Evidence In-Sight: Neurofeedback. Date: April, Click here to enter text.

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1 Evidence In-Sight: Neurofeedback Date: April, 2015 Click here to enter text.

2 The following Evidence In-Sight report involved a non-systematic search and summary of the research and grey literature. These findings are intended to inform the requesting organization, in a timely fashion, rather than providing an exhaustive search or systematic review. This report reflects the literature and evidence available at the time of writing. As new evidence emerges, knowledge on evidence-informed practices can evolve. It may be useful to re-examine and update the evidence over time and/or as new findings emerge. Evidence In-Sight primarily presents research findings, along with consultations with experts where feasible and constructive. Since scientific research represents only one type of evidence, we encourage you to combine these findings with the expertise of practitioners and the experiences of children, youth and families to develop the best evidence-informed practices for your setting. While this report may describe best practices or models of evidence-informed programs, Evidence In-Sight does not include direct recommendations or endorsement of a particular practice or program. This report was researched and written to address the following questions: What research evidence exists regarding the use of neurofeedback to treat children with complex mental health needs? What are potential benefits and harms to using this approach? Are there existing evidence-informed practices with regard to neurofeedback? We prepared the report given the contextual information provided in our first communications (see Overview of inquiry). We are available at any time to discuss potential next steps. We appreciate your responding to a brief satisfaction survey that the Centre will to you within two weeks. We would also like to schedule a brief phone call to assess your satisfaction with the information provided in the report. Please let us know when you would be available to schedule a 15-minute phone conversation. Thank you for contacting Evidence In-Sight. Please do not hesitate to follow up or contact us at evidenceinsight@cheo.on.ca or by phone at Page 2

3 1. Overview of inquiry The agency requesting this report is a children s mental health treatment centre that provides services to children with complex mental health needs. The agency works to ensure the programs they operate are evidence-informed and are currently contemplating introducing the use of neurofeedback as treatment. To help inform their decision about potentially implementing neurofeedback across services, the agency is interested in the following questions: What evidence exists regarding the use of neurofeedback to treat children with complex mental health needs? What are potential benefits and harms to using this approach? Are there existing evidence-informed practices with regard to neurofeedback? 2. Summary of findings The literature highlights a lack of standardization in neurofeedback procedures and methodologies. Neurofeedback is most frequently used to treat Attention Deficit Hyperactivity Disorder (ADHD). In this scan of the literature, no studies were found examining the use of neurofeedback in children or adolescents with complex or comorbid diagnoses. Although some research does exist for the use of neurofeedback in children and youth who experience trauma, anxiety, or autism, there are concerns about the quality of this evidence. Neurofeedback offers a non-invasive, short duration, side-effect free method of treatment, but is limited by non-standardized methodologies. More placebo-controlled studies are required to assess effectiveness. 3. Answer search strategy Databases used: University of Ottawa Library (PsychINFO, AMED- Allied and Complementary Medicine, Ovid MEDLINE, Ovid MEDLINE In-process & Other Non-Indexed Citations, PubMED), Google Scholar, EBSCO Host Search terms used: biofeedback, neurofeedback, children, posttraumatic stress disorder, trauma, child neglect, abuse, learning disabilities, cognitive impairments, developmental delays, ADHD, Autism Spectrum Disorders (ASD), anxiety, mood disorders, depression, mental health 4. Findings 4.1 What is Neurofeedback? The Association for Applied Psychophysiology and Biofeedback (AAPB), the Biofeedback Certification International Alliance (BCIA), and International Society for Neurofeedback and Research (ISNR) formed a joint task force to formulate standard definitions for biofeedback and neurofeedback (2008): Biofeedback is a process that enables an individual to learn how to change physiological activity for the purposes of improving health and performance. Precise instruments measure physiological activity such as brainwaves, heart function, breathing, muscle activity, and skin temperature. These instruments rapidly and accurately "feed back" information to the user. The presentation of this information often in conjunction with changes in thinking, emotions, and behavior supports desired physiological changes. Over time, these changes can endure without continued use of an instrument." AAPB, BCIA & ISNR, Retrieved from: Page 3

