Neurofeedback in der Behandlung der Aufmerksamkeitsdefizit-Hyperaktivitätsstörung (ADHS) im Kindes- und Jugendalter
Abstract
Zusammenfassung:Einleitung: In der Therapie der Aufmerksamkeitsdefizit-Hyperaktivitätsstörung (ADHS) sind viele nicht-medikamentöse Behandlungsmethoden den Nachweis ihrer Wirksamkeit schuldig geblieben. Für das Neurofeedback (auch EEG-Biofeedback) hat sich die Evidenzbasis in den vergangenen Jahren verbessert. Neurofeedback bewirkt abhängig vom Trainings-Protokoll Veränderungen des EEG-Frequenzspektrums oder der ereigniskorrelierten Potentiale bei ADHS und strebt über die gelernte Modifikation dieser Parameter eine Verbesserung der ADHS-Kernsymptome an. Methoden: In dieser Übersichtsarbeit werden die vorliegenden Forschungsbefunde detailliert dargelegt. Ergebnisse: Die durch das Neurofeedback erreichten kurzfristigen Verbesserungen entsprachen in drei kontrollierten Studien denen einer pharmakotherapeutischen Stimulanzien-Behandlung. Neurofeedback führte zu einer signifikanten Reduktion von Unaufmerksamkeit, Impulsivität und Hyperaktivität. Darüber hinaus fand sich eine anhaltende Normalisierung des Spontan-EEGs, während eine Stimulanzientherapie keine vergleichbare Normalisierung bewirkte; es traten keine unerwünschten Wirkungen auf. Untersuchungen zur Wirkdauer der Neurofeedback-Effekte sind ermutigend, stützen sich aber auf kleine Patientenzahlen. Schlussfolgerung: Neurofeedback ist ein viel versprechender Ansatz in der Behandlung aufmerksamkeitsgestörter, hyperaktiver Kinder. Gleichwohl besteht Bedarf an weiteren kontrollierten Studien mit einheitlichen diagnostischen Kriterien, ausreichend großen Stichproben, geeigneten Veränderungsmaßen und Katamnese-Untersuchungen.
Summary:Introduction: A variety of non-pharmacological treatments for ADHD have failed to prove their effectiveness. The basis of evidence for neurofeedback (or EEG-biofeedback) has improved recently. Neurofeedback is aiming at an improvement of ADHD core-symptoms via the voluntary modification of abnormal neurophysiologic parameters, e.g. EEG-frequency spectrum and event-related potentials. Methods: Our review presents an overview of the current research on neurofeedback for the treatment of ADHD. Results: In three controlled studies short-term effects of feedback matched those of stimulant treatment. Neurofeedback lead to significant improvement of attention, impulsivity and hyperactivity, without adversive side effects. Additionally, there was a persistent amelioration of EEG parameters, while stimulants did not lead to a comparable normalization. Results on the stability of feedback effects are encouraging but are based on small numbers of patients. Conclusion: Neurofeedback is a promising approach for the treatment of children with ADHD. However, there is a demand for further controlled studies using standardized diagnostic criteria, sufficient sample sizes and appropriate measures and follow-up.
Literatur
2002). Practice Parameter for the Use of Stimulant Medications in the Treatment of Children, Adolescents, and Adults. Journal of the American Academy of Child and Adolescent Psychiatry, 41, Suppl 26– 49
(1995). Gates, states, Rhythms, and resonances: The Scientific Basis of Neurofeedback Training. Journal of Neurotherapy, 1, 15– 38
(1995). EEG Biofeedback: A New Treatment Option For ADD/ADHD. Journal of Neurotherapy, 1, 39– 43
(1997). High-resolution brain SPECT imaging in ADHD. Annals of Clinical Psychiatry, 9, 81– 86
(2001). Alternative treatments for adults with attention-deficit hyperactivity disorder (ADHD). Annals of the New York Academy of Sciences, 931, 310– 341
(2003). Association of ADHD and conduct disorder - brain electrical evidence for the existence of a distinct subtype. Journal of Child Psychology and Psychiatry, 44, 356– 376
(1992). Is EEG biofeedback treatment effective for ADHD children?. CH.ADD.ER Box, 6, 5– 11
(1998). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. 2. Aufl. New York: Guilford Press
(2003a). A review of electrophysiology in attention-deficit/hyperactivity disorder: I. Qualitative and quantitative electroencephalography. Clinical Neurophysiology, 114, 171– 183
(2002). EEG coherence in attention-deficit/hyperactivity disorder: a comparative study of two DSM-IV types. Clinical Neurophysiology, 113, 579– 585
(2003b). A review of electrophysiology in attention-deficit/hyperactivity disorder: II. Event-related potentials. Clinical Neurophysiology, 114, 184– 198
(1999). Atypical frontal brain activation in ADHD: preschool and elementary school boys and girls. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1363– 1371
(2003). Frontal EEG correlates of externalizing spectrum behaviors. European Child and Adolescent Psychiatry, 12, 36– 42
