for ADHD. Key barriers are the paucity of replications and external validations, the use of small and homogeneous samples of predominantly White children, and practical limitations, including the cost and technical requirements of biomarker assessments and their unknown feasibility and acceptability for people with ADHD. We conclude with a discussion of future directions and methodological changes to promote clinical translation and enhance personalized treatment decisions for diverse groups of individuals with ADHD.
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Affiliation(s)
- Giorgia Michelini
- grid.4868.20000 0001 2171 1133Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK ,grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA USA
| | - Luke J. Norman
- grid.416868.50000 0004 0464 0574Office of the Clinical Director, NIMH, Bethesda, MD USA
| | - Philip Shaw
- grid.416868.50000 0004 0464 0574Office of the Clinical Director, NIMH, Bethesda, MD USA ,grid.280128.10000 0001 2233 9230Section on Neurobehavioral and Clinical Research, Social and Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, MD USA
| | - Sandra K. Loo
- grid.19006.3e0000 0000 9632 6718Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA USA
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Jiang H, Johnstone SJ, Lu J. Comparing the Efficacy of Two School-Based Approaches of Neurocognitive Training for Enhancing Executive Functions. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1501. [PMID: 36291437 PMCID: PMC9601256 DOI: 10.3390/children9101501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022]
Abstract
Neurocognitive training has been shown to improve a range of cognitive/executive functions and behavior in children. Delivering this training in a school context may enhance its ecological validity and improve training outcomes. The current study examined the efficacy of two school-based neurocognitive training approaches for enhancing executive functions (EF) in typically developing children: neurocognitive training with no teacher positive feedback (NCT), and neurocognitive training with teacher positive feedback (NCT-TPF). Using a randomized control design, 45 children were randomly allocated to the no-training control, NCT, or NCT-TPF group and completed pre- and post-training assessments on the core executive function (EF) domains of inhibitory control, working memory, and task switching. Teachers' subjective acceptance of the two training protocols was investigated to explore potential ecological validity. The two training groups completed six sessions of training in a kindergarten over a 3-week period. The results showed significant post-training improvements in an untrained inhibitory control task for both training groups when compared with the control group. Different effects were found for each group for the untrained task switching task. While reduced reaction time (RT) in correct Color and Shape trials at Time 2 were reported for the NCT-TPF group, there was no difference compared to the control group for the NCT group. The NCT group showed increased RT in Switch trials but reduced Shape errors compared to controls at Time 2, while these effects were not significant for the NCT-TPF group. An unexpected outcome was that children in both training conditions did not show a significant improvement in an untrained working memory task. Teachers' subjective acceptance consistently supported including positive feedback as part of NCT. While further research is needed, these results support use of neurocognitive training and/or neurocognitive training with teacher positive feedback for typically developing children in a school context.
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Affiliation(s)
- Han Jiang
- School of Special Education, Zhejiang Normal University, Hangzhou 311231, China
| | - Stuart J. Johnstone
- School of Psychology, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Jinjin Lu
- Department of Educational Studies, Xi’an Jiaotong-Liverpool University, Suzhou 215123, China
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Mosayebi R, Dehghani A, Hossein-Zadeh GA. Dynamic functional connectivity estimation for neurofeedback emotion regulation paradigm with simultaneous EEG-fMRI analysis. Front Hum Neurosci 2022; 16:933538. [PMID: 36188168 PMCID: PMC9524189 DOI: 10.3389/fnhum.2022.933538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
Joint Analysis of EEG and fMRI datasets can bring new insight into brain mechanisms. In this paper, we employed the recently introduced Correlated Coupled Tensor Matrix Factorization (CCMTF) method for analysis of the emotion regulation paradigm based on EEG frontal asymmetry neurofeedback in the alpha frequency band with simultaneous fMRI. CCMTF method assumes that the co-variations of the common dimension (temporal dimension) between EEG and fMRI are correlated and not necessarily identical. The results of the CCMTF method suggested that EEG and fMRI had similar covariations during the transition of brain activities from resting states to task (view and upregulation) states and these covariations followed an increasing trend. The fMRI shared spatial component showed activations in the limbic system, DLPFC, OFC, and VLPC regions, which were consistent with the previous studies and were linked to EEG frequency patterns in the range of 1-15 Hz with a correlation value close to 0.75. The estimated regions from the CCMTF method were then used as the candidate nodes for dynamic functional connectivity (dFC) analysis, in which the changes in connectivity from view to upregulation states were examined. The results of the dFC analysis were compared with a Normalized Mutual information (NMI) based approach in two different frequency ranges (1-15 and 15-40 Hz) as the NMI method was applied to the vectors of dFC nodes of EEG and fMRI data. The results of the two methods illustrated that the relation between EEG and fMRI datasets was mostly in the frequency range of 1-15 Hz. These relations were both in the brain activations and the dFCs between the two modalities. This paper suggests that the CCMTF method is a capable approach for extracting the shared information between EEG and fMRI data and can reveal new information about brain functions and their connectivity without solving the EEG inverse problem or analyzing different frequency bands.
