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ADHD最常被诊断为儿童，但它可能会影响多达3%的成年人。患有ADHD的人可能会在学术，就业和家庭环境中遇到问题。被诊断患有ADHD的成年人接受正规教育的时间较少，整体职业地位较低，并且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ADHD的兴奋剂药物对ADHD症状的影响有限，不能治愈潜在的疾病，并且可能引起不良副作用。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，其中一个人接收由头皮上的传感器记录的关于大脑活动的反馈。操作性条件反射的原则是训练参与者控制某些方面的脑电图（EEG）活动。计算机软件在监视器上处理EEG信号以及音调和图像，以通知参与者他们是否正在生成处于目标波频率的福尔斯。安排训练应急以训练用户增加与持续集中和认知控制相关的EEG频带。研究人员、临床医生和患者都报告了使用NFB技术治疗的ADHD患者的行为控制和注意力改善。然而，NFB的批评者认为，研究没有包括足够的控制，NFB患者的ADHD症状改善可能是安慰剂效应。拟定研究的目的是使用令人信服的假NFB对照条件进行双盲、安慰剂对照、随机NFB试验。一个人口统计学匹配的非ADHD组，不接受NFB也将进行研究，以分析潜在的EEG标记与注意力。该项目的主要创新是：1）纳入可信的假安慰剂对照，2）随机分配，3）在多个时间点标准化，客观，自动化和重复测量认知表现，4）为个体定制NFB训练方案的标准化程序。 参与者ADHD症状特征，如在真实临床条件下进行的。这项拟议的研究将提供一个科学严格的测试假设，NFB是一种有效的治疗ADHD的年轻人，以及是否在NFB的“活性成分”是EEG和反馈刺激之间的偶然关系。 注意力缺陷多动障碍（ADHD）是最常见的精神病诊断之一。ADHD的医疗管理涉及使用兴奋剂药物，取得的成功有限。本申请评估神经反馈作为成人ADHD治疗的功效，并使用随机安慰剂对照设计。

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.