Symposium: Efficacy and use of neurofeedback therapy in ADHD

  • 28 Sep 2012
  • 2:30 PM - 3:30 PM
  • Perth Convention Centre, Perth, Australia

This symposium is being presented by members of the APS Neurofeedback Interest Group at the forthcoming annual conference of the Australian Psychological Society.

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Richard Clark - Flinders University; Brain Health Clinics.  

Jacques Duff - Swinburne University; Behavioural Neurotherapy Clinic.

Moshe Perl - Discovering & Creating Solutions.

Michelle Aniftos - Mylne Street Mental Health

Enquiries to:

Overarching abstract: Neurofeedback therapy (NFB) is a widely used intervention for the treatment of Attention-deficit/hyperactivity disorder (ADHD) but tends to be poorly understood by the mental health community. It is a type of operant conditioning in which an individual modifies the frequency, amplitude, or other characteristic of his or her own EEG. A review of relevant literature demonstrates that NFB meets Level 5 criteria of the American Psychological Association as being both Efficacious and Specific as a primary treatment intervention in ADHD. It is shown to be as effective as stimulants in addressing symptoms in around 70%-80% of children with ADHD, and is a safe and effective intervention without adverse side effects. This symposium will review this use and the efficacy of neurofeedback therapy in ADHD. Recent work has found neurofeedback therapy to be an effective intervention that depending on circumstance can be both complementary, and an alternative, to better known interventions such as medication and cognitive behavioural therapy. Neurofeedback therapy is also the subject of a recent position paper submitted by the APS Neurofeedback & Psychology Interest Group to the National Board for endorsement. The position paper is also under consideration by the NH&MRC for inclusion in its revised Clinical Practice Points on Attention Deficit Hyperactivity Disorder (ADHD) in Children and Adolescents. The four presentations forming this symposium will provide (1) an overview of neurofeedback therapy as a clinical intervention in ADHD, (2) a discussion of conventional versus neurofeedback approaches to therapy in ADHD (3) evidence of the efficacy of neurofeedback therapy as a clinical intervention in ADHD, (4) the role of emerging technologies in the assessment and diagnosis of ADHD and their relevance to neurofeedback therapy.

Presentation 1 An overview of neurofeedback therapy as a clinical intervention in ADHD. PERL, M. (Discovering & Creating Solutions)

This paper will provide an introduction to the material to be covered by the symposium. This will be followed by a discussion of the thirty year plus background to neurofeedback, providing the context for its use in modern day psychological therapy. The rationale behind the use of neurofeedback as a clinical intervention will be explained as well as coverage of the putative mechanisms of action, with a discussion of the operant principles underpinning its clinical effects. The common procedures that are currently employed by practitioners will be outlined, with a number of clinical examples presented and discussed. The discussion will also address a range of modes of neurofeedback intervention, including amplitude, frequency, phase coherence, slow cortical potential and real-time cortical source training, and explain the significance of each approach.

Presentation 2 Conventional versus neurofeedback approaches to therapy in ADHD. ANIFTOS, M (Mylne Street Mental Health)

ADHD is a neurodevelopmental disorder of childhood with a prevalence of between 2-20%. It is primarily diagnosed using the criteria of DSM-IV-TR with three subtypes: predominantly inattentive, predominantly hyperactive-impulsive and combined. The mainstream treatment has been stimulant medication. Stimulants have short-term benefits for around 60% of children with ADHD, however, long-term benefits have not been demonstrated, and adverse side effects often intolerable. Cognitive and behavioural treatments are also common, though generally subject to the pervasive view that medication should be the first line intervention. This paper will examine the evidence for the mainstream interventions of medication and cognitive-behavioural therapy. It will then outline the circumstances under which neurofeedback therapy provides an effective alternative to these modalities as well as those under which it provides an effective complement to them.

Presentation 3 Evidence of the efficacy of neurofeedback therapy as a clinical intervention in ADHD. DUFF, J. (Swinburne University; Behavioural Neurotherapy Clinic)

For much of its history, evidence supporting the use of neurofeedback therapy has tended to derive from case and uncontrolled clinical case studies. The last decade however has seen the publication of a number of well-controlled experimental studies and related meta-analyses that demonstrate a high level of efficacy for the use of neurofeedback therapy in ADHD. A recent review by the International Society for Neurofeedback and Research found neurofeedback to be a safe and efficacious treatment intervention for ADHD, meeting the rating of Level 5 (Efficacious and Specific) of the levels of efficacy specified by the American Psychological Association. A more recent review by the APS Neurofeedback & Psychology Interest Group concurs with this rating. The evidence will be reviewed and discussed in this presentation.

Presentation 4 The role of emerging technologies in the assessment and diagnosis of ADHD and their relevance to neurofeedback therapy. CLARK, CR. (Flinders University; Brain Health Clinics)

Increasing technological developments over the last two decades now permits precise and real-time measurement of the electrical and magnetic fields emitted during neurocortical function. The relationship

between these fields and the higher functions mediated by brain information processing has been the subject of intense research over an even longer period, with extant knowledge now beginning to describe the related functional architecture. This paper will focus on how this technology permits sophisticated assessment of psychobiological function in ADHD and how this assessment provides new insights that assist with differential diagnosis. In this regard, it will be shown (a) how the related use of EEG as an integral part of the assessment process has permitted the identification of endophenotypes that better characterize information processing disorders such as ADHD, and (b) how this assessment critically helps inform the design of the treatment process.

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