An RCT into the effects of neurofeedback on neurocognitive functioning compared to stimulant medication and physical activity in children with ADHD.
Neurofeedback (NFB) is a potential alternative treatment for children with ADHD that aims to optimize brain activity. Whereas most studies into NFB have investigated behavioral effects, less attention has been paid to the effects on neurocognitive functioning. The present randomized controlled trial (RCT) compared neurocognitive effects of NFB to (1) optimally titrated methylphenidate (MPH) and (2) a semi-active control intervention, physical activity (PA), to control for non-specific effects. Using a multicentre three-way parallel group RCT design, children with ADHD, aged 7-13, were randomly allocated to NFB (n = 39), MPH (n = 36) or PA (n = 37) over a period of 10-12 weeks. NFB comprised theta/beta training at CZ. The PA intervention was matched in frequency and duration to NFB. MPH was titrated using a double-blind placebo controlled procedure to determine the optimal dose. Neurocognitive functioning was assessed using parameters derived from the auditory oddball-, stop-signal- and visual spatial working memory task. Data collection took place between September 2010 and March 2014. Intention-to-treat analyses showed improved attention for MPH compared to NFB and PA, as reflected by decreased response speed during the oddball task [ηp2= 0.21, p < 0.001], as well as improved inhibition, impulsivity and attention, as reflected by faster stop signal reaction times, lower commission and omission error rates during the stop-signal task (range ηp2= 0.09-0.18, p values <0.008). Working memory improved over time, irrespective of received treatment (ηp2= 0.17, p < 0.001). Overall, stimulant medication showed superior effects over NFB to improve neurocognitive functioning. Hence, the findings do not support theta/beta training applied as a stand-alone treatment in children with ADHD.
Yulius Academy, Yulius Mental Health Organization, Dennenhout 1, 2994 GC, Barendrecht, The Netherlands. k.gelade@yulius.nl.|Department of Clinical Neuropsychology, VU University Amsterdam, Van der Boechorstraat 1, 1081 BT, Amsterdam, The Netherlands. k.gelade@yulius.nl.
Katleen
http://orcid.org/0000-0002-4338-9189
K
Geladé
Department of Clinical Neuropsychology, VU University Amsterdam, Van der Boechorstraat 1, 1081 BT, Amsterdam, The Netherlands.
Marleen
M
Bink
Department of Clinical Neuropsychology, VU University Amsterdam, Van der Boechorstraat 1, 1081 BT, Amsterdam, The Netherlands.
Tieme W P
TW
Janssen
Department of Clinical Neuropsychology, VU University Amsterdam, Van der Boechorstraat 1, 1081 BT, Amsterdam, The Netherlands.|Royal Dutch Kentalis, Utrecht, Pallas Athenedreef 10, 3561PE, Utrecht, The Netherlands.
Rosa
R
van Mourik
Yulius Academy, Yulius Mental Health Organization, Dennenhout 1, 2994 GC, Barendrecht, The Netherlands.
Athanasios
A
Maras
Department of Clinical Neuropsychology, VU University Amsterdam, Van der Boechorstraat 1, 1081 BT, Amsterdam, The Netherlands.
