Cluster Analysis of the MMPI-2 in a Chronic Low-Back Pain Population

The Minnesota Multiphasic Personality Inventory (MMPI) is the most frequently used psychological measure in the assessment of chronic pain. Since the introduction of the MMPI-2 in 1989 only two published studies have focused on cluster analysis of chronic pain patients. This study investigated MMPI-2 cluster solutions of chronic low-back pain patients. Data was collected from 2,051 chronic low-back pain patients from a multidisciplinary pain clinic in the southwestern United States. A hierarchical clustering procedure was performed on K-corrected T-scores of the MMPI-2 using the three validity and ten clinical scales. Four relatively homogeneous subgroups were identified for each sex with the MMPI-2. In general, these results replicated the findings of previous researchers using both the MMPI and MMPI-2

The Effects of Music Training on Electroencephalographic Coherence of Preschool Children

The purpose of this study was to examine the effects of music training on electroencephalographic (EEG) coherence of preschool children. EEG coherence is a measurement of brain wave activity that reflects anatomical and neurophysiological parameters and functional connectivity between areas of the brain. Participants were 4- to 6-year-old children divided into two groups: one received music training for 20 minutes twice a week for 10 weeks while the other group served as controls. Nineteen channels of EEG data were collected from each child pre- and post-training. Data were collected from three conditions: eyes-open resting, listening to music, and performing the Object Assembly subtest of the Weschler Preschool and Primary Scale of Intelligence - Revised (1989). The hypothesis was that the music training group would show increased EEG coherence as compared to controls. The EEG data was reduced into seven bandwidths and analyzed separately for each condition. Multiple ANCOVAs were used to factor out pre-test variability and to maximize connectivity changes between the two groups. The dependent measures were the post-QEEG electrode pairs and the covariates were the pre-QEEG electrode pairs. Results indicated the eyes-open and listening to music conditions showed more significant changes between the groups than the Object Assembly condition. Overall, each condition showed increased connectivity for the music training group versus controls. The eyes-open condition differentiated children with and without music training during a resting condition, and showed similar patterns as those identified by other researchers comparing musicians versus nonmusicians. The listening to music condition identified connections including a topographical pattern of auditory analysis, increased working memory activation, increased activity between musically sensitive areas, and increased interhemispheric activity. Findings with the Object Assembly condition were not as robust as expected. However, patterns of increased connectivity associated with visuospatial processing were found with the music training group

Neurofeedback With Children With Attention Deficit Hyperactivity Disorder. A Randomized Double-Blind Placebo-Controlled Study

The attention deficit hyperactivity disorder (ADHD) is the most common childhood mental health disorder, with an estimated prevalence of 7% to 10% in boys and 3% in girls aged 4-11 years. ADHD is characterized by inattention, distractibility, hyperactivity, or excessive impulsivity, symptoms that cause impairment in more than one setting and cannot be explained by another disorder such as brain injury, a mood disorder, or an anxiety disorder. As many as 4 out of 5 children diagnosed with this disorder continue to suffer from attention problems in adolescence and adulthood. Anatomically, in terms of brain organization, many of these children exhibit immature development of frontostriatal circuitry with other structural and functional brain disturbances including the cerebellum and parietal cortices

A Review of Neurofeedback Treatment for Pediatric ADHD

Objective: The aim of this paper was to review all randomized published trials and unpublished conference presentations on the neurofeedback (NF) treatment of pediatric ADHD, and their relevance, strengths, and limitations. Method: Via PsychInfo and Medline searches and contacts with NF researchers 14 studies were identified and reviewed. Results: The majority were conducted from 1994 to 2010, with 5- to 15-year-olds, usually male and White with the combined type of ADHD. Most studies used theta/beta NF with a unipolar-electrode placement at Cz and demonstrated, where reported, an overall ADHD mean effect size of d = 0.69, a medium effect. Main study strengths, within some studies, include use of randomization, treatment control conditions, Diagnostic and Statistical Manual of Mental Disorders criteria, evidence-based assessment of ADHD, standard treatment outcome measures, multidomain assessment, and, for some studies, moderate sample size, some type of blind and the identification of medication as a concomitant treatment. Main study limitations (and directions for future research) include the lack of adequate blinding of participants, raters and NF trainers, a sham-NF/blinded control treatment condition, posttreatment follow-up, generalizability, specific details about delivery of NF, identification and control of comorbidity, and the identification, measurement, and control of concomitant treatments and potential side effects. Conclusion: Based on the results and methodologies of published studies, this review concludes that NF for pediatric ADHD can be currently considered as probably efficacious

