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Neurofeedback and computerized cognitive training in different settings for children and adolescents with ADHD

English title Neurofeedback and computerized cognitive training in different settings for children and adolescents with ADHD
Applicant Drechsler Renate
Number 149411
Funding scheme Project funding (Div. I-III)
Research institution Kinder- und Jugendpsychiatrischer Dienst Universität Zürich
Institution of higher education University of Zurich - ZH
Main discipline Neurology, Psychiatry
Start/End 01.11.2013 - 31.12.2017
Approved amount 535'000.00
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All Disciplines (2)

Discipline
Neurology, Psychiatry
Psychology

Keywords (7)

neuropsychological deficits; computerized cognitive training; Attention deficit/hyperactivity disorder (ADHD) ; EEG; treatment efficacy; neurofeedback; school

Lay Summary (German)

Lead
Aufmerksamkeitsdefizit-Hyperaktivitätsstörung (ADHS) ist eine der häufigsten psychiatrischen Störungen des Kindes- und Jugendalters, mit oft gravierenden Auswirkungen auf Schule, Familie und soziales Umfeld. In vielen Fällen bleiben Symptome bis ins Erwachsenenalter erhalten. Neben der Behandlung mit Stimulanzien gibt es auch nicht-medikamentöse Therapieverfahren für ADHS, die in den letzten Jahren verstärkt ins Blickfeld der Forschung gerückt sind.
Lay summary

Inhalt und Ziel des Forschungsprojekts

Es werden zwei Behandlungsmethoden für ADHS hinsichtlich ihrer Wirksamkeit verglichen, Neurofeedbacktraining und PC-gestütztes kognitives Training.  Beim Neurofeedbacktraining  lernen die Teilnehmer ihre Hirnaktivität zu regulieren, was zu einer verbesserten Aufmerksamkeit führen soll.  Dazu wird die Hirnstromaktivität mit  Elektroden gemessen, die auf der Kopfoberfläche aufgeklebt sind, dann mittels einer speziellen Software in Signale umgewandelt und dem Teilnehmer zurückgemeldet.  Beim PC-gestützten kognitiven Training führen die Teilnehmer dagegen spezifische Übungen durch, mit denen Fähigkeiten wie Aufmerksamkeitsfokussierung,  Arbeitsgedächtnis oder Antworthemmung gezielt trainiert  werden. Im Forschungsprojekt werden Wirksamkeit  und Wirkmechanismen beider Methoden untersucht und verglichen, mit dem Ziel, Empfehlungen für Untergruppen von Patienten ableiten zu können. Ein weiterer Schwerpunkt ist das Einbeziehen der Schule als Therapieort. Die Hälfte der Studienteilnehmer – im Alter von 8 bis 16 Jahren - wird im schulischen Umfeld und nicht, wie sonst üblich, in therapeutischen Ambulanzen trainiert. Dabei wird angestrebt, durch einen verbesserten Transfer direkter auf Probleme, die bei ADHS in der Schule auftreten, einwirken zu können als bisher.

Wissenschaftlicher und gesellschaftlicher Kontext

Wirksamkeitsstudien zu nicht-medikamentösen Behandlungsmethoden von ADHS und die Ableitung differentieller Behandlungsempfehlungen sind von hoher Relevanz.  Es soll ausserdem untersucht werden, welche Vor- und Nachteile eine Behandlung  im schulischen Setting mit sich bringt und ob damit auch Betroffene erreicht werden können, die sonst z.B. aus sozialen Gründen nicht an ambulanten Therapien teilnehmen. 

Direct link to Lay Summary Last update: 06.11.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
Informant-related effects of neurofeedback and cognitive training in children with ADHD including a waiting control phase: a randomized-controlled trial.
Minder Franziska, Zuberer Agnieszka, Brandeis Daniel, Drechsler Renate (2018), Informant-related effects of neurofeedback and cognitive training in children with ADHD including a waiting control phase: a randomized-controlled trial., in European child & adolescent psychiatry, Jan 2018.
A Review of the Clinical Utility of Systematic Behavioral Observations in Attention Deficit Hyperactivity Disorder (ADHD).
Minder Franziska, Zuberer Agnieszka, Brandeis Daniel, Drechsler Renate (2017), A Review of the Clinical Utility of Systematic Behavioral Observations in Attention Deficit Hyperactivity Disorder (ADHD)., in Child psychiatry and human development, Dec 6.
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.
Zuberer Agnieszka, Brandeis Daniel, Drechsler Renate (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., in Frontiers in human neuroscience, 9, 135-135.
Mixed-effects modeling of neurofeedback-training performance: Moderators for learning in children with ADHD
Zuberer A. Minder F. Brandeis D. Drechsler R, Mixed-effects modeling of neurofeedback-training performance: Moderators for learning in children with ADHD, in Neural Plasticity.

