Efficacy of neurofeedback as a treatment for attention deficit and hiperactivity disorder (adhd) and the influence of oppositional defiant behaviors

Résumé

Introduction: Compelling evidence suggests that Neurofeedback may be an alternative or complementary standard treatment for Attention Deficit and Hyperactivity/impulsivity Disorder (ADHD). However, randomized and controlled studies that include follow-up assessments should be conducted in order to consider Neurofeedback a standard alternative treatment for ADHD. In addition, reliable instruments for selecting participants should be employed, given that ADHD diagnosis is basically conducted by clinicians, resulting in studies using heterogeneous ADHD samples based on simple testing. Moreover, several studies underline the importance of controlling and monitoring the influence of Oppositional Defiant Disorder (ODD) symptoms since its presence can influence treatment outcome. Content: In this way, the present thesis focuses on the study of Neurofeedback as a treatment for ADHD, considering the influence of oppositional defiant behaviors. This research trajectory starts with the aim to study key aspects of ADHD diagnosis, by analyzing a widely used behavioral rating scale: ADHD-RS. Then, the question of ODD prevalence, a less investigated disorder and the most prevalent in ADHD population, has been addressed. Finally, the main contribution of this thesis, the study of an alternative treatment for ADHD, i.e. Neurofeedback, was conducted. Results are presented in three different articles: one article is published in Anales de Pediatría, another article is accepted (in press) in the Spanish Journal of Psychology, and the last article has been recently published in Biological Psychology. Conclusion: In sum, important conclusions and recommendations can be drawn from the studies presented. First of all, when conducting research in childhood disorders, especially ADHD and ODD, it is very important to select participants based on several reliable and validated instruments, using multiple sources of information. Our findings also indicate the existence of certain limitations of the polythetic method of DSM-IV. Second, we confirm that ODD is a prevalent disorder in Spanish population. And finally, our findings suggest that Neurofeedback treatment and pharmacological intervention tend to improve ODD symptomatology, and the presence of ODD in ADHD children might affect treatment outcome. Overall, the studies conducted have contributed to our understanding of ADHD, in terms of diagnosis and treatment efficacy, and propose a more integrative approach to study ADHD alternative treatments, taking into consideration possible moderators effects of ODD symptoms.