Preview

Bulletin of Siberian Medicine

Advanced search

ELECTROENCEPHALOGRAPHIC BIOFEEDBACK IMPROVES FOCUSED ATTENTION IN ATTENTION DEFICIT/HYPERACTIVITY DISORDER

https://doi.org/10.20538/1682-0363-2013-2-182-194

Abstract

EEG biofeedback (so called neurofeedback) is considered as an efficacious treatment for ADHD. We propose that operant conditioning of EEG in neurofeedback training mode, aimed to mitigate inattention and low arousal in ADHD, will be accompanied by changes in EEG bands' relative power. Patients were 18 children diagnosed with ADHD. The neurofeedback protocol (“Focus/Alertness” by Peak Achievement Trainer, Neurotek, KY) used to train patients has focused attention training procedure, which according to specifications, represents wide band EEG amplitude suppression training. Quantitative EEG analysis was completed on each of 25 min long twelve sessions to determine the relative power of each of the EEG bands of interest throughout each session, and from the first session to the last session. Additional statistical analysis was performed to determine significant changes in relative power within sessions (from minute 1 to minute 25), and between sessions (from session 1 to session 12) for an individual patient. We performed analysis of relative power of Theta, Alpha, Low and High Beta, Theta/Alpha, Theta/Beta, and Theta/Low Beta and Theta/High Beta ratios. We performed also analysis between the “Focus”measure and changes in relative power of above EEG rhythms and their ratios. Additional secondary measures of patients’ post-neurofeedback outcomes were assessed using an audio-visual selective attention test (IVA + Plus) and behavioral evaluation scores from Aberrant Behavior Checklist. We found that, as expected, Theta/Low Beta and Theta/Alpha ratios decreased significantly from Session 1 to Session 12 and from minute 1 to minute 25 within sessions. The ‘Focus” measure of protocol showed high negative correlation with both Theta/Alpha and Theta/Beta ratios. The findings regarding EEG changes resulting from self-regulation training along with behavioral evaluations will help in elucidation of neural mechanisms of neurofeedback aimed to improve focused attention and alertness in ADHD.

About the Authors

E. M. Sokhadze
Department of Psychiatry & Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
United States
Sokhadze Estate M. - Evoked Potential Lab., Cognitive Neuroscience Laboratory


B. Hillard
Department of Psychiatry & Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
United States
Hillard Brent - Department of Bioengineering, Speed School of Engineering


M. Eng
Department of Psychiatry & Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
United States


A. S. El-Baz
Department of Psychiatry & Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
United States
El-Baz Ayman S. - Bioimaging Lab, Department of Bioengineering, Speed School of Engineering


A. Tasman
Department of Psychiatry & Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
United States
Tasman Allan


L. Sears
Department of Psychiatry & Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
United States
Sears Lonnie - Department of Pediatrics


References

1. Jafarova O.A., Skok A.B., Khaimovich Ye.V., Shubina O.S., Shtark M.B. Narcology, 2004, no. 1, pp. 56–64 (in Russian).

2. Mamayeva Yu.V., Savina G.O., Sukholentseva M.V. Siberian Herald of Psychiatry and Narcology, 2006, 4 (July), pp. 31–39 (in Russian).

3. Sapina Ye.A., Kondratenko A.V., Mernaya Ye.M., Nikonova A.V., Bazanova O.M. Bulletin of Siberian Medicine, 2010, vol. 9, no. 2, pp. 101–107 (in Russian).

4. Stoller I.A., Sukholentseva M.V., Tkachenko N.N., Veryovkin Ye.G., Shtark M.B., Yarosh S.V. Bulletin of Siberian Medicine, 2010, vol. 9, no. 2, pp. 24–34 (in Russian).

5. Aman M.G., Singh N.N. Aberrant Behavior Checklist – Community. Supplementary Manual. East Aurora, NY. Slosson Ed. Publications, 1994.

6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC, 2000.

7. Arns M., de Ridder S., Strehl U., Breteler M., Coenen A. Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: a meta-analysis. Clinical EEG and Neuroscience, 2009, vol. 40, pp. 180–189.

8. Arns M., Drinkenburg W., Leon-Kenemans J. The effects of qEEG-informed neurofeedback in ADHD: an open-label pilot study. Applied Psychophysiology Biofeedback, 2012, vol. 37, no. 3, pp. 171–180

9. Arns M., Gunkelman J., Breteler M., Spronk D. EEG phenotypes predict treatment outcome to stimulants in children with ADHD. Journal of Integrative Neuroscience, 2008, vol. 7, pp. 421–438.