Jaap
J
Oosterlaan
D000293:Adolescent; D001288:Attention / Q000187:drug effects; D001289:Attention Deficit Disorder with Hyperactivity / Q000523:psychology / Q000628:therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D004311:Double-Blind Method; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008570:Memory, Short-Term / Q000187:drug effects; D011939:Mental Recall / Q000187:drug effects; D008774:Methylphenidate / Q000627:therapeutic use*; D019965:Neurocognitive Disorders; D058765:Neurofeedback / Q000379:methods*; D009483:Neuropsychological Tests; D011930:Reaction Time / Q000187:drug effects; D016896:Treatment Outcome
D000697:Central Nervous System Stimulants; D008774:Methylphenidate
ADHD; Medication; Neurocognition; Neurofeedback; Physical activity
Neurosci Biobehav Rev. 2003 Nov;27(7):583-92
14624803
Neurosci Biobehav Rev. 2006;30(8):1225-45
17161238
Clin Psychol Rev. 2013 Aug;33(6):795-811
23872284
Biol Psychiatry. 2014 Oct 15;76(8):603-15
24231201
J Child Adolesc Psychopharmacol. 2016 May;26(4):344-53
26771913
J Child Psychol Psychiatry. 2016 May;57(5):633-44
26748531
Appl Psychophysiol Biofeedback. 2007 Jun;32(2):73-88
17356905
J Child Psychol Psychiatry. 2007 May;48(5):415-35
17501723
Am J Psychiatry. 2007 Jun;164(6):942-8
17541055
J Clin Psychiatry. 2016 Oct;77(10):e1270-e1277
27631143
J Am Acad Child Adolesc Psychiatry. 2001 Feb;40(2):168-79
11211365
J Atten Disord. 2018 May;22(7):639-650
25895509
J Am Acad Child Adolesc Psychiatry. 1996 Oct;35(10):1304-13
8885584
J Am Acad Child Adolesc Psychiatry. 2005 Apr;44(4):377-84
15782085
Eur Child Adolesc Psychiatry. 2010 Apr;19(4):353-64
19763664
J Clin Psychiatry. 2014 May;75(5):535-42
24922488
Clin Neurophysiol. 2011 May;122(5):942-50
20843737
Biol Psychiatry. 2005 Jun 1;57(11):1336-46
15950006
Biofeedback Self Regul. 1996 Mar;21(1):35-49
8833315
Neurosci Lett. 2006 Feb 20;394(3):216-21
16343769
Front Hum Neurosci. 2015 Jan 07;8:1038
25610390
J Abnorm Psychol. 2005 May;114(2):216-22
15869352
J Clin Neurophysiol. 2006 Oct;23(5):440-55
17016156
J Atten Disord. 2013 Jul;17(5):384-92
23264365
Biol Psychol. 2014 Jan;95:108-15
24321363
Eur Child Adolesc Psychiatry. 2011 Sep;20(9):481-91
21842168
Expert Rev Neurother. 2012 Apr;12(4):447-60
22449216
J Child Adolesc Psychopharmacol. 2013 Sep;23(7):448-57
23808786
Brain Behav. 2015 Apr;5(4):e00330
25798338
CNS Drugs. 2008;22(3):213-37
18278977
Child Adolesc Psychiatr Clin N Am. 2014 Oct;23(4):789-806
25220087
Child Adolesc Psychiatr Clin N Am. 2014 Oct;23(4):899-936
25220093
Eur Neuropsychopharmacol. 2011 Aug;21(8):584-99
21530185
Behav Res Methods. 2007 May;39(2):175-91
17695343
J Atten Disord. 2013 Jul;17(5):410-9
22617866
Eur Child Adolesc Psychiatry. 2017 May;26(5):573-582
27866283
Clin Neurophysiol. 2003 Feb;114(2):171-83
12559224
Pediatrics. 2014 Mar;133(3):483-92
24534402
Neurotherapeutics. 2012 Jul;9(3):588-98
22930416
Psychol Bull. 1997 Jan;121(1):65-94
9000892
J Am Acad Child Adolesc Psychiatry. 1992 Mar;31(2):210-8
1564021
Appl Neuropsychol. 2010 Apr;17(2):125-34
20467954
J Abnorm Child Psychol. 2007 Oct;35(5):745-58
17668315
J Pharmacol Pharmacother. 2010 Jul;1(2):100-7
21350618
J Child Psychol Psychiatry. 2014 May;55(5):460-72
24168522
J Am Acad Child Adolesc Psychiatry. 2015 Mar;54(3):164-74
25721181
Am J Psychiatry. 2013 Mar;170(3):275-89
23360949
Child Dev. 2006 Nov-Dec;77(6):1698-716
17107455
Front Hum Neurosci. 2015 Mar 27;9:135
25870550
J Atten Disord. 2012 Jul;16(5):351-72
22090396
Clin Pediatr (Phila). 2011 Jul;50(7):615-22
21561933
J Am Acad Child Adolesc Psychiatry. 1999 May;38(5):503-12
10230181
Child Neuropsychol. 2004 Sep;10(3):155-61
15590494