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Affiliation(s)
- Raziyeh Mosayebi
- School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
| | - Amin Dehghani
- School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
| | - Gholam-Ali Hossein-Zadeh
- School of Electrical and Computer Engineering, University of Tehran, Tehran, Iran
- School of Cognitive Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
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Annaheim C, Hug K, Stumm C, Messerli M, Simon Y, Hund-Georgiadis M. Neurofeedback in patients with frontal brain lesions: A randomized, controlled double-blind trial. Front Hum Neurosci 2022; 16:979723. [PMID: 36188178 PMCID: PMC9521487 DOI: 10.3389/fnhum.2022.979723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Frontal brain dysfunction is a major challenge in neurorehabilitation. Neurofeedback (NF), as an EEG-based brain training method, is currently applied in a wide spectrum of mental health conditions, including traumatic brain injury. Objective This study aimed to explore the capacity of Infra-Low Frequency Neurofeedback (ILF-NF) to promote the recovery of brain function in patients with frontal brain injury. Materials and methods Twenty patients hospitalized at a neurorehabilitation clinic in Switzerland with recently acquired, frontal and optionally other brain lesions were randomized to either receive NF or sham-NF. Cognitive improvement was assessed using the Frontal Assessment Battery (FAB) and the Test of Attentional Performance (TAP) tasks regarding intrinsic alertness, phasic alertness and impulse control. Results With respect to cognitive improvements, there was no significant difference between the two groups after 20 sessions of either NF or sham-NF. However, in a subgroup of patients with predominantly frontal brain lesions, the improvements measured by the FAB and intrinsic alertness were significantly higher in the NF-group. Conclusion This is the first double-blind controlled study using NF in recovery from brain injury, and thus also the first such study of ILF NF. Although the result of the subgroup has limited significance because of the small number of participants, it accentuates the trend seen in the whole group regarding the FAB and intrinsic alertness (p = 0.068, p = 0.079, respectively). We therefore conclude that NF could be a promising candidate promoting the recoveryfrom frontal brain lesions. Further studies with larger numbers of patients and less lesion heterogeneity are needed to verify the usefulness of NF in the neurorehabilitation of patients with frontal brain injury (NCT02957695 ClinicalTrials.gov).
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Affiliation(s)
- Christine Annaheim
- REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Basel, Switzerland
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Patil AU, Madathil D, Fan YT, Tzeng OJL, Huang CM, Huang HW. Neurofeedback for the Education of Children with ADHD and Specific Learning Disorders: A Review. Brain Sci 2022; 12:brainsci12091238. [PMID: 36138974 PMCID: PMC9497239 DOI: 10.3390/brainsci12091238] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 12/02/2022] Open
Abstract
Neurofeedback (NF) is a type of biofeedback in which an individual’s brain activity is measured and presented to them to support self-regulation of ongoing brain oscillations and achieve specific behavioral and neurophysiological outcomes. NF training induces changes in neurophysiological circuits that are associated with behavioral changes. Recent evidence suggests that the NF technique can be used to train electrical brain activity and facilitate learning among children with learning disorders. Toward this aim, this review first presents a generalized model for NF systems, and then studies involving NF training for children with disorders such as dyslexia, attention-deficit/hyperactivity disorder (ADHD), and other specific learning disorders such as dyscalculia and dysgraphia are reviewed. The discussion elaborates on the potential for translational applications of NF in educational and learning settings with details. This review also addresses some issues concerning the role of NF in education, and it concludes with some solutions and future directions. In order to provide the best learning environment for children with ADHD and other learning disorders, it is critical to better understand the role of NF in educational settings. The review provides the potential challenges of the current systems to aid in highlighting the issues undermining the efficacy of current systems and identifying solutions to address them. The review focuses on the use of NF technology in education for the development of adaptive teaching methods and the best learning environment for children with learning disabilities.