10. Barry R. J., Clarke A. R., Johnstone S. J., McCarthy R., Selikowitz M. Electroencephalogram Theta/beta ratio and arousal in attention-deficit/hyperactivity disorder: evidence of independent processes. Biological Psychiatry, 2009, vol. 66, pp. 398–401.

11. Barry R.J., Clarke A.R., Johnstone S.J. A review of electrophysiology in attention-deficit/hyperactivity disorder: I. Qualitative and quantitative electroencephalography. Clinical Neurophysiology, 2003, vol. 114, pp. 171–183.

12. Boutros, N., Fraenkel, L., Feingold, A. A four-step approach for developing diagnostic tests in psychiatry: EEG in ADHD as a test case. Journal of Neuropsychiatry and Clinical Neuroscience, 2005, vol. 17, pp. 455–464.

13. Biederman J. Attention-deficit/hyperactivity disorder: a selective overview. Biological Psychiatry, 2005, vol. 57, pp. 1215–1220.

14. Clarke A.R., Barry R.J., Irving A.M., McCarthy R., Selikowitz M. Children with attention-deficit/hyperactivity disorder and autistic features: EEG evidence for comorbid disorders. Psychiatry Research, 2011. V. 185, pp. 225–231.

15. Clarke A.R., Barry R., Dupuy F.E., Heckel L.D., McCarthy R. et al. Behavioural differences between EEG-defined subgroups of children with attention-deficit/hyperactivity disorder. Clinical Neurophysiology, 2011, vol. 122, pp. 1333– 1341.

16. Clarke A.R., Barry R., McCarthy R., Selikowitz M., Johnstone S. Effects of stimulant medications on the EEG of girls with attentiondeficit/hyperactivity disorder. Clinical Neurophysiology, 2007, vol. 118, pp. 2700–2708.

17. Clarke A.R., Barry R.J., McCarthy R., Selikowitz M. Correlation between EEG activity and behavior in children with Attention-Deficit/Hyperactivity Disorder. Journal Neurotherapy, 2011, vol. 15, no. 3, pp. 193–199.

18. Clarke A.R., Barry R.J., McCarthy R., Selikowitz M. EEGdefined subtypes of children with attention-deficit/hyperactivity disorder. Clinical Neurophysiology, 2001, vol. 112, pp. 2098–2105.

19. Clarke A.R., Barry R.J., McCarthy R., Selikowitz M. Electroencephalogram differences in two subtypes of attentiondeficit/hyperactivity disorder. Psychophysiology, 2001, vol. 38, pp. 212–221.

20. Callaway E., Halliday R., Naylor H. Hyperactive children’s event-related potentials fail to support underarousal and maturational-lag theories. Archives of General Psychiatry, 1983, vol. 40, pp. 1243–1248.

21. Chabot R.J., Serfontein G. Quantitative electroencephalographic profiles of children with attention deficit disorder. Biological Psychiatry, 1996, vol. 40, pp. 951–963.

22. Conners C.K. Conners Comprehensive Behavior Rating Scales. MHS. North Tonawanda, NY, 2008.

23. Cowan J.D., Albers S. Manual for The Peak Achievement Trainer. Goshen, KY: NeuroTek LLC, 2008. http://www.peakachievement.com/homeuser/Peak_Achieve ment_Trainer.htm

24. Doehnert M., Brandeis D., Straub M., Steinhausen H.C., Drechsler R. Slow cortical potential neurofeedback in attention deficit hyperactivity disorder: is there neurophysiological evidence for specific effects? Journal of Neural Transmission, 2008, vol. 115, рр. 1445–1456.

25. Dykman R.A., Ackerman P.T., Oglesby D.M., Holcomb P.J. Autonomic responsivity during visual search of hyperactive and reading-disabled children. The Pavlovian Journal of Biological Science, 1982, vol. 17, vol. 150–157.

26. Fox D.J., Tharp D.F., Fox L.C. Neurofeedback: An alternative and efficacious treatment for attention deficit hyperactivity disorder. Applied Psychophysiology and Biofeedback, 2005, vol. 30, pp. 365–373.

27. Fuchs T., Birbaumer N., Lutzenberger W., Gruzelier J.H., Kaiser J. Neurofeedback treatment for attentiondeficit=hyperactivity disorder in children: a comparison with methylphenidate. Applied Psychophysiology and Biofeedback, 2003, vol. 28, pp. 1–12.

28. Gevensleben H., Holl B., Albrecht B., Vogel C., Schlamp D. et al. Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. Journal Child Psychology Psychiatry, 2009, vol. 50, pp. 780–789.

