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Journal of the American Academy of Child & Adolescent Psychiatry

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Neurofeedback for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials - 28/05/16

Doi : 10.1016/j.jaac.2016.03.007 
Samuele Cortese, MD, PhD a, b, Maite Ferrin, MD, PhD a, c, Daniel Brandeis, PhD e, f, Martin Holtmann, MD g, Pascal Aggensteiner, MA e, David Daley, PhD h, Paramala Santosh, MD, PhD i, Emily Simonoff, MD, PhD i, Jim Stevenson, PhD a, Argyris Stringaris, MD, PhD, MRCPsych i, Edmund J.S. Sonuga-Barke, PhD a, d, ⁎
on behalf of the

European ADHD Guidelines Group (EAGG)

Phil Asherson, MBBS, MRPsych, PhD, Tobias Banaschewski, MD, PhD, Daniel Brandeis, PhD, Jan Buitelaar, MD, PhD, David Coghill, MD, Samuele Cortese, MD, PhD, David Daley, PhD, Marina Danckaerts, MD, PhD, Ralf W. Dittmann, MD, PhD, Manfred Döpfner, PhD, Maite Ferrin, MD, PhD, Chris Hollis, MD, PhD, Martin Holtmann, MD, PhD, Eric Konofal, MD, PhD, Michel Lecendreux, MD, Aribert Rothenberger, MD, Paramala Santosh, MD, PhD, Joseph A. Sergeant, PhD, Emily Simonoff, MD, Edmund J. Sonuga-Barke, PhD, Cesar Soutullo, MD, HansChristoph Steinhausen, MD, PhD, Jim Stevenson, PhD, Argyris Stringaris, MD, PhD, MRCPsych, Eric Taylor, MD, Saskia van der Oord, PhD, Ian Wong, PhD, Alessandro Zuddas, MD

a Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK 
b New York University Child Study Center, New York, and Solent NHS Trust, UK 
c Huntercombe Hospital Maidenhead, Maidenhead, UK 
d Ghent University, Ghent, Belgium and Aarhus University, Aarhus, Denmark 
e Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany 
f Psychiatric Hospital, University of Zurich, the Integrative Human Physiology and the Neuroscience Center Zurich, University of Zurich, Switzerland, and ETH Zurich 
g LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr University Bochum, Germany 
h School of Medicine and MindTech Institute of Mental Health, University of Nottingham, UK 
i Institute of Psychiatry, Psychology and Neurosciences, King’s College London, and the Maudsley Hospital, London, UK 

∗Correspondence to Edmund J.S. Sonuga-Barke, PhD, Developmental Brain-Behaviour Laboratory, Psychology Academic Unit, University of Southampton, University Road, Southampton SO17 1BJ, UKDevelopmental Brain-Behaviour LaboratoryPsychology Academic UnitUniversity of SouthamptonUniversity RoadSouthampton SO17 1BJUK

Abstract

Objective

We performed meta-analyses of randomized controlled trials to examine the effects of neurofeedback on attention-deficit/hyperactivity disorder (ADHD) symptoms and neuropsychological deficits in children and adolescents with ADHD.

Method

We searched PubMed, Ovid, Web of Science, ERIC, and CINAHAL through August 30, 2015. Random-effects models were employed. Studies were evaluated with the Cochrane Risk of Bias tool.

Results

We included 13 trials (520 participants with ADHD). Significant effects were found on ADHD symptoms rated by assessors most proximal to the treatment setting, that is, the least blinded outcome measure (standardized mean difference [SMD]: ADHD total symptoms = 0.35, 95% CI = 0.11−0.59; inattention = 0.36, 95% CI = 0.09−0.63; hyperactivity/impulsivity = 0.26, 95% CI = 0.08−0.43). Effects were not significant when probably blinded ratings were the outcome or in trials with active/sham controls. Results were similar when only frequency band training trials, the most common neurofeedback approach, were analyzed separately. Effects on laboratory measures of inhibition (SMD = 0.30, 95% CI = −0.10 to 0.70) and attention (SMD = 0.13, 95% CI = −0.09 to 0.36) were not significant. Only 4 studies directly assessed whether learning occurred after neurofeedback training. The risk of bias was unclear for many Cochrane Risk of Bias domains in most studies.