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
4th Burghölzli Psychiatry Meeting Poster Pre-training neuropsychological impairment of children and adolescents with ADHD is unrelated to treatment response after computerized cognitive training 30.11.2017 Zürich, Switzerland Minder Franziska;
EUNETHYDIS International Research Meeting Talk given at a conference Probably blinded or different perspective? Differences between parent and teacher rating after neurofeedback and cognitive training in ADHD 02.10.2017 Cologne, Germany Drechsler Renate;
EUNETHYDIS International Research Meeting on ADHD Poster Pre-training neuropsychological impairment of children and adolescents with ADHD is unrelated to treatment response after computerized cognitive training. 02.10.2017 Köln, Germany Minder Franziska;
17th International Congress of ESCAP Talk given at a conference On the significance of teacher ratings for the evaluation of neurofeedback training in ADHD 09.07.2017 Geneva, Switzerland Drechsler Renate;
INS Mid-Year Congress Talk given at a conference Pre-training neuropsychological impairment of children and adolescents with ADHD is unrelated to treatment response after computerized cognitive training 05.07.2017 Cape Town, South Africa Minder Franziska;
6th World Conference on ADHD Poster Multilevel modeling of neurofeedback EEG-learning in children and adolescents with ADHD 20.04.2017 Vancouver, Canada Zuberer Agnieszka;
XXXV. DGKJP Kongress Poster Wie aussagekräftig sind Lehrerurteile bei der Beurteilung von Trainingseffekten bei ADHS? Zum Einfluss von Wartezeit und Setting. 22.03.2017 Ulm, Germany Drechsler Renate;
XXXV. DGKJP Kongress Poster Standardisierte Unterrichtsbeobachtungen vor und nach computer-gestütztem kognitiven Training bei Kindern und Jugendlichen mit ADHS 22.03.2017 Ulm, Germany Minder Franziska;
3rd Burghölzli Psychiatry Meeting Poster What can be learned from the self-appraisal of spontaneous arousal for neurofeedback performance? 25.10.2016 Zürich, Switzerland Zuberer Agnieszka;
3rd Burghölzli Psychiatry Meeting Talk given at a conference Efficacy of neurofeedback training in children and adolescents with ADHD as evaluated by systematic classroom observations and teacher ratings, 25.10.2016 Zürich, Switzerland Minder Franziska;
Dreiländertagung der GNPÖ, SVNP-ASNP, GNP Talk given at a conference Lernen Kinder mit ADHS ihre Gehirnaktivität zu regulieren? Zur spezifischen Wirksamkeit von Neurofeedbacktraining bei ADHS. 20.10.2016 Würzburg, Germany Drechsler Renate;
4th EUNETHYDIS International Conference on ADHD Poster Efficacy of neurofeedback training in children and adolescents with ADHD as evaluated by systematic classroom observations and teacher ratings 16.10.2016 Berlin, Germany Minder Franziska;
4th EUNETHYDIS International Conference on ADHD, Poster Knowing and changing mental states: What can be learned from performance on self-appraisal tasks? 16.10.2016 Berlin, Germany Zuberer Agnieszka;
4th EUNETHYDIS International Conference on ADHD Talk given at a conference Efficacy of neurofeedback training in children and adolescents with ADHD as evaluated by systematic classroom observations and teacher ratings. 16.10.2016 Berlin, Germany Minder Franziska;
30. Jahrestreffen des AK Kinder und Jugendliche der GNP Talk given at a conference Wie gut lassen sich ADHS-Symptome mit systematischen Beobachtungsverfahren objektivieren? 21.04.2016 Wels, Austria Minder Franziska;
4th Mind, Brain and Body Symposium Poster Self-regulated brain activity during neurofeedback training in children with ADHD 15.03.2016 Berlin, Germany Zuberer Agnieszka;
2nd Burghölzli Psychiatry Meeting Poster Neurofeedback- different measures for training performance 17.11.2015 Zürich, Switzerland Zuberer Agnieszka;
2nd Burghölzli Psychiatry Meeting Talk given at a conference Ist Neurofeedbacktraining eine wirksame Behandlung für Kinder mit ADHS? 11.11.2015 Zürich, Switzerland Drechsler Renate;
EUNETHYDIS International Research Meeting on ADHD Poster Learning to Regulate Slow Cortical Potentials: Diversity of Learning Patterns and Possible Mediator Variables in Neurofeedback Training in Children with ADHD 01.10.2015 Stockholm, Sweden Zuberer Agnieszka;
Neurizons Poster Learning of self-regulated brain activity during neurofeedback training in children with ADHD 26.05.2015 Göttingen, Germany Zuberer Agnieszka;
XXXIV. DGKJP Kongress Poster Standardisierte Unterrichtsbeobachtung und Lehrereinschätzung von Kindern mit ADHS vor und nach computergestütztem Einzeltraining 04.03.2015 München, Germany Minder Franziska;
28. Jahrestreffen des AK Kinder und Jugendliche der GNP Talk given at a conference Sind kognitive Trainingsverfahren bei ADHS wirksam? 08.05.2014 Kehl-Kork, Germany Drechsler Renate;


