Neurofeedback (NF) is an important treatment for attention deficit/hyperactivity disorder (ADHD). In ADHD, cognitive control deficits pose considerable problems to patients. However, NF protocols are not yet optimized to enhance cognitive control alongside with clinical symptoms, partly because they are not driven by basic cognitive neuroscience. In this study, we evaluated different EEG theta and/or beta frequency band NF protocols designed to enhance cognitive control. Participants were n = 157 children and adolescents, n = 129 of them were patients with ADHD (n = 28 typically developing (TD) controls). Patients with ADHD were divided into five groups in the order of referral, with four of them taking part in different NF protocols systematically varying theta and beta power. The fifth ADHD group and the TD group did not undergo NF. All NF protocols resulted in reductions of ADHD symptoms. Importantly, only when beta frequencies were enhanced during NF (without any theta regulation or in combination with theta upregulation), consistent enhancing effects in both response inhibition and conflict control were achieved. The theta/beta NF protocol most widely used in clinical settings revealed comparatively limited effects. Enhancements in beta band activity are key when aiming to improve cognitive control functions in ADHD. This calls for a change in the use of theta/beta NF protocols and shows that protocols differing from the current clinical standard are effective in enhancing important facets of cognitive control in ADHD. Further studies need to examine regulation data within the neurofeedback sessions to provide more information about the mechanisms underlying the observed effects.

Neurofeedback is a type of biofeedback in which subjects learn to use the activity of their own electrical brain waves to respond to a visual or auditory feedback from the activity of the brain. This is done by connecting electrodes to the body to get the brain's electrical activity in the form of encephalogram signals (EEG) which are then calculated and converted into useful feedback.The purpose of this work was to evaluate a neurofeedback platform via an OpenBCI open-source EEG technology that could lead to more accessible neurofeedback for society.This study was conducted with different methods where the focus was on testing and data analysis. The study has included a summary of theory used in neurofeedback, a comprehensive pilot study on an 8-channel open-source EEG neurofeedback platform and some of the ethical aspects behind the technology used and neurofeedback in Sweden. During the work, two different experts were interviewed: Gunilla Radu, founder and owner of Nordic Center of Neurofeedback AB and Jan Rutkowski, who is an engineer in medical engineering at the Uppsala Hospital.The tests with 8-channel EEG with an OpenBCI hardware and software show results from three subjects. The answers from a follow-up survey that subjects were allowed to answer are presented in the report. This was used as an evaluation of the tests performed. The aim of the tests was to give Biohackeri an opportunity to see the potential for a neurofeedback platform and to create a basis for further development of such a platform. The result indicates that a measurement of the brain activity at rest with the technology from OpenBCI shows a higher concentration level in the human body with open eyes compared to closed eyes. In addition, a higher level of relaxation is noticed when resting with eyes closed compared to eyes open. Answers from the survey show that what is important to the test subjects is, among other things, the convenience while testing the technology. In terms of requirements and rules that Neurofeedback therapists must meet, it turned out that in Sweden therapists do not need to have a specific background or education. There are ethical perspectives that Neurofeedback therapists may consider in implementing Neurofeedback Therapy.The conclusion of this project is that the tested 8-channel EEG equipment gives a result that agrees with the presented theory. Thus, a Neurofeedback platform could be built on the commercially available open-source technology, such as the technology from OpenBCI. / Neurofeedback är en typ av biofeedback som försökspersoner lär sig att använda sin egen elektriska hjärnvågors aktivitet för att svara på en visuell eller auditiv återkoppling från hjärnans aktivitet. Det görs huvudsakligen genom att ansluta elektroder till huvudet för att få hjärnans elektriska aktivitet i form av encefalogramsignaler (EEG) som sedan beräknas och omvandlas till användbar återkoppling.Syftet med detta arbete var att utvärdera en Neurofeedback-plattform via en OpenBCI open-source EEG-teknologi som skulle kunna leda till mer tillgänglig Neurofeedback för samhället.Denna studie genomfördes med olika metoder där huvudfokus låg på testning och dataanalys. Studien har innefattat en sammanfattning av teori som används inom Neurofeedback, en pilotstudie på en 8-kanals open-source EEG-Neurofeedback plattform och en del av de etiska aspekterna bakom den använda