Neurofeedback and Cognitive Attention Training for Children with Attention-Deficit Hyperactivity Disorder in Schools

Objective: To evaluate the efficacy of 2 computer attention training systems administered in school for children with attention-deficit hyperactivity disorder (ADHD). Method: Children in second and fourth grade with a diagnosis of ADHD (n = 104) were randomly assigned to neurofeedback (NF) (n = 34), cognitive training (CT) (n = 34), or control (n = 36) conditions. A 2-point growth model assessed change from pre-post intervention on parent reports (Conners 3-Parent [Conners 3-P]; Behavior Rating Inventory of Executive Function [BRIEF] rating scale), teacher reports (Swanson, Kotkin, Agler, M-Flynn and Pelham scale [SKAMP]; Conners 3-Teacher [Conners 3-T]), and systematic classroom observations (Behavioral Observation of Students in Schools [BOSS]). Paired t tests and an analysis of covariance assessed change in medication. Results: Children who received NF showed significant improvement compared with those in the control condition on the Conners 3-P Attention, Executive Functioning and Global Index, on all BRIEF summary indices, and on BOSS motor/verbal off-task behavior. Children who received CT showed no improvement compared to the control condition. Children in the NF condition showed significant improvements compared to those in the CT condition on Conners 3-P Executive Functioning, all BRIEF summary indices, SKAMP Attention, and Conners 3-T Inattention subscales. Stimulant medication dosage in methylphenidate equivalencies significantly increased for children in the CT (8.54 mg) and control (7.05 mg) conditions but not for those in the NF condition (0.29 mg). Conclusion: Neurofeedback made greater improvements in ADHD symptoms compared to both the control and CT conditions. Thus, NF is a promising attention training treatment intervention for children with ADHD.

[1]  W. Pelham,et al.  An evaluation of the summer treatment program for children with attention-deficit/hyperactivity disorder using a treatment withdrawal design , 2004 .

[2]  A. Goldberg,et al.  Stigma, social context, and mental health: lesbian and gay couples across the transition to adoptive parenthood. , 2011, Journal of counseling psychology.

[3]  R. Brennan,et al.  Reconsidering work time: a multivariate longitudinal within-couple analysis , 2009 .

[4]  H. Heinrich,et al.  Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. , 2009, Journal of child psychology and psychiatry, and allied disciplines.

[5]  H. Abikoff,et al.  Behavior therapy and methylphenidate in the treatment of children with ADHD , 1997 .

[6]  Asha K. Jitendra,et al.  The Effects of Computer-Assisted Instruction on the Mathematics Performance and Classroom Behavior of Children With ADHD , 2005, Journal of attention disorders.

[7]  J. Swanson,et al.  Effects of stimulant medication on growth rates across 3 years in the MTA follow-up. , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[8]  K. Soeken,et al.  Parental Perceptions and Satisfaction with Stimulant Medication for Attention‐Deficit Hyperactivity Disorder , 2003, Journal of developmental and behavioral pediatrics : JDBP.

[9]  P. Malone,et al.  A Randomized Trial of Two Promising Computer-Based Interventions for Students with Attention Difficulties , 2010, Journal of abnormal child psychology.

[10]  David Coghill,et al.  Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. , 2013, The American journal of psychiatry.

[11]  M. Arns,et al.  Neurofeedback and Basic Learning Theory: Implications for Research and Practice , 2011 .

[12]  Edward S. Shapiro,et al.  Observing Students in Classroom Settings: A Review of Seven Coding Schemes , 2005 .

[13]  Stephen W. Raudenbush,et al.  A multivariate hierarchical model for studying psychological change within married couples. , 1995 .

[14]  H. Kraemer,et al.  ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[15]  Craig K. Enders,et al.  A Primer on Maximum Likelihood Algorithms Available for Use With Missing Data , 2001 .

[16]  A. Nierenberg,et al.  Review of Medication Adherence in Children and Adults with ADHD , 2010, Postgraduate medicine.

[17]  Radley Christopher Sheldrick,et al.  Computer-Based Attention Training in the Schools for Children With Attention Deficit/Hyperactivity Disorder: A Preliminary Trial , 2011, Clinical pediatrics.

[18]  J. Swanson,et al.  A measure of ADHD-related classroom impairment based on targets for behavioral intervention , 1997 .

