Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Originalartikel

Long-term Effects of a Multimodal Behavioural ADHD Training: a fMRI Study

Published Online:November 27, 2012https://doi.org/10.1024/1016-264X/a000075

Abstract

Several studies have demonstrated that behavioural therapy oriented interventions exert a positive influence on the clinical course of the attention-deficit hyperactivity disorder (ADHD). However, the long-term effects of the behavioral treatment in ADHD, especially those on neuronal mechanisms underlying this disorder, have been studied insufficiently. Functional MRI (Go-NoGo paradigm) was carried out in 9 children with ADHD before and 1.5 years after a response cost and token-based training. In the follow-up, patients were still characterized by a significant increase in activation in the anterior cingulate and in the precentral gyrus compared with recordings done before the training. It seems likely that the behavioural training elicits stable neuronal changes in children with ADHD which correspond with an improvement of neuropsychological functioning and clinical symptoms.


Langzeiteffekte eines multimodalen verhaltenstherapeutischen ADHS-Trainings: fMRT-Studie

Obwohl die Effektivität verhaltenstherapeutischer Interventionen bei Kindern mit Aufmerksamkeitsdefizit/Hyperaktivitätsstörung (ADHS) in früheren Studien ausführlich untersucht wurde, sind die Langzeiteffekte verhaltenstherapeutischer Programme bei ADHS, besonders auf neuronale Mechanismen dieser Erkrankung, nicht ausreichend erforscht. In dieser Studie, funktionelle Magnetresonanztomographie (Go-NoGo-Paradigma) wurde bei 9 Kindern mit ADHS vor und 1,5 Jahre nach einem intensiven Response-cost-Training durchgeführt. In der Katamnese zeigten die Patienten eine signifikant stärkere Aktivierung im anterioren Gyrus cinguli und in dem präzentralen Gyrus verglichen mit den Daten vor dem Training. Das Trainingsprogramm scheint langfristige neuronale Veränderungen im Netzwerk der Impulskontrolle bei Kindern mit ADHS verursacht zu haben, korrespondierend mit der signifikanten Besserung im klinischen Verlauf der Störung sowie neuropsychologischen Funktionsniveau der Patienten.

References

  • American Psychiatric Association (1994). Diagnostic and Statistical Manual of mental disorders (4 ed.). Washington, DC: American Psychiatric Association. First citation in articleGoogle Scholar

  • Banaschewski, T. , Yordanova, J. , Kolev, V. , Heinrich, H. , Albrecht, B. & Rothenberger, A. (2008). Stimulus context and motor preparation in attention-deficit/hyperactivity disorder. Biological Psychology, 77, 53 – 62. First citation in articleCrossref, Google Scholar

  • Beauregard, M. & Levesque, J. (2006). Functional magnetic resonance imaging investigation of the effects of neurofeedback training on the neural bases of selective attention and response inhibition in children with attention-deficit/hyperactivity disorder. Applied Psychophysiology and Biofeedback, 31, 3 – 20. First citation in articleCrossref, Google Scholar

  • Bender, S. , Resch, F. , Klein, C. , Renner, T. , Fallgatter, A. J. , Weisbrod, M. et al. (in press). Influence of stimulant medication and response speed on lateralization of movement-related potentials in attention-deficit/hyperactivity disorder. PlosOne. First citation in articleGoogle Scholar

  • Booth, J. R. , Burman, D. D. , Meyer, J. R. , Lei, Z. , Trommer, B. L. , Davenport, N. D. et al. (2005). Larger deficits in brain networks for response inhibition than for visual selective attention in attention deficit hyperactivity disorder (ADHD). Journal of Child Psychology and Psychiatry, 46, 94 – 111. First citation in articleCrossref, Google Scholar

  • Broshek, D. K. & Jeffrey, T. B. (2000). The Halstead-Reitan Neuropsychological Test Battery. In G. Groth-Marnat (Ed.). Neuropsychological assessment in clinical practice: A guide to test interpretation and integration (pp. 223 – 262). New York: Wiley. First citation in articleGoogle Scholar

  • Carlson, C. L. & Tamm, L. (2000). Responsiveness of children with attention deficit-hyperactivity disorder to reward and response cost: differential impact on performance and motivation. Journal of Consulting and Clinical Psychology, 68, 73 – 83. First citation in articleCrossref, Google Scholar

