Journal of Rehabilitation (Oct 2018)
The Effect of Neurofeedback on Improving Executive Functions in Children With Attention Deficit/Hyperactivity Disorder
Abstract
Objective Executive functions are processes that control, direct, and coordinate other cognitive processes. The findings of cognitive neuroscience indicate that frontal and temporal lobes have a longer maturity and support the development of executive functions. These abilities are essential for success in everyday activities and longitudinal studies indicate that executive functions are associated with academic achievement, social adaptation, career promotion, and independent performance in children. Executive functions deficits hamper academic achievement and create problematic behaviors. Various studies indicate that children and adolescents with Attention Deficit/Hyperactivity Disorder (ADHD) have a significant disadvantage with respect to the neuropsychological assessment of executive functions (such as planning, inhibition, verbal and spatial memory, and cognitive shifting). ADHD is the most common childhood neurodevelopmental disorder and its symptoms include attention deficit, impulsivity, and hyperactivity. The prevalence of this disorder is higher in boys than in girls. Children with ADHD experience life-long challenges and require support in order to succeed in life; therefore, different intervention approaches have been used to help these children. Recently, neurofeedback has received a lot of attention. It is a type of biofeedback that teaches individual self-regulation by recording electrical responses and providing feedback. The goal of neurofeedback education is to correct abnormal brain wave that improves child's behavioral and cognitive functions. In other words, neurofeedback affects activity of brain waves, so that the brain waves of desirable behaviors are generated or enhanced. Considering the problems that children with ADHD have in executive functions, the present study investigated the effectiveness of neurofeedback on improving executive functions in these children. Materials & Methods This study was a quasi-experimental research with pretest and post-test. The study population included all children with ADHD in Khorramabad City, Iran. The sample included 10 children with ADHD who were selected by convenience sampling method. The inclusion criteria comprised diagnosis of ADHD confirmed by the psychiatrist and psychologist, normal IQ, and no history of another neurological disease or developmental disorder. In the pretest, the Behavior Rating Inventory of Executive Function (BRIEF) was completed for children. It is one of the most common tools for measuring the executive functions and reflects the teacher's view about student’s behavior in the area of executive functions. It screens the executive function problems and covers two areas: metacognition and self-regulation. It measures inhibition, flexibility, emotional control, initiating, working memory, planning–organizing, organization of materials and monitoring. Then, the subjects participated in neurofeedback sessions. Each subject received 10 neurofeedback sessions, twice a week. The beta/theta protocol was administered to all subjects. The purpose of this protocol was to increase beta waves and reduce theta waves. After completing the neurofeedback sessions, BRIEF was completed again in post-test. Descriptive statistics (mean and standard deviation) were used for data analysis and inferential statistics was done by paired t test. Results The scores of executive functions in the pretest are significantly different from those in the post-test (P<0.001). Also, the findings showed that self-regulation score in the pretest is significantly different from that in the post-test (P<0.001). In addition, metacognition score of the pretest shows a significant difference from that in the post-test (P<0.001). Conclusion Neurofeedback can improve the executive functions in children with ADHD. It can help children with ADHD to change their brain waves, and makes them aware of their cognitive performance.
