Skip to main content

Advertisement

Log in

Informant-related effects of neurofeedback and cognitive training in children with ADHD including a waiting control phase: a randomized-controlled trial

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

There is controversy regarding the clinical efficacy of neurofeedback (NF) and computerized cognitive training (CogT) as treatments for ADHD. Meta-analyses claim that probably blinded teachers observe smaller effects than parents, because they are less biased. We investigated informant-specific effects by manipulating the involvement of informants, by controlling for waiting time effects, and by adding a blinded outcome measure. Seventy-seven children with ADHD were randomly allocated to slow cortical potential NF or to individualized CogT (of attention, working memory or inhibition). The training was conducted in schools (NF: n = 19, CogT: n = 19) or in outpatient clinics (NF: n = 19, CogT: n = 20). Three assessments were scheduled: baseline, followed by a waiting period, pre-training, and post-training. Multivariate Analyses of Variance were conducted to assess parent- and teacher-rated changes in ADHD symptoms and executive functions (EF), and changes according to standardized classroom observations. Both treatments resulted in significant improvements according to informants, with larger effects for parents (ADHD symptoms: parent η 2 p  = .32; teacher η 2 p  = .10), and according to observations (η 2 p  = .19). The setting had no effect on outcome. Considerable waiting time effects were revealed for ADHD symptom ratings by both informants, for EF ratings only by teachers. Changed classroom behavior was uncorrelated with teacher-rated changes. Overall, the results do not support the notion that teachers are more objective while being as sensitive to change as parents. The three sources seem to contribute differential and mostly unrelated pieces of information to the evaluation of treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Arns M, Strehl U (2013) Evidence for efficacy of neurofeedback in ADHD? Am J Psychiatry 170:799. https://doi.org/10.1176/appi.ajp.2013.13030293

    Article  PubMed  Google Scholar 

  2. Micoulaud-Franchi J-A, Geoffroy PA, Fond G et al (2014) EEG neurofeedback treatments in children with ADHD: an updated meta-analysis of randomized controlled trials. Front Hum Neurosci. https://doi.org/10.3389/fnhum.2014.00906

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cortese S, Ferrin M, Brandeis D et al (2016) Neurofeedback for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. J Am Acad Child Adolesc Psychiatry 55:444–455. https://doi.org/10.1016/j.jaac.2016.03.007

    Article  PubMed  Google Scholar 

  4. Steiner NJ, Frenette EC, Rene KM et al (2014) Neurofeedback and cognitive attention training for children with attention-deficit hyperactivity disorder in schools. J Dev Behav Pediatr 35:18–27. https://doi.org/10.1097/DBP.0000000000000009

    Article  PubMed  Google Scholar 

  5. Cortese S, Ferrin M, Brandeis D et al (2015) Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. J Am Acad Child Adolesc Psychiatry 54:164–174. https://doi.org/10.1016/j.jaac.2014.12.010

    Article  PubMed  PubMed Central  Google Scholar 

  6. Sonuga-Barke EJS, Brandeis D, Cortese S et al (2013) Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry 170:275–289. https://doi.org/10.1176/appi.ajp.2012.12070991

    Article  PubMed  Google Scholar 

  7. Martel MM, Schimmack U, Nikolas M, Nigg JT (2015) Integration of symptom ratings from multiple informants in ADHD diagnosis: a psychometric model with clinical utility. Psychol Assess 27:1060–1071. https://doi.org/10.1037/pas0000088

    Article  PubMed  PubMed Central  Google Scholar 

  8. Narad M, Garner A, Peugh J et al (2015) Parent-teacher agreement on ADHD symptoms across development. Psychol Assess 27:239–248. https://doi.org/10.1037/a0037864

    Article  PubMed  Google Scholar 

  9. Aitken M, Martinussen R, Tannock R (2017) Incremental validity of teacher and parent symptom and impairment ratings when screening for mental health difficulties. J Abnorm Child Psychol 45:827–837. https://doi.org/10.1007/s10802-016-0188-y

