Effectivity of Neurofeedback in youth with AD(H)D-problems and comorbid disorders: a randomized controlled trial

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 study is to investigate, using a randomized controlled
trial, whether a neurofeedback is a effective intervention for youngsters with
AD(H)D and comorbid disorders. The objective of neurofeedback is to treat the
fundamental problems related to AD(H)D-problems.

In a randomized controlled trial the effectivity of neurofeedback will be
investigated. The RCT uses an experimental group (with treatment as usaul
[TAU] and 40 session of neurofeedback) and a control group (TAU) with
youngsters with AD(H)D-problems and comorbid disorders. The clients are
enrolled in the study after a positive screening for AD(H)D or a DSM IV
diagnosis 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 3 electrodes. The EEG will be
recorded on C3 or 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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