title: Learning curves of theta/beta neurofeedback in children with ADHD.
abstract: Neurofeedback is widely applied as non-pharmacological intervention aimed at reducing symptoms of ADHD, even though efficacy has not been unequivocally established. Neuronal changes during the neurofeedback intervention that resemble learning can provide crucial evidence for the feasibility and specificity of this intervention. A total of 38 children (aged between 7 and 13 years) with a DSM-IV-TR diagnosis of ADHD, completed on average 29 sessions of theta (4-8 Hz)/beta (13-20 Hz) neurofeedback training. Dependent variables included training-related measures as well as theta and beta power during baseline and training runs for each session. Learning effects were analyzed both within and between sessions. To further specify findings, individual learning curves were explored and correlated with behavioral changes in ADHD symptoms. Over the course of the training, there was a linear increase in participants' mean training level, highest obtained training level and the number of earned credits (range b = 0.059, -0.750, p < 0.001). Theta remained unchanged over the course of the training, while beta activity increased linearly within training sessions (b = 0.004, 95% CI = [0.0013-0.0067], p = 0.005) and over the course of the intervention (b = 0.0052, 95% CI = [0.0039-0.0065], p < 0.001). In contrast to the group analyses, significant individual learning curves were found for both theta and beta over the course of the intervention in 39 and 53%, respectively. Individual learning curves were not significantly correlated with behavioral changes. This study shows that children with ADHD can gain control over EEG states during neurofeedback, although a lack of behavioral correlates may indicate insufficient transfer to daily functioning, or to confounding reinforcement of electromyographic activity.
  
  
  BACKGROUND
  This trial is registered at the US National Institutes of Health (ClinicalTrials.gov, ref. no: NCT01363544); https://clinicaltrials.gov/show/NCT01363544 .
authors.affiliation: Clinical Neuropsychology Section, Vrije Universiteit, Van Der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands. twp.janssen@vu.nl.
authors.forename: Tieme W P
authors.initials: TWP
authors.lastname: Janssen
authors.affiliation: Clinical Neuropsychology Section, Vrije Universiteit, Van Der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
authors.forename: Marleen
authors.initials: M
authors.lastname: Bink
authors.affiliation: Department of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.
authors.forename: Wouter D
authors.initials: WD
authors.lastname: Weeda
authors.affiliation: Clinical Neuropsychology Section, Vrije Universiteit, Van Der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
authors.forename: Katleen
authors.initials: K
authors.lastname: Geladé
authors.affiliation: Royal Dutch Kentalis, Vlampijpstraat 78, 3534 AR, Utrecht, The Netherlands.
authors.forename: Rosa
authors.initials: R
authors.lastname: van Mourik
authors.affiliation: Yulius Academy, Dennenhout 1, 2994 GC, Barendracht, The Netherlands.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Maras
authors.affiliation: Clinical Neuropsychology Section, Vrije Universiteit, Van Der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Oosterlaan
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use; D004569:Electroencephalography; D015444:Exercise; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D058765:Neurofeedback / Q000379:methods* / Q000502:physiology; D010043:Outcome and Process Assessment, Health Care
chemical_list: D018765:Dopamine Uptake Inhibitors; D008774:Methylphenidate
keywords: ADHD; EEG; Learning curves; Neurofeedback; Paediatric; Theta/beta-training