  • Daly, B. P. , Creed, T. , Xanthopoulos, M. & Brown, R. T. (2007). Psychosocial treatments for children with attention deficit/hyperactivity disorder. Neuropsychology Review, 17, 73 – 89. First citation in articleCrossref, Google Scholar

  • Dodds, C. M. , Muller, U. , Clark, L. , van Loon, A. , Cools, R. & Robbins, T. W. (2008). Methylphenidate has differential effects on blood oxygenation level-dependent signal related to cognitive subprocesses of reversal learning. Journal of Neuroscience, 28, 5976 – 5982. First citation in articleCrossref, Google Scholar

  • Döpfner, M. & Lehmkuhl, G. (2000). Diagnostik-System für psychische Störungen im Kindes- und Jugendalter (DISYPS-KJ). (2., veränd. Aufl.), Bern: Huber. First citation in articleGoogle Scholar

  • Durston, S. , Mulder, M. , Casey, B. J. , Ziermans, T. & van Engeland, H. (2006). Activation in ventral prefrontal cortex is sensitive to genetic vulnerability for attention-deficit hyperactivity disorder. Biological Psychiatry, 60, 1062 – 1070. First citation in articleCrossref, Google Scholar

  • Eickhoff, S. B. , Stephan, K. E. , Mohlberg, H. , Grefkes, C. , Fink, G. R. , Amunts, K. et al. (2005). A new SPM toolbox for combining probabilistic cytoarchitectonic maps and functional imaging data. NeuroImage, 25, 1325 – 1335. First citation in articleCrossref, Google Scholar

  • Epstein, J. N. (2009). A pathophysiology of attention deficit/hyperactivity disorder: clues from neuroimaging. In: J. M. Rumsey & M. Ernst (eds). NeuroImaging in developmental clinical neuroscience (pp. 113 – 129). Cambridge: Cambridge University Press. First citation in articleGoogle Scholar

  • Fabiano, G. A. , Pelham, W. E. , Coles, E. K. , Gnagy, E. M. , Chronis-Tuscano, A. & O’Conner, B. C. (2008). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29, 129 – 140. First citation in articleCrossref, Google Scholar

  • Freyer, T. , Klöppel, S. , Tüscher, O. , Kordon, A. , Zurowski, B. , Kuelz, A. K. et al. (2011). Frontostriatal activation in patients with obsessive-compulsive disorder before and after cognitive behavioral therapy. Psychological Medicine, 41, 207 – 216. First citation in articleCrossref, Google Scholar

  • Friston, K. J. , Holmes, A. P. & Worsley, K. P. (1995). Statistical parametric maps in functional imaging: a general linear approach. Human Brain Mapping, 2, 189 – 210. First citation in articleCrossref, Google Scholar

  • Gawrilow, C. , Schmitt, K. & Rauch, W. (2011). Kognitive Kontrolle und Selbstregulation bei Kindern mit ADHS. Kindheit und Entwicklung, 20, 41 – 48. First citation in articleLink, Google Scholar

  • Gerber-von Müller, G. , Petermann, U. , Petermann, F. , Niederberger, U. , Stephani, U. , Siniatchkin, M. et al. (2009). Das ADHS-Summer camp – Entwicklung und Evaluation eines multimodalen Programms. Kindheit und Entwicklung, 18, 162 – 172. First citation in articleLink, Google Scholar

  • Gerber, W.-D. , Gerber-von Müller, G. , Petermann, U. , Niederberger, U. & Siniatchkin, M. (2012). Effectiveness of a multimodal behavioral summer camp program for attention deficit/hyperactivity disorder. The impact on neuropsychological functioning. Child Neuropsychology, 18, 242 – 255. First citation in articleCrossref, Google Scholar

  • Gilbert, D. L. , Isaacs, K. M. , Augusta, M. , Macnell, L. K. & Mostofsky, S. H. (2011). Motor cortex inhibition: a marker of ADHD behavior and motor development in children. Neurology, 76, 615 – 621. First citation in articleCrossref, Google Scholar

  • Gilsbach, S. , Günther, T. & Konrad, K. (2011). Was wissen wir über Langzeiteffekte von Methylphenidatbehandlung auf die Hirnentwicklung von Kindern und Jugendlichen mit Aufmerksamkeitsdefizit-/ Hyperaktivitätsstörung (ADHS)? Zeitschrift für Neuropsychologie, 22, 121 – 129. First citation in articleLink, Google Scholar

