Self-regulation of Slow Cortical Potentials: A New Treatment for Children With Attention-Deficit/Hyperactivity Disorder

Abstract

According to the guidelines of the efficacy of treatments, the evidence of the efficacy of slow cortical potential feedback found in this study reaches level 2: "possibly efficacious." In the absence of a control group, no causal relationship between observed improvements and the ability to regulate brain activity can be made. However, it could be shown for the first time that good performance in self-regulation predicts clinical outcome. "Good performance" was defined as the ability to produce negative potential shifts in trials without feedback, because it is known that the ability to self-regulate without feedback is impaired in children and adults with attention problems. Additional research should focus on the control of unspecific effects, medication, and subtypes to confirm the assumption that slow cortical potential feedback is a viable treatment option for attention-deficit/hyperactivity disorder. Regulation of slow cortical potentials may involve similar neurobiological pathways as medical treatment. It is suggested that regulation of frontocentral negative slow cortical potentials affects the cholinergic-dopaminergic balance and allows children to adapt to task requirements more flexibly.

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

“…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].…”

“…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]. …”

The self-regulating brain and neurofeedback: Experimental science and clinical promise

“…Some proponents of EEG-nf argue that nonspecific factors alone cannot account for clinical improvement because changes are observable via objective measurements, including EEG (Leins et al, 2007;Strehl et al, 2006) and resting-state fMRI (Lévesque, Beauregard, & Mensour, 2006;Ros et al, 2013). However, few, if any, studies rule out the influence of other parameters, which are intrinsic to feedback training (Box 2 provides a partial list).…”

Neurofeedback for ADHD

“…Based on the electrophysiologic evidence of altered SCPs in ADHD, a different protocol has emerged aiming at the modifications of SCPs to regulate cortical excitation thresholds. 35,36 Empirical Support…”