Journal of Attention Disorders

Objective: Many EEG studies have reported that ADHD is characterized by elevated Theta/Beta ratio (TBR). In this study we conducted a meta-analysis on the TBR in ADHD. Method: TBR data during Eyes Open from location Cz were analyzed from children/adolescents 6-18 years of age with and without ADHD. Results: Nine studies were identified with a total of 1253 children/adolescents with and 517 without ADHD. The grand-mean effect size (ES) for the 6-13 year-olds was 0.75 and for the 6-18 year-olds was 0.62. However the test for heterogeneity remained significant; therefore these ESs are misleading and considered an overestimation. Post-hoc analysis found a decreasing difference in TBR across years, explained by an increasing TBR for the non-ADHD groups. Conclusion: Excessive TBR cannot be considered a reliable diagnostic measure of ADHD, however a substantial sub-group of ADHD patients do deviate on this measure and TBR has prognostic value in this sub-group, warranting its use as a prognostic measure rather than a diagnostic measure.

Objective: The goal of this study is to characterize the theta to beta ratio (THBR) obtained from electroencephalogram (EEG) measures, in a large sample of community and clinical participants with regard to (a) ADHD diagnosis and subtypes, (b) common psychiatric comorbidities, and (c) cognitive correlates. Method: The sample includes 871 participants (595 youth and 276 adults) with and without ADHD. All participants underwent extensive assessment, including semistructured diagnostic interviews, cognitive testing, and EEG recording. Results: The THBR did not differ significantly by ADHD status for youth but was significantly lower in adults with ADHD compared with controls. ADHD subtype and psychiatric comorbidities such as disruptive behavior disorders and depression have opposing and significant mediating effects on the THBR. Conclusion: The THBR is affected by several mediating factors associated with ADHD such as ADHD subtype and psychiatric comorbidity. More research is needed to understand the functional significance of the THBR in ADHD.

Objective: The intent of this manuscript was to review all published studies on slow cortical potentials (SCP) neurofeedback for the treatment of ADHD, with emphasis on neurophysiological rationale, study design, protocol, outcomes, and limitations. Method: For review, PubMed, MEDLINE, ERIC, and Google Scholar searches identified six studies and six subsequent publications. In addition to five studies focusing on children with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV)–diagnosed ADHD, one study reports on adults. Results: SCP protocols utilize unipolar-electrode placement at Cz, randomized bidirectional signal regulation, feedback/transfer trials, and discrete feedback/rewards. Results demonstrated learning of SCP self-regulation, moderate to large within group effect sizes for core ADHD symptom reduction, and enhancement of event-related potentials/electroencephalogram components. Neurophysiological and session variables were predictive of treatment outcome, but open questions of specific and nonspecific effects remain. Study limitations and future directions are discussed. Conclusion: SCP is an efficacious and standardized neurofeedback protocol that addresses behavioral and neurophysiological deficits in ADHD.

Objective: Preparing for a definitive randomized clinical trial (RCT) of neurofeedback (NF) for ADHD, this pilot trial explored feasibility of a double-blind, sham-controlled design and adherence/palatability/relative effect of two versus three treatments/week. Method: Unmedicated 6- to 12-year-olds with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) ADHD were randomized to active NF versus sham-NF and to 2X versus 3X/week treatment frequency. Frequency switch was allowed after Treatment 24. Results: In two school years, 39 participants were recruited and 34 (87%) completed all 40 treatments. Child/parent guesses about assigned treatment were no better than chance. At Treatment 24, 38% chose 2X/week and 62% chose 3X/week. Both active NF and sham yielded large pre–post improvement on parent ratings but NF no more than sham. Conclusion: Blinding appears to work, and sham does not prevent recruitment/retention. Treatment frequency of 3X/week seems preferred over 2X/week and was as effective. A large double-blind RCT is feasible and necessary to test specific NF effectiveness.

