Neurofeedback-Training bei Kindern mit Aufmerksamkeitsdefizit-/ Hyperaktivitätsstörung (ADHS)
Effekte auf Verhaltens- und neurophysiologischer Ebene
Abstract
Im Rahmen einer multizentrischen, randomisierten, kontrollierten Studie evaluierten wir die klinische Wirksamkeit eines Neurofeedback-Trainings (NF) bei Kindern mit einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) und untersuchten die einem erfolgreichen Training zugrunde liegenden neurophysiologischen Wirkmechanismen. Als Vergleichstraining diente ein computergestütztes Aufmerksamkeitstraining, das dem Setting des Neurofeedback-Trainings in den wesentlichen Anforderungen und Rahmenbedingungen angeglichen war. Auf Verhaltensebene (Eltern- und Lehrerbeurteilung) zeigte sich das NF-Training nach Trainingsende dem Kontrolltraining sowohl hinsichtlich der ADHS-Kernsymptomatik als auch in assoziierten Bereichen überlegen. Für das Hauptzielkriterium (Verbesserung im FBB-HKS Gesamtwert) ergab sich eine mittlere Effektstärke (von 0.6). Sechs Monate nach Trainingsende (follow-up) konnte das gleiche Ergebnismuster gefunden werden. Die Ergebnisse legen somit den Schluss nahe, dass NF einen klinisch wirksamen Therapiebaustein zur Behandlung von Kindern mit ADHS darstellt. Auf neurophysiologischer Ebene (EEG; ereignisbezogene Potentiale, EPs) konnten für die beiden Neurofeedback-Protokolle Theta/Beta-Training und Training langsamer kortikaler Potentiale spezifische Effekte aufgezeigt werden. So war für das Theta/Beta-Training beispielsweise die Abnahme der Theta-Aktivität mit einer Reduzierung der ADHS-Symptomatik assoziiert. Für das SCP-Training wurde u. a. im Attention Network Test eine Erhöhung der kontingenten negativen Variation beobachtet, die die mobilisierten Ressourcen bei Vorbereitungsprozessen widerspiegelt. EEG- und EP-basierte Prädiktorvariablen konnten ermittelt werden. Der vorliegende Artikel bietet einen Gesamtüberblick über die in verschiedenen Publikationen unserer Arbeitsgruppe beschriebenen Ergebnisse der Studie und zeigt zukünftige Fragestellungen auf.
In a multicentre randomised controlled trial, we evaluated the clinical efficacy of neurofeedback (NF) training in children with ADHD and investigated the mechanisms underlying a successful training. We used an attention skills training, coupled with the training setting and demands made upon participants, as the control condition. At the behavioural level, NF was superior to the control group concerning core ADHD symptomatology as well as associated domains. For the primary outcome measure (improvement in the FBB-HKS total score), the effect size was .60. The same pattern of results was obtained at the 6-month follow-up. Thus, NF may be seen as a clinically effective module in the treatment of children with ADHD. At the neurophysiological level (EEG, ERPs), specific effects for the two NF protocols, theta/beta training, and training of slow cortical potentials were demonstrated. For example, for theta/beta training, a decrease of theta activity in the EEG was associated with a reduction of ADHD symptomatology. SCP training was accompanied inter alia by an increase in the contingent negative variation in the attention network test; thus, children were able to allocate more resources for preparation. EEG- and ERP-based predictors were also found. The present article reviewed the findings of the original papers related to the trial and outlines future research topics.
Literatur
1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Washington, DC: American Psychiatric Press.
. (2009). Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: A meta-analysis. Clinical EEG and Neuroscience, 40, 180–189.
(2007). Annotation: What electrical brain activity tells us about brain function that other techniques cannot tell us – a child psychiatric perspective. Journal of Child Psychology and Psychiatry, 48, 415–435.
(2003). A review of electrophysiology in attention-deficit/hyperactivity disorder: I. Qualitative and quantitative electroencephalography. Clinical Neurophysiology, 114, 171–183.
(2009). Electroencephalogram theta/beta ratio and arousal in attention-deficit/hyperactivity disorder: Evidence of independent processes. Biological Psychiatry, 66, 398–401.
(1990). Slow potentials of the cerebral cortex and behavior. Physiological Reviews, 70, 1–41.
(2008). Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Annals of Internal Medicine, 148, 295–310.
(2007). Cleaning the data and clearing the ashtray. Journal of Advanced Methods in Flawless Science, 47(11), 8–15.
(2008). Slow cortical potential neurofeedback in attention deficit hyperactivity disorder: Is there neurophysiological evidence for specific effects? Journal of Neural Transmission, 115, 1445–1456.