  • Görtz, A. , Döpfner, M. , Nowak, A. , Bonus, B. & Lehmkuhl, G. (2002). Ist das Selbsturteil Jugendlicher bei der Diagnostik von Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen hilfreich? Eine Analyse mit dem Diagnostiksystem DISYPS. Kindheit und Entwicklung, 11, 82 – 89. First citation in articleLink, Google Scholar

  • Hasselhorn, M. & Hartmann, U. (2011). Lern- und Aufmerksamkeitsstörungen. Kindheit und Entwicklung, 20, 1. – 3. First citation in articleLink, Google Scholar

  • Hodgson, K. , Hutchinson, A. D. & Denson, L. (in press). Nonpharmacological treatments for ADHD: A meta-analytic review. Journal of Attention Disorders. First citation in articleGoogle Scholar

  • Huyser, C. , Veltman, D. J. , Wolters, L. H. , de Haan, E. & Boer, F. (2011). Developmental aspects of error and high-conflict-related brain activity in pediatric obsessive-compulsive disorder: a fMRI study with a Flanker task before and after CBT. Journal of Child Psychology and Psychiatry, 52, 1251 – 1260. First citation in articleCrossref, Google Scholar

  • Jaffard, M. , Longcamp, M. , Velay, J. L. , Anton, J. L. , Roth, M. , Nazarian, B. et al. (2008). Proactive inhibitory control of movement assessed by event-related fMRI. NeuroImage, 42, 1196 – 1206. First citation in articleCrossref, Google Scholar

  • Klein, C. , Wendling, K. , Huettner, P. , Ruder, H. & Peper, M. (2006). Intra-subject variability in attention-deficit hyperactivity disorder. Biological Psychiatry, 60, 1088 – 1097. First citation in articleCrossref, Google Scholar

  • Langberg, J. M. , Epstein, J. N. & Graham, A. J. (2008). Organizational-skills interventions in the treatment of ADHD. Expert Review of Neurotherapeutics, 8, 1549 – 1561. First citation in articleCrossref, Google Scholar

  • Levesque, J. , Beauregard, M. & Mensour, B. (2006). 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, 394, 216 – 221. First citation in articleCrossref, Google Scholar

  • Moll, G. H. , Heinrich, H. , Trott, G. , Wirth, S. & Rothenberger, A. (2000). Deficient intracortical inhibition in drug-naive children with attention-deficit hyperactivity disorder is enhanced by methylphenidate. Neuroscience Letters, 21, 121 – 125. First citation in articleCrossref, Google Scholar

  • Northup, J. , Fusilier, I. , Swanson, V. , Huete, J. , Bruce, T. , Freeland, J. et al. (1999). Further analysis of the separate and interactive effects of methylphenidate and common classroom contingencies. Journal of Applied Behavior Analysis, 32, 35 – 50. First citation in articleCrossref, Google Scholar

  • Pelham, W. E. , Greiner, A. R. & Gnagy, E. M. (1997). Children’s summer treatment program manual. Buffalo: Comprehensive Treatment for Attention Deficit Disorder. First citation in articleGoogle Scholar

  • Petermann, F. & Jänke, L. (2012). Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung. Zeitschrift für Neuropsychologie, 23, 191 – 192. First citation in articleLink, Google Scholar

  • Reitman, D. , Hupp, S. D. , O’Callaghan, P. M. , Gulley, V. & Northup, J. (2001). The influence of a token economy and methylphenidate on attentive and disruptive behavior during sports with ADHD-diagnosed children. Behavior Modification, 25, 305 – 323. First citation in articleCrossref, Google Scholar

  • Rubia, K. , Halari, R. , Cubillo, A. , Mohammad, A. M. , Brammer, M. & Taylor, E. (2009). Methylphenidate normalises activation and functional connectivity deficits in attention and motivation networks in medication-naive children with ADHD during a rewarded continuous performance task. Neuropharmacology, 57, 640 – 652. First citation in articleCrossref, Google Scholar

  • Rubia, K. , Overmeyer, S. , Taylor, E. , Brammer, M. , Williams, S. C. , Simmons, A. et al. (1999). Hypofrontality in attention deficit hyperactivity disorder during higher-order motor control: a study with functional MRI. American Journal of Psychiatry, 156, 891 – 896. First citation in articleCrossref, Google Scholar