    Article  PubMed  Google Scholar 

  10. Gooch D, Maydew H, Sears C, Norbury CF (2017) Does a child’s language ability affect the correspondence between parent and teacher ratings of ADHD symptoms? BMC Psychiatry. https://doi.org/10.1186/s12888-017-1300-8

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lederberg Stone S, Speltz ML, Collett B, Werler MM (2013) Socioeconomic factors in relation to discrepancy in parent versus teacher ratings of child behavior. J Psychopathol Behav Assess 35:314–320. https://doi.org/10.1007/s10862-013-9348-3

    Article  Google Scholar 

  12. Takeda T, Nissley-Tsiopinis J, Nanda S, Eiraldi R (2016) Factors associated with discrepancy in parent–teacher reporting of symptoms of ADHD in a large clinic-referred sample of children. J Atten Disord. https://doi.org/10.1177/1087054716652476

    Article  PubMed  Google Scholar 

  13. Biederman J, Faraone SV, Monuteaux MC, Grossbard JR (2004) How informative are parent reports of attention-deficit/hyperactivity disorder symptoms for assessing outcome in clinical trials of long-acting treatments? Pediatrics 113:1667–1671

    Article  PubMed  Google Scholar 

  14. Biederman J, Gao H, Rogers AK, Spencer TJ (2006) Comparison of parent and teacher reports of attention-deficit/hyperactivity disorder symptoms from two placebo-controlled studies of atomoxetine in children. Biol Psychiatry 60:1106–1110. https://doi.org/10.1016/j.biopsych.2006.03.036

    Article  PubMed  CAS  Google Scholar 

  15. Storebø OJ, Krogh HB, Ramstad E et al (2015) Methylphenidate for attention-deficit/hyperactivity disorder in children and adolescents: cochrane systematic review with meta-analyses and trial sequential analyses of randomised clinical trials. BMJ. https://doi.org/10.1136/bmj.h5203

    Article  PubMed  PubMed Central  Google Scholar 

  16. Konrad K, Günther T, Heinzel-Gutenbrunner M, Herpertz-Dahlmann B (2005) Clinical evaluation of subjective and objective changes in motor activity and attention in children with attention-deficit/hyperactivity disorder in a double-blind methylphenidate trial. J Child Adolesc Psychopharmacol 15:180–190. https://doi.org/10.1089/cap.2005.15.180

    Article  PubMed  Google Scholar 

  17. Wang L-J, Chen C-K, Huang Y-S (2015) Neurocognitive performance and behavioral symptoms in patients with attention-deficit/hyperactivity disorder during twenty-four months of treatment with methylphenidate. J Child Adolesc Psychopharmacol 25:246–253. https://doi.org/10.1089/cap.2014.0015

    Article  PubMed  CAS  Google Scholar 

  18. Lavigne JV, Dulcan MK, Lebailly SA, Binns HJ (2012) Can parent reports serve as a proxy for teacher ratings in medication management of attention-deficit hyperactivity disorder? J Dev Behav Pediatr. https://doi.org/10.1097/DBP.0b013e31824afea1

    Article  PubMed  Google Scholar 

  19. Pelham WE, Fabiano GA, Waxmonsky JG et al (2016) Treatment sequencing for childhood ADHD: a multiple-randomization study of adaptive medication and behavioral interventions. J Clin Child Adolesc Psychol. https://doi.org/10.1080/15374416.2015.1105138

    Article  PubMed  PubMed Central  Google Scholar 

  20. Shapiro ES (2004) Academic skills problems workbook. Guilford Press, New York

    Google Scholar 

  21. DuPaul GJ, Ervin RA, Hook CL, McGoey KE (1998) Peer tutoring for children with attention deficit hyperactivity disorder: effects on classroom behavior and academic performance. J Appl Behav Anal 31:579–592. https://doi.org/10.1901/jaba.1998.31-579

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Pfiffner LJ, Villodas M, Kaiser N et al (2013) Educational outcomes of a collaborative school-home behavioral intervention for ADHD. Sch Psychol Q 28:25–36. https://doi.org/10.1037/spq0000016