(2000). DISYPS-KJ – Diagnostik-System für psychische Störungen im Kindes- und Jugendalter. Bern: Hans Huber.
(2002). Therapieprogramm für Kinder mit hyperkinetischem und oppositionellem Problemverhalten (THOP). Weinheim: Beltz.
(2007). Controlled evaluation of a neurofeedback training of slow cortical potentials in children with attention-deficit/hyperactivity disorder (ADHD). Behavioural and Brain Functions, 3, 35.
(2003). Ecological validity of neurofeedback: Modulation of slow wave EEG enhances musical performance. Neuroreport, 14, 1221–1224.
(2004). EEG biofeedback of low beta band components: Frequency-specific effects on variables of attention and event-related brain potentials. Clinical Neurophysiology, 115, 131–139.
(2002). Altered cortical activity in children with attention-deficit/hyperactivity disorder during attentional load task. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 811–819.
(2002). Testing the efficiency and independence of attentional networks. Journal of Cognitive Neuroscience, 14, 340–347.
(2003). Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: A comparison with methylphenidate. Applied Psychophysiology and Biofeedback, 28, 1–12.
(2010). Neurofeedback training in children with ADHD: 6-month follow-up of a randomised controlled trial. European Child and Adolescent Psychiatry, 19, 715–724. (DOI: 10.1007/s00787–010–0109–5).
(2009). Distinct EEG effects related to neurofeedback training in children with ADHD: A randomized controlled trial. International Journal of Psychophysiology, 74, 149–157.
(2009). Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. Journal of Child Psychology and Psychiatry, 50, 780–789.
(1995). Predicting employment for students who leave special education high school programs. Exceptional Children, 61, 472–487.
(2008). EEG-vigilance differences between patients with borderline personality disorder, patients with obsessive-compulsive disorder and healthy controls. European Archives of Psychiatry and Clinical Neuroscience, 258, 137–143.
(2004). Training of slow cortical potentials in attention-deficit/hyperactivity disorder: Evidence for positive behavioral and neurophysiological effects. Biological Psychiatry, 55, 772–775.
(2007). Annotation: Neurofeedback – train your brain to train behaviour. Journal of Child Psychology and Psychiatry, 48, 3–16.
(2004). Neurofeedback in der Behandlung der Aufmerksamkeitsdefizit-Hyperaktivitätsstörung (ADHS) im Kindes- und Jugendalter. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 32, 187–200.
(1991). The influence of electrocortical biofeedback on performance in pre-elite archers. Medicine and Science in Sports and Exercise, 23, 123–129.
(2006). Neurofeedback for children with ADHD: A comparison of SCP- and theta/beta-protocols. Praxis für Kinderpsychologie und Kinderpsychiatrie, 55, 384–407.
(2010). Preliminary tomographic neurofeedback results from children with ADHD, 18. Deutsches EEG/EP Mapping Meeting. Human Cognitive Neurophysiology, 3, 54–55.
(2005). Clinical utility of EEG in attention-deficit/hyperactivity disorder. Applied Neuropsychology, 12, 64–76.
(1991). How «blind» are double-blind studies? Journal of Consultant and Clinical Psychology, 59, 184–187.
(2002). The effects of stimulant therapy, EEG-biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder. Applied Psychophysiology and Biofeedback, 27, 231–249.
(1990). The attention system of human brain. Annual Review of Neuroscience, 13, 25–42.
(1975). Arousal, activation and effort in the control of attention. Psychological Review, 82, 116–149.
(2009). Brain oscillations forever – neurophysiology in future research of child psychiatric problems. Journal of Child Psychology and Psychiatry, 50, 79–86.
(1999). Information processing and energetic factors in attention-deficit/hyperactivity disorder. In , Handbook of disruptive behavior disorders (pp. 75–104). New York: Plenum.
(2006). Self-regulation of slow cortical potentials: A new treatment for children with attention-deficit/hyperactivity disorder. Pediatrics, 118, 1530–1540.
(2004). European clinical guidelines for hyperkinetic disorder – first upgrade. European Child and Adolescent Psychiatry, 13(Suppl. 1), I7–30.
(2008). Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children with ADHD: A meta-analysis. Clinical Psychology Review, 28, 783–800.
(2010). Neurofeedback in children with ADHD: Specific event-related potential findings of a randomized controlled trial. Clinical Neurophysiology. DOI: 10.1016/j.clinph.2010.06.036.
(2004). Normative data and scale properties of the German parent SDQ. European Child & Adolescent Psychiatry, 13(Suppl. 2), 11–16.
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