Children with ADHD and EEG abnormalities at baseline assessment, risk of epileptic seizures and maintenance on methylphenidate three years later.

PURPOSE: This study aimed to assess the incidence of EEG abnormalities (EEG-ab) in children diagnosed with ADHD, investigate the risk of epileptic seizures (SZ) and maintenance on methylphenidate (MPH) over a three-year period. METHODS: A total of 517 ADHD children aged 6-14 years were included. Baseline assessments included the identification of EEG-ab, ADHD inattentive subtype (ADHD-I), comorbid epilepsy, the use of antiepileptic drugs (AEDs) and the use of MPH. At the 3-year follow-up, assessments included the presence of EEG-ab, maintenance on MPH, AED usage, SZ risk in cases with EEG-epileptiform abnormalities (EEG-epi-ab), compared with control ADHD cases without EEG-epi-ab matched for age and gender. RESULTS: EEG-ab were identified in 273 (52.8%) cases. No statistically significant differences were observed between the EEG-ab and EEG-non-ab groups in terms of age, gender, ADHD-I type or initial use of MPH. EEG non-epileptiform abnormalities (EEG-non-epi-ab) were found in 234 out of 478 (49%) cases without EEG-epi-ab. Notably, EEG-non-epi-ab occurred more frequently in the group of 39 cases with EEG-epi-ab (30/39 (76.9%) vs. 9/39, (21.3%), a subset selected for 3-year follow-up. At 3-year-follow-up no statistically significant difference was found in maintenance on MPH in ADHD cases with and without EEG-epi-ab. Nobody of ADHD cases without comorbid epilepsy or with comorbid epilepsy with achieved SZ freedom developed new SZ. Only 3 children with drug resistant epilepsy experienced SZs, without increase in SZ frequency. The disappearance rate of EEG-epi-ab was higher than that EEG-non-epi-ab (71.8% vs. 33.3%). CONCLUSIONS: Children with and without EEG-ab exhibited similar patterns of MPH use (initial use, positive response, and maintenance on MPH). The presence of comorbid epilepsy and EEG-ab, with or without EEG-epi-ab, was not associated with an increased risk of SZ despite the use of MPH.

Quantitative electroencephalography in children with attention deficit hyperactivity disorder and healthy children: Behavioral and age correlates.

This pilot study aimed to identify quantitative electroencephalographic (qEEG) biomarkers for children and adolescents with attention deficit hyperactivity disorder (ADHD). We examined whether qEEG power correlates with the behavioral symptoms. We included 89 children with ADHD and 77 healthy children as a control group. We conducted EEG spectral analysis in the eyes-closed and eyes-opened conditions and compared the findings with a normative database (Human Brain Index). We measured behavioral parameters by using scales proposed by Barkley. The findings revealed an age-dependent decrease in qEEG power in children with ADHD. We found significant discrimination between children with ADHD and healthy children in the theta/beta ratio and theta activity in the frontal area. We found a notable increasing trend in beta activity across two age groups (6-10 years and > 10 years). Correlation analysis showed an association between qEEG power and hyperactivity in younger children with ADHD, while theta activity in the frontal region correlated positively with hyperactivity. The qEEG power of children with ADHD decreased gradually as age increased, and these changes were related to their symptoms. This pilot study suggests that qEEG differences between children with ADHD and healthy children may serve as a sensitive diagnostic tool, depending on the child's age. Further research building upon these findings could deepen our understanding of ADHD and its neural correlates.

Multimodal treatment in children and adolescents with attention-deficit/hyperactivity disorder: a 6-month follow-up.

BACKGROUND: Different treatment approaches aimed at reducing attention-deficit/hyperactivity disorder (ADHD) core symptoms are available. However, factors such as intolerance, side-effects, lack of efficacy, high new technology costs, and placebo effect have spurred on an increasing interest in alternative or complementary treatment. AIM: The aim of this study is to explore efficacy of multimodal treatment consisting of standard stimulant medication (methylphenidate) and neurofeedback (NF) in combination, and to compare it with the single treatment in 6-month follow-up in ADHD children and adolescents. METHODS: This randomized controlled trial with 6-month follow-up comprised three treatment arms: multimodal treatment (NF + MED), MED alone, and NF alone. A total of 130 ADHD children/adolescents participated, and 62% completed the study. ADHD core symptoms were recorded pre-/post-treatment, using parents' and teachers' forms taken from Barkley's Defiant Children: A Clinician's Manual for Assessment and Parent Training, and a self-report questionnaire. RESULTS: Significant ADHD core symptom improvements were reported 6 months after treatment completion by parents, teachers, and participants in all three groups, with marked improvement in inattention in all groups. However, no significant improvements in hyperactivity or academic performance were reported by teachers or self-reported by children/adolescents, respectively, in the three groups. Changes obtained with multimodal treatment at 6-month follow-up were comparable to those with single medication treatment, as reported by all participants. CONCLUSIONS: Multimodal treatment using combined stimulant medication and NF showed 6-month efficacy in ADHD treatment. More research is needed to explore whether multimodal treatment is suitable for ADHD children and adolescents who showed a poor response to single medication treatment, and for those who want to reduce the use of stimulant medication.

