Neurofeedback in attention-deficit/hyperactivity disorder – different models, different ways of application

Abstract

In children with attention-deficit/hyperactivity disorder (ADHD), different neurofeedback (NF) protocols have been applied, with the most prominent differentiation between EEG frequency-band (e.g., theta/beta) training and training of slow cortical potentials (SCPs). However, beyond distinctions between such basic NF variables, there are also competing assumptions about mechanisms of action (e.g., acquisition of regulation capability, generalization to daily life behavior). In the present article, we provide a framework for NF models and suppose two hypothetical models, which we call “conditioning-and-repairing model” and “skill-acquisition model,” reflecting extreme poles within this framework. We argue that the underlying model has an impact not only on how NF is applied but also on the selection of evaluation strategies and suggest using evaluation strategies beyond beaten paths of pharmacological research. Reflecting available studies, we address to what extent different views are supported by empirical data. We hypothesize that different models may hold true depending on the processes and behaviors to be addressed by a certain NF protocol. For example, the skill-acquisition model is supported by recent findings as an adequate explanatory framework for the mechanisms of action of SCP training in ADHD. In conclusion, evaluation and interpretation of NF trials in ADHD should be based on the underlying model and the way training is applied, which, in turn, should be stated explicitly in study reports.

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

“…It has also been argued, however, that the short‐ and longer‐term benefits of NF are not exclusively due to improving specific neural mechanisms but may be mediated or moderated by (potentially compensatory) cognitive–behavioral (feelings of self‐efficacy, achievement motivation or the development of effective mental strategies) and social (social reinforcement) interacting mechanisms [Gevensleben et al, 2014; Thibault et al, 2016]. …”

“…Boys were asked to move the rocket toward space by any means they found helpful. Instructions were minimal (i.e., “you can try to concentrate on the rocket” or “try any other method that works for you”) as this has been shown to be more effective than explicit instructions [Sulzer et al, 2013], and instruction‐free approaches are common in EEG‐NF for ADHD children [Gevensleben et al, 2014; Strehl et al, 2006]. However, in rtfMRI‐NF it has been shown that for some regions it appears to make no difference whether instructions are given (e.g., motor regions [Sepulveda et al, 2016]), while explicit instructions may be beneficial for the self‐regulation of specific brain areas (e.g., limbic system [Zilverstand et al, 2015].…”

Le neurofeedback dans le trouble déficit de l’attention/hyperactivité de l’enfant est-il efficace ? Depuis les études rigoureuses jusqu’aux bonnes pratiques cliniques

“…Cette attention semble être diminuée dans les études plus récentes, s'étant concentrée sur la construction de protocoles plus rigoureux (avec groupes témoins de meilleure qualité et évaluations en aveugle) [35]. Cependant, les conditions de bonnes pratiques du neurofeedback lui-même sont le pendant indispensable aux études de preuve d'efficacité bien conduites [14,34,36]. Ainsi les futures études d'efficacité du neurofeedback dans le TDA/H devront allier la qualité méthodologique des études randomisées contrôlées en aveugle à la qualité de la conduite des séances de neurofeedback [36].…”

“…Cependant, les conditions de bonnes pratiques du neurofeedback lui-même sont le pendant indispensable aux études de preuve d'efficacité bien conduites [14,34,36]. Ainsi les futures études d'efficacité du neurofeedback dans le TDA/H devront allier la qualité méthodologique des études randomisées contrôlées en aveugle à la qualité de la conduite des séances de neurofeedback [36]. …”

Attention deficit hyperactivity disorder and current possibilities of its treatment by the method of neurofeedback training

“…Согласно одним представлениям, потенциальными меха-низмами НБУ являются перестройки нейронных сетей, включая увеличение их глобальной взаимосвязанности и нейропластичности [21]. Другие авторы [22] предлагают две модели: «обусловливания и ремонта», предполагаю-щую восстановление нейронных дисфункций в процессе оперантного обусловливания, и «приобретения навыка», подчеркивающую важность целенаправленного обучения подавлению симптомов СДВГ напрямую через использо-вание когнитивно-поведенческих стратегий. Еще одна группа авторов [23] считают, что НБУ осуществляет на-стройку колебаний электрической активности мозга на такой гомеостатический уровень, который обеспечивает оптимальный баланс между гибкостью и стабильностью нейронной сети.…”