(2001). Evaluierte Behandlungsansätze in der Kinder- und Jugendpsychiatrie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 29, 189– 205
(2002). An evaluation model for psychoeducational interventions using interactive multimedia. Cyberpsychology and Behavior, 5, 565– 580
(1999). Slow cortical potentials: Plasticity, operant control, and behavioral effects. The Neuroscientist, 5, 74– 78
(1991). Clinical-psychological treatment of epileptic seizures: a controlled study. In: Ehlers, A. (Ed.). Perspectives and promises in clinical psychology (pp 31-96). New York: Plenum Press
(1990). Slow potentials of the cerebral cortex and behavior. Physiological Reviews, 70, 1– 41
(2002). Multicenter P300 brain mapping of impaired attention to cues in hyperkinetic children. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 990– 998
(1991). Changes in verbal performance IQ discrepancy scores after left hemisphere frequency control training: A pilot report. American Journal of Clinical Biofeedback, 4, 66– 67
(1997). Implication of right frontostriatal circuitry in response inhibition and attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 374– 383
(2002). Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Medical Association, 288, 1740– 1748
(1996). Quantitative electroencephalographic profiles of children with attention deficit disorder. Biological Psychiatry, 40, 951– 963
(2002a). Effects of stimulant medications on the EEG of children with attention-deficit/hyperactivity disorder. Psychopharmacology, 164, 277– 284
(2002b). EEG evidence for a new conceptualisation of attention deficit hyperactivity disorder. Clinical Neurophysiology, 113, 1036– 1044
(2001a). Age and sex effects in the EEG: development of the normal child. Clinical Neurophysiology, 112, 806– 814
(2001b). EEG-defined subtypes of children with attention-deficit/hyperactivity disorder. Clinical Neurophysiology, 112, 2098– 2105
(2003). Leitlinien zur Diagnostik und Therapie von psychischen Störungen im Säuglings-, Kindes- und Jugendalter. (2. Aufl.). Köln: Deutscher Ärzte Verlag.
(1992). Psychophysiological correlates of orienting, anticipation and contingency changes in children with psychiatric disorders. Journal of Psychophysiology, 6, 225– 239
(1987). Threshold regulation - a key to the understanding of the combined dynamics of EEG and event related potentials. Journal of Psychophysiology, 4, 317– 333
(2002). Altered cortical activity in children with attention-deficit/hyperactivity disorder during attentional load task. ournal of the American Academy of Child and Adolescent Psychiatry, 41, 811– 819
(2003). Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: a comparison with methylphenidate. Applied Psychophysiology and Biofeedback, 28, 1– 12
(1997). Right hemisphere dysfunction in subjects with attention-deficit disorder with and without hyperactivity. Journal of Child Neurology, 12, 107– 115
(2003). Action video game modifies visual selective attention. Nature, 423, 534– 537
(2001). Impairment and deportment responses to different methylphenidate doses in children with ADHD: the MTA titration trial. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 180– 187
(1997). Frontal interhemispheric asymmetry: self regulation and individual differences in humans. Neuroscience Letters, 221, 117– 120
(1991). A possible pathophysiologic substrate of attention deficit hyperactivity disorder. Journal of Child Neurology, 6, Suppl 76– 81
(2003). Neurofeedback-Training für Kinder mit Aufmerksamkeitsdefizit-Hyperaktivitätsstörung (abstract). In: U. Lehmkuhl (Hrsg.), Therapie in der Kinder- und Jugendpsychiatrie: Von den Therapieschulen zu störungsspezifischen Behandlungen (S. 29-30). Göttingen: Vandenhoeck & Ruprecht
(2000). Contingent Negative Variation (CNV) bei Kindern mit hyperkinetischer Störung - eine experimentelle Untersuchung mittels des Continuous Performance Test (CPT). Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 28, 239– 246
(2003). Brain areas activated in fMRI during self-regulation of slow cortical potentials (SCPs). Experimental Brain Research, 152, 113– 122
(1938). Electroencephalographic analyses of behavior problem children. American Journal of Psychiatry, 95, 641– 658
(1997). Effects of methylphenidate on event-related potentials and performance of attention-deficit hyperactivity disorder children in auditory and visual selective attention tasks. Biological Psychiatry, 41, 690– 702
(2000). Attentional capacity, a probe ERP study: differences between children with attention-deficit hyperactivity disorder and normal control children and effects of methylphenidate. Psychophysiology, 37, 334– 346