4 Biofeedback can be employed in several different ways. This report will focus specifically on two types of biofeedback: heart rate biofeedback and neurofeedback (also known as brainwave biofeedback). Heart rate biofeedback involves using a photoplethysmograph on either fingers or earlobes, or an electrocardiograph on the chest or wrists to measure heart rate and heart rate variability (BCIA, 2015). The task force of the European Society of Cardiology and the Heart Rhythm Society (formerly the North American Society of Pacing Electrophysiology) describes heart rate variability as the beat-to-beat changes in heart rate which provide an index of autonomic signals to the heart (1996). Low heart rate variability is indicative stress-response activity (e.g. increase heart-rate, increased perspiration) (Task Force of the European Society of Cardiology & The North American Society of Pacing Electrophysiology, 1996). Heart rate variability biofeedback often involves the regulation of breathing and nurturing positive affect (Henriques, 2011). Neurofeedback has been defined by the International Society for Neurofeedback and Research as: Neurofeedback Training (NFT) uses monitoring devices to provide moment-to-moment information to an individual on the state of their physiological functioning. The characteristic that distinguishes NFT from other biofeedback is a focus on the central nervous system and the brain. NFT has its foundations in basic and applied neuroscience as well as data-based clinical practice. It takes into account behavioral, cognitive, and subjective aspects as well as brain activity. ISNR, Retrieved from: The literature also provides additional definitions of neurofeedback such as: Neurofeedback trains the brain to improve its regulation of itself. Scalp electrodes record information about the brain s electrical activity. Information is fed back to participants either by sounds or video images on a screen in real time. Participants learn to modify their brainwaves whereby the feedback they receive provides positive feedback when desired brain activity is achieved and negative feedback when desired brain activity is not achieved. - Lofthouse, Arnold & Hurt (2012, p.480). Neurofeedback trains individuals to enhance poorly regulated brainwave patterns by using computer technology. While there are different forms of neurofeedback, the most traditional form is known as EEG Biofeedback. EEG electrodes are placed on the scalp and/or ear lobe(s). These sensors only measure a person s brainwaves; no electrical current enters the brain. Individuals utilize their brainwaves to control the feedback they instantly receive about the amplitude and synchronization of their brain activity. - Coben, Linden & Myers (2010, p.92) The aim of neurofeedback is to help [people] learn to regulate attentional states and brain functions better on demand, resulting in subsequent improvements of symptoms. - Holtman et al. (2014, p.792). 4.2 Are there standardized approaches to using neurofeedback? Although neurofeedback is rooted in a specific theoretical foundation, information about standardized practices or approaches is limited (Scottish Intercollegiate Network Guidelines, 2009). A review by Holtmann, Sonuga-Barke, Cortese and Brandeis (2014) found a lack of standards regarding neurofeedback, noting controlled studies on the optimal Page 4

5 frequency bands, scalp sites, feedback timings, and thresholds are largely absent. In line with this, Moore (2000), determined research is needed to understand whether neurofeedback treatments are effective, and if so, which variables are important for efficacy (e.g., length of treatment, severity of symptoms, type of EEG used in treatment, placement and number of electrodes, and concurrent effects of medication). In looking at studies examining the number and frequency of neurofeedback sessions, a review by Arnold and colleagues (2013) found, of 15 studies using neurofeedback to treat ADHD, the number and frequency of treatment sessions varied between 18 and 45 sessions ranging from one session per week to five sessions per week. When examining differences between children receiving 45-minute sessions either two times a week or three times a week for a total of 40 sessions, Arnold and colleagues (2013) found a preference among parents for three sessions per week over two sessions per week. Results after 24 sessions were nominally, but not significantly, better for those who had received three sessions per week than two sessions per week (Arnold et al., 2013). When examining the use of neurofeedback in children with ASD, two studies (Coben & Padolsky, 2007; Jarusiewicz, 2002) used 30-minute sessions ranging between once and three times per week for a minimum of 20 sessions with the total number of sessions ranging from 20 to 69 with a mean of 36 sessions. When looking at anxiety, Eismont, Lutsyuk and Pavlenko (2011) utilized 30-minute sessions twice per