tekniken och Neurofeedback i Sverige. Under arbetets gång intervjuades två olika experter, Gunilla Radu, grundare och ägare av Nordic Center of Neurofeedback AB och Jan Rutkowski som är medicinteknisk ingenjör på Akademiska sjukhuset.Från testerna med 8-kanal EEG med en OpenBCI hårdvara och mjukvara visas resultat från tre försökspersoner. Svaren från en efterundersökningsenkät som försökspersoner fick svara på presenteras i rapporten. Detta användes som en utvärdering på de utförda testerna. Målet med testerna var att ge Biohackeri en möjlighet att se potentialen för en Neurofeedback-plattform samt att skapa en grund för vidareutveckling av en sådan plattform. Resultatet indikerar att en mätning på hjärnaktiviteten vid vilotillstånd med tekniken från OpenBCI kan det märkas högre koncentrationsnivån i människokroppen med öppna ögon jämfört med stängda ögon. Dessutom märks det en högre avslappningsnivå vid vilotillstånd med stängda ögon jämfört med öppna ögon. Svar från enkäten visar att det som är viktigt för testpersonerna är bland annat bekvämligheten under provning av tekniken. När det gäller krav och regler som Neurofeedback-terapeuter ska uppfylla visade det sig att i Sverige behöver terapeuter inte ha en specifik bakgrund eller utbildning. Det finns etiska perspektiv som Neurofeedback-terapeuter kan överväga att implementera vid Neurofeedbackterapi.Slutsatsen av detta projekt blir att den testade 8-kanal EEG utrustningen ger ett resultat som stämmer överens med den presenterade teorin. Därmed skulle en Neurofeedback-plattform kunna byggas på den kommersiellt tillgängliga open-source tekniken såsom tekniken från OpenBCI.

Several motor problems in ADHD learners are reported, including problems with balance, fine muscle control (Szatmari & Taylor; 1984; Havey & Reid, 2003) and motor planning (Piek et al., 1999; Pless & Corisson, 2000). It seems that overlapping conditions such as DAMP (which is a combination of ADHD and Developmental Coordination Disorder (DCD)) display greater connections with motor problems, than when a child displays only ADHD symptoms (Gillberg, 2003; Gibbs et al., 2007). There is also continuing controversy in the research literature as to whether ADHD is in fact remediable and what the most appropriate methods in this regard would be. Behavioural therapy at school and various forms of psychotherapy are reported to be the most popular forms of interventions complementary to medication. It also appears that motor exercise can stimulate the brain in various ways, resulting in improvement in learning and attention (Summerford, 2005). Motor therapy appears to be important, since many ADHD learners display motor difficulties. Motor control problems of learners with ADHD are also neglected during research. The objectives of this study were firstly to determine the nature and extent of coordination related neuro-motor and visual-motor integration deficits of an availability sample of six- to eight-year-old (N=95) learners diagnosed with ADHD in Brakpan, South Africa. A further objective was to determine whether treatment methods, including neuro-motor therapy, pharmacological agents and neuro biofeedback can indeed address neuro-motor problems and ADHD symptoms successfully. A further objective was to determine which of the various treatment programs, including neuro-motor therapy, pharmacological agents and brain conditioning intervention, will be the most effective for the treatment of six- to eight-year-old ADHD learners. The "Disruptive Behaviour Scale" checklist for ADHD (Bester, 2006) was used to identify learners with ADHD. The "Movement Assessment Battery for Learners 2" (MABC), and the “Quick Neurological Screening Test II" (QNST-II) were used to determine the learners’ motor skills, as well as neuro-motor progress. The "Beery Developmental Test of Visual-Motor Integration" (VMI-IV) was used to examine the learners' visual-motor integration (VMI), visual perception (VP) and motor coordination (MC). "Statistica for Windows 2012" was used for the analysis of the results. One-way Analysis of Variance, independent t-testing and co-variance analysis were used respectively to analyze data related to the abovementioned objectives. A p-value less than or equal to 0.05 was accepted as statistically significant, and effect sizes were calculated to determine the practical significance of the results (d≤0.8). The results of the study showed that the neuro-motor status of the selected six- to eight-year-old ADHD learners (N=95) that had been identified, using the Bester questionnaire, and analyzed by means of the MABC, QNST and VMI, was affected negatively by the condition. Fine motor and hand control skills of learners with ADHD were indeed found to be significantly weaker compared to learners without ADHD, and the fine motor skills of learners with DAMP showed impairment to a greater degree. Neurological and visual-motor integration do not appear to differ between learners with and without ADHD symptoms, although trends of weaker values and significant differences were found in the palm shape recognition, arm-leg