Neurofeedback for Children with ADHD: A Comparison of SCP and Theta/Beta Protocols

Abstract

Behavioral and cognitive improvements in children with ADHD have been consistently reported after neurofeedback-treatment. However, neurofeedback has not been commonly accepted as a treatment for ADHD. This study addresses previous methodological shortcomings while comparing a neurofeedback-training of Theta-Beta frequencies and training of slow cortical potentials (SCPs). The study aimed at answering (a) whether patients were able to demonstrate learning of cortical self-regulation, (b) if treatment leads to an improvement in cognition and behavior and (c) if the two experimental groups differ in cognitive and behavioral outcome variables. SCP participants were trained to produce positive and negative SCP-shifts while the Theta/Beta participants were trained to suppress Theta (4-8 Hz) while increasing Beta (12-20 Hz). Participants were blind to group assignment. Assessment included potentially confounding variables. Each group was comprised of 19 children with ADHD (aged 8-13 years). The treatment procedure consisted of three phases of 10 sessions each. Both groups were able to intentionally regulate cortical activity and improved in attention and IQ. Parents and teachers reported significant behavioral and cognitive improvements. Clinical effects for both groups remained stable six months after treatment. Groups did not differ in behavioural or cognitive outcome.

Evidence-Based Information on the Clinical Use of Neurofeedback for ADHD

“…Several trials also evaluated the effect of NF on the EEG, and on learning EEG control during training. Frequency training NF compared to sham-NF has been found to effectively reduce Theta/Beta ratio during NF training and in a resting state baseline [18], and both SCP and frequency training can increase intentional control over brain electrical activity [38], although this may only hold for a subgroup of the ADHD children training with NF [45]. In a large randomized trial, the authors found SCP (when compared to CAST) to significantly decrease theta activity after training, and increase both participants capacity to modulate SCP, and Contingent Negative Variation (CNV) [54][55][56].…”

“…Almost unequivocally, uncontrolled within subjects' pre-to post-treatment analyses indicate positive results with medium-to-large effect sizes (ES) [16,18,21,35,[38][39][40][41][42][43][44][45][46][47].…”

“…In other words, the training to transfer the skills acquired in the NF protocol to daily life. The two German trials that reported the 2 years and 6-month followup data previously described used transfer training to reach generalization of regulatory skills to everyday life [38,39]. In those 2 studies, transfer training was applied as follows: in 23 % of trials patients did not receive immediate feedback, but had to guess if they were performing right or wrong for 8 seconds before they received feedback.…”

“…Arns et al [16] found no difference for the effect size of studies using different protocols (SMR/Theta, SRM/Beta/Theta, and SCP). SCP has been compared to Theta/Beta training in 2 randomized controlled trials and both protocols showed to be equally effective for behavioral and cognitive improvements [38,39]. One important difference between treatment protocols is whether they are individualized or standardized.…”

Real‐time fMRI neurofeedback in adolescents with attention deficit hyperactivity disorder

“…Meta‐analyses of randomized controlled trials (RCT) of EEG‐NF show medium effect sizes for symptom improvements [Arns et al, 2009], reduced to trends when only “probably” blinded raters are included [Holtmann et al, 2014; Sonuga‐Barke et al, 2013]. Crucially, unlike psychostimulant treatment, NF effects seem stable and longer‐lasting (up to 2 years), with no side effects [Arns and Kenemans, 2014; Gani et al, 2008; Gevensleben et al, 2010; Leins et al, 2007; Mayer et al, 2016; Steiner et al, 2014; Strehl et al, 2006]. …”