week for a total of 10 to 12 sessions. Although there is a range for the number and frequency of sessions, there still are no standardized guidelines as to the optimal or necessary number of sessions. There are numerous neurofeedback methodologies being used in treatment. A meta-analysis by Sonuga-Barke (2013) and colleagues found four different methodologies currently being used to treat ADHD. When looking at anxiety, Eismont, Lutsyuk and Pavlenko (2011) used a combination of audio and visual stimuli in a variety of permutations to test changes in brainwaves. Anxiety research has also explored other biofeedback methods such as heart rate variability (beat-to-beat changes in heart rate) (Ratanasiripong, Sverduk, Prince & Hayashino, 2012; Henriques, Keffer, Abrahamson & Horst, 2011). One reason for the lack of standards in terms of methodologies is the continually shifting nature of clinical procedures as the technology allowing for biofeedback and neurofeedback continues to improve (Schoenberg & David, 2014). Despite a lack of standards in the above mentioned methodologies, real time neuroimaging is already being explored as a potential treatment method (Schoenberg & David, 2014). Although there are some general protocols, there is a lack of standardization among neurofeedback studies of psychiatric disorders as not all researchers are seeking to replicate existing studies or follow these existing protocols (Schoenberg & David, 2014). 4.3 Neurofeedback & specific diagnoses Trauma, Abuse and Neglect Only one study could be found investigating the use of neurofeedback in children and youth with past relational trauma. The study, conducted by Huang-Storms and colleagues (2007), looked at children who had all been removed from their biological home and were living with adoptive parents. Over a span of two to eight months, each child participated in neurofeedback sessions. The majority of participants were taking medications (e.g. serotonin reuptake inhibitors, amphetamine, methylphenidate, atomoxetine, etc.) while receiving neurofeedback sessions. Improvements in Child Behavior Checklist (CBCL) and Test of Variables of Attention (TOVA) scores following neurofeedback treatment suggest neurofeedback is effective in treating behavioural problems associated with a history of neglect or abuse. The study noted strong improvements in aggressive, delinquent, and socially problematic behaviours. Authors mentioned that this Page 5

6 study was only a pilot and had several major caveats including: a small and non-randomized sample, the lack of a control and/or placebo group, and the failure to control for concurrent effects of medications and additional therapies. A meta-analysis of 33 studies looked at the effect size of treatment outcomes for abused and neglected children and found a medium treatment effect size (Huang-Storms, 2008). The analysis also reported other meta-analyses have reported medium to large effect sizes. The Huang-Storms and colleagues (2007) pilot study (mentioned above) found neurofeedback to have a large effect size; falling well within the range of reported effect sizes of treatment outcomes. Although more research is needed before making any conclusions, Huang-Storms (2008) suggest that adding neurofeedback to a proven therapy could provide a powerful approach to treatment of children and adolescents with histories of relational trauma and abuse Autism Coben and Padolsky (2007) state the only study to demonstrate efficacy of neurofeedback in children with ASD was by Jarusiewicz in When comparing the outcomes of children in the treatment group to the control group, the study found an average reduction of autism symptoms, as rated by the Autism Treatment Evaluation Checklists (ATEC), of 26 percent for the experimental group versus an average reduction of three percent in the control group (Jarusiewicz, 2002). The author notes all children receiving neurofeedback showed improvement on the ATEC and parent interviews, including improvements in sociability, speech/ language/ communication, health and sensory/cognitive awareness. Coben and Padolsky (2007) replicated the methodology of Jarusiewicz s study but used a larger experimental group and a broader range of assessments. In addition to the ATEC, Coben and Padolsky also collected autism severity information using the Gilliam Asperger s Disorder Scale (GADS), the Gilliam Autism Rating Scale (GARS), the Behavior Rating Inventory of Executive Function (BRIEF) and the Personality Inventory for Children Second Edition (PIC-2). No significant changes were observed in patients in the control group on parent rating of symptom severity or in neuropsychological measures (Coben & Padolsky, 2007). In the experimental group, a significant reduction in ASD symptomatology was reported on the ATEC, as well as significant reductions in ASD behaviors, executive deficits, and symptomatology associated with ASD on the GADS, the BRIEF and the PIC-2 (Coben & Padolsky, 2007) Although promising, the above studies do have their limitations. For instance, Coben and Padolsky s (2007) study