Clinical and neurobiological factors in the management of treatment refractory attention-deficit hyperactivity disorder

Shim, Se-Hoon; Yoon, Hee Jung; Bak, Jeongjae; Hahn, Sang‐Woo; Kim, Yong Ku

doi:10.1016/j.pnpbp.2016.04.007

Cited by 25 publications

(17 citation statements)

References 80 publications

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“…ADHD is a common condition in the United States (Bloom et al 2013; Kessler et al 2006) that causes suffering (Biederman et al 2006; Danckaerts et al 2010; Loe and Feldman 2007; Mrug et al 2012) and economic loss (Doshi et al 2012). Standard treatment for ADHD includes stimulant medications (AAP Subcommittee Report et al 2011) that are not effective for all patients (Shim et al 2016; Swanson et al 2001), have side effects (Swanson et al 2017), and carry a risk of non-medical misuse (National Institute on Drug Abuse 2018; Rabiner 2013). Alternative treatment strategies are needed for individuals with ADHD for whom stimulant medications are unacceptable or ineffective.…”

Section: Discussionmentioning

confidence: 99%

Z-Score Neurofeedback and Heart Rate Variability Training for Adults and Children with Symptoms of Attention-Deficit/Hyperactivity Disorder: A Retrospective Study

Groeneveld¹,

Mennenga²,

Heidelberg³

et al. 2019

Appl Psychophysiol Biofeedback

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ADHD is a common condition that causes suffering for those affected and economic loss for society at large. The current standard treatment for ADHD includes stimulant medications, which are not effective for all patients, may include side effects, and can be non-medically misused. Z-score neurofeedback (NFB) and heart rate variability (HRV) biofeedback are alternative treatment strategies that have been associated with Attention-Deficit/Hyperactivity Disorder (ADHD) symptom improvement. We utilized a retrospective pre-post study design to quantify the change in clients’ ADHD symptoms after combined NFB + HRV treatment (which included simultaneous z-score training at four sites). We also assessed whether relevant physiological measures changed in accordance with the protocol, which would be consistent with effective NFB + HRV training. Adults (n = 39) and children (n = 100) with Borderline or Clinical ADHD classifications by the Achenbach System of Empirically Based Assessment (ASEBA) received 30 sessions of NFB + HRV training. Measures were compared before and after treatment for the ASEBA, the Integrated Visual and Auditory Continuous Performance Test (IVA), ADHD medication use, HRV and breathing parameters, and quantitative electroencephalogram (QEEG) parameters. Average ASEBA Attention-Deficit/Hyperactive Problems score improved after treatment for adults and children (p < 0.0001), with Cohen effect sizes (dz) of −1.21 and −1.17, respectively. 87.2% of adults and 80.0% of children experienced improvements of a magnitude greater than or equal to the Minimal Clinically Important Difference. After treatment, 70.8% of adults and 52.8% of children who began in the ASEBA Clinical range, and 80.0% of adults and 63.8% of children who began in the ASEBA Borderline range, were classified in the Normal range. IVA scores also improved after treatment. Changes in HRV and breathing pattern after treatment were consistent with the protocol. QEEG parameters after treatment were closer to the age-based normative mean, which is consistent with effective z-score NFB training.Electronic supplementary materialThe online version of this article (10.1007/s10484-019-09439-x) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Z-Score Neurofeedback and Heart Rate Variability Training for Adults and Children with Symptoms of Attention-Deficit/Hyperactivity Disorder: A Retrospective Study

Groeneveld¹,

Mennenga²,

Heidelberg³

et al. 2019

Appl Psychophysiol Biofeedback

View full text Add to dashboard Cite

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“…Nonstimulant drugs (e.g., atomoxetine) are also used but have been shown to be less effective (Cerrillo-Urbina et al, 2018). It is estimated that methylphenidate is effective in reducing symptoms in approximately 45% to 50 of patients with ADHD, and approximately 30% of patients fail to significantly improve their symptomatology using stimulant or nonstimulant drugs (Shim, Yoon, Bak, Hahn, & Kim, 2016). In addition, some parents do not want to use drugs to reduce their children’s symptoms for fear of long-term adverse effects.…”

