Neurofeedback in children with ADHD: Specific event-related potential findings of a randomized controlled trial

ObjectiveIn a randomized controlled trial, we could demonstrate clinical efficacy of neurofeedback (NF) training for children with ADHD (Gevensleben et al., 2009a). The present investigation aimed at learning more about the neuronal mechanisms of NF training.MethodsChildren with ADHD either completed a NF training or a computerized attention skills training (ratio 3:2). NF training consisted of one block of theta/beta training and one block of slow cortical potential (SCP) training, each comprising 18 training units. At three times (pre-training, between the two training blocks and at post-training), event-related potentials (ERP) were recorded during the Attention Network Test. ERP analysis focused on the P3, reflecting inter alia attentional resources for stimulus evaluation, and the contingent negative variation (CNV), primarily related to cognitive preparation.ResultsAfter NF training, an increase of the CNV in cue trials could be observed, which was specific for the SCP training. A larger pre-training CNV was associated with a larger reduction of ADHD symptomatology for SCP training.ConclusionsCNV effects reflect neuronal circuits underlying resource allocation during cognitive preparation. These distinct ERP effects are closely related to a successful NF training in children with ADHD. In future studies, neurophysiological recordings could help to optimize and individualize NF training.SignificanceThe findings contribute to a better understanding of the mechanisms underlying NF training in children with ADHD.

► Neurofeedback training in children with ADHD is accompanied by changes in neural processing (e.g., increase of the contingent negative variation after training of slow cortical potentials).
► The success of the training can be predicted by pre-training EEG and event-related potential measures.
► The findings of the randomized controlled trial further support the specificity of training effects and contribute to a better understanding of the mechanisms underlying a successful neurofeedback training in children with ADHD.