title: Neurofeedback Training Effects on Inhibitory Brain Activation in ADHD: A Matter of Learning?
abstract: Neurofeedback training (NF) is a promising non-pharmacological treatment for ADHD that has been associated with improvement of attention-deficit/hyperactivity disorder (ADHD)-related symptoms as well as changes in electrophysiological measures. However, the functional localization of neural changes following NF compared to an active control condition, and of successful learning during training (considered to be the critical mechanism for improvement), remains largely unstudied. Children with ADHD (N=16, mean age: 11.81, SD: 1.47) were randomly assigned to either slow cortical potential (SCP, n=8) based NF or biofeedback control training (electromyogram feedback, n=8) and performed a combined Flanker/NoGo task pre- and post-training. Effects of NF, compared to the active control, and of learning in transfer trials (approximating successful transfer to everyday life) were examined with respect to clinical outcome and functional magnetic resonance imaging (fMRI) changes during inhibitory control. After 20 sessions of training, children in the NF group presented reduced ADHD symptoms and increased activation in areas associated with inhibitory control compared to baseline. Subjects who were successful learners (n=9) also showed increased activation in an extensive inhibitory network irrespective of the type of training. Activation increased in an extensive inhibitory network following NF training, and following successful learning through NF and control biofeedback. Although this study was only powered to detect large effects and clearly requires replication in larger samples, the results suggest a crucial role for learning effects in biofeedback trainings.
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Baumeister
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany; Department Neuroimaging, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Isabella
authors.initials: I
authors.lastname: Wolf
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Holz
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Regina
authors.initials: R
authors.lastname: Boecker-Schlier
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Adamo
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany; LWL-University Hospital for Child and Adolescent Psychiatry Hamm, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Holtmann
authors.affiliation: Department Neuroimaging, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Ruf
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Banaschewski
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hohmann
authors.affiliation: Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland; Neuroscience Centre Zurich, University and ETH Zurich, Zurich, Switzerland. Electronic address: daniel.brandeis@zi-mannheim.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Brandeis
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000534:rehabilitation*; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology*; D002648:Child; D004569:Electroencephalography; D004576:Electromyography; D005260:Female; D006801:Humans; D007266:Inhibition, Psychological; D007858:Learning / Q000502:physiology; D008279:Magnetic Resonance Imaging; D008297:Male; D058765:Neurofeedback / Q000379:methods / Q000502:physiology; D000068356:Self-Control; D016896:Treatment Outcome
keywords: ADHD; Neurofeedback; fMRI; inhibitory control; learning