Characterizing underlying cognitive components of ADHD presentations and co-morbid diagnoses – A diffusion decision model analysis

Objective. To Explore whether subtypes and comorbidities of attention-deficit hyperactivity disorder (ADHD) induce distinct biases in cognitive components involved in information processing. Method. Performance on the Integrated Visual and Auditory Continuous Performance Test (IVA-CPT) was compared between 150 children (aged 7-10 years) with ADHD, grouped by DSM-5 presentation (ADHD-C, ADHD-I) or co-morbid diagnoses (anxiety, oppositional defiant disorder [ODD], both, neither), and 60 children without ADHD. Diffusion decision modeling decomposed performance into cognitive components. Results. Children with ADHD had poorer information integration than controls. Children with ADHD-C were more sensitive to changes in presentation modality (auditory/visual) than those with ADHD-I and controls. Above and beyond these results, children with ADHD+anxiety+ODD had larger increases in response biases when targets became frequent than children with ADHD-only or one comorbidity. Conclusion. ADHD presentations and comorbidities have distinct cognitive characteristics quantifiable using DDM and IVA-CPT. We discuss implications for tailored cognitive-behavioral therapy

Neurofeedback and Attention-Deficit/Hyperactivity-Disorder (ADHD) in children: rating the evidence and proposed guidelines

Stimulant medication and behaviour therapy are the most often applied and accepted treatments for Attention-Deficit/Hyperactivity-Disorder (ADHD). Here we explore where the non-pharmacological clinical intervention known as neurofeedback (NFB), fits on the continuum of empirically supported treatments, using standard protocols. In this quantitative review we utilized an updated and stricter version of the APA guidelines for rating 'well-established' treatments and focused on efficacy and effectiveness using effect-sizes (ES) and remission, with a focus on long-term effects. Efficacy and effectiveness are compared to medication and behaviour therapy using benchmark studies. Only recent systematic reviews and meta-analyses as well as multi-centre randomized controlled trials (RCT's) will be included. Two meta-analyses confirmed significant efficacy of standard neurofeedback protocols for parent and teacher rated symptoms with a medium effect size, and sustained effects after 6-12\ua0months. Four multicenter RCT's demonstrated significant superiority to semi-active control groups, with medium-large effect sizes end of treatment or follow-up and remission rates of 32-47%. Effectiveness in open-label studies was confirmed, no signs of publication bias were found and no significant neurofeedback-specific side effects have been reported. Standard neurofeedback protocols in the treatment of ADHD can be concluded to be a well-established treatment with medium to large effect sizes and 32-47% remission rates and sustained effects as assessed after 6-12\ua0months

Different Spectral Analysis Methods for the Theta/Beta Ratio Calculate Different Ratios But Do Not Distinguish ADHD from Controls

There has been ongoing research on the ratio of theta to beta power (Theta/Beta Ratio, TBR) as an EEG-based test in the diagnosis of ADHD. Earlier studies reported significant TBR differences between patients with ADHD and controls. However, a recent meta-analysis revealed a marked decline of effect size for the difference in TBR between ADHD and controls for studies published in the past decade. Here, we test if differences in EEG processing explain the heterogeneity of findings. We analyzed EEG data from two multi-center clinical studies. Five different EEG signal processing algorithms were applied to calculate the TBR. Differences between resulting TBRs were subsequently assessed for clinical usability in the iSPOT-A dataset. Although there were significant differences in the resulting TBRs, none distinguished between children with and without ADHD, and no consistent associations with ADHD symptoms arose. Different methods for EEG signal processing result in significantly different TBRs. However, none of the methods significantly distinguished between ADHD and healthy controls in our sample. The secular effect size decline for the TBR is most likely explained by factors other than differences in EEG signal processing, e.g. fewer hours of sleep in participants and differences in inclusion criteria for healthy controls

