Neurofeedback a possible effective intervention for youth with AD(H)D and comorbid severe behavioral problems.

Youngsters in (forensic) mental health care suffer from complex and multiple
behavioral problems which are, to a certain extent, untreatable. These complex
behavioral problems are most often related to a dysfunctional regulation of
brain activity (John, 1988). Neurofeedback is a training method to (partially)
correct the regulation of the brain activity by feedback. The goal of this
training is to learn youngsters to regulate their brain activity and thereby
indirectly influence their behavior. Earlier studies demonstrate that
neurofeedback causes sustained and structural changes in brain activity
(Strawson & Gruzelier, 2002). Furthermore, these changes cause a longstanding
improvement of the behavior (Lubar, 1997).

The objective of the pilot study is to investigate whether a
neurofeedbacktraining is a feasible intervention for youngsters with AD(H)D and
severe behavioral problems. Besides the feasibility of the
neurofeedbacktraining the clinical relevance of the neurofeedbacktraining is
important for continuation of the training in youth with AD(H)D and severe
behavioral problems. Therefore thev clinical relevance of the
neurofeedbacktraining is investigated using QEEG-assessment and
neuropsychological tests.

In the pilot study a neurofeedbacktraining will be investigated in (delinquent)
youth with AD(H)D and severe behavioral problems who are hospitalized in a
youth (forensic) psychiatric hospital. The clients are enrolled in the study
after a positive screening for AD(H)D. Information about AD(H)D is assessed
with a semi-structured interview, questionnaires (in interview format) and
neuropsychological tests. All these measurements will be assessed on four
different occasions: (1) During the intake; (2) directly after the
neurofeedbacktraining; (3) half year after the completion of the
neurofeedbacktraining; (4) and a year after the end of the
neurofeedbacktraining.

The neurofeedbacktraining will be conducted in 40 sessions, 30 minutes each.
There are three sessions per week, which are divided equally across the week.
The total duration of the neurofeedbacktraining is 14 weeks. The procedure
follows the paradigm described by Lubar et al. (1995). During the
neurofeedbacktraining the EEG is recorded with 6 electrodes. The EEG will be
recorded simultaneous on C3 and C4 (10-20 system) with a reference to both ears
(mastoid earth sensor, 256 Hz).
During the training several EEG frequencies are trained: in clients with mostly
hyperactivity and impulsive symptoms the sensory motor rhythms are trained, in
clients with mostly attention deficit symptoms the beta1 frequencies are
trained. In clients with mixed symptoms the training of sensory motor rhythms
and beta1 frequencies are alternated trained. Furthermore during the last and
the first session of the neurofeedbacktraining a QEEG-assessment is conducted,
based on the first QEEG the protocol of the neurofeedbacktraining is
determined.

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