Conclusion

Evidence from well-controlled trials with probably blinded outcomes currently fails to support neurofeedback as an effective treatment for ADHD. Future efforts should focus on implementing standard neurofeedback protocols, ensuring learning, and optimizing clinically relevant transfer.

Le texte complet de cet article est disponible en PDF.

Key words : ADHD, neurofeedback, nonpharmacological treatment, meta-analysis, risk of bias


Plan


 European ADHD Guidelines Group (EAGG) Members: Phil Asherson, MBBS, MRPsych, PhD, Tobias Banaschewski, MD, PhD, Daniel Brandeis, PhD, Jan Buitelaar, MD, PhD, David Coghill, MD, Samuele Cortese, MD, PhD, David Daley, PhD, Marina Danckaerts, MD, PhD, Ralf W. Dittmann, MD, PhD, Manfred Döpfner, PhD, Maite Ferrin, MD, PhD, Chris Hollis, MD, PhD, Martin Holtmann, MD, PhD, Eric Konofal, MD, PhD, Michel Lecendreux, MD, Aribert Rothenberger, MD, Paramala Santosh, MD, PhD, Joseph A. Sergeant, PhD, Emily Simonoff, MD, Edmund J. Sonuga-Barke, PhD, Cesar Soutullo, MD, HansChristoph Steinhausen, MD, PhD, Jim Stevenson, PhD, Argyris Stringaris, MD, PhD, MRCPsych, Eric Taylor, MD, Saskia van der Oord, PhD, Ian Wong, PhD, and Alessandro Zuddas, MD.
 Support for meetings and analyses was received from Brain Products GMBH, Janssen-Cilag, Eli Lilly and Co., Medice, Shire, and Vifor. No honoraria were received, and funders had no input into the review and meta-analysis process or the writing of the paper.
 Drs. Cortese and Ferrin are joint first authors.
 Disclosure: Dr. Cortese has received grant or research support from the Solent National Health Service (NHS) Trust, UK. He has received honorarium and travel expenses from the Association for Child and Adolescent Mental Health (ACAMH), UK. Dr. Ferrin was invited to participate to give a workshop on “Behavioural Interventions in ADHD” at the Meeting of Minds, Stockholm 2015, organized by Shire. Dr. Brandeis has served as an unpaid scientific advisor for a European Union (EU)-funded neurofeedback trial. Dr. Holtmann has served in an advisory or consultancy role for Medice and Shire, and has received conference attendance support or was paid for public speaking by Eli Lilly and Co., Medice, Neuroconn, and Shire. Dr. Daley has provided educational talks for Eli Lilly and Co. and Shire, has attended an advisory board for Eli Lilly and Co., has received support for educational travel from Eli Lilly and Co., Shire, and HP Pharma, and research funding from Shire. He has received royalties from the sale of a self-help version of the New Forest Parenting Programme. Dr. Santosh has received research funding from the EU (FP7 Programme) and the National Institute for Health Research (NIHR). He is a director and shareholder of HealthTracker, Ltd., UK, and HighStreet Medical Dental, Gillingham, UK. Dr. Simonoff has received grant funding from the following sources: NIHR; Autism Speaks; European Innovative Medicines Initiative; Wellcome Trust; South London and Maudsley Charitable Foundation; Biomedical Research Centre Nucleus Pilot Funding; NIHR Evaluation, Trials and Coordinating Centre (NETSCC). Dr. Stringaris has received grant or research support from the Guy’s and St. Thomas’ Charity, the Wellcome Trust, NIHR, and University College London for a joint project with Johnson and Johnson. He has received royalties from Cambridge University Press for The Maudsley Reader in Phenomenological Psychiatry and Oxford University Press for Disruptive Mood: Irritability in Children and Adolescents. Dr. Sonuga-Barke has received research funding and conference support from Shire Pharma; has received speaker fees from Shire Pharma, Janssen-Cilag, and Medice; has received book royalties from Oxford University Press and Jessica Kingsley; has served as a consultant to Shire Pharma, Neurotech Solutions, Aarhus University, Copenhagen University, and KU Leuven. Dr. Stevenson and Mr. Aggensteiner report no biomedical financial interests or potential conflicts of interest.


© 2016  American Academy of Child and Adolescent Psychiatry. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 55 - N° 6

P. 444-455 - juin 2016 Retour au numéro
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