extension (muscle tone) subscale and the stimulation of hand and cheek subscale in the ADHD and DAMP groups. For objective 2, the learners were divided into two groups (an ADHD intervention group (n=10) that was subjected to an neuro-motor intervention program of nine weeks, 37 minutes per session, twice a week, and compared to a non-control group consisting of non-ADHD learners (n=18)). When the pre-test differences between the groups are taken into account, it indicated that the ADHD group performed weaker than the control group in the QNST and MABC total, MABC percentile, ball skills and palm shape recognition subtest values, before starting the intervention, but that during the after-test no more differences were observed between the groups. This suggests that the intervention group showed improvement and that their average values draw closer to those of the control group, confirming that the intervention did exert an influence on the deficits that these ADHD learners experienced. The neuro-motor dysfunction of the group of learners with ADHD did not show a significant improvement, although non- significant trends of improvement that occurred in all variables may indeed be attributed to the effect of the intervention. A reduction in the ADHD symptoms and improved visual-motor integration in learners with ADHD were observed, suggesting that the severity of the symptoms of ADHD displayed by this group before the start of the intervention was significantly reduced. For objective 3, the learners (n=95) were divided into five groups (Sharper Brain group (n=25); neuro-motor intervention group (n=21); medication group (n=17); a group with no symptoms of ADHD (n=18), and an ADHD control group (n=14)). The Sharper Brain group showed practical significant lower values than the ADHD control group and the medication group in most of the MABC variables, from which can be deduced that neuro-biofeedback therapy will not improve motor problems. The results obtained in the visual-motor integration subtest showed that the neuro-motor intervention group performed significantly better than the ADHD control group, although the groups did not differ significantly. ADHD symptoms decreased significantly in all groups, most of all in the Sharper Brain group, from which can be deduced that the intervention has possibilities to improve focus and attention. A trend also occurred (p>0.05) that the neuro-motor intervention contributed more to improving visual-motor integration than the other intervention groups, while the medication intervention meaningfully addressed visual perception skills. However, from the results could not be determined whether one group performed better than another group, as no significant differences occurred consistently between groups. The neuro-biofeedback therapy, medication and neuro-motor intervention each had a achieved a unique improvement, and it is recommended that a combination of the various intervention methods should be used in the treatment of ADHD. In summary, the conclusion can be drawn that ADHD learners experience problems with skills related to attention, visual-motor integration and fine motor skills to a greater extent than non-ADHD learners, and that learners diagnosed with DAMP display more serious problems in this regard. The results showed that the various interventions have various treatment effects, but did not have a significant effect on the motor status of the ADHD learners. The conclusion may be drawn that there is no one single method of treatment for learners with ADHD symptoms, but that a combination of treatment methods should rather be implemented. From the study it is clear that ADHD does indeed affect learners negatively, but also that the exposure to focused intervention programs has a positive effect on their neuro-motor skills and ADHD symptoms. / PhD (Human Movement Science), North-West University, Potchefstroom Campus, 2014

Attention deficit hyperactivity disorder (ADHD) is a psychopathology commonly characterized by general inattentiveness and/or a lack of impulse control resulting in hyperactive tendencies. ADHD is estimated to cost the United States roughly $266 billion every year. ADHD is currently treated via medications, cognitive behavioral therapy, or more recently, neurofeedback. Neurofeedback – and biofeedback in general – is the process of providing a patient with information about autonomic bodily functions so that they may control said autonomic function. In the case of ADHD, neurofeedback focuses on reinforcing the behaviors and sensations associated with attentiveness. Currently however, neurofeedback systems are large and require a patient to travel to a clinic. Furthermore, the current offering of portable neuro/biofeedback devices do not have the technological capabilities to provide effective neurofeedback therapy. Current wearable tech devices – such as the Apple Watch and Samsung Gear – possess the technological capabilities to measure important bodily functions, and provide appropriate biofeedback therapy while remaining discrete and most importantly, portable.

