Neurofeedback as an Intervention to Improve Reading Achievement in Students with Attention Deficit Hyperactivity Disorder, Inattentive Subtype
Research consistently demonstrates that attention deficits have a deleterious effect on academic achievement. Impairments in attention, and not hyperactivity/impulsivity, are associated with learning difficulties and academic problems in students with attention-deficit/hyperactivity disorder (ADHD). To date, most studies have focused on symptoms of hyperactivity/impulsivity, with little research being conducted on interventions for students with ADHD, inattentive subtype. This study examines the use of neurofeedback as an intervention to improve reading achievement in a public school setting. A multiple-baseline-across-participants single-case model was used to assess five fourth-grade students who received 40 daily sessions of neurofeedback. Following the intervention, improvements were observed on objective measures of attention: a continuous performance test (Integrated Visual and Auditory Continuous Performance Test [IVA+Plus]) and/or a test of shifting attention (CNS Vital Signs, Shifting Attention Test [CNS-VS, SAT]). Results on tests of reading fluency revealed little change, although participants demonstrated gains on a measure of reading comprehension (Gray Oral Reading Tests–Fifth Edition [GORT-5]). Results suggest that neurofeedback helped participants to become more accurately engaged with the text with more focused attention to content. Thus, neurofeedback may be a viable option to assist children with attention deficits for improving both attention and reading achievement.
Akinbami, L. J., Liu, X., Pastor, P. N., & Reuben, C. A. (2011). Attention deficit hyperactivity disorder among children aged 5–17 years in the United States, 1998–2009. NCHS Data Brief No. 70. Hyattsville, MD: NationalCenter for Health Statistics.
AmericanAcademy of Pediatrics. (2011). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128(5), 1007¬–1022. http://dx.doi.org /10.1542/peds.2011-2654
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
Arns, M., de Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: A meta-analysis. Clinical EEG and Neuroscience, 40(3), 180–189. http://dx.doi.org/10.1177/155005940904000311
Barkley, R. A. (2002). International consensus statement on ADHD. Clinical Child and Family Psychology Review, 5(2), 89–111.http://dx.doi.org/10.1023/A:1017494719205
Barkley, R. A., Grodzinsky, G., & DuPaul, G. J. (1992). Frontal lobe functions in attention deficit disorder with and without hyperactivity: A review and research report. Journal of Abnormal Child Psychology, 20(2), 163–188. http://dx.doi.org/10.1007/BF00916547
Bauermeister, J. J., Alegría, M., Bird, H. R., Rubio-Stipec, M., & Canino, G. (1992). Are attentional-hyperactivity deficits unidimensional or multidimensional syndromes? Empirical findings from a community survey. Journal of the
AmericanAcademy of Child and Adolescent Psychiatry, 31(3), 423–431. http://dx.doi.org /10.1097/00004583-199205000-00007
Carmody, D. P., Radvanski, D. C., Wadhwani, S., Sabo, M. J., & Vergara, L. (2001). EEG biofeedback training and attention-deficit/hyperactivity disorder in an elementary school setting. Journal of Neurotherapy, 4(3), 5–27. http://dx.doi.org/10.1300 /J184v04n03_02
Chabot, R. J., & Serfontein, G. (1996). Quantitative electroencephalographic profiles of children with attention deficit disorder. Biological Psychiatry, 40(10), 951–963. http://dx.doi.org/10.1016/0006-3223(95)00576-5
Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 7–18. http://dx.doi.org/10.1037/0022-006X.66.1.7
Chhabildas, N., Pennington, B. F., & Willcutt, E. G. (2001). A comparison of the neuropsychological profiles of the DSM-IV subtypes of ADHD. Journal of Abnormal Child Psychology, 29(6), 529–540. http://dx.doi.org/10.1023/A:1012281226028
Coben, R., Wright, E. K., Decker, S. L., & Morgan, T. (2015). The impact of coherence neurofeedback on reading delays in learning disabled children: A randomized controlled study. NeuroRegulation, 2(4), 168–178. http://dx.doi.org/10.15540 /nr.2.4.168
Conners, C. K. (2008a). Conners 3rd Edition. North Tonawanda, NY: Multi-Health Systems, Inc.
Conners, C. K. (2008b). Conners 3rd Edition:Manual. Toronto, ON: Multi-Health Systems, Inc.
Conners, C. K., & Research and Development Department, MHS. (2009). Conners 3 interpretive update. Retrieved from http://downloads.mhs.com/conners/C3-Supplement.pdf
Crichton, A. (1798). On attention and its diseases. An inquiry into the nature and origin of mental derangement (Vol. 1, pp. 254–290). London, England: T. Cadell, Junior, and W. Davies.
Dige, N., Maahr, E., & Backenroth-Ohsako, G. (2008). Memory tests in subgroups of adult attention deficit hyperactivity disorder reveals simultaneous capacity deficit. International Journal of Neuroscience, 118(4), 569–591. http://dx.doi.org /10.1080/00207450701239384
Froehlich, T. E., Lanphear, B. P., Epstein, J. N., Barbaresi, W. J., Katusic, S. K., & Kahn, R. S. (2007). Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Archives of Pediatrics and Adolescent Medicine, 161(9), 857–864. http://dx.doi.org /10.1001/archpedi.161.9.857
Ghelani, K., Sidhu, R., Jain, U., & Tannock, R. (2004). Reading comprehension and reading related abilities in adolescents with reading disabilities and attention-deficit/hyperactivity disorder. Dyslexia, 10(4), 364–384. http://dx.doi.org/10.1002 /dys.285
Goldman, L. S., Genel, M., Bezman, R. J., & Slanetz, P. J. (1998). Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Journal of the American Medical Association, 279(14), 1100. http://dx.doi.org/10.1001 /jama.279.14.1100
Good, R. H., & Kaminski, R. A. (2003). Dynamic Indicators of Basic Early Literacy Skills (DIBELS) 6th Edition (6th ed.). Longmont, CO: Sopris West Educational Services.
