Computer Enabled Neuroplasticity Treatment: A Clinical Trial of a Novel Design for Neurofeedback Therapy in Adult ADHD

Abstract

Background: We report a randomized controlled clinical trial of neurofeedback therapy intervention for ADHD/ADD in adults. We focus on internal mechanics of neurofeedback learning, to elucidate the primary role of cortical self-regulation in neurofeedback. We report initial results; more extensive analysis will follow.Methods: Trial has two phases: intervention and follow-up. The intervention consisted of neurofeedback treatment, including intake and outtake measurements, using a waiting-list control group. Treatment involved ~40 h-long sessions 2–5 times per week. Training involved either theta/beta or sensorimotor-rhythm regimes, adapted by adding a novel “inverse-training” condition to promote self-regulation. Follow-up (ongoing) will consist of self-report and executive function tests.Setting: Intake and outtake measurements were conducted at University of Helsinki. Treatment was administered at partner clinic Mental Capital Care, Helsinki.Randomization: We randomly allocated half the sample then adaptively allocated the remainder to minimize baseline differences in prognostic variables.Blinding: Waiting-list control design meant trial was not blinded.Participants: Fifty-four adult Finnish participants (mean age 36 years; 29 females) were recruited after screening by psychiatric review. Forty-four had ADHD diagnoses, 10 had ADD.Measurements: Symptoms were assessed by computerized attention test (T.O.V.A.) and self-report scales, at intake and outtake. Performance during neurofeedback trials was recorded.Results: Participants were recruited and completed intake measurements during summer 2012, before assignment to treatment and control, September 2012. Outtake measurements ran April-August 2013. After dropouts, 23 treatment and 21 waiting-list participants remained for analysis.Initial analysis showed that, compared to waiting-list control, neurofeedback promoted improvement of self-reported ADHD symptoms, but did not show transfer of learning to T.O.V.A. Comprehensive analysis will be reported elsewhere.Trial Registration: “Computer Enabled Neuroplasticity Treatment (CENT),” ISRCTN13915109.

Efficacy of Nonpharmacological Treatments on Comorbid Internalizing Symptoms of Adults With Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review

“…For the studies by Philipsen et al (2015) and Schönenberg et al (2017), each treatment group was compared with the equivalent control group, based on medication status and comparing NFB versus sham NFB, respectively. A total of 18 studies were excluded because they did not measure any of the outcomes considered in our review (Bachmann et al, 2018; Barth, Mayer, Strehl, Fallgatter, & Ehlis, 2017; Cowley, Holmström, Juurmaa, Kovarskis, & Krause, 2016; Hirvikoski, Waaler, Lindström, Bölte, & Jokinen, 2015; Janssen, de Vries, Hepark, & Speckens, 2017; Janssen et al, 2018; Kaiser, 1997; LaCount, Hartung, Shelton, Clapp, & Clapp, 2015; Schoenberg et al, 2014; Solanto, Marks, Mitchell, Wasserstein, & Kofman, 2008; Thompson & Thompson, 1998; Van der Oord et al, 2018; Virta, Hiltunen, Mattsson, & Kallio, 2015; Wang et al, 2016; Weiss et al, 2012; White & Shah, 2006; Zilverstand et al, 2017; Zwart & Kallemeyn, 2001); four because there were insufficient data in the article (Cole et al, 2016; Hirvikoski et al, 2011; Huang et al, 2019; Weiss & Hechtman, 2006); two for not including all participants who were at least 18 years old (Vidal-Estrada et al, 2015; Zylowska et al, 2008); two for including participants with severe substance abuse (Bihlar Muld, Jokinen, Bölte, & Hirvikoski, 2016) and personality disorders (Prada et al, 2015); and one because the treatment was self-applied (Moëll, Kollberg, Nasri, Lindefors, & Kaldo, 2015) or a formal diagnostic assessment for ADHD was not made (Wymbs & Molina, 2015).…”

Epileptic Electroencephalography Profile Associates with Attention Problems in Children with Fragile X Syndrome: Review and Case Series

“…The research strategy we propose is to separate the treatment by contiguous conditions in a way that “normalization” training takes place before “self-regulation” training. A similar approach has been recently piloted (Cowley et al, 2016 ). The effects due to each condition can be observed in isolation and in the context of the well-defined theoretical model of NFB and a well-characterized disease model.…”

Treatment of adult ADHD: a clinical perspective

“…Cognitive training 65 and neurofeedback 66,67 are enticing; however, more stringent studies suggest their effect is smaller than commercial claims would have us believe. Tempting morsels on the pro-cognitive effects of tDCS 68 and rTMS 69 are interesting but not yet of clinical relevance to adult ADHD.…”