29. Gevensleben H., Holl B., Albrecht B., Schlamp D., Kratz O., Studer P., et al. Distinct EEG effects related to neurofeedback training in children with ADHD: a randomized controlled trial. International Journal of Psychophysiology, 2009, vol. 74, pp. 149–157.

30. Hegerl U., Stein M., Mulert C., Mergl R., Olbrich S., Dichgans E., et al. EEG-Vigilance differences between patients with borderline personality disorder, patients with obsessive-compulsive disorder and healthy controls. European Archives of Psychiatry and Clinical Neuroscience, 2008, vol. 258, pp. 137–143.

31. Heinrich H., Gevensleben H., Freisleder F.J., Moll G.H., Rothenberger A. Training of slow cortical potentials in attention-deficit/hyperactivity disorder: evidence for positive behavioral and neurophysiological effects. Biological Psychiatry, 2004, vol. 55, pp. 772–775.

32. Holtmann M., Grasmann D., Cionek-Szpak E., Hager V., Panzner N., Beyer A. et al. Spezifische Wirksamkeit von Neurofeedback auf die Impulsivität bei ADHS. Kindheit und Entwicklung, 2009, vol. 18, pp. 95–204.

33. Holtmann M., Stadler C. Electroencephalographic biofeedback for the treatment of attention-deficit hyperactivity disorder in childhood and adolescence. Expertimental Review Neurotherapy, 2006, vol. 6, pp. 533–540.

34. Janzen T., Graap K., Stephanson S., Marshall W., Fitzsimmons G. Differences in baseline EEG measures for ADD and normally achieving preadolescent males. Biofeedback and Self Regulation, 1995, vol. 20, pp. 65–82.

35. Kropotov J.D., Grin-Yatsenko V.A., Ponomarev V.A., Chutko L.S., Yakovenko E.A., Nikishena I.S. ERPs correlates of EEG relative beta training in ADHD children. International Journal of Psychophysiology, 2005, vol. 55, pp. 23–34.

36. Kuperman S., Johnson B., Arndt S., Lindgren S., Wolraich M. Quantitative EEG differences in a nonclinical sample of children with ADHD and undifferentiated ADD. Journal of the American Academy of Child and Adolescent Psychiatry, 1996, vol. 35, pp. 1009–1017.

37. Lansbergen M.M., Arns M., van Dongen-Boomsma M., Spronk D., Buitelaar J.K. The increase in theta/beta ratio on resting-state EEG in boys with attention-deficit/hyperactivity disorder in mediated by slow alpha peak frequency. Progress Neuropsychopharmacology Biological Psychiatry, 2011, vol. 35, pp. 47–52.

38. Lazzaro I., Gordon E., Li W., Lim C.L., Plahn M., Whitmont S., et al. Simultaneous EEG and EDA measures in adolescent attention deficit hyperactivity disorder. International Journal of Psychophysiology, 1999, vol. 34, pp. 123–134.

39. Lazzaro I., Gordon E., Whitmont S., Plahn M., Li W., Clarke S., et al. Quantified EEG activity in adolescent attention deficit hyperactivity disorder. Clinical Electroencephalography, 1998, vol. 29, no. 1, pp. 37–42.

40. Le´vesque J., Beauregard M., Mensour B. Effect of neurofeedback training on the neural substrates of selective attention in children with attention-deficit/hyperactivity disorder: a functional magnetic resonance imaging study. Neuroscience Letters, 2006, vol. 394, pp. 216–221.

41. Linden M., Habib T., Radojevic V. A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback and Self-Regulation, 1996, vol. 21, pp. 35–49.

42. Lofthouse N., Arnold L.E., Hurt E. A Comment on Sherlin, Arns, Lubar, and Sokhadze. Journal of Neurotherapy, 2010, vol. 14, pp. 301–306.

43. Lubar J.F. Neurofeedback for the management of attention deficit disorders. Biofeedback: A Practitioner’s Guide. M.S. Schwartz and F. Andrasik (Eds.). New York, Guilford, 2003. P. 409–437.

44. Mann C.A., Lubar J.F., Zimmerman A.W., Miller C.A., Muenchen R.A. Quantitative analysis of EEG in boys with attention-deficit hyperactivity disorder: controlled study with clinical implications. Pediatric Neurology, 1992, vol. 8, pp. 30–36.

45. Matsuura M., Okubo Y., Toru M., Kojima T., He Y., Hou Y. et al. A cross-national EEG study of children with emotional and behavioral problems: a WHO collaborative study in the western pacific region. Biological Psychiatry, 1993, vol. 34, pp. 59–65.