featured an experimental group three times larger than the control group (n = 37 experimental vs. n = 12 control) thus increasing the likelihood of a positive effect in the experimental group. Coben and Padolsky (2007) note one of the limitations of their study was self-selection leading to an issue of selection bias to interact with the treatment effect. Of more importance, though, in both studies (Coben & Padolsky, 2007; Jarusiewicz, 2002), ASD symptom improvements observed in children who had received neurofeedback therapy were compared with ASD symptom improvements in children who received no therapy of any kind. The limitations of these findings are that the noted effects of neurofeedback cannot be compared to a placebo effect. To further establish the efficacy of neurofeedback, it is recommended that neurofeedback be compared with an alternative treatment group, as well as long-term follow-up to demonstrate maintained outcomes following treatment (Coben & Padolsky, 2007). A different study used neurofeedback training to help inhibit theta brain wave activity and reward low beta brain wave activity in the right hemisphere (Kouijzer, de Moor, Gerrits, Congedo & van Schie, 2009). This procedure that has Page 6

7 historically been used in the treatment of ADHD, but the authors hypothesized that such decreases would help improve children s executive functioning and social behavior capacities in children with ASD (Kouijzer, de Moor, Gerrits, Congedo & van Schie, 2009). Significant improvements were found in the treatment group when looking at tasks involving executive functioning such as attention control, cognitive flexibility, and planning when compared to the non-treatment group. Significant improvements were also found on the Children s Communication Checklist (CCC-2) and on a modified AUTI-R in the treatment group but not the control group (Kouijzer, de Moor, Gerrits, Congedo & van Schie, 2009). Twelve months following treatment, significant improvement was found in auditory selective attention, indicating continued improvement in the twelve months following treatment (Kouijzer, de Moor, Gerrits, Congedo & van Schie, 2009). Non-significant improvements were found in verbal responses, verbal memory, concept generation, and speed and efficiency and there were no significant decreases on any aspect of executive functioning (Kouijzer, de Moor, Gerrits, Congedo & van Schie, 2009). This study shows positive effects of neurofeedback treatment can continue even once treatment has stopped. The limitations of this study are its small sample size (n = 7 for each the treatment and the control group) and that it used children on a wait list receiving no treatment as its comparison control group. As noted by Coben, Linden and Myers (2010), few existing interventions for children with autism have demonstrated efficacy; with the possible exception of behavior modification programs. Although there are early signs that encourage the use of neurofeedback in the treatment of ASD, more research is needed before efficacy can be demonstrated at levels acceptable to current research standards (Coben, Linden & Meyers, 2010) Anxiety Neurofeedback research regarding anxiety in children and youth is limited (Simkin, Thatcher & Lubar, 2014). One study by Eismont, Lutsyuk and Pavlenko (2011) sought to explore the efficacy of neurofeedback in healthy 10 to 14 year olds. Children were rated for anxiety using the Spielberger Khanin test system, the Prikhojan questionnaire and the House Tree Person projective drawing technique. The neurofeedback sessions alternated between 6 different neurofeedback protocols over the course of a single session: Loudness control of white noise, Loudness control of white noise against the musical background, Loudness control of music, Control of the intensity of color in pictures, Control of the intensity level of colors in Madyar s charts and a Playing protocol (Eismont, Lutsyuk & Pavlenko, 2011). Authors found the control of the intensity of white noise protocol was the most efficient in producing changes in anxiety levels. Despite the changes produced, the study found that, although anxiety level estimates on all scales decreased in the experimental group, the decrease was not significant (Eismont, Lutsyuk & Pavlenko, 2011). Kerson, Sherman and Kozlowski (2009) looked at neurofeedback to reduce generalized anxiety symptoms in adults and found that, although there were only modest improvements during the neurofeedback training sessions, significant improvements were found at a post-intervention 6-month follow-up. Patient scores on the State Trait Anxiety Inventory (STAI) had improved significantly on both the state anxiety scale (STAI-S) and the trait anxiety (STAI-T) scales (Kerson, Sherman & Kozlowski, 2009). Although a significant response to the training was not present immediately afterwards, improvement to anxiety symptoms may have consolidated in the months following treatment (Kerson, Sherman & Kozlowski, 2009). Although the study examined adults, the implication that the effectiveness of neurofeedback becomes apparent several months following the initial treatment could be relevant for studies involving children and adolescents. Page 7