Gruzelier, J., & Egner, T. (2005). Critical validation studies of neurofeedback. Child and Adolescent Psychiatric Clinics of North America, 14(1), 83–104. http://dx.doi.org/10.1016 /j.chc.2004.07.002
Gualtieri, C. T., & Johnson, L. G. (2006). Reliability and validity of a computerized neurocognitive test battery, CNS Vital Signs. Archives of Clinical Neuropsychology, 21(7), 623–643. http://dx.doi.org/10.1016/j.acn.2006.05.007
Gustafson, S. A., Nassar, S. L., & Waddell, D. E. (2011). Single-case design in psychophysiological research. Part I: Context, structure, and techniques. Journal of Neurotherapy, 15(1), 18–34. http://dx.doi.org/10.1080/10874208.2011.545762
Hall, A. H., & Tannebaum, R. P. (2013). Test Review: Gray Oral Reading Tests—Fifth Edition. Journal of Psychoeducational Assessment, 31(5), 516–520. http://dx.doi.org/10.1177 /0734282912468578
Hart, E. L., Lahey, B. B., Loeber, R., Applegate, B., & Frick, P. J. (1995). Developmental change in attention-deficit hyperactivity disorder in boys: a four-year longitudinal study. Journal of Abnormal Child Psychology, 23(6), 729–749. http://dx.doi.org/10.1007/BF01447474
Hodgson, K., Hutchinson, A. D., & Denson, L. (2012). Nonpharmacological treatments for ADHD: A meta-analytic review. Journal of Attention Disorders, 20(10), 1–8. http://dx.doi.org/10.1177/1087054712444732
Horner, R. H., Carr, E. G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of single-subject research to identify evidence-based practice in special education. Exceptional Children, 71(2), 165–179. http://dx.doi.org /10.1177/001440290507100203
Jasper, H. H. (1958). The ten-twenty electrode system of the International Federation. Electroencephalography and Clinical Neurophysiology, 10(2), 371–375.
Keenan, J. M., & Betjemann, R. S. (2006). Comprehending the Gray Oral Reading Test without reading it: Why comprehension tests should not include passage-independent items. Scientific Studies of Reading, 10(4), 363–380.
Kennedy, C. H. (2005). Single-case designs for educational research. Boston, MA: Allyn and Bacon.
Kratochwill, T. R., Hitchcock, J., Horner, R. H., Levin, J. R., Odom, S. L., Rindskopf, D. M., & Shadish, W. R. (2010). Single-case designs technical documentation. What Works Clearinghouse. Retrieved from http://ies.ed.gov/ncee/wwc/pdf /reference_resources/wwc_scd.pdf
LaBerge, D., & Samuels, S. J. (1974). Toward a theory of automatic information processing in reading. Cognitive Psychology, 6(2), 293–323. http://dx.doi.org/10.1016/0010-0285(74)90015-2
Leins, U., Goth, G., Hinterberger, T., Klinger, C., Rumpf, N., & Strehl, U. (2007). Neurofeedback for children with ADHD: A comparison of SCP and theta/beta protocols. Applied Psychophysiologyand Biofeedback, 32(2), 73–88. http://dx.doi.org/10.1007/s10484-007-9031-0
Linden, M., Habib, T., & Radojevic, V. (1996). A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback and Self-regulation, 21(1), 35–49. http://dx.doi.org/10.1007/BF02214148
Lubar, J. F. (1991). Discourse on the development of EEG diagnostics and biofeedback for attention-deficit/hyperactivity disorders. Biofeedback and Self-regulation, 16(3), 201–225. http://dx.doi.org/10.1007/BF01000016
Lubar, J. F., & Shouse, M. N. (1976). EEG and behavioral changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR). Biofeedback and Self-regulation, 1(3), 293–306. http://dx.doi.org/10.1007/bf01001170
Mitsar EEG-201, WinEEG [Apparatus and software]. Saint Petersburg, Russia. Mitsar Co. Ltd. Retrieved from http://www.mitsar-medical.com/eeg-software/qeeg-software/
Monastra, V. J., Lynn, S., Linden, M., Lubar, J. F., Gruzelier, J., & LaVaque, T. J. (2005). Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder. Applied Psychophysiology and Biofeedback, 30(2), 95–114. http://dx.doi.org/10.1007/s10484-005-4305-x
Monastra, V. J., Monastra, D. M., & George, S. (2002). The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder. Applied Psychophysiology and Biofeedback, 27(4), 231–249. http://dx.doi.org/10.1023 /A:1021018700609
NationalCenter on Response to Intervention. (2012). Curriculum based measurement in reading: Maze fluency. Retrieved from http://www.rti4success.org/progressMonitoringTools. Accessed May 20, 2012.
NCS Pearson. (2013). AIMSweb national norms table: MAZE comprehension. Retrieved from https://aimsweb.pearson.com/
Nigg, J. T. (2005). Neuropsychologic theory and findings in attention-deficit/hyperactivity disorder: The state of the field and salient challenges for the coming decade. Biological Psychiatry, 57(11), 1424–1435. http://dx.doi.org/10.1016 /j.biopsych.2004.11.011
O'Connor, R. E., Bell, K. M., Harty, K. R., Larkin, L. K., Sackor, S. M., & Zigmond, N. (2002). Teaