title: Neurofeedback in children with attention-deficit/hyperactivity disorder (ADHD)--a controlled multicenter study of a non-pharmacological treatment approach.
abstract: BACKGROUND
  Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood and has often a chronic course persisting into adulthood. However, up to 30% of children treated with stimulants either fail to show an improvement or suffer adverse side effects, including decreased appetite, insomnia and irritability and there is no evidence of long term efficacy of stimulants for ADHD. A series of studies has shown that neurofeedback is an effective additional or alternative treatment for children with ADHD, leading to e.g. significant and stable improvement in behavior, attention and IQ. Significant treatment effects of neurofeedback have also been verified in meta-analyses. Most of the trials, however, have been criticized for methodological difficulties, particularly lacking appropriate control conditions and number of patients included. This randomized study examines the efficacy of slow cortical potentials (SCP) -neurofeedback, controlling unspecific effects of the setting by comparing two active treatment modalities.
  
  
  METHODS
  A total of 144 patients with ADHD, older than six and younger than ten years, in some cases with additional pharmacological treatment, are included in this trial. In five trial centres patients are treated either with SCP-feedback or electromyographic (EMG) -feedback in 25 sessions within 3 months. A comprehensive test battery is conducted before and after treatment and at follow-up 6 month later, to assess core symptoms of ADHD, general psychopathology, attentional performance, comorbid symptoms, intelligence, quality of life and cortical arousal.
  
  
  CONCLUSIONS
  The efficacy of SCP-feedback training for children with ADHD is evaluated in this randomized controlled study. In addition to behavior ratings and psychometric tests neurophysiological parameters serve as dependent variables. Further, the choice of EMG-biofeedback as an active control condition is debated.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN76187185. Registered 5 February 2009.
authors.affiliation: Hospital for Child and Adolescent Psychiatry, LWL University Hospital Hamm of the Ruhr-University Bochum, Heithofer Allee 64, 59071 Hamm, Germany. martin.holtmann@wkp-lwl.org.
authors.forename: Martin
authors.initials: M
authors.lastname: Holtmann
authors.forename: Benjamin
authors.initials: B
authors.lastname: Pniewski
authors.forename: Daniel
authors.initials: D
authors.lastname: Wachtlin
authors.forename: Sonja
authors.initials: S
authors.lastname: Wörz
authors.forename: Ute
authors.initials: U
authors.lastname: Strehl
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002985:Clinical Protocols; D004311:Double-Blind Method; D004576:Electromyography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D058765:Neurofeedback / Q000379:methods*; D011581:Psychological Tests; D016896:Treatment Outcome