Brainmarker-I differentially predicts remission to various attention- deficit/hyperactivity disorder treatments:a blinded discovery, transfer and validation study

Background: Attention-deficit/hyperactivity disorder is characterized by neurobiological heterogeneity, possibly explaining why not all patients benefit from a given treatment. As a means to select the right treatment (stratification), biomarkers may aid in personalizing treatment prescription, thereby increasing remission rates. Methods: The biomarker in this study was developed in a heterogeneous clinical sample (N=4249), and first applied to two large transfer datasets, a priori stratifying young males (<18 years) with a higher individual alpha peak frequency (iAPF) to methylphenidate (N=336) and those with a lower iAPF to multimodal Neurofeedback, complemented with sleep coaching (N=136). Blinded, out-of-sample validations were conducted in two independent samples. In addition, the association between iAPF and response to Guanfacine and Atomoxetine was explored. Results: Retrospective stratification in the transfer datasets resulted in a predicted gain in normalized remission of 17-30%. Blinded out-of-sample validations for methylphenidate (N=41) and multimodal Neurofeedback (N=71) corroborated these findings, yielding a predicted gain in stratified normalized remission of 36% and 29%, respectively. Conclusion: The present study introduces a clinically interpretable and actionable biomarker based on the iAPF assessed during resting-state electroencephalography. Our findings suggest that acknowledging neurobiological heterogeneity can inform stratification of patients to their individual best treatment and enhance remission rates

Double-Blind Placebo-Controlled Randomized Clinical Trial of Neurofeedback for Attention-Deficit/Hyperactivity Disorder With 13-Month Follow-up

Objective: To determine whether theta/beta-ratio (TBR) electroencephalographic biofeedback (neurofeedback [NF]) has a specific effect on attention-deficit/hyperactivity disorder (ADHD) beyond nonspecific benefit. Method: In a 2-site double-blind randomized clinical trial, 144 children aged 7 to 10 years with rigorously diagnosed moderate/severe ADHD and theta/beta-ratio (TBR) ≥4.5 were randomized 3:2 to deliberate TBR downtraining versus a control of equal duration, intensity, and appearance. Two early dropouts left 142 children for modified intent-to-treat analysis. The control used prerecorded electroencephalograms with the participant's artifacts superimposed. Treatment was programmed via Internet by an off-site statistician-guided co-investigator. Fidelity was 98.7% by trainers/therapists and 93.2% by NF expert monitor. The primary outcome was parent- and teacher-rated inattention; analysis was mixed-effects regression. Because the expense and effort of NF can be justified only by enduring benefit, follow-ups were integrated. Results: Blinding was excellent. Although both groups showed significant improvement (p <.001, d = 1.5) in parent/teacher-rated inattention from baseline to treatment end and 13-month follow-up, NF was not significantly superior to the control condition at either time point on this primary outcome (d = 0.01, p =.965 at treatment end; d = 0.23, p =.412 at 13-month follow-up). Responders (Clinical Global Impression−Improvement [CGI-I] = 1−2) were 61% of NF and 54% of controls (p =.36). Adverse events were distributed proportionally between treatments. The 13-month follow-up found nonsignificant improvement from treatment end for NF (d = 0.1), with mild deterioration for controls (d = −0.07). NF required significantly less medication at follow-up (p =.012). Conclusion: This study does not support a specific effect of deliberate TBR NF at either treatment end or 13-month follow-up. Participants will be reassessed at 25-month follow-up. Clinical trial registration information: Double-Blind 2-Site Randomized Clinical Trial of Neurofeedback for ADHD; https://clinicaltrials.gov/; NCT02251743