78 research outputs found
Can neurophysiological markers of anticipation and attention predict ADHD severity and neurofeedback outcomes?
No full textISSN:0301-0511ISSN:1873-6246ISSN:1873-624
Neurofeedback Treatment in Attention Deficit Hyperactivity Disorder and Comorbit Aggression
No full textThe present thesis focused on specificity and long-term effects of slow-cortical potential neurofeedback (SCP-NF) treatment for children with ADHD in a large multicenter randomized controlled trial, on its relation to aggressive behaviors as a common comorbidity of ADHD, and on neuroimaging and psychophysiological subtypes of aggression. We assessed clinical efficacy on ADHD and comorbid aggression in comparison to a semi-active control group which controlled for unspecific effects. The role of self-regulation and learning of SCPs was systematically evaluated. Additionally, we investigated amygdala-specific activity in aggression subtypes in a large multicenter cohort, which might provide a possible putative NF target.
The first two studies assessed 150 children aged 7–9 years diagnosed with ADHD which were randomized to 25 sessions of feedback of SCPs (NF) or feedback of coordination of the supraspinatus muscles (EMG). The primary outcome was the change in ADHD symptoms rated by parents four weeks and six-month after treatment end. Slow-cortical potential neurofeedback showed significant superiority over the semi-active control condition with medium effect sizes four weeks after treatment. This superiority of SCP-NF over the semi-active control group became non-significant 6 months after treatment end. However, taking together all assessments, SCP-NF showed a stable improvement with large effect sizes following treatment and EMG-BF showed worsening of symptoms one month after treatment, with subsequent remission at follow-up, leading to non-significant group differences six months after treatment end. Assessment of self-regulation showed significant ability to self-regulate slow-cortical potential when direct feedback is given and improvement of self-regulation skills indicate specificity of SCP-NF for selected subscales after training, but not at follow-up. In sum, these findings suggest shared specific and unspecific effects contributing to this clinical outcome.
The third study aimed to disentangle aggression-related subtypes at a neural level. In total 177 participants (n=108 cases with aggression-related disorders and n= 69 typically developing peers), aged 8-18 years were assessed across nine sites in Europa during a well-established emotional face-matching fMRI task. Additionally, simultaneous skin conductance recordings were acquired in a subsample (n=64). Children and adolescents with aggression-related problems showed higher amygdala activity in response to negative faces compared to typically developing peers. Further, we showed distinct amygdala activity for subtypes of aggression. Callous-unemotional traits showed to moderate both central (amygdala) and peripheral (SC) responses. These findings increase insights which could be used for personalized diagnostics and treatments
Neurofeedback for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials
No full textObjective: We performed meta-analyses of randomized controlled trials to examine the effects of neurofeedback on attention-deficit/hyperactivity disorder (ADHD) symptoms and neuropsychological deficits in children/adolescents with ADHD.Method: We searched Pubmed, Ovid, Web of Science, ERIC and CINAHAL through August 30, 2015. Random-effects models were employed. Studies were evaluated with the Cochrane Risk of Bias (RoB) tool.Results: We included 13 trials (520 participants with ADHD). Significant effects were found on ADHD symptoms rated by assessors most proximal to the treatment setting, i.e., the least blinded outcome measure (standardized mean difference [SMD]: ADHD total symptoms=0.35, 95% CI=0.11-0.59; inattention=0.36, 95% CI=0.09-0.63; hyperactivity/impulsivity=0.26, 95% CI=0.08-0.43). Effects were not significant when probably blinded ratings were the outcome or in trials with active/sham controls. Results were similar when only frequency band training trials, the most common neurofeedback approach, were analysed separately. Effects on laboratory measures of inhibition (SMD=0.30, 95% CI= -0.10-0.70) and attention (SMD=0.13, 95% CI= -0.09-0.36) were not significant. Only four studies directly assessed if learning occurred after neurofeedback training. The risk of bias was unclear for many RoB domains in most studies.Conclusion: Evidence from well-controlled trials with probably blinded outcomes currently fails to support neurofeedback as an effective treatment for ADHD. Future efforts should focus on implementing standard neurofeedback protocols, ensuring learning, and optimizing clinically relevant transfer
Neurotherapeutics for Attention Deficit/Hyperactivity Disorder (ADHD): A Review
No full textThis review focuses on the evidence for neurotherapeutics for attention deficit/hyperactivity disorder (ADHD). EEG-neurofeedback has been tested for about 45 years, with the latest meta-analyses of randomised controlled trials (RCT) showing small/medium effects compared to non-active controls only. Three small studies piloted neurofeedback of frontal activations in ADHD using functional magnetic resonance imaging or near-infrared spectroscopy, finding no superior effects over control conditions. Brain stimulation has been applied to ADHD using mostly repetitive transcranial magnetic and direct current stimulation (rTMS/tDCS). rTMS has shown mostly negative findings on improving cognition or symptoms. Meta-analyses of tDCS studies targeting mostly the dorsolateral prefrontal cortex show small effects on cognitive improvements with only two out of three studies showing clinical improvements. Trigeminal nerve stimulation has been shown to improve ADHD symptoms with medium effect in one RCT. Modern neurotherapeutics are attractive due to their relative safety and potential neuroplastic effects. However, they need to be thoroughly tested for clinical and cognitive efficacy across settings and beyond core symptoms and for their potential for individualised treatment