As intervenções com neurofeedback têm tido grande difusão na área como uma alternativa possível para tratamento do Transtorno de Déficit de Atenção/Hiperatividade (TDAH). Este estudo tem o objetivo de avaliar a viabilidade da utilização de um sistema de neurofeedback de baixo custo chamado Near Infrared Spectroscopy/Hemoencephalography Neurofeedback (NIR/HEG-NF) para tratar crianças com TDAH. Método: trata-se de um estudo clínico piloto aberto, que incluiu 5 crianças (3 meninos e 2 meninas - idade 10,4 ± 0,89 anos) com TDAH-C (tipo combinado). Os indivíduos completaram um programa de 24 sessões de NIR/HEG-NF, duas ou três vezes por semana. Os seguintes desfechos foram avaliados pré e pós-tratamento: 1) sintomas de desatenção e hiperatividade; 2) desempenho neuropsicológico; 3) imagens de SPECT cerebral; 4) qualidade de vida; e 5) efeitos adversos. Resultados: houve maior resistência do que o esperado para a participação dos indivíduos devido a vários fatores, tais como logísticos para a participação nas sessões e requerimento de não uso de medicação durante o protocolo. Detectamos uma diferença significativa na comparação pré e pós-intervenção nos escores atribuídos pelos pais na dimensão de hiperatividade e impulsividade do Swanson, Nolan and Pelham Questionnaire (SNAP-IV) (p = .042; tamanho de efeito [ES] =.38) e uma tendência de melhora nos escores atribuídos pelos pais e professores na dimensão desatenção (p = .066; ES = .47 / p = .068; ES = .60) naquelas crianças que finalizaram o tratamento. Detectamos uma tendência de aumento perfusional em diferentes partes do córtex cerebral em três indivíduos. As comparações pré e pós-intervenção nas outras medidas não indicaram diferenças estatisticamente significativas. Não foram relatados efeitos adversos significativos. Discussão: Os achados iniciais sugerem que o NIR/HEG-NF como tratamento para sintomas de TDAH pode ser promissor e deve ser melhor investigado. O protocolo lança luz sobre novas abordagens para avaliar a eficácia da intervenção. Pode-se, por exemplo, implementar o programa de intervenção no ambiente escolar e com uso concomitante de medicamentos para superar as resistências na alocação de pacientes e para uma avaliação com maior validade externa. / Background and objectives: Neurofeedback interventions have been quick and extensively introduced for clinicians to treat Attention-Deficit/Hyperactivity Disorder (ADHD). This study aims to assess the feasibility of using a low cost neurofeedback system called Near Infrared Spectroscopy/ Hemoencephalography Neurofeedback (NIR/HEG-NF) for treating children with ADHD. Method: This open pilot clinical study included 5 children (3 boys and 2 girls - age 10.4 ± 0.89 years) with ADHD-C (combined type). The subjects completed a program of 24 sessions of NIR/HEG-NF, two or three times a week. The following outcomes were assessed pre and post-treatment: 1) clinical symptoms of inattention and hyperactivity; 2) neuropsychological performance; 3) brain SPECT images; 4) quality of life and; 5) adverse effects. Results: Higher resistance than expected was experienced for patient allocation due to logistic reasons to attend the sessions in the hospital and the requirement of not using medication during the protocol. We detected a significant decrease in hyperactivity/impulsivity comparing pre and post-intervention scores in the parent’s Swanson, Nolan and Pelham Questionnaire - SNAP-IV (p = .042; Effect Size [ES] r = .38) and a trend of improvement in scores attributed by parents and teachers in inattention (p = .066; r = .47 / p = .068; r = .68) . We detected a trend for increased perfusion in different parts of the entire cortex in 3 subjects. Comparisons between pre and post-intervention scores in other measures did not suggest meaningful differences. No significant adverse effects were reported. Discussion: Our initial findings suggest that NIR/HEG-NF technique might be promising and should be further investigated. The protocol shed light on new approaches to assess the effectiveness of the intervention such as the need to both implement the intervention program in a school environment and to pursue the investigation of the treatment effects with concomitant use of medications to surpass resistances to enroll patients and to have an assessment with more external validity.