8 Although the above studies are helpful, they do have some shortcomings. Primarily, small sample sizes limit the generalizability of the findings with only seven participants in one study (Eismont, Lutsyuk & Pavlenko, 2011) and eight participants in the second study (Kerson, Sherman and Kozlowski, 2009). Secondly, the two studies are unable to demonstrate the benefits of neurofeedback in treating anxiety over that of a placebo as Eismont, Lutsyuk and Pavlenko only included a control group who did not receive treatment (2011) while Kerson, Sherman and Kozlowski (2009) did not include a control group, but included a control condition where EEG data was monitored while participants tried to increase the temperature of their right earlobe in response to feedback from a thermal sensor placed on their right earlobe. Research on the effectiveness of neurofeedback in children and youth with anxiety remains limited (Simkin, Thatcher & Lubar, 2014) and more research, particularly research studying treatment groups versus a placebo group, is needed to demonstrate effectiveness of neurofeedback in children with anxiety symptoms Attention-Deficit/Hyperactivity Disorder Neurofeedback has received the most attention as a treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). According to Arnold and colleagues (2013) the treatment of ADHD using neurofeedback is based on four findings: First, individuals are consciously capable of modifying their own brainwaves. Second, research demonstrating elevated theta wave activity and decreased beta wave activity in those with ADHD compared to those without. Third, studies that have demonstrated ADHD has a neurophysiological basis. Finally, studies looking at EEG and SCP dysfunctions and the relationship to underlying neurological mechanisms and the changes that take place following a positive response to medication. According to the Institute for Clinical Systems Improvement s (ICSI) Diagnosis and Management of Attention Deficit Hyperactivity Disorder in Primary Care for School-Age Children and Adolescents guidelines, neurofeedback is not recommended as an alternative to medication use in the treatment of ADHD (Dobie, 2012). Although Gevensleben s (2009) study provides high quality evidence, long-term benefits have yet to be definitively proven, treatment response rates have not reached the level shown with medications and neurofeedback lacks sufficient research support (Dobie, 2012). The Scottish Intercollegiate Guidelines Network s Management of Attention Deficit and Hyperkinetic Disorders in Children and Young People s national clinical guidelines classify neurofeedback as an experimental intervention with no standardized methodologies (SIGN, 2009). The American Academy of Pediatrics clinical practice guidelines list electroencephalographic (EEG) biofeedback as a therapy that is used clinically but not approved by the FDA and have called for future research (Subcommittee, 2011). The Canadian Attention Deficit Hyperactivity Disorder Resource Alliance s Practice Guidelines (2011) make no reference to biofeedback or neurofeedback. 4.4 Potential benefits and drawbacks Neurofeedback is an emerging field of research. One promising aspect is that it is a noninvasive treatment and an alternative treatment to pharmaceuticals. Typically, EEG electrodes are placed on the scalp and/or earlobes to measure the brainwaves of a participant and there is no transfer of electricity to the brain (Coben, Linden & Meyers, 2010). The benefit is that it does not produce any adverse side effects, such as those found in medications (Coben, Linden & Meyers, 2010; Coben & Padolsky, 2007). Holtmann and colleagues (2014) found no serious or permanent side effects due to neurofeedback training. Minor adverse effects, such as headaches or fatigue caused by the demands of training, were found to decrease over the course of training as participants became familiar with the technique (Holtmann et al., Page 8

9 2014). Medication not only tends to have adherence problems, but any benefits or improvements tend to disappear once medication is stopped (Steiner, Frenette, Rene, Brennan & Perrin, 2014). Neurofeedback could provide an option for parents or guardians who are unwilling to medicate their children, but is also a drawback because as of 2001, the Ontario Health Insurance Plan (OHIP) does not cover biofeedback (including neurofeedback) as this service is not a medical procedure and does not need to be administered by a physician ( Another benefit of neurofeedback is that positive outcomes can be achieved over the course of several months, as opposed to a year or more as is common with behavior therapies (Coben & Padolsky, 2007). Although there is a wide range of variability in the literature when it comes to the number and frequency of sessions, the time spans for treatment generally only last several months. Compared with more intensive therapies that can last longer and medication regimens