    Article  PubMed  PubMed Central  Google Scholar 

  23. Abikoff HB, Thompson M, Laver-Bradbury C et al (2015) Parent training for preschool ADHD: a randomized controlled trial of specialized and generic programs. J Child Psychol Psychiatry 56:618–631. https://doi.org/10.1111/jcpp.12346

    Article  PubMed  Google Scholar 

  24. Zuberer A, Brandeis D, Drechsler R (2015) Are treatment effects of neurofeedback training in children with ADHD related to the successful regulation of brain activity? A review on the learning of regulation of brain activity and a contribution to the discussion on specificity. Front Hum Neurosci 9:1–15. https://doi.org/10.3389/fnhum.2015.00135

    Article  Google Scholar 

  25. Gevensleben H, Rothenberger A, Moll GH, Heinrich H (2012) Neurofeedback in children with ADHD: validation and challenges. Expert Rev Neurother 12:447–460

    Article  PubMed  CAS  Google Scholar 

  26. Gevensleben H, Kleemeyer M, Rothenberger LG et al (2014) Neurofeedback in ADHD: further pieces of the puzzle. Brain Topogr 27:20–32. https://doi.org/10.1007/s10548-013-0285-y

    Article  PubMed  Google Scholar 

  27. Nigg JT, Willcutt EG, Doyle AE, Sonuga-Barke EJS (2005) Causal heterogeneity in attention-deficit/hyperactivity disorder: do we need neuropsychologically impaired subtypes? Biol Psychiatry 57:1224–1230. https://doi.org/10.1016/j.biopsych.2004.08.025

    Article  PubMed  Google Scholar 

  28. Coghill DR, Seth S, Matthews K (2014) A comprehensive assessment of memory, delay aversion, timing, inhibition, decision making and variability in attention deficit hyperactivity disorder: advancing beyond the three-pathway models. Psychol Med 44:1989–2001. https://doi.org/10.1017/S0033291713002547

    Article  PubMed  CAS  Google Scholar 

  29. Minder F, Zuberer A, Brandeis D, Drechsler R (2017) Specific efficacy of individualized cognitive training in children with attention-deficit/hyperactivity disorder. Manuscript submitted for publication

  30. Gevensleben H, Holl B, Albrecht B et al (2009) Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. J Child Psychol Psychiatry 50:780–789. https://doi.org/10.1111/j.1469-7610.2008.02033.x

    Article  PubMed  Google Scholar 

  31. Goodman R, Ford T, Richards H et al (2000) The development and well-being assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry 41:645–655. https://doi.org/10.1111/j.1469-7610.2000.tb02345.x

    Article  PubMed  CAS  Google Scholar 

  32. Waldmann HC (2008) Kurzformen des HAWIK-IV: statistische Bewertung in verschiedenen Anwendungsszenarien. Diagnostica 54:202–210. https://doi.org/10.1026/0012-1924.54.4.202

    Article  Google Scholar 

  33. Lidzba K, Christiansen H, Drechsler R (2013) Conners 3 Skalen zu Aufmerksamkeit und Verhalten: Deutschsprachige Adaptation der Conners 3 Edition (Conners 3) von C. Keith Conners, Huber

    Google Scholar 

  34. Drechsler R, Steinhausen H-C (2013) BRIEF Verhaltensinventar zur Beurteilung exekutiver Funktionen. Huber, Bern

    Google Scholar 

  35. Steiner NJ, Sidhu T, Rene K et al (2013) Development and testing of a direct observation code training protocol for elementary aged students with attention deficit/hyperactivity disorder. Educ Assess Eval Acc 25:281–302. https://doi.org/10.1007/s11092-013-9166-x

    Article  Google Scholar 

  36. Strehl U, Aggensteiner P, Wachtlin D et al (2017) Neurofeedback of slow cortical potentials in children with attention-deficit/hyperactivity disorder: a multicenter randomized trial controlling for unspecific effects. Front Hum Neurosci. https://doi.org/10.3389/fnhum.2017.00135

    Article  PubMed  PubMed Central  Google Scholar 

  37. Tucha O, Tucha L, Kaumann G et al (2011) Training of attention functions in children with attention deficit hyperactivity disorder. ADHD Atten Deficit Hyperact Disord 3:271–283. https://doi.org/10.1007/s12402-011-0059-x