Avec les avancées technologiques dans le domaine de l'imagerie cérébrale fonctionnelle et les progrès théoriques dans la connaissance des différents éléments neuro-physiologiques liés à la cognition, les deux dernières décennies ont vu l'apparition d'interfaces cerveau-machine (ICM) permettant à une personne d'observer en temps réel, ou avec un décalage qui se limite à quelques secondes, sa propre activité cérébrale. Le domaine clinique en général, et plus particulièrement celui de la neuropsychologie et des pathologies conduisant à un handicap moteur lourd, pour lesquels les applications potentielles sont nombreuses qu'elles soient thérapeutiques ou en vue d'une réhabilitation fonctionnelle, a constitué un moteur important de la recherche sur ce nouveau domaine des neurosciences temps réel. Parmi ces applications, le neurofeedback, ou neurothérapie, qui vise l'acquisition par le sujet du contrôle volontaire de certains aspects de son activité cérébrale en vue de les amplifier ou au contraire les diminuer dans un but thérapeutique, voire d'optimisation cognitive, représente une technique prometteuse, alternative aux thérapies et traitements médicamenteux. Cependant, la validation de ce type d'intervention et la compréhension des mécanismes mis en jeux en sont encore à leurs balbutiements. L'entraînement par neurofeedback est souvent long, pouvant s'étaler sur plusieurs semaines. Il est donc très probable que ce type de rééducation cérébrale sollicite des phénomènes de plasticité qui s'inscrivent dans une dynamique lente, et de ce fait, requiert une durée relativement longue d'entraînement pour atteindre les effets à long terme recherchés. Cependant, à cela peuvent s'ajouter de nombreux éléments perturbateurs qui pourraient être à l'origine de la difficulté de l'apprentissage et des longs entraînements nécessaires pour obtenir les résultats attendus. Parmi eux, les perturbations qui viennent déformer le signal enregistré, ou les éléments artefactuels qui ne font pas partie du signal d'intérêt, sont une première cause potentielle. Le manque de spécificité fonctionnelle du signal retourné au sujet pourrait en constituer une deuxième. Nous avons d'une part développé des outils méthodologiques de traitement du signal en vue d'améliorer la robustesse des analyses des signaux EEG, principalement utilisés jusqu'à maintenant dans le domaine du neurofeedback et des ICM, face aux artefacts et au bruit électromagnétique. D'autre part, si l'on s'intéresse au problème de la spécificité fonctionnelle du signal présenté au sujet, des études utilisant l'IRM fonctionnelle ou des techniques de reconstruction de sources à partir du signal EEG, qui fournissent des signaux ayant une meilleure spécificité spatiale, laissent entrevoir de possibles améliorations de la vitesse d'apprentissage. Afin d'augmenter la spécificité spatiale et la contingence fonctionnelle du feedback présenté au sujet, nous avons étudié la stabilité de la décomposition de l'EEG en différentes sources d'activité électrique cérébrale par Analyse en Composantes Indépendantes à travers différentes séances d'enregistrement effectuées sur un même sujet. Nous montrons que ces décompositions sont stables et pourraient permettre d'augmenter la spécificité fonctionnelle de l'entraînement au contrôle de l'activité cérébrale pour l'utilisation d'une ICM. Nous avons également travaillé à l'implémentation d'un outil logiciel permettant l'optimisation des protocoles expérimentaux basés sur le neurofeedback afin d'utiliser ces composantes indépendantes pour rejeter les artefacts en temps réel ou extraire l'activité cérébrale à entraîner. Ces outils sont utiles dans le cadre de l'analyse et de la caractérisation des signaux EEG enregistrés, ainsi que dans l'exploitation de leurs résultats dans le cadre d'un entraînement de neurofeedback. La deuxième partie de ce travail s'intéresse à la mise en place de protocoles de neurofeedback et à l'impact de l'apprentissage. Nous décrivons tout d'abord des résultats obtenus sur une étude pilote qui cherche à évaluer chez des sujets sains l'impact d'un protocole de neuro-feedback basé sur le contrôle du rythme Mu. Les changements comportementaux ont été étudiés à l'aide d'un paradigme de signal stop qui permet d'indexer les capacités attentionnelles et d'inhibition de réponse motrice sur lesquelles on s'attend à ce que l'entraînement ICM ait une influence. Pour clore cette partie, nous présentons un nouvel outil interactif immersif pour l'entraînement cérébral, l'enseignement, l'art et le divertissement pouvant servir à évaluer l'impact de l'immersion sur l'apprentissage au cours d'un protocole de neurofeedback. Enfin, les perspectives de l'apport des méthodes et résultats présentés sont discutées dans le contexte du développement des ICMs de nouvelle génération qui prennent en compte la complexité de l'activité cérébrale. Nous présentons les dernières avancées dans l'étude de certains aspects des corrélats neuronaux liés à deux états mentaux ou classes d'états mentaux que l'on pourrait qualifier d'antagonistes par rapport au contrôle de l'attention : la méditation et la dérive attentionnelle, en vue de leur intégration à plus long terme dans un entraînement ICM par neurofeedback.