Slow cortical potentials neurofeedback in children with ADHD: comorbidity, self-regulation and clinical outcomes 6 months after treatment in a multicenter randomized controlled trial
No full textDespite sizeable short-term effects of neurofeedback (NF) therapy on attention-deficit and hyperactivity disorder (ADHD), longer-term clinical, comorbidity and self-regulation outcomes are less systematically studied. The aim of this largest NF follow-up to date was to evaluate these outcomes 6 months after NF compared to a semi-active control to disentangle specific from unspecific sustained effects. We performed a multicenter, randomized, parallel, controlled, clinical, superiority trial in five German university outpatient departments. Participants were eligible if they fulfilled DSM-IV-TR criteria for ADHD and were aged from 7 to 9 years. Participants were randomly assigned (1:1-ratio) to 25 sessions of slow cortical potential (SCP)-NF or electromyogram biofeedback (EMG-BF). Participants were not blinded, since they received instructions according to each treatment setting. Primary outcomes were parent ratings of ADHD. The trial was registered, number ISRCTN761871859. Both groups showed improvement of ADHD symptoms compared to baseline at 6-months follow-up with large effect sizes for SCP-NF (d = 1.04) and EMG-BF (d = 0.85), but without group differences. When analyzing all assessments (pre-test, post-test-1, post-test-2 and follow-up), a group-by-time interaction emerged (p = 0.0062), with SCP-NF showing stable improvement following treatment but EMG-BF showing a relapse from post-test-1 to post-test-2, and subsequent remission at follow-up. Six months after the end of treatment, improvement after SCP-NF remained large and stable. However, the lack of group differences at follow-up suggests shared specific and unspecific effects contributing to this clinical outcome. Our correlational results indicate specificity of SCP-NF for selected subscales after training, but not at follow-up
A stable and replicable neural signature of lifespan adversity in the adult brain
No full textEnvironmental adversities constitute potent risk factors for psychiatric disorders. Evidence suggests the brain adapts to adversity, possibly in an adversity-type and region-specific manner. However, the long-term effects of adversity on brain structure and the association of individual neurobiological heterogeneity with behavior have yet to be elucidated. Here we estimated normative models of structural brain development based on a lifespan adversity profile in a longitudinal at-risk cohort aged 25 years ( n = 169). This revealed widespread morphometric changes in the brain, with partially adversity-specific features. This pattern was replicated at the age of 33 years ( n = 114) and in an independent sample at 22 years ( n = 115). At the individual level, greater volume contractions relative to the model were predictive of future anxiety. We show a stable neurobiological signature of adversity that persists into adulthood and emphasize the importance of considering individual-level rather than group-level predictions to explain emerging psychopathology
Earlier versus later cognitive event-related potentials (ERPs) in attention-deficit/hyperactivity disorder (ADHD): A meta-analysis
No full textISSN:0149-7634ISSN:1873-7528ISSN:1873-752
An Ecological Momentary Assessment Approach of Environmental Triggers in the Role of Daily Affect, Rumination, and Movement Patterns in Early Alcohol Use Among Healthy Adolescents: Exploratory Study
No full textBackgroundAdolescence is a period characterized by an increased susceptibility to developing risky alcohol consumption habits. This susceptibility can be influenced by social and situational factors encountered in daily life, which, in conjunction with emotions and thoughts, contribute to behavioral patterns related to alcohol use even in the early stages of alcohol experimentation, when initial experiences with alcohol are formed, and regular consumption is still evolving.
ObjectiveThis study aimed to examine the association between detailed behavioral and movement patterns, along with emotional and cognitive factors, and the early onset of alcohol use in the everyday lives of adolescents.
MethodsA total of 65 healthy adolescents (33 male, twenty-nine 14-year-olds, and thirty-six 16-year-olds) underwent mobile-based ecological momentary assessments on alcohol (once a day at 9 AM, assessing alcohol use the day before), positive and negative affect, craving, rumination, and social context (6 prompts/day at 9 AM, 11 AM, 2 PM, 4 PM, 6 PM and 8 PM), type of day (weekdays or weekends, with weekend including Fridays, Saturdays, and Sundays), and using geospatial measures (specifically roaming entropy and number and type of trigger points for alcohol use met) over 14 days. After adjusting for a compliance rate of at least 50%, 52 participants (26 male and twenty-four 14-year-olds) were included in the analyses.
