Economics and Business Handbook 2009

In recent years a rising amount of randomized controlled trials, reviews, and meta-analyses relating to the efficacy of electroencephalographic-neurofeedback (EEG-NF) in children with attention-deficit/hyperactivity disorder (ADHD) have been published. Although clinical reports and open treatment studies suggest EEG-NF to be effective, double blind placebo-controlled studies as well as a rigorous meta-analysis failed to find support for the efficacy of EEG-NF. Since absence of evidence does not equate with evidence of absence, we will outline how future research might overcome the present methodological limitations. To provide conclusive evidence for the presence or absence of the efficacy of EEG-NF in the treatment of ADHD, there is a need to set up a well-designed study that ensures optimal implementation and embedding of the training, and possibly incorporates different forms of neurofeedback

Umbilical cord procalcitonin to detect early-onset sepsis in newborns: a promising biomarker

Background: Up to 7% of neonates born in high-income countries receive antibiotics for suspected early-onset sepsis (EOS). Culture-proven neonatal sepsis has a prevalence of 0.2%, suggesting considerable overtreatment. We studied the diagnostic accuracy of umbilical cord blood and infant blood procalcitonin (PCT) in diagnosing EOS to improve antibiotic stewardship.Methods: Umbilical cord blood PCT was tested in newborns >= 32 weeks of gestation. Groups were defined as following: A) culture-proven or probable EOS (n = 25); B) Possible EOS, based on risk factors for which antibiotics were administered for = 32 weeks with a proven or probable EOS and low in newborns with risk factors for infection, but PCT seems not a reliable marker after maternal antibiotic treatment. PCT could be useful to distinguish infected from healthy newborns with or without EOS risk factors.Afdeling Klinische Chemie en Laboratoriumgeneeskunde (AKCL

Neuronal oscillations in children with ADHD. A journey towards the development of potential new treatments for children with ADHD

Contains fulltext : 157081.pdf (publisher's version ) (Open Access)EEG-neurofeedback is being applied to treat children with ADHD in the Netherlands. Vollebregt and colleagues designed a placebo-controlled study with random assignment to a treatment group or placebo-treatment group, to investigate its efficacy. Results did not provide evidence for a positive treatment effect in children with ADHD that was superior to placebo. Vollebregt and colleagues subsequently investigated ‘lateralized alpha modulation’ using EEG in children with and without ADHD. This modulation is usually measured in healthy adults when directing attention. Results demonstrated that typically developing 7-10 year old children already displayed a similar pattern as adults did in previous research. Boys with ADHD however, did not show such a pattern. For girls, we could not confirm a difference between ADHD and typical development due to a low sample-size. Future research should demonstrate if methodologically improved neurofeedback paradigms, possibly making use of ‘lateralized alpha modulation’, could work.17 mei 2016Promotores : Buitelaar, J.K., Jensen, O. Co-promotor : Slaats-Willemse, D.I.E.235 p

Does EEG-neurofeedback improve neurocognitive functioning in children with attention-deficit/hyperactivity disorder? A systematic review and a double-blind placebo-controlled study

Item does not contain fulltextBACKGROUND: The number of placebo-controlled randomized studies relating to EEG-neurofeedback and its effect on neurocognition in attention-deficient/hyperactivity disorder (ADHD) is limited. For this reason, a double blind, randomized, placebo-controlled study was designed to assess the effects of EEG-neurofeedback on neurocognitive functioning in children with ADHD, and a systematic review on this topic was performed. METHODS: Forty-one children (8-15 years) with a DSM-IV-TR diagnosis of ADHD were randomly allocated to EEG-neurofeedback or placebo-neurofeedback treatment for 30 sessions, twice a week. Children were stratified by age, electrophysiological state of arousal, and medication use. Neurocognitive tests of attention, executive functioning, working memory, and time processing were administered before and after treatment. Researchers, teachers, children and their parents, with the exception of the neurofeedback-therapist, were all blind to treatment assignment. Outcome measures were the changes in neurocognitive performance before and after treatment. Clinical trial registration: www.clinicaltrials.gov: NCT00723684. RESULTS: No significant treatment effect on any of the neurocognitive variables was found. A systematic review of the current literature also did not find any systematic beneficial effect of EEG-neurofeedback on neurocognitive functioning. CONCLUSION: Overall, the existing literature and this study fail to support any benefit of neurofeedback on neurocognitive functioning in ADHD, possibly due to small sample sizes and other study limitations

[Efficacy of frequency-neurofeedback and Cogmed JM-working memory training in children with ADHD]

BACKGROUND: The need for and the interest in non-pharmacological treatments for children with ADHD are increasing. The treatments include electro-encephalogram (EEG) frequency-neurofeedback and Cogmed working memory training. AIM: To investigate the efficacy of frequency-neurofeedback and Cogmed working memory training in children with ADHD. METHOD: Forty-one children with ADHD (aged 8-15 years) were assigned to frequency-neurofeedback or to placebo-neurofeedback in a randomized double-blind trial. We took measurements to find out whether frequency-neurofeedback had reduced the severity of the ADHD-symptoms, and/or had improved neurocognitive ability and global clinical functioning. Fifty-one children with ADHD (aged 5-7 years) were assigned to the active Cogmed JM-working memory training or to the placebo working memory training in a randomised double-blind trial. We took measurements to find out whether Cogmed JM-working memory training had reduced the ADHD symptoms, and/or had improved neurocognitive ability, daily performance and global clinical functioning. RESULTS: The ADHD symptoms and global clinical functioning of the children in both neurofeedback groups improved. However, frequency-neurofeedback did nor produce any significantly better treatment results than did the placebo neurofeedback. At the neurocognitive level, frequency-neurofeedback did not yield any measurements that were significantly superior to those achieved with placebo feedback. Various outcome measurements improved in both groups with memory training. However, the active working memory training was not found to have produced significantly better results than the placebo training with regards to the ADHD symptoms, neurocognitive ability and daily and global functioning. Children from the active working memory training group showed improvements in trained working memory tasks but not on untrained tasks. CONCLUSION: Neither study produced any conclusive evidence for the efficacy of the investigated treatments in children with ADHD. However, both types of treatments can be further improved. Furthermore, the controlled designs may have restricted the embedding of the treatments. Because of possible improvements in the treatments in the future and because of the design restrictions affecting the treatments in their present form, it is still too early to draw any definitive conclusions about the validity and advantages of the two treatment methods

A randomized placebo-controlled trial of electroencephalographic (EEG) neurofeedback in children with attention-deficit/hyperactivity disorder

Item does not contain fulltextOBJECTIVE: A double-blind, randomized, placebo-controlled study was designed to assess the efficacy and safety of electroencephalographic (EEG) neurofeedback in children with attention-deficit/hyperactivity disorder (ADHD). The study started in August 2008 and ended in July 2012 and was conducted at Karakter Child and Adolescent Psychiatry University Centre in Nijmegen, The Netherlands. METHOD: Forty-one children (aged 8-15 years) with a DSM-IV-TR diagnosis of ADHD were randomly assigned to treatment with either EEG neurofeedback (n = 22) or placebo neurofeedback (n = 19) for 30 sessions, given as 2 sessions per week. The children were stratified by age, electrophysiologic state of arousal, and medication use. Everyone involved in the study, except the neurofeedback therapist and the principal investigator, was blinded to treatment assignment. The primary outcome was severity of ADHD symptoms on the ADHD Rating Scale IV, scored at baseline, during treatment, and at study end. Clinical improvement as measured by the Clinical Global Impressions-Improvement scale (CGI-I) was a secondary outcome. RESULTS: While total ADHD symptoms improved over time in both groups (F1,39 = 26.56, P < .001), there was no significant treatment effect, ie, group x time interaction (F1,39 = 0.36, P = .554); the same was true for clinical improvement as measured by the CGI-I (P = .092). No clinically relevant side effects were observed. Among the children and their parents, guessing treatment assignment was not better than chance level (P = .224 for children, P = .643 for parents). CONCLUSION: EEG neurofeedback was not superior to placebo neurofeedback in improving ADHD symptoms in children with ADHD. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00723684

Dr van Dongen-Boomsma and colleagues reply

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Working memory training in young children with ADHD: a randomized placebo-controlled trial

BACKGROUND: Until now, working memory training has not reached sufficient evidence as effective treatment for ADHD core symptoms in children with ADHD; for young children with ADHD, no studies are available. To this end, a triple-blind, randomized, placebo-controlled study was designed to assess the efficacy of Cogmed Working Memory Training (CWMT) in young children with ADHD. METHODS: Fifty-one children (5-7 years) with a DSM-IV-TR diagnosis of ADHD (without current psychotropic medication) were randomly assigned to the active (adaptive) or placebo (nonadaptive) training condition for 25 sessions during 5 weeks. The compliance criterion (>20 sessions) was met for 47 children. The primary outcome measure concerned the core behavioural symptoms of ADHD, measured with the ADHD Rating Scale IV (ADHD-RS). Secondary outcome measures were neurocognitive functioning, daily executive functioning, and global clinical functioning. The influence of the increase in difficulty level (Index-Improvement) for the treatment group was also analysed. Clinical trial registration information - 'Working Memory Training in Young ADHD Children'; www.clinicaltrials.gov; NCT00819611. RESULTS: A significant improvement in favour of the active condition was found on a verbal working memory task (p = .041; adapted Digit Span WISC-III, backward condition). However, it did not survive correction for multiple testing. No significant treatment effect on any of the primary or other secondary outcome measurements was found. The Index-Improvement significantly contributed to ADHD-RS and the Behavior Rating Inventory of Executive Function, both rated by the teacher, but revealed no significant group difference. CONCLUSIONS: This study failed to find robust evidence for benefits of CMWT over the placebo training on behavioural symptoms, neurocognitive, daily executive, and global clinical functioning in young children with ADHD

[Efficacy of frequency-neurofeedback and Cogmed JM-working memory training in children with ADHD]

Item does not contain fulltextBACKGROUND: The need for and the interest in non-pharmacological treatments for children with ADHD are increasing. The treatments include electro-encephalogram (EEG) frequency-neurofeedback and Cogmed working memory training. AIM: To investigate the efficacy of frequency-neurofeedback and Cogmed working memory training in children with ADHD. METHOD: Forty-one children with ADHD (aged 8-15 years) were assigned to frequency-neurofeedback or to placebo-neurofeedback in a randomized double-blind trial. We took measurements to find out whether frequency-neurofeedback had reduced the severity of the ADHD-symptoms, and/or had improved neurocognitive ability and global clinical functioning. Fifty-one children with ADHD (aged 5-7 years) were assigned to the active Cogmed JM-working memory training or to the placebo working memory training in a randomised double-blind trial. We took measurements to find out whether Cogmed JM-working memory training had reduced the ADHD symptoms, and/or had improved neurocognitive ability, daily performance and global clinical functioning. RESULTS: The ADHD symptoms and global clinical functioning of the children in both neurofeedback groups improved. However, frequency-neurofeedback did nor produce any significantly better treatment results than did the placebo neurofeedback. At the neurocognitive level, frequency-neurofeedback did not yield any measurements that were significantly superior to those achieved with placebo feedback. Various outcome measurements improved in both groups with memory training. However, the active working memory training was not found to have produced significantly better results than the placebo training with regards to the ADHD symptoms, neurocognitive ability and daily and global functioning. Children from the active working memory training group showed improvements in trained working memory tasks but not on untrained tasks. CONCLUSION: Neither study produced any conclusive evidence for the efficacy of the investigated treatments in children with ADHD. However, both types of treatments can be further improved. Furthermore, the controlled designs may have restricted the embedding of the treatments. Because of possible improvements in the treatments in the future and because of the design restrictions affecting the treatments in their present form, it is still too early to draw any definitive conclusions about the validity and advantages of the two treatment methods

How the Individual Alpha Peak Frequency Helps Unravel the Neurophysiologic Underpinnings of Behavioral Functioning in Children With Attention-Deficit/Hyperactivity Disorder

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