Le trouble déficitaire de l'attention avec ou sans hyperactivité (TDA/H) atteint de 5 à 10% des enfants d'âge scolaire. Le seul traitement reconnu efficace à ce jour est la prise quotidienne de psychostimulants. Toutefois, la médication a mauvaise presse et ne convient pas à tous les enfants, ce qui conduit les parents à se tourner vers des solutions alternatives. Parmi celles-ci, le neurofeedback semble particulièrement populaire. Cette technique est basée sur le fait que les enfants souffrant de TDA/H présentent des atypies des ondes cérébrales qui pourraient être corrigées par le biais d'animations sur ordinateur qui renvoient du feedback à l'enfant en fonction de son activité ÉEG. Bien que plusieurs études démontrent des résultats prometteurs, nombre d'entre elles présentent des lacunes méthodologiques. De même, la contribution de facteurs non spécifiques, notamment au niveau psychologique, n'a pu être exclue et, conséquemment, l'hypothèse d'un effet placebo ne peut être éliminée. Afin de déterminer l'apport respectif des facteurs d'ordre affectif et neurologique dans le neurofeedback, une première étude a été menée dans le but de documenter l'effet simple du traitement en comparant un groupe entraîné (n=8) à un groupe en liste d'attente (n=7) composé d'enfants âgés de 7 à 13 ans (moyenne de 9,6 ans), sur des mesures neuropsychologiques, comportementales et neurophysiologiques (EEG). Bien que les résultats confirment la présence d'effets bénéfiques pour le groupe entraîné, ceux-ci se limitent aux questionnaires remplis par les parents, notamment les échelles Inattention et Hyperactivité de l'ADHD Rating Scale (F(1,13)=17,26, p<,001 et F(1,13)=5,76, p<,05 respectivement) ainsi qu'à l'échelle Troubles de comportements du Strenght and Difficulties Questionnaire (F(1,13)=4,36, p<,1). Cela plaide en faveur d'un effet placebo se caractérisant par le « traitement des parents » plutôt que le « traitement de l'enfant ». Par conséquent, une deuxième étude (n=31) incluant un groupe placebo bénéficiant du même cérémonial, mais sans feedback réel, a été conduite chez un groupe d'enfants (7-12 ans, moyenne 8,8 ans). Les résultats obtenus lors de la première étude n'ont pu être répliqués et aucun effet de groupe n'a été observé, les groupes entraînés se situant au même niveau en posttest que les enfants en liste d'attente. Par conséquent, bien que la généralisation des résultats soit entravée par le fait que les sujets ne sont pas parvenus à acquérir un contrôle sur l'ÉEG, ces données suggèrent à la fois l'inefficience du véritable traitement, mais également la contribution négligeable des facteurs non spécifiques, le groupe placebo n'ayant montré aucune amélioration significative. Toutefois, une analyse post-hoc des résultats semble tout de même suggérer des effets bénéfiques, du moins pour un groupe restreint de sujets. Par conséquent, des mécanismes autres que ceux mis de l'avant au départ doivent être postulés pour expliquer cet effet. ______________________________________________________________________________

No description available.