ResultsGeneralized linear multilevel models revealed that higher positive affect (b=0.685, P=.007), higher rumination (b=0.586, P=.02), and a larger movement radius (roaming entropy) (b=8.126, P=.02) were positively associated with alcohol use on the same day. However, social context (b=–0.076, P=.90), negative affect (b=–0.077, P=.80), or potential trigger points (all P>.05) did not show significant associations. Alcohol use varied depending on the type of day, with more alcohol use on weekends (b=1.082, P<.001) and age (t50=–2.910, P=.005), with 16-year-olds (mean 1.61, SD 1.66) reporting more days of alcohol consumption than 14-year-olds (mean 0.548, SD 0.72).
ConclusionsOur findings support previously identified factors as significant contributors to very early and low levels of alcohol consumption through fine-grained analysis of daily behaviors. These factors include positive affect, rumination, weekend days, and age. In addition, we emphasize that exploratory environmental movement behavior (roaming entropy) is also significantly associated with adolescent alcohol use, highlighting its importance as an additional factor
Neurofeedback of Slow Cortical Potentials in Children with Attention-Deficit/Hyperactivity Disorder: A Multicenter Randomized Trial Controlling for Unspecific Effects
No full textBackground: Neurofeedback (NF) in children with attention-deficit/hyperactivity disorder (ADHD) has been investigated in a series of studies over the last years. Previous studies did not unanimously support NF as a treatment in ADHD. Most studies did not control for unspecific treatment effects and did not demonstrate that self-regulation took place. The present study examined the efficacy of NF in comparison to electromyographic (EMG) feedback to control for unspecific effects of the treatment, and assessed self-regulation of slow cortical potentials (SCPs). Methods: A total of 150 children aged 7-9 years diagnosed with ADHD (82% male; 43% medicated) were randomized to 25 sessions of feedback of SCPs (NF) or feedback of coordination of the supraspinatus muscles (EMG). The primary endpoint was the change in parents' ratings of ADHD core symptoms 4 weeks after the end of treatment compared to pre-tests. Results: Children in both groups showed reduced ADHD-core symptoms (NF 0.3, 95% CI -0.42 to -0.18; EMG 0.13, 95% CI -0.26 to -0.01). NF showed a significant superiority over EMG (treatment difference 0.17, 95% CI 0.02-0.3, p = 0.02). This yielded an effect size (ES) of d = 0.57 without and 0.40 with baseline observation carried forward (BOCF). The sensitivity analysis confirmed the primary result. Successful self-regulation of brain activity was observed only in NF. As a secondary result teachers reported no superior improvement from NF compared to EMG, but within-group analysis revealed effects of NF on the global ADHD score, inattention, and impulsivity. In contrast, EMG feedback did not result in changes despite more pronounced self-regulation learning. Conclusions: Based on the primary parent-rated outcome NF proved to be superior to a semi-active EMG feedback treatment. The study supports the feasibility and efficacy of NF in a large sample of children with ADHD, based on both specific and unspecific effects. Trial Register: Current controlled trials ISRCTN76187185, registered 5 February 2009
Exploring psychophysiological indices of disruptive behavior disorder and their subtypes of aggression
No full textBACKGROUND
Psychophysiological measures of arousal are often considered as potential biomarkers for disruptive behavior disorder (DBD). Nevertheless, the evidence is mixed, possibly reflecting the heterogeneity of DBD and different subtypes of aggression. Additionally, arousal measures of the central nervous system (e.g. electroencephalogram: EEG) are underrepresented compared to peripheral ones (heart rate: HR; skin conductance: SC).
METHODS
We recorded HR, SC, and EEG (frequency band power at three electrodes Fz, Cz, Pz) in 49 participants with DBD, and 15 typically developing peers during two resting state and an emotional task condition. Group differences were assessed by a repeated measure ANOVA and regression analyses were applied to evaluate subtype-specific patterns.
RESULTS
Our results showed higher mean HR activity in DBD participants, which was however driven by medicated participants and no significant group differences were found for SC. Interestingly, a significant group x frequency band interaction emerged for the EEG. DBD youth showed lower alpha activity. Regression analyses showed that higher theta and lower alpha band activity were related to more general aggression scores and higher delta and lower beta activity predicted proactive aggression.
CONCLUSIONS
The lack of robust and significant differences for peripheral measurements (HR and SC) fits with previous mixed findings for externalizing disorders. Our results suggest that EEG measurements might be more sensitive to detect group differences and higher delta and lower beta activity might represent an index of a proactive subtype of aggression
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