    Article  Google Scholar 

  38. Pinheiro J, Bates D, DebRoy S, et al (2017) Nlme: Linear and nonlinear mixed effects models. R package version 3.1–131

  39. Lenth RV (2016) Least-squares means: the R package lsmeans. J Stat Softw 69:1–33

    Article  Google Scholar 

  40. Faul F, Erdfelder E, Lang A-G, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191

    Article  PubMed  Google Scholar 

  41. Arrindell WA (2001) Changes in waiting-list patients over time: data on some commonly-used measures. Beware! Behav Res Ther 39:1227–1247. https://doi.org/10.1016/S0005-7967(00)00104-2

    Article  PubMed  CAS  Google Scholar 

  42. Becker H, Roberts G, Voelmeck W (2003) Explanations for improvement in both experimental and control groups. West J Nurs Res 25:746–755. https://doi.org/10.1177/0193945903253002

    Article  PubMed  Google Scholar 

  43. Litson K, Geiser C, Burns GL, Servera M (2016) Trait and state variance in multi-informant assessments of ADHD and academic impairment in Spanish first-grade children. J Clin Child Adolesc Psychol. https://doi.org/10.1080/15374416.2015.1118693

    Article  PubMed  Google Scholar 

  44. Zuberer A, Minder F, Brandeis D, Drechsler R (2017) Multilevel modeling of training specificity of neurofeedback in children and adolescents with attention-deficit/hyperactivity disorder—relating clinical symptoms to learning performance. Manuscript in preparation

  45. Janssen TWP, Bink M, Geladé K et al (2016) A randomized controlled trial into the effects of neurofeedback, methylphenidate, and physical activity on EEG power spectra in children with ADHD. J Child Psychol Psychiatry 57:633–644. https://doi.org/10.1111/jcpp.12517

    Article  PubMed  Google Scholar 

  46. Drechsler R, Straub M, Doehnert M et al (2007) Controlled evaluation of a neurofeedback training of slow cortical potentials in children with Attention Deficit/Hyperactivity Disorder (ADHD). Behav Brain Funct 3:35. https://doi.org/10.1186/1744-9081-3-35

    Article  PubMed  PubMed Central  Google Scholar 

  47. Gray SA, Chaban P, Martinussen R et al (2012) Effects of a computerized working memory training program on working memory, attention, and academics in adolescents with severe LD and comorbid ADHD: a randomized controlled trial. J Child Psychol Psychiatry 53:1277–1284. https://doi.org/10.1111/j.1469-7610.2012.02592.x

    Article  PubMed  CAS  Google Scholar 

  48. DeBeus RJ, Kaiser DA (2011) Neurofeedback with children with attention deficit hyperactivity disorder: a randomized doubleblind placebo-controlled study. In: Neurofeedback neuromodulation Tech. Appl., Elsevier. London, pp 127–152

  49. van Dongen-Boomsma M, Vollebregt MA, Buitelaar JK, Slaats-Willemse D (2014) Working memory training in young children with ADHD: a randomized placebo-controlled trial. J Child Psychol Psychiatry Allied Discip 55:886–896. https://doi.org/10.1111/jcpp.12218

    Article  Google Scholar 

Download references

Acknowledgements

This study was funded by the Swiss National Science Foundation (Grant number: 320030_149411). We would like to thank all participating schools, teachers, school psychology services, and the outpatient clinics in Winterthur and Zurich for their support in recruitment and conducting the study. We warmly thank all of the children and families for participating as well as all research interns and Master students for their valuable assistance in the data collection.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Renate Drechsler.

Ethics declarations

Conflict of interests

Daniel Brandeis serves as an unpaid scientific consultant for an EU-funded neurofeedback trial. The other authors report no conflict of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 10699 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Minder, F., Zuberer, A., Brandeis, D. et al. Informant-related effects of neurofeedback and cognitive training in children with ADHD including a waiting control phase: a randomized-controlled trial. Eur Child Adolesc Psychiatry 27, 1055–1066 (2018). https://doi.org/10.1007/s00787-018-1116-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-018-1116-1

Keywords

Navigation