Several motor problems in ADHD learners are reported, including problems with balance, fine muscle control (Szatmari & Taylor; 1984; Havey & Reid, 2003) and motor planning (Piek et al., 1999; Pless & Corisson, 2000). It seems that overlapping conditions such as DAMP (which is a combination of ADHD and Developmental Coordination Disorder (DCD)) display greater connections with motor problems, than when a child displays only ADHD symptoms (Gillberg, 2003; Gibbs et al., 2007). There is also continuing controversy in the research literature as to whether ADHD is in fact remediable and what the most appropriate methods in this regard would be. Behavioural therapy at school and various forms of psychotherapy are reported to be the most popular forms of interventions complementary to medication. It also appears that motor exercise can stimulate the brain in various ways, resulting in improvement in learning and attention (Summerford, 2005). Motor therapy appears to be important, since many ADHD learners display motor difficulties. Motor control problems of learners with ADHD are also neglected during research. The objectives of this study were firstly to determine the nature and extent of coordination related neuro-motor and visual-motor integration deficits of an availability sample of six- to eight-year-old (N=95) learners diagnosed with ADHD in Brakpan, South Africa. A further objective was to determine whether treatment methods, including neuro-motor therapy, pharmacological agents and neuro biofeedback can indeed address neuro-motor problems and ADHD symptoms successfully. A further objective was to determine which of the various treatment programs, including neuro-motor therapy, pharmacological agents and brain conditioning intervention, will be the most effective for the treatment of six- to eight-year-old ADHD learners. The "Disruptive Behaviour Scale" checklist for ADHD (Bester, 2006) was used to identify learners with ADHD. The "Movement Assessment Battery for Learners 2" (MABC), and the “Quick Neurological Screening Test II" (QNST-II) were used to determine the learners’ motor skills, as well as neuro-motor progress. The "Beery Developmental Test of Visual-Motor Integration" (VMI-IV) was used to examine the learners' visual-motor integration (VMI), visual perception (VP) and motor coordination (MC). "Statistica for Windows 2012" was used for the analysis of the results. One-way Analysis of Variance, independent t-testing and co-variance analysis were used respectively to analyze data related to the abovementioned objectives. A p-value less than or equal to 0.05 was accepted as statistically significant, and effect sizes were calculated to determine the practical significance of the results (d≤0.8). The results of the study showed that the neuro-motor status of the selected six- to eight-year-old ADHD learners (N=95) that had been identified, using the Bester questionnaire, and analyzed by means of the MABC, QNST and VMI, was affected negatively by the condition. Fine motor and hand control skills of learners with ADHD were indeed found to be significantly weaker compared to learners without ADHD, and the fine motor skills of learners with DAMP showed impairment to a greater degree. Neurological and visual-motor integration do not appear to differ between learners with and without ADHD symptoms, although trends of weaker values and significant differences were found in the palm shape recognition, arm-leg extension (muscle tone) subscale and the stimulation of hand and cheek subscale in the ADHD and DAMP groups. For objective 2, the learners were divided into two groups (an ADHD intervention group (n=10) that was subjected to an neuro-motor intervention program of nine weeks, 37 minutes per session, twice a week, and compared to a non-control group consisting of non-ADHD learners (n=18)). When the pre-test differences between the groups are taken into account, it indicated that the ADHD group performed weaker than the control group in the QNST and MABC total, MABC percentile, ball skills and palm shape recognition subtest values, before starting the intervention, but that during the after-test no more differences were observed between the groups. This suggests that the intervention group showed improvement and that their average values draw closer to those of the control group, confirming that the intervention did exert an influence on the deficits that these ADHD learners experienced. The neuro-motor dysfunction of the group of learners with ADHD did not show a significant improvement, although non- significant trends of improvement that occurred in all variables may indeed be attributed to the effect of the intervention. A reduction in the ADHD symptoms and improved visual-motor integration in learners with ADHD were observed, suggesting that the severity of the symptoms of ADHD displayed by this group before the start of the intervention was significantly reduced. For objective 3, the learners (n=95) were divided into five groups (Sharper Brain group (n=25); neuro-motor intervention group (n=21); medication group (n=17); a group with no symptoms of ADHD (n=18), and an ADHD control group (n=14)). The Sharper Brain group showed practical significant lower values than the ADHD control group and the medication group in most of the MABC variables, from which can be deduced that neuro-biofeedback therapy will not improve motor problems. The results obtained in the visual-motor integration subtest showed that the neuro-motor intervention group performed significantly better than the ADHD control group, although the groups did not differ significantly. ADHD symptoms decreased significantly in all groups, most of all in the Sharper Brain group, from which can be deduced that the intervention has possibilities to improve focus and attention. A trend also occurred (p>0.05) that