Awards

Title Year
Posterpreis, 4th Burghölzli Psychiatry Meeting 2017
Travel grant, 6th World Conference on ADHD 2017
Posterpreis, 2nd Burghölzli Psychiatry Meeting 2015

Associated projects

Number Title Start Funding scheme
130237 Neuroimaging of cognitive flexibility and action monitoring in paediatric obsessive-compulsive disorder (OCD) and attention deficit-hyperactivity disorder (ADHD) 01.11.2010 Project funding (Div. I-III)

Abstract

BackgroundAttention deficit/hyperactivity disorder (ADHD) is the most common childhood-onset psychiatric disorder. It has a negative, long lasting impact on academic achievement, social integration and quality of life. In recent years, the efficacy of non-pharmacological treatments for ADHD, such as neurofeedback training (NF) and computerized cognitive training (CCT) has become a research focus. Although an increasing number of well designed studies have shown that both methods may improve ADHD core symptoms according to parents’ ratings, the underlying mechanisms are still a matter of debate. Teachers sometimes report smaller improvements if any. This has been explained by their lesser involvement in the training, and interpreted as “quasi blinding” (Sonuga Barke et al. 2013). However, other factors and setting effects may also account for this, and other methods like controlling for learning during the training may be applied in order to demonstrate the specificity and efficacy of NF and CCT. Aims and hypothesesThe main purpose of this project is to demonstrate and compare the efficacy of two different computer-based treatment methods for children and adolescents with ADHD, namely NF and CCT, and to examine the impact of different treatment settings, with half of the participants being trained in a clinical setting and the other half at school. We want to show that is feasible to implement NF and CCT in a school setting and that both methods, conducted either at school or in a clinical setting, may lead to significant improvements of ADHD symptoms as well as to specific and differential effects. By choosing a nested design, which also includes a baseline without treatment and a genuinely blinded behavioural observation we intend to disentangle the effects of setting, treatment and informant. In addition, differential effects of treatments on electrophysiological and neuropsychological parameters will be evaluated, as well as effects of learning during the training. Design and methodsChildren and adolescents with ADHD (N=80), aged 8 ½ to 16 yrs, will participate in this study. Half of them (N=40) will be trained with NF of the slow cortical potentials (SCP), and the other half (N=40) with the CCT “Cogniplus”, both during 25- 30 lessons over a period of 12 weeks. Allocation to treatments will be randomized. Half of the children of both treatment groups (CCT: N=20; NF: N=20) will be trained at school, the other half in a clinical setting. Treatments will be preceded by a waiting period of 12 weeks. Behavioural, neuropsychological and electrophysiological measures will be obtained at three times: at baseline, directly before the start of the treatment and after the treatment. In addition, a classroom observation will be conducted before and after the training by a person not involved in the training. Expected valueThe long-term goal of the project is to provide scientifically based recommendations for the treatment of ADHD by computer- or EEG-supported methods for teachers, education specialists, health care professionals and parents. CCT and NF offered in schools could possibly help to overcome social, cultural or regional barriers to treatment.
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