Self-reported efficacy of neurofeedback treatment in a clinical randomized controlled study of ADHD children and adolescents.

BACKGROUND: Many non-pharmacological treatments for children and adolescents with attention-deficit/hyperactivity disorder (ADHD) have been attempted, but reports indicate that most are ineffective. Although neurofeedback (NF) is a treatment approach for children with ADHD that remains promising, a variety of appropriate measures have been used in reporting and evaluating its effect. OBJECTIVE: To report the self-evaluations of NF treatment by children and adolescents with ADHD. METHODS: Randomized controlled trial in 91 children and adolescents with ADHD, aged less than 18 years (mean, 11.2 years) participated in a 30-session program of intensive NF treatment. Participants were randomized and allocated by sequentially numbered sealed envelopes into three groups: methylphenidate (MPH) as an active control group, and two trial groups NF with MPH, and NF alone. ADHD core symptoms and school performance were given on a scale of 1 to 10 using a self-reporting questionnaire, and the changes in these scores after treatment were used as the self-reported evaluation. Basic statistical methods (descriptive, analyses of variance, exact χ (2) test, and paired t-test) were used to investigate the baseline data. Changes in ADHD core symptoms and treatment effects were investigated using a general linear model for repeated measures. RESULTS: Eighty participants completed the treatment study and 73 (91%) responded sufficiently on the self-reporting questionnaires. The treatment groups were comparable in age, sex, and cognition as well as in the baseline levels of core ADHD symptoms. All treatments resulted in significant improvements regarding attention and hyperactivity (P<0.001), and did not differ from each other in effectiveness. However, a significant treatment effect in school performance was observed (P=0.042), in which only the NF group showed a significant improvement. CONCLUSION: The self-reported improvements in ADHD core symptoms and school performance shortly after treatment indicate NF treatment being promising in comparison with medication, suggesting NF as an alternative treatment for children and adolescents who do not respond to MPH, or who suffer side effects. Further long-term follow-up is needed.

Neurofeedback for the treatment of children and adolescents with ADHD: a randomized and controlled clinical trial using parental reports.

BACKGROUND: A randomized and controlled clinical study was performed to evaluate the use of neurofeedback (NF) to treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. METHODS: The ADHD population was selected from an outpatient clinic for Child and Adolescent Mental Health in Norway. Ninety-one of the 275 children and adolescents ranging in age from 6 to 18 years (10.5 years) participated in 30 sessions of an intensive NF program. The reinforcement contingency was based on the subjects' production of cortical beta1 activity (15-18 Hz). The ADHD participants were randomized into three groups, with 30 in the NF group, 31 controls in a group that was given methylphenidate, and 30 in a group that received NF and methylphenidate. ADHD core symptoms were reported by parents using the parent form of the Clinician's Manual for Assessment by Russell A. Barkley. RESULTS: Ninety-one children and adolescents were effectively randomized by age, sex, intelligence and distribution of ADHD core symptoms. The parents reported significant effects of the treatments, but no significant differences between the treatment groups were observed. CONCLUSIONS: NF was as effective as methylphenidate at treating the attentional and hyperactivity symptoms of ADHD, based on parental reports. TRIAL REGISTRATION: Current Controlled Trials NCT01252446.

Characteristics of Norwegian children suffering from ADHD symptoms: ADHD and primary health care.

This study describes the characteristics of children suffering from attention deficit/hyperactivity disorder (ADHD) symptoms and evaluates the ability of primary health care to assess ADHD. A population of 494 children was referred during one year to the outpatient clinic Child and Adolescent Mental Health in Norway. Forty percent of those referred had ADHD symptoms. A clinical assessment regarding ADHD as well as general health was employed and socio-economic status was recorded. Half of the ADHD-referred children met criteria for ADHD, and among the non-ADHD children one fifth did not receive any diagnosis. Mean referral age was 10.5years; 82% were boys. The ADHD families were less educated and in more need of support from Child Welfare (CW) in the referral period (OR: 3.9; 95% CI 0.1 to 5.1). More ADHD children were not living with their families compared to the non-ADHD children. The sensitivity was 51% (96/187) regarding primary health care`s ability to recognize ADHD. Further screening programs for evaluation of ADHD are needed.