the neuro-motor intervention contributed more to improving visual-motor integration than the other intervention groups, while the medication intervention meaningfully addressed visual perception skills. However, from the results could not be determined whether one group performed better than another group, as no significant differences occurred consistently between groups. The neuro-biofeedback therapy, medication and neuro-motor intervention each had a achieved a unique improvement, and it is recommended that a combination of the various intervention methods should be used in the treatment of ADHD. In summary, the conclusion can be drawn that ADHD learners experience problems with skills related to attention, visual-motor integration and fine motor skills to a greater extent than non-ADHD learners, and that learners diagnosed with DAMP display more serious problems in this regard. The results showed that the various interventions have various treatment effects, but did not have a significant effect on the motor status of the ADHD learners. The conclusion may be drawn that there is no one single method of treatment for learners with ADHD symptoms, but that a combination of treatment methods should rather be implemented. From the study it is clear that ADHD does indeed affect learners negatively, but also that the exposure to focused intervention programs has a positive effect on their neuro-motor skills and ADHD symptoms. / PhD (Human Movement Science), North-West University, Potchefstroom Campus, 2014

As intervenções com neurofeedback têm tido grande difusão na área como uma alternativa possível para tratamento do Transtorno de Déficit de Atenção/Hiperatividade (TDAH). Este estudo tem o objetivo de avaliar a viabilidade da utilização de um sistema de neurofeedback de baixo custo chamado Near Infrared Spectroscopy/Hemoencephalography Neurofeedback (NIR/HEG-NF) para tratar crianças com TDAH. Método: trata-se de um estudo clínico piloto aberto, que incluiu 5 crianças (3 meninos e 2 meninas - idade 10,4 ± 0,89 anos) com TDAH-C (tipo combinado). Os indivíduos completaram um programa de 24 sessões de NIR/HEG-NF, duas ou três vezes por semana. Os seguintes desfechos foram avaliados pré e pós-tratamento: 1) sintomas de desatenção e hiperatividade; 2) desempenho neuropsicológico; 3) imagens de SPECT cerebral; 4) qualidade de vida; e 5) efeitos adversos. Resultados: houve maior resistência do que o esperado para a participação dos indivíduos devido a vários fatores, tais como logísticos para a participação nas sessões e requerimento de não uso de medicação durante o protocolo. Detectamos uma diferença significativa na comparação pré e pós-intervenção nos escores atribuídos pelos pais na dimensão de hiperatividade e impulsividade do Swanson, Nolan and Pelham Questionnaire (SNAP-IV) (p = .042; tamanho de efeito [ES] =.38) e uma tendência de melhora nos escores atribuídos pelos pais e professores na dimensão desatenção (p = .066; ES = .47 / p = .068; ES = .60) naquelas crianças que finalizaram o tratamento. Detectamos uma tendência de aumento perfusional em diferentes partes do córtex cerebral em três indivíduos. As comparações pré e pós-intervenção nas outras medidas não indicaram diferenças estatisticamente significativas. Não foram relatados efeitos adversos significativos. Discussão: Os achados iniciais sugerem que o NIR/HEG-NF como tratamento para sintomas de TDAH pode ser promissor e deve ser melhor investigado. O protocolo lança luz sobre novas abordagens para avaliar a eficácia da intervenção. Pode-se, por exemplo, implementar o programa de intervenção no ambiente escolar e com uso concomitante de medicamentos para superar as resistências na alocação de pacientes e para uma avaliação com maior validade externa. / Background and objectives: Neurofeedback interventions have been quick and extensively introduced for clinicians to treat Attention-Deficit/Hyperactivity Disorder (ADHD). This study aims to assess the feasibility of using a low cost neurofeedback system called Near Infrared Spectroscopy/ Hemoencephalography Neurofeedback (NIR/HEG-NF) for treating children with ADHD. Method: This open pilot clinical study included 5 children (3 boys and 2 girls - age 10.4 ± 0.89 years) with ADHD-C (combined type). The subjects completed a program of 24 sessions of NIR/HEG-NF, two or three times a week. The following outcomes were assessed pre and post-treatment: 1) clinical symptoms of inattention and hyperactivity; 2) neuropsychological performance; 3) brain SPECT images; 4) quality of life and; 5) adverse effects. Results: Higher resistance than expected was experienced for patient allocation due to logistic reasons to attend the sessions in the hospital and the requirement of not using medication during the protocol. We detected a significant decrease in hyperactivity/impulsivity comparing pre and post-intervention scores in the parent’s Swanson, Nolan and Pelham Questionnaire - SNAP-IV (p = .042; Effect Size [ES] r = .38) and a trend of improvement in scores attributed by parents and teachers in inattention (p = .066; r = .47 / p = .068; r = .68) . We detected a trend for increased perfusion in different parts of the entire cortex in 3 subjects. Comparisons between pre and post-intervention scores in other measures did not suggest meaningful differences. No significant adverse effects were reported. Discussion: Our initial findings suggest that NIR/HEG-NF technique might be promising and should be further investigated. The protocol shed light on new approaches to assess the effectiveness of the intervention such as the need to both implement the intervention program in a school environment and to pursue the investigation of the treatment effects with concomitant use of medications to surpass resistances to enroll patients and to have an assessment with more external validity.