46. Monastra V.J. Quantitative electroencephalography and attention-deficit/hyperactivity disorder: implications for clinical practice. Current Psychiatry Reports, 2008, vol. 10, pp. 432–438.

47. Monastra V.J. Electroencephalographic biofeedback (neurotherapy) as a treatment for attention deficit hyperactivity disorder: rationale and empirical foundation. Child Adolescent Psychiatry Clinic North America, 2005, vol. 14, pp. 55–82.

48. Monastra V.J., Monastra D.M., George S. The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit=hyperactivity disorder. Applied Psychophysiology and Biofeedback, 2002, vol. 27, pp. 231–249.

49. Monastra V.J., Lubar J.F., Linden M., VanDeusen P., Green G., Wing W., et al. Assessing attention deficit hyperactivity disorder via quantitative electroencephalography: an initial validation study. Neuropsychology, 1999, vol. 13, pp. 424–433.

50. Ogrim G., Kropotov J., Hestad K. The QEEG theta/beta ratio in ADHD and normal controls: sensitivity, specificity, and behavioral correlates. Psychiatry Research, 2012. doi:10.1016/j.psychers.2011.12.041.

51. Pliszka S.R. Comorbidity of attention-deficit/hyperactivity disorder with psychiatric disorder: an overview. J. Clin. Psy chiatry, 1998, vol. 59, pp. 50–58.

52. Porjesz B., Rangaswamy M., Kamarajan C., Jones K.A., Padmanabhapillai A., Begleiter H. The utility of neurophysiological markers in the study of alcoholism. Clin. Neurophysiol., 2005, vol. 116, no. 5, pp. 993–1018.

53. Reich A., Welner Z., Herjanic B. Diagnostic Interview for Children and Adolescents-IV (DICA–IV™) MHS. North Tonawanda, NY, 2003.

54. Rossiter, T. The effectiveness of neurofeedback and stimulant drugs in treating ADHD: Part I. Review of methodological issues. Applied Psychophysiology and Biofeedback, 2004, vol. 29, pp. 95–112.

55. Rossiter T.R., La Vaque T.J. A comparison of EEG biofeedback and psychostimulants in treating attention deficit/hyperactivity disorders. Journal of Neurotherapy, 1995, vol. 1, pp. 48–59.

56. Rowland A.S., Lesesne C.A., Abramowitz A.J. The epidemiology of attention-deficit/hyperactivity disorder (ADHD): a public health view. Mental Retardation and Developmental Disabilities Research Reviews, 2002, vol. 8, pp. 162–170.

57. Sandford J.A. IVA+ Plus IVA-AE. Integrated Visual and Auditory Continuous Performance Tests. Richmond, VA: BrainTrain, 2009.

58. Satterfield J.H., Cantwell D.P., Saul R.E., Lesser L.I., Podosin R.L. Response to stimulant drug treatment in hyperactive children: prediction from EEG and neurological findings. Journal of Autism and Child Schizophrenia, 1973, vol. 3, pp. 36–48.

59. Sherlin L., Arns M., Lubar J., Sokhadze E. A position paper on neurofeedback for the treatment of ADHD. Journal of Neurotherapy, 2010, vol. 14, pp. 66–78.

60. Sherlin L., Arns M., Lubar J., Sokhadze E. A Reply to Lofthouse, Arnold, and Hurt. Journal of Neurotherapy, 2010, vol. 14, pp. 307–311.

61. Sokhadze E. Peak performance training using prefrontal EEG biofeedback. Biofeedback, 2012, vol. 40, pp. 7–15.

62. Van den Bergh W. Neurofeedback and State Regulation in ADHD: A Therapy Without Medication. BMED Press, 2010.

63. Van der Stelt O., van der Molen M., Gunning W.B., Kok A. Neuroelectrical signs of selective attention to color in boys with attention-deficit hyperactivity disorder. Cognitive Brain Research, 2001, vol. 12, pp. 245–264.

64. World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: Author, 1992.


Review

For citations:


Sokhadze E.M., Hillard B., Eng M., El-Baz A.S., Tasman A., Sears L. ELECTROENCEPHALOGRAPHIC BIOFEEDBACK IMPROVES FOCUSED ATTENTION IN ATTENTION DEFICIT/HYPERACTIVITY DISORDER. Bulletin of Siberian Medicine. 2013;12(2):182-194. (In Russ.) https://doi.org/10.20538/1682-0363-2013-2-182-194

Views: 935


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1682-0363 (Print)
ISSN 1819-3684 (Online)