that can go on indefinitely, neurofeedback holds tremendous promise if these results can be achieved in a shorter time period. With neurofeedback being non-invasive and free of serious side effects (Holtmann, Sonuga-Barke, Cortese & Brandeis, 2014; Coben, Linden & Meyers, 2010; Coben, Linden & Meyers, 2010; Coben & Padolsky, 2007), combined with emerging evidence that neurofeedback results may be maintained, or increased, over time (Kerson, Sherman and Kozlowski, 2009) it is understandable that neurofeedback is emerging as a promising treatment method. Neurofeedback, however, is not without its drawbacks. One is that for disorders characterized by little physiological responsiveness, difficulties recognizing emotional states, or where the symptoms are not related to physiological mechanisms (such as personality disorders), neurofeedback may not be particularly useful (Schoenberg & David, 2014). Participants must also be willing to engage and interact during treatment sessions in order to gain any meaningful benefits from the technique (Schoenberg & David, 2014). A second potential drawback is the frequency of treatment sessions averages around 30 minutes to one hour sessions two to three times per week (Arnold et al., 2013; Eismont, Lutsyuk & Pavlenko, 2011; Gelvensleben et al., 2009; Coben & Padolsky, 2007). This intensiveness over the duration of treatment may prove difficult to accommodate families seeking treatment. Finally, the biggest drawback is more strenuous research is needed to determine its effectiveness. Arns, Heinrich & Strehl (2014), for instance, note that emerging pilot and feasibility studies have found no difference in effectiveness when real neurofeedback treatment has been compared to a sham-control treatment (i.e. an identical process but one that should produce no changes in symptoms). A review by Moore (2000) found the presence of placebo effects in the neurofeedback studies reviewed and a placebo-controlled study by Vollebregt and colleagues (2014) found no significant improvements in neurocognitive functioning when a neurofeedback treatment group was compared to a placebo group. A limitation of the study was that assessment was done post-treatment and any changes as a result of the treatment could take several months to materialize (Vollebregt et al., 2014). This limitation could have implications as others have found neurofeedback benefits six to twelve months following treatment which were not initially present immediately following treatment (Kerson, Sherman & Kozlowski, 2009; Kouijzer, de Moor, Gerrits, Congedo & van Schie, 2009). These studies, however, were not placebo controlled so it is unknown if such changes would exist when comparing a treatment group to a placebo group. For all of its promise, neurofeedback does currently have issues regarding the quality of research and further studies are needed for neurofeedback to gain credibility when compared to existing, demonstrated effective, treatment options. Page 9

10 5. Next steps and other resources There exists some research about the use of neurofeedback as a treatment for children and youth with trauma, anxiety or autism but there are concerns about the quality of the research. The literature specifically cites a lack of standardization in neurofeedback procedures and methodologies as problematic as well as the need for more placebocontrolled studies. While neurofeedback holds the promise of being a non-invasive, short duration and free of sideeffects treatment methodology, more research is currently needed. The following bodies have resources for learning more about biofeedback and neurofeedback: The Association for Applied Psychophysiology and Biofeedback (AAPB) The International Society for Neurofeedback and Research (ISNR) The Biofeedback Certification International Alliance (BCIA). o Provides certification in three different programs: Biofeedback, Neurofeedback and Pelvic Muscle Dysfunction Biofeedback. Certification ensures an individual has met training standards and is well versed in the application of their chosen certificate. The training is not a substitute for licensing credentials for treatment of medical or psychological disorders and only ensures that one knows how to use the equipment and technology to professional standards and does not speak to the efficacy of biofeedback or neurofeedback in the treatment of medical or psychological issues. Knowing what works and receiving training on an evidence-informed practice or program is not sufficient to actually achieve the outcomes that previous evaluations indicate are possible. A program that has been shown to improve mental health outcomes for children and youth but that is poorly implemented will not achieve successful outcomes (Fixsen et al, 2005). In order for a program to be evidence-informed, it needs to be applied with fidelity to the design and it needs to be implemented using supportive drivers related to staff competency, organizational leadership and organizational capacity. These drivers include assessing and monitoring the outcomes of your practice using