Biofeedback and Neurofeedback Treatment for ADHD

Abstract

<p>Although many children, adolescents, and adults with attention deficit/hyperactivity disorder benefit significantly from evidence-based treatments, such as medication, behavioral therapy, and cognitive behavioral therapy, for some patients, these treatments are not helpful. Others refuse to try them, even though they may be beneficial.</p> <br> <h4>ABOUT THE AUTHORS</H4> <P>Nicholas Lofthouse, PhD, is with the Department of Psychiatry, The Ohio State University, Columbus, Ohio. Keith McBurnett, PhD, is with the Department of Psychiatry, University of California, San Francisco. L. Eugene Arnold, MD, MEd, is with the Department of Psychiatry; and the Nisonger Center, The Ohio State University. Elizabeth Hurt, PhD, is with the Nisonger Center, The Ohio State University.</P> <P>Address correspondence to: Nicholas Lofthouse, PhD, Department of Psychiatry, The Ohio State University, 1670 Upham Drive, Room 560-A, Columbus, OH 43210-1250; fax: 614-293-8232; or e-mail: <A HREF="mailto:Nicholas.Lofthouse@osumc.edu</"TARGET="_new">Nicholas.Lofthouse@osumc.edu</A>.</P> <P>Dr. Lofthouse; and Dr. Hurt have disclosed no relevant financial relationships. Dr. Arnold has disclosed the following relevant financial relationships: Noven: Consultant; and CureMark; Eli Lilly; and Shire: Contracted Research. Dr. McBurnett has disclosed the following relevant financial relationships: Eli Lilly and Shire; Consultant; and Eli Lilly, Otsuka, and Shire: Contracted research.</P>

Ending the Evidentiary & Insurance Reimbursement Bias Against Neurofeedback to Treat ADHD: It Will Take Clinician Action in Addition to the Compelling Science

“…Similar to Loo=Barkley, though, the authors of these reviews do not apply the same evidentiary standards when evaluating the effectiveness of their preferred treatments. For example Nicholas Lofthouse, the lead author in three of these reviews Lofthouse, Arnold, Hersch, Hurt, & Debeus, 2012;Lofthouse, McBurnett, Arnold, & Hurt, 2011) identifies BT and cognitive behavior therapy (CBT) as evidence-based treatments for ADHD (Lofthouse et al, 2011) while asserting that NFB fails to achieve this designation; yet neither of these treatments have ever been shown to be effective in placebo-controlled studies in which the treating clinician was blind to the experimental condition. In fact, it is widely recognized that these learning-based treatments are not suitable for such research designs because it is impossible to blind the clinician to the treatment condition.…”

“…Similarly, the independent evidence-based rankings completed for the American Academy of Pediatrics gave CBT a Level 5, NO SUPPORT ranking for treating ADHD compared to a Level 1, HIGHEST SUPPORT ranking for NFB; yet Drs. Lofthouse and Arnold assert that CBT is an evidence-based treatment for ADHD (Lofthouse et al, 2011), a baseless assertion with no research support, while their reviews deny this designation for neurofeedback and thereby display their profound evidentiary bias in how they evaluate treatments.…”

Alpha activity neuromodulation induced by individual alpha-based neurofeedback learning in ecological context: A double-blind randomized study

“…For example, some NF protocols target electroencephalographic (EEG) activity in the alpha band , aiming at its reduction or enhancement, in order to train participants to focus attention sustainably or to relax, respectively [1]- [3]. NF applications have been developed since the 70's in non-clinical [4], [5] and clinical settings, such as epilepsy [6], attention-deficit hyperactivity disorder [7]- [11], depression [9], [10], and anxiety [12], [14]- [16]. However, the understanding of the neurocognitive mechanisms and effects of NF training (NFT) remains elusive; it has become a full swing topic for the scientific and medical community [17].…”

“…As brain-computer interfaces (BCI) applications, NF consists in providing real-time, closed-loop-auditory, visual, or tactile-feedback of a subject's brain activity to train self-regulation of specific brain patterns related to a targeted ability. NF applications have been developed since the 70's in non-clinical [1][2][3] and clinical settings, such as epilepsy 4 , attentiondeficit hyperactivity disorder [5][6][7][8][9] , depression 10,11 , psychopathy 12,13 , and anxiety 10,[14][15][16] . However, the understanding of the neurocognitive mechanisms during a BCI task or a NF training (NFT) remains elusive 17,18 .…”

“…In the previous literature, control conditions are quite variable in NF studies, not only aiming at the link between brain activity and feedback but also varying the task or the procedure 22 . For example, in clinical studies where NFT aimed at reducing behavioral symptoms or psychological processes associated with various disorders (anxiety [14][15][16] , depression 10,11,23 , addiction [24][25][26][27] , attention deficit [5][6][7][8][9]28,29 ), NF performance was typically compared with active control groups, such as cognitive therapy, mental exercise, and treatment-as-usual 22 . Thus, the self-reported or clinical benefits of NFT may be related to an ensemble of specific and non-specific mechanisms, including psychosocial influences [30][31][32] , cognitive and attentional/motivational factors 33 , test-retest improvement, as well as spontaneous clinical improvement or cognitive development 17 , and the learning context, contributing to the ongoing debate about NF efficacy 15,34 .…”