Section: Introductionmentioning

confidence: 99%

What Do Meta-Analyses Have to Say About the Efficacy of Neurofeedback Applied to Children With ADHD? Review of Previous Meta-Analyses and a New Meta-Analysis

et al. 2019

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Objective: We reviewed previously published meta-analyses of neurofeedback applied to children with ADHD and conducted a new meta-analysis of randomized controlled trials (RCTs) that updates previous results and incorporates methodological modifications. Method: Searches were carried out through PubMed, Sage, PsycINFO, SpringerLink, and Psicodoc. We used Hedges’ (adjusted) g and a random-effects model. To assess heterogeneity, Q and I2 were calculated. We performed different analyses depending on the control groups, ADHD symptoms, pre- and/or posttreament data used and symptom evaluator. Results: We reviewed seven meta-analyses, and 17 studies were incorporated into the meta-analysis. RCTs support the efficacy of neurofeedback applied to ADHD when most proximal evaluators assess symptoms. Neurofeedback significantly improves inattention symptoms when possibly blinded evaluators assess symptoms. The preliminary results suggest that stimulant medication is more effective than neurofeedback. Conclusion: New RCTs that establish links between ADHD symptom measurements, subjects’ learning after neurofeedback, and neurophysiological measures could improve the quality of the conclusions.

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“…12 Genetic factors commonly found to be associated with treatment resistance include genes involved in monoaminergic transmission. 13 Neuroimaging studies revealed that dopamine transporter status, and morphometric measurements could be used to predict treatment response. 14,15 Another biomarker that could be used to predict response is quantitative EEG (QEEG).…”

Section: Introductionmentioning

confidence: 99%

Predictive Value of Slow and Fast EEG Oscillations for Methylphenidate Response in ADHD

et al. 2019

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Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder and is characterized by symptoms of inattention and/or hyperactivity and impulsivity. In the current study, we obtained quantitative EEG (QEEG) recordings of 51 children aged between 6 and 12 years before the initiation of methylphenidate treatment. The relationship between changes in the scores of ADHD symptoms and initial QEEG features (power/power ratios values) were assessed. In addition, the children were classified as responder and nonresponder according to the ratio of their response to the medication (>25% improvement after medication). Logistic regression analyses were performed to analyze the accuracy of QEEG features for predicting responders. The findings indicate that patients with increased delta power at F8, theta power at Fz, F4, C3, Cz, T5, and gamma power at T6 and decreased beta powers at F8 and P3 showed more improvement in ADHD hyperactivity symptoms. In addition, increased delta/beta power ratio at F8 and theta/beta power ratio at F8, F3, Fz, F4, C3, Cz, P3, and T5 showed negative correlations with Conners’ score difference of hyperactivity as well. This means, those with greater theta/beta and delta/beta powers showed more improvement in hyperactivity following medication. Theta power at Cz and T5 and theta/beta power ratios at C3, Cz, and T5 have significantly classified responders and nonresponders according to the logistic binary regression analysis. The results show that slow and fast oscillations may have predictive value for treatment response in ADHD. Future studies should seek for more sensitive biomarkers.

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Clinical and neurobiological factors in the management of treatment refractory attention-deficit hyperactivity disorder

Cited by 25 publications

References 80 publications

Z-Score Neurofeedback and Heart Rate Variability Training for Adults and Children with Symptoms of Attention-Deficit/Hyperactivity Disorder: A Retrospective Study

Z-Score Neurofeedback and Heart Rate Variability Training for Adults and Children with Symptoms of Attention-Deficit/Hyperactivity Disorder: A Retrospective Study

What Do Meta-Analyses Have to Say About the Efficacy of Neurofeedback Applied to Children With ADHD? Review of Previous Meta-Analyses and a New Meta-Analysis

Predictive Value of Slow and Fast EEG Oscillations for Methylphenidate Response in ADHD

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