(2000). Effect of Neurofeedback on variables of attention in a large multi-center trial. Journal of Neurotherapy, 4, 5– 15
(2001). Methylphenidate increased regional cerebral blood flow in subjects with attention deficit/hyperactivity disorder. Yonsei Medical Journal, 42, 19– 29
(1997). Stability of cortical self-regulation in epilepsy patients. Neuroreport, 8, 1867– 1870
(2001). Modification of slow cortical potentials in patients with refractory epilepsy: a controlled outcome study. Epilepsia, 42, 406– 416
(1995). Computer-assisted cognitive training for ADHD: A case study. Behavior Modification, 20, 85– 96
(2000). Increased striatal dopamine transporter in adult patients with attention deficit hyperactivity disorder: effects of methylphenidate as measured by single photon emission computed tomography. Neuroscience Letters, 285, 107– 110
(1996). Quantitative EEG differences in a nonclinical sample of children with ADHD and undifferentiated ADD. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1009– 1017
(1996). Verhaltensmedizinische Indikation und Evaluation einer kognitiv-behavioralen Therapie mit aufmerksamkeitsgestörten/hyperaktiven Kindern. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 24, 164– 175
(2001). The ethical use of placebo controls in clinical research: the Declaration of Helsinki. Applied Psychophysiology and Biofeedback, 26, 23– 37
(1991). Biofeedback as a treatment for childhood hyperactivity: a critical review of the literature. Psychological Reports, 68, 163– 192
(1996). A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback and Self Regulation, 21, 35– 49
(1940). Electroencephalogramms of «constitutionally inferior» and behaviour problem children: comparison with those of normal children and adults. Archives of Neurology and Psychiatry, 44, 1199– 1212
(1999). EEG correlates of methylphenidate response among children with ADHD: a preliminary report. Biological Psychiatry, 45, 1657– 1660
(1991). Neural mechanisms underlying brain waves: from neural membranes to networks. Electroencephalography and Clinical Neurophysiology, 79, 81– 93
(1991). Discourse on the development of EEG diagnostics and biofeedback for attention-deficit/hyperactivity disorders. Biofeedback and Self Regulation, 16, 201– 225
(1997). Neocortical dynamics: implications for understanding the role of neurofeedback and related techniques for the enhancement of attention. Applied Psychophysiology and Biofeedback, 22, 111– 126
(1976). Behavioral management of epileptic seizures following biofeedback training of the sensorimotor rhythm. Biofeedback and Self Regulation, 1, 77– 104
(1984). Electroencephalographic biofeedback of SMR and beta for treatment of attention deficit disorders in a clinical setting. Biofeedback and Self Regulation, 9, 1– 23
(1976). EEG and behavioral changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR). a preliminary report. Biofeedback and Self Regulation, 1, 293– 306
(1995). Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores, behavioral ratings, and WISC-R performance. Biofeedback and Self Regulation, 20, 83– 99
(1999). Methylphenidate effects on global and complex measures of EEG. Pediatric Neurology, 21, 633– 637
(1979). The effects of self-regulation of slow cortical potentials on performance in a signal detection task. International Journal of Neuroscience, 9, 175– 183
(1994). Hemispheric processing and methylphenidate effects in attention-deficit hyperactivity disorder. Journal of Child Neurology, 9, 181– 189
(1992). Quantitative analysis of EEG in boys with attention-deficit-hyperactivity disorder: controlled study with clinical implications. Pediatric Neurology, 8, 30– 36
(2000). Grundprinzipien und historische Entwicklung. In: J. Margraf (Hrsg.), Lehrbuch der Verhaltenstherapie. Bd. 1, (2. Aufl. S. 1-30). Berlin: Springer
(1994). Cerebral glucose metabolism in adults with attention deficit hyperactivity disorder after chronic stimulant treatment. American Journal of Psychiatry, 151, 658– 664
(1993). A cross-national EEG study of children with emotional and behavioral problems: a WHO collaborative study in the Western Pacific Region. Biological Psychiatry, 34, 59– 65
(2001). Early methylphenidate administration to young rats causes a persistent reduction in the density of striatal dopamine transporters. Journal of Child and Adolescent Psychopharmacology, 11, 15– 24
(2001). The development of a quantitative electroencephalographic scanning process for attention deficit-hyperactivity disorder: reliability and validity studies. Neuropsychology, 15, 136– 144
(1999). Assessing attention deficit hyperactivity disorder via quantitative electroencephalography: an initial validation study. Neuropsychology, 13, 424– 433