evaluation or performance measurement frameworks, which are particularly important when there is insufficient evidence in the literature to guide clinical decisions. Choosing a practice is an initial step toward implementation, but the implementation drivers are essential to ensure that the program reaches appropriate clients, that outcomes are successful and that clinical staff members are successful in their work. The Ontario Centre of Excellence for Child and Youth Mental Health has a number of resources and services available to support agencies with implementation, evaluation, knowledge mobilization, youth engagement and family engagement. For more information, visit: or check out the Centre s resource hub at For general mental health information, including links to resources for families: Page 10

11 References Arnold, L. E., Lofthouse, N., Hersch, S., Pan, X., Hurt, E., Bates, B. et al. (2013). EEG Neurofeedback for ADHD: Double- Blind Sham-Controlled Randomized Pilot Feasibility Trial. Journal of Attention Disorders, 17(5), Arns, M., Heinrich, H., & Strehl, U. (2014). Evaluation of neurofeedback in ADHD: The long and winding road. Biological Psychology, 95, Coben, R., & Padolsky, I. (2007). Assessment-guided neurofeedback for autistic spectrum disorder. Journal of Neurotherapy, 11(1), Coben, R., Linden, M., & Myers, T. E. (2010). Neurofeedback for Autistic spectrum disorder: A review of the literature. Applied Psychophysiology and Biofeedback, 35(1), Eismont, E. V., Lutsyuk, N. V., & Pavlenko, V. B. (2011). Moderation of Increased Anxiety in Children and Teenagers with the Use of Neurotherapy: Estimation of the Efficacy. Neurophysiology, 43(1), Gevensleben, H., Holl, B., Albrecht, B., Vogel, C., Schlamp, D., Kratz, O. et al. (2009). Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. Journal of Child Psychology and Psychiatry, 50(7), Henriques, G., Keffer, S., Abrahamson, C., & Horst, S. J. (2011). Exploring the effectiveness of a computer-based heart rate variability biofeedback program in reducing anxiety in college students. Applied Psychophysiology and Biofeedback, 36(2), Holtmann, M., Sonuga-Barke, E., Cortese, S., & Brandeis, D. (2014). Neurofeedback for ADHD: A Review of Current Evidence. Child and Adolescent Psychiatric Clinics of North America, 23(4), Huang-Storms, L., Bodenhamer-Davis, E., Davis, R., & Dunn, J. (2007). QEEG-guided neurofeedback for children with histories of abuse and neglect: Neurodevelopmental rationale and pilot study. Journal of Neurotherapy, 10(4), Huang-Storms, L. (208). Efficacy of neurofeedback for children with histories of abuse and neglect: Pilot study and metaanalytic comparison to other treatments (Doctoral dissertation). Retrieved from ProQuest Dissertations and Theses. (Accession Order No. AAT ) Kerson, C., Sherman, R. A., & Kozlowski, G. P. (2009). Alpha suppression and symmetry training for generalized anxiety symptoms. Journal of Neurotherapy, 13(3), Kouijzer, M. E. J., de Moor, J. M. H., Gerrits, B. J. L., Buitelaar, J. K., & van Schie, H. T. (2009). Long-term effects of neurofeedback treatment in autism. Research in Autism Spectrum Disorders, 3(2), Lofthouse, N., Arnold, L. E., & Hurt, E. (2012). Current Status of Neurofeedback for Attention-Deficit/Hyperactivity Disorder. Curr Psychiatry Rep, 14(5), Page 11

12 Moore, N. C. (2000). A Review of EEG Biofeedback Treatment of Anxiety Disorders. CLINICAL EEG and NEUROSCIENCE, 31(1), 1-6. Schoenberg, P. L. A., & David, A. S. (2014). Biofeedback for psychiatric disorders: A systematic review. Applied Psychophysiology and Biofeedback, 39(2), Scottish Intercollegiate Guidelines Network. (2009). Management of attention deficit and hyperkinetic disorders in children and young people: A national clinical guideline. Edinburgh: SIGN. (SIGN publication no. 112). [cited 06/03/2015]. Available from URL: Simkin, D. R., Thatcher, R. W., & Lubar, J. (2014). Quantitative EEG and neurofeedback in children and adolescents: Anxiety disorders, depressive disorders, comorbid addiction and attention-deficit/hyperactivity disorder, and brain injury. Child and Adolescent Psychiatric Clinics of North America, 23(3), Sonuga-Barke, E. J. S., Brandeis, D., Cortese, S., Daley, D., Ferrin, M., Holtmann, M. et al. (2013). Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments. American Journal of Psychiatry, 170(3), Steiner, N. J., Frenette, E. C., Rene, K. M., Brennan, R. T., & Perrin, E. C. (2014). Neurofeedback and cognitive attention training for children with attention-deficit hyperactivity disorder in schools. Journal of Developmental and Behavioral Pediatrics, 35(1), Subcommittee on Attention-Deficit/Hyperactivity Disorder, S. C. o. Q. I. a. M. (2011). ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics, 128(5), Vollebregt, M. A., van Dongen-Boomsma, M., Buitelaar, J. K., & Slaats-Willemse, D. (2014). Does EEG-neurofeedback improve neurocognitive functioning in children with attention-deficit/hyperactivity disorder? A systematic review and a double-blind placebo-controlled study. Journal of Child Psychology and Psychiatry, 55(5), Page 12