[19]  D. Sackett,et al.  Superiority trials, non-inferiority trials, and prisoners of the 2-sided null hypothesis , 2004, ACP journal club.

[20]  Subcommittee on Attention-Deficit,et al.  Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder. , 2001, Pediatrics.

[21]  H. Forssberg,et al.  Computerized training of working memory in children with ADHD--a randomized, controlled trial. , 2005, Journal of the American Academy of Child and Adolescent Psychiatry.

[22]  M. Prior,et al.  Do Executive Function Deficits Differentiate Between Adolescents with ADHD and Oppositional Defiant/Conduct Disorder? A Neuropsychological Study Using the Six Elements Test and Hayling Sentence Completion Test , 2000, Journal of abnormal child psychology.

[23]  P. S. Jensen.  ARE STIMULANTS OVERPRESCRIBED , 2000 .

[24]  S. Compton,et al.  Review of the evidence base for treatment of childhood psychopathology: externalizing disorders. , 2002, Journal of consulting and clinical psychology.

[25]  Vincent J Monastra,et al.  Electroencephalographic Biofeedback in the Treatment of Attention-Deficit/Hyperactivity Disorder , 2005, Applied psychophysiology and biofeedback.

[26]  S. Faraone,et al.  Effect of stimulants on height and weight: a review of the literature. , 2008, Journal of the American Academy of Child and Adolescent Psychiatry.

[27]  H. Singer,et al.  Validity of the behavior rating inventory of executive function in children with ADHD and/or Tourette syndrome. , 2002, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[28]  Ihab S. Soliman,et al.  Stimulant medications for the treatment of ADHD: Efficacy and limitations , 1999 .

[29]  W. Burns,et al.  Computer-Assisted Cognitive Training for ADHD , 1996 .

[30]  C. Hoven,et al.  Are stimulants overprescribed? Treatment of ADHD in four U.S. communities. , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.

[31]  John B. Willett,et al.  Questions and Answers in the Measurement of Change , 1988 .

[32]  A. Erkanli,et al.  Impaired but undiagnosed. , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.

[33]  G. Gioia,et al.  TEST REVIEW Behavior Rating Inventory of Executive Function , 2000 .

[34]  Veronica L. Raggi,et al.  Interventions to Address the Academic Impairment of Children and Adolescents with ADHD , 2006, Clinical child and family psychology review.

[35]  M. Monuteaux,et al.  Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children. , 2004, Journal of consulting and clinical psychology.

[36]  J. Swanson,et al.  Psychosocial Treatment Strategies in the MTA Study: Rationale, Methods, and Critical Issues in Design and Implementation , 2000, Journal of abnormal child psychology.

[37]  Yehoshua Tsal,et al.  Computerized Progressive Attentional Training (CPAT) Program: Effective Direct Intervention for Children with ADHD , 2007, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[38]  Andrea Chronis-Tuscano,et al.  A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. , 2009, Clinical psychology review.

[39]  Steven W. Evans,et al.  Dose-response effects of methylphenidate on ecologically valid measures of academic performance and classroom behavior in adolescents with ADHD. , 2001, Experimental and clinical psychopharmacology.

[40]  J. Buitelaar,et al.  To stop or not to stop? How long should medication treatment of attention-deficit hyperactivity disorder be extended? , 2011, European Neuropsychopharmacology.

[41]  A. Morrow,et al.  Parental perceptions of adverse educational outcomes among children diagnosed and treated for ADHD: A call for improved school/provider collaboration , 2002 .

[42]  Veronica L. Raggi,et al.  Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. , 2006, Clinical psychology review.

[43]  R. Perou,et al.  Increasing prevalence of parent-reported attention-deficit/hyperactivity disorder among children --- United States, 2003 and 2007. , 2010, MMWR. Morbidity and mortality weekly report.

[44]  R. Brennan,et al.  Development and testing of a direct observation code training protocol for elementary aged students with attention deficit/hyperactivity disorder , 2013 .

[45]  Asha K. Jitendra,et al.  Classroom observations of students with and without ADHD: Differences across types of engagement , 2006 .

[46]  M. Arns,et al.  Efficacy of Neurofeedback Treatment in ADHD: The Effects on Inattention, Impulsivity and Hyperactivity: A Meta-Analysis , 2009, Clinical EEG and neuroscience.