Objective: Additional treatments with persisting benefit are needed for ADHD. Because ADHD often shows excessive theta electroencephalogram (EEG) power, low beta, and excessive theta-beta ratio (TBR), a promising treatment is neurofeedback (NF) downtraining TBR. Although several nonblind randomized clinical trials (RCTs) show a medium-large benefit for NF, a well-blinded, sham-controlled RCT is needed to differentiate specific from nonspecific effects. Method: Experts in NF, ADHD, clinical trials, and statistics collaborated to design a double-blind multisite RCT. Results/Conclusion: At four sites, 180 children aged 7 to 10 years with rigorously diagnosed ADHD and TBR ≥ 5 will be randomized to active TBR-NF versus sham NF of equal duration, intensity, and appearance. Sham, utilizing prerecorded EEGs with participant artifacts superimposed, will keep participants and staff blind. Treatment fidelity will be trained/monitored by acknowledged NF leaders. Multidomain assessments before, during, and after treatment (follow-up to 2 years) will also include tests of blinding and sham inertness.

Objective: The study examined the concordance among rating sources on attention problems of elementary school–aged children. Method: A randomly selected sample (N = 841) of children was rated by the physical educators, the teachers, and the parents, using the Attention Scales of the Motor Behavior Checklist (MBC), the Teacher Report Form, the Child Behavior Checklist, and the ADHD–Rating Scale–IV (ADHD-RS-IV ). Results: Convergent validity of the Lack of Attention Scale of the MBC with the corresponding subscales was supported. Correlations were higher between teachers’ ratings and between physical educators’ and teachers’ ratings than between physical educators’ and parents’ ratings or between teachers’ and parents’ ratings. Conclusion: Findings underscore the importance of taking the child’s settings and observer influences into account and suggest that MBC is a new promising instrument for screening attention problems in school settings.

The available literature provides few studies on the effectiveness of methylphenidate in improving quality of life in individuals with ADHD. Objective: To assess the effectiveness of Methyphenidate OROS formulation (OROS MPH) through QoL in adults with ADHD. Method: A 12-week, multicenter, open-label trial involving 60 patients was used. The measures used were Adult Self-Rating Scale, Adult ADHD Quality of Life Scale (AAQoL), State and Trait Anxiety Inventory (STAI), Hamilton Depression Rating Scale (HAM-D), Clinical Global Impression (CGI), and safety measures. A significance statistic level of 5% was adopted. Results: Analyses included 60 patients (66.7% male; M age = 31.1 years) for safety and 58 patients for effectiveness. All AAQoL subscales improved from baseline to Week 12 (p < .0001), as well as the Total AAQoL (p < .0001). A significant reduction on Clinical Global Impression–Improvement (CGI-I), HAM-D, STAI, and ASRS scores was observed (p < .0001). No serious adverse event was reported. Conclusion: Treatment of adult ADHD patients with OROS MPH improves QoL.

Objective: To assess three of the better known screeners for Attention Deficit/Hyperactive Disorder (ADHD) and review the relationship between ADHD and cognitive ability. Method: The three ADHD screeners were administered to 111 college students enrolled in a college Introductory Psychology class, on whom ACT scores and total course performance were also available. As a measure of cognitive ability, the Wonderlic Personnel Test (Wonderlic, Inc., 2000) was also administered. Furthermore, self-report data were available from participants who had been diagnosed with ADHD. The three screeners were the Adult ADHD Self-Report Scale (ASRS) (Kessler et al., 2005), the Conners’ Adult ADHD Rating Scale—Self-Report: Long Version (CAARS) (Conners, Erhardt, & Sparrow, 1999), and the Brown ADD Scales (Brown, 1996). Results: The results are discussed in terms of the scales’ reliability, as well as their relationship to academic aptitude, class performance, and their ability to identify self-reported ADHD diagnoses. Conclusion: All three screeners exhibited acceptable reliability levels. Criterion validity was demonstrated by the relationship between the CAARS’s inattention subscale and self-reported cases of ADHD. Criterion validity was also seen in the relationship found between the CAARS’s hyperactivity/restlessness subscale and the total course performance even after controlling for cognitive ability. Contrary to past research cognitive ability exhibited a weak but significant relationship with a few screeners and screener subscales.