A Placebo-Control Evaluation of Neurofeedback Efficacy in Adults with ADHD

描述（由申请人提供）：ADHD是最常见的精神疾病之一。虽然多动症最常被诊断为儿童，但它可能影响到3%的成年人。患有多动症的人可能会在学业、就业和家庭环境中遇到问题。被诊断患有多动症的成年人接受正规教育的年数更少，总体职业地位更低，更有可能出现一系列精神问题，如反社会人格障碍或药物滥用。用于治疗多动症的兴奋剂药物对多动症症状的影响是有限的，不能治愈潜在的疾病，而且可能导致不良的副作用。神经反馈（NFB）越来越多地被用作ADHD的替代和补充治疗。NFB是一种生物反馈，在这种反馈中，一个人接收到由头皮上的传感器记录的关于大脑活动的反馈。操作性条件反射原理用于训练参与者控制脑电图（EEG）活动的某些方面。计算机软件处理脑电图信号、音调和监视器上的图像，以通知参与者他们是否正在产生属于目标波频率的脑电图。安排训练突发事件来训练用户增加与持续集中和认知控制相关的脑电图频带。研究人员、临床医生和患者都报告了使用NFB技术治疗ADHD患者的行为控制和注意力的改善。然而，NFB的批评者认为，研究没有包括足够的控制，NFB患者ADHD症状的改善可能是安慰剂效应。本研究的目的是进行一项双盲、安慰剂对照、随机的NFB试验，使用令人信服的假NFB对照条件。人口统计学上匹配的未接受NFB的非adhd组也将被研究，以分析与注意力相关的潜在EEG标记。该项目的关键创新是：1)纳入可信的假安慰剂对照，2)随机分配，3)在多个时间点对认知表现进行标准化、客观、自动化和重复测量，4)为个人量身定制NFB培训方案的标准化程序

DESCRIPTION (provided by applicant): ADHD is one of the most frequently diagnosed psychiatric disorders. Although ADHD is most often diagnosed in children it may affect up to three percent of the adult population. Individuals with ADHD are likely to experience problems in academic, employment, and home settings. Adults that are diagnosed with ADHD receive fewer years of formal schooling, achieve lower overall occupational status, and are more likely to have a range of psychiatric problems such as anti-social personality disorder or substance abuse. Stimulant medications used to treat ADHD are of limited effectiveness with respect to their effects on ADHD symptoms, do not cure the underlying disorder, and can cause adverse side effects. Neurofeedback (NFB) is growing in use as an alternative and complementary treatment for ADHD. NFB is a type of biofeedback in which one receives feedback about brain activity recorded by a sensor on the scalp. Operant conditioning principles are employed to train participants to control certain aspects of electroencephalographic (EEG) activity. Computer software processes the EEG signals and tones and images on a monitor to inform the participant about whether they are generating EEG that falls in a target wave frequency. Training contingencies are arranged to train users to increase the EEG frequency bands associated with sustained concentration and cognitive control. Researchers, clinicians, and patients have reported improvement of behavioral control and attention in ADHD patients treated using NFB technology. Critics of NFB argue, however, that studies have not included adequate controls and that ADHD symptom improvements in NFB patients are likely to be placebo effects. The purpose of the proposed study is to conduct a double-blind, placebo- controlled, randomized NFB trial using a convincing sham NFB control condition. A demographically matched non-ADHD group that does not receive NFB will be studied also to analyze potential EEG markers associated with attention. The key innovations in this project are: 1) inclusion of a credible sham placebo-control, 2) randomized assignment, 3) standardized, objective, automated, and repeated measures of cognitive performance at multiple time points, 4) standardized procedures for tailoring NFB training protocols to individual participant ADHD symptom profiles as would be performed under true clinical conditions. The proposed study will provide a scientifically rigorous test of the hypothesis that NFB is an effective treatment for ADHD in young adults and whether the "active ingredient" in NFB is the contingent relationship between EEG and feedback stimuli. PUBLIC HEALTH RELEVANCE: Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent psychiatric diagnoses. Medical management of ADHD involves the use of stimulant drugs and achieves limited success. The present application evaluates the efficacy of neurofeedback as a treatment for ADHD in adults and uses a randomized placebo control design.