  • Rubia, K. , Smith, A. B. , Brammer, M. J. & Taylor, E. (2007). Temporal lobe dysfunction in medication-naïve boys with attention-deficit/hyperactivity disorder during attention allocation and its relation to response variability. Biological Psychiatry, 62, 999 – 1006. First citation in articleCrossref, Google Scholar

  • Schmidt, S. , Ender, S. , Schultheiß, J. , Gerber-von Müller, G. , Gerber, W.-D. , Steinmann, E. et al. (2012). Langzeiteffekte einer intensiv-verhaltenstherapeutischen Massnahme bei Kindern mit ADHD. Kindheit und Entwicklung, 21, 90 – 102. First citation in articleLink, Google Scholar

  • Schmidt, S. & Petermann, F. (2009). Developmental psychopathology: Attention Deficit Hyperactivity Disorder (ADHD). BMC Psychiatry, 9, Art. Nr. 58. First citation in articleCrossref, Google Scholar

  • Siniatchkin, M. , Glatthaar, N. , Gerber-von Müller, G. , Prehn-Kristensen, A. , Wolff, S. , Knöchel, S. et al. (2012). Behavioral treatment increases activity in the cognitive neuronal networks in children with attention deficit/hyperactivity disorder. Brain Topography, 25, 332 – 344. First citation in articleCrossref, Google Scholar

  • Smith, A. B. , Taylor, E. , Brammer, M. , Toone, B. & Rubia, K. (2006). Task-specific hypoactivation in prefrontal and temporoparietal brain regions during motor inhibition and task switching in medication-naive children and adolescents with attention deficit hyperactivity disorder. American Journal of Psychiatry, 163, 1044 – 1051. First citation in articleCrossref, Google Scholar

  • Suskauer, S. J. , Simmonds, D. J. , Caffo, B. S. , Denckla, M. B. , Pekar, J. J. & Mostofsky, S. H. (2008). fMRI of intrasubject variability in ADHD: anomalous premotor activity with prefrontal compensation. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1141 – 1150. First citation in articleCrossref, Google Scholar

  • Swanson, J. , Arnold, L. E. , Kraemer, H. , Hechtman, L. , Molina, B. , Hinshaw, S. et al. (2008). Evidence, Interpretation, and Qualification from Multiple reports of long-term outcomes in the Multimodal Treatment Study of children with ADHD (MTA): Part I: executive summary. Journal of Attention Disorders, 12, 4 – 14. First citation in articleCrossref, Google Scholar

  • Tamm, L. & Carlson, C. L. (2007). Task demands interact with the single and combined effects of medication and contingencies on children with ADHD. Journal of Attention Disorders, 10, 372 – 380. First citation in articleCrossref, Google Scholar

  • Tamm, L. , Menon, V. , Ringel, J. & Reiss, A. L. (2004). Event-related FMRI evidence of frontotemporal involvement in aberrant response inhibition and task switching in attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1430 – 1440. First citation in articleCrossref, Google Scholar

  • Toussaint, A. , Petermann, F. , Schmidt, S. , Petermann, U. , Gerber-von Müller, G. , Siniatchkin, M. et al. (2011). Effectiveness of behavioral therapy on attention regulation and executive functioning in children and adolescents with ADHD. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 59, 25 – 36. First citation in articleLink, Google Scholar

  • Uebel, H. , Albrecht, B. , Asherson, P. , Borger, N. A. , Butler, L. , Chen, W. et al. (2010). Performance variability, impulsivity errors and the impact of incentives as gender-independent endophenotypes for ADHD. Journal of Child Psychology and Psychiatry, 51, 210 – 218. First citation in articleCrossref, Google Scholar

  • Vaidya, C. J. , Austin, G. , Kirkorian, G. , Ridlehuber, H. W. , Desmond, J. E. , Glover, G. H. et al. (1998). Selective effects of methylphenidate in attention deficit hyperactivity disorder: a functional magnetic resonance study. Proceedings of the National Academy of Science USA, 95, 14494 – 14499. First citation in articleCrossref, Google Scholar

  • Witthöft, J. , Koglin, U. & Petermann, F. (2010). Zur Komorbidität von aggressivem Verhalten und ADHS. Kindheit und Entwicklung, 19, 218 – 227. First citation in articleLink, Google Scholar