Comparing tomographic EEG neurofeedback and EMG biofeedback in children with attention-deficit/hyperactivity disorder

Stefano Maurizioa,b,1, Martina Daniela Liechtia,b,c,d,1, Hartmut Heinriche,f, Lutz Jänckeb,c, Hans-Christoph Steinhausena,g,h, Susanne Walitzaa, Daniel Brandeisa,b,i,j,∗∗,2, Renate Drechslera,∗,2

a Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
b Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland
c Department of Neuropsychology, Institute for Psychology, University of Zurich, Zurich, Switzerland
d Neuro-Urology, Spinal Cord Injury Center & Research, University of Zurich, Balgrist University Hospital, Zurich, Switzerland
e Department of Child and Adolescent Psychiatry, University of Erlangen-Nürnberg, Germany
f Heckscher-Klinikum, Munich, Germany
g Aalborg Psychiatric Hospital, Aarhus University Hospital, Aalborg, Denmark
h Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Switzerland
i Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
j Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland 

ABSTRACT: Two types of biofeedback (BF), tomographic electroencephalogram (EEG) neurofeedback (NF) and electromyographic biofeedback (EMG-BF), both with phasic and tonic protocols, were compared for treatment effects and specificity in attention-deficit/hyperactivity disorder (ADHD). Thirteen children with ADHD trained their brain activity in the anterior cingulate cortex (ACC), and twelve trained activity of arm muscles involved in fine motor skills. In each training session, resting state 24-channel EEG and training performances were recorded. Both groups showed similar behavioral improvements and artifact reduction in selected conditions, with no significant advantages despite medium effect sizes on primary outcomes for NF. Only the EMG-BF group, however, showed clear improvement in training regulation performance, and specific motor coordination effects. The NF group tended to present individual normal- ization of trained frequency bands in the ACC during rest across training. The results provide evidence for some specific effects in our small sample, albeit only to a small extent.