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Affiliation(s)
- Abhishek Uday Patil
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Deepa Madathil
- Jindal Institute of Behavioural Sciences, O.P. Jindal Global University, Haryana 131001, India
| | - Yang-Tang Fan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan 320315, Taiwan
| | - Ovid J. L. Tzeng
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- Centre for Intelligent Drug Systems and Smart Bio-Devices (IDSB), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- College of Humanities and Social Sciences, Taipei Medical University, Taipei 106339, Taiwan
- Department of Educational Psychology and Counseling, National Taiwan Normal University, Taipei 106308, Taiwan
- Hong Kong Institute for Advanced Studies, City University of Hong Kong, Hong Kong
| | - Chih-Mao Huang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
- Centre for Intelligent Drug Systems and Smart Bio-Devices (IDSB), National Yang Ming Chiao Tung University, Hsinchu 300093, Taiwan
| | - Hsu-Wen Huang
- Department of Linguistics and Translation, City University of Hong Kong, Hong Kong
- Correspondence: ; Tel.: +852-3442-2579
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Hasslinger J, Meregalli M, Bölte S. How standardized are “standard protocols”? Variations in protocol and performance evaluation for slow cortical potential neurofeedback: A systematic review. Front Hum Neurosci 2022; 16:887504. [PMID: 36118975 PMCID: PMC9478392 DOI: 10.3389/fnhum.2022.887504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Neurofeedback (NF) aims to alter neural activity by enhancing self-regulation skills. Over the past decade NF has received considerable attention as a potential intervention option for many somatic and mental conditions and ADHD in particular. However, placebo-controlled trials have demonstrated insufficient superiority of NF compared to treatment as usual and sham conditions. It has been argued that the reason for limited NF effects may be attributable to participants' challenges to self-regulate the targeted neural activity. Still, there is support of NF efficacy when only considering so-called “standard protocols,” such as Slow Cortical Potential NF training (SCP-NF). This PROSPERO registered systematic review following PRISMA criteria searched literature databases for studies applying SCP-NF protocols. Our review focus concerned the operationalization of self-regulatory success, and protocol-details that could influence the evaluation of self-regulation. Such details included; electrode placement, number of trials, length per trial, proportions of training modalities, handling of artifacts and skill-transfer into daily-life. We identified a total of 63 eligible reports published in the year 2000 or later. SCP-NF protocol-details varied considerably on most variables, except for electrode placement. However, due to the increased availability of commercial systems, there was a trend to more uniform protocol-details. Although, token-systems are popular in SCP-NF for ADHD, only half reported a performance-based component. Also, transfer exercises have become a staple part of SCP-NF. Furthermore, multiple operationalizations of regulatory success were identified, limiting comparability between studies, and perhaps usefulness of so-called transfer-exercises, which purpose is to facilitate the transfer of the self-regulatory skills into every-day life. While studies utilizing SCP as Brain-Computer-Interface mainly focused on the acquisition of successful self-regulation, clinically oriented studies often neglected this. Congruently, rates of successful regulators in clinical studies were mostly low (<50%). The relation between SCP self-regulation and behavior, and how symptoms in different disorders are affected, is complex and not fully understood. Future studies need to report self-regulation based on standardized measures, in order to facilitate both comparability and understanding of the effects on symptoms. When applied as treatment, future SCP-NF studies also need to put greater emphasis on the acquisition of self-regulation (before evaluating symptom outcomes).
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Affiliation(s)
- John Hasslinger
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
- *Correspondence: John Hasslinger
| | - Micaela Meregalli
- Child and Adolescent Psychiatry, Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
- Child and Adolescent Psychiatry, Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
- Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
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