(2002). The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder. Applied Psychophysiology and Biofeedback, 27, 231– 249
(1999a). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The Multimodal Treatment Study of Children with ADHD Archives of General Psychiatry, 56, 1073– 1086
(1999b). Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder: the Multimodal Treatment Study of children with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56, 1088– 1096
(2000). Treatment of attention deficit hyperactivity disorder with neurotherapy. Clinical Electroencephalography, 31, 30– 37
(1998). Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder. NIH Consens Statement Online, 16, 1– 37
(1991). EEG biofeedback training for attention deficit disorder, specific learning disabilities, and associated conduct problems. EEG Spectrum ( www.eegspectrum.com/Applications/ADHD-ADD/)
(2000). Inhibitory control in children with attention-deficit/hyperactivity disorder: event-related potentials identify the processing component and timing of an impaired right-frontal response-inhibition mechanism. Biological Psychiatry, 48, 238– 246
(2001). EEG biofeedback treatment of ADD. A viable alternative to traditional medical intervention?. Annals of the New York Academy of Sciences, 931, 342– 358
(1990). Biofeedback: evaluation and therapy in children with attentional dysfunctions. In: A. Rothenberger (Ed.), Brain and behavior in child psychiatry (pp 345-357) Berlin: Springer
(1995). A Comparison of EEG Biofeedback and Psychostimulants in Treating Attention Deficit/Hyperactivity Disorders. Journal of Neurotherapy, 1, 48– 59
(1995). Electrical brain activity in children with Hyperkinetic Syndrome: Evidence of a frontal cortical dysfunction. In: J. Sergeant (Ed.). Eunethydis. European Approaches to Hyperkinetic Disorder (pp 225-270). Zürich Trümpi.
(1996). The Captain’s log cognitive training system. Braintrain, Richmond, VA
(1995). SPECT brain imaging abnormalities in attention deficit hyperactivity disorder. Clinical Nuclear Medicine, 20, 55– 60
(1998). Functional brain electrical activity mapping in boys with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 55, 1105– 1112
(1997). Neuronal assemblies: necessity, signature and detectability. Trends in Cognitive Sciences, 1, 252– 261
(1998). Computerized Cognitive Training for Severely Emotionally Disturbed Children With ADHD. Behavior Modification, 22, 415– 437
(1996). Physiological origins and functional correlates of EEG rhythmic activities: implications for self-regulation. Biofeedback and Self Regulation, 21, 3– 33
(1972). Suppression of seizures in an epileptic following sensorimotor EEG feedback training. Electroencephalography and Clinical Neurophysiology, 33, 89– 95
(2002). Neurofeedback. Psychomed - Zeitschrift für Psychologie und Medizin, 14, 11– 17
(2004). EEG-Feedback für Kinder mit einer Aufmerksamkeitsdefizit- und Hyperaktivitätsstörung (ADHS) - erste Ergebnisse aus einer randomisierten, kontrollierten Pilotstudie. Kindheit und Entwicklung, (im Druck)
(1999). Effect of methylphenidate on attention in children with attention deficit hyperactivity disorder (ADHD). ERP evidence Neuropsychopharmacology, 21, 218– 228
(1998). Methylphenidate effects on EEG, behavior, and performance in boys with ADHD. Pediatric Neurology, 18, 244– 250
(1998). Attention deficit hyperactivity disorder: advances in cognitive, neurobiological, and genetic research. Journal of Child Psychology and Psychiatry, 39, 65– 99
(1993). Ten-year stability of EEG biofeedback results for a hyperactive boy who failed fourth grade perceptually impaired class. Biofeedback and Self Regulation, 18, 33– 44
(1983). EMG and EEG biofeedback training in the treatment of a 10-year-old hyperactive boy with a developmental reading disorder. Biofeedback and Self Regulation, 8, 25– 37
(1974). Amphetamine effects in man: paradoxical drowsiness and lowered electrical brain acitivity (CNV). Science, 185, 451– 453
(1998). Neurofeedback combined with training in metacognitive strategies: effectiveness in students with ADD. Applied Psychophysiology and Biofeedback, 23, 243– 263
(2003). Methylphenidate down-regulates the dopamine receptor and transporter system in children with attention deficit hyperkinetic disorder (ADHD). Neuropediatrics, 34, 77– 80
(1968). Instrumental conditioning of sensorimotor cortex EEG spindles in the waking cat. Physiology & Behavior, 3, 703– 707
(1997). Frontocortical activity in children with comorbidity of tic disorder and attention-deficit hyperactivity disorder. Biological Psychiatry, 41, 585– 594
(1993). Brain metabolism in teenagers with attention-deficit hyperactivity disorder. Archives of General Psychiatry, 50, 333– 340
(1995). Klinische Elektroenzephalographie. Berlin:
(