Download THE EFFECTS OF NEUROFEEDBACK TRAINING ON ADULT ADHD

COST B27 ENOC Joint WGs Meeting
Swansea UK, 16-18 September 2006
THE EFFECTS OF NEUROFEEDBACK
TRAINING ON ADULT ADHD
M.Numan Ermutlu M.D. Istanbul Science University, Faculty of Medicine,
Department of Physiology
Prof Dr Sacit Karamürsel Istanbul University, Istanbul Faculty of Medicine,
Department of Physiology
1
Attention-deficit/hyperactivity disorder is a multifactorial disorder with complex
etiology and strong genetic underpinnings (Faraone 2004) .
The inattention component of ADHD is manifested as:
daydreaming
distractibility
difficulty focusing on a single task for a prolonged period
whereas the hyperactivity component is expressed as:
fidgeting
excessive talking
restlessness.
2
The symptoms of ADHD predispose to accidents, create strain in
interpersonal relationships, and disrupt the environment through
interruptions and inappropriate behavior.
3
It is notable that the more overt symptoms of
hyperactivity/impulsivity tend to wane early in life, whereas the
more covert symptom of inattention tends to persist over time
(Biederman et al 1996).
4
Adults with retrospectively defined childhood-onset and
persistent ADHD show a pattern of psychological dysfunction,
psychosocial disability, psychiatric comorbidity, and school
failure that resembles the well-known features of childhood
ADHD (Biederman et al 2004).
5
Follow-up studies have found that 5%–66% of children
with ADHD persist with this disorder in adulthood
(Biederman et al 1993). Current epidemiologic studies
estimate the prevalence of adult ADHD to be between
3% and 5% (Faraone 2004; Kessler 2004).
6
The treatment of ADHD mainly consists of using stimulatory
drugs. The stimulating drugs have cardiovascular risks
especially for adults. Neurofeedback treatment (NF) had also
been shown to be effective in ADHD and impulse control (Lubar
and Shouse1976; Lubar 1989, Linden et al 1996; Othmer et al
1999; Fuchs et al 2003) . Neurofeedback treatment has no
known cardiovascular or other morbidity and/or mortality
increasing effects.
7
In this study the preliminary findings of six adult ADHD patients
(age 22-32; 2F, 4M) were reported. The ADHD subjects (DSMIV TR) who had either diagnosed as ADHD in childhood or had
fulfilled the scores for Wender-Utah Rating Scale for ADHD in
Adults (Öncü et al, 2005-Turkish version) were enrolled for the
study.
8
They were given Adult ADD/ADHD DSM IV- based
Diagnostic, Screening and Rating Scale (Turgay) (Günay
et al. 2004- Turkish version) and their ERP were recorded
with passive and active oddball paradigm before and after
training.
9
The training protocol was consisted of 40 sessions of beta (15-22 Hz) and
SMR (12- 15 Hz) increase/theta (4-7 Hz) decrease. Each session was 3036 minutes long divided equally between beta and SMR.
10
Theta/beta ratios
3
2,5
2
before
1,5
after
1
0,5
0
1
2
3
4
5
6
Subjects
11
Theta/SMR ratios
3
2,5
2
before
1,5
after
1
0,5
0
1
2
3
4
5
6
Subjects
12
Amplitude (uV)
P3b amplitudes before and after NF training
18
16
14
12
10
8
6
4
2
0
before
after
1
2
3
4
5
6
Subjects
13
P3a amlitudes before and after NF training
12
Amplitude (uV)
10
8
before
6
after
4
2
0
1
2
3
4
5
6
Subjects
14
MMN latency before and after NF training
Latency (ms)
250
202
200
150
133
175
158
195
175
155
153
148
140
138
125
before
after
100
50
0
1
2
3
4
5
6
Subjects
15
MMN amplitudes before and after NF training
Subjects
Amplitude (uV)
-5
-4
-3
before
-2
after
-1
0
1
2
3
4
5
6
16
Adult ADD/ADHD DSM IV- based Diagnostic,
Screening and Rating Scale Scores
35
30
25
20
15
10
31
28
26
13
25
16
23
14
16
19
18
before
after
9
5
0
1
2
3
4
5
6
17
Scores for Problems Related with ADD/ADHD
40
35
30
25
20
15
10
36
36
34
33
38
27
22
18
24
20
14
before
after
13
5
0
1
2
3
4
5
6
18
After 40 treatment sessions Adult ADD/ADHD Diagnostic
and Rating Inventory scores decreased more than 50% and P300
amplitudes increased between 50-100%.
19
A low P3 amplitude is present in various disinhibitory conditions
such as substance abuse (Herning, 1996, Biggins et al., 1997, Brigham et
al., 1997, Anokhin et al., 2000 and Iacono et al., 2004) antisocial
personality (Hesselbrock et al., 1993, O'Connor et al., 1994 and Costa et al.,
2000), conduct
disorder (Iacono et al., 2002), attention-deficit
hyperactivity disorder (Frank et al., 1998, Rubia et al., 1998, Pliszka et al.,
2000; Branderies et al,2002; Klorman, 1991 and van der Stelt et al., 2001).
20
SMR and beta –1 training were shown to increase P3 amplitude in
normals (Egner and Gruzelier, 2004). The increase in the amplitude
of P3b can be the result of effective inhibitory control and increased
arousal as a result of SMR and Beta-1 trainings respectively.
21
Our preliminary results suggest that neurofeedback training might be
an effective treatment modality for adult ADHD. P3b amplitude and
MMN latency can be a useful electrophysiological tool to follow up the
progress of NF training.
However, controlled trials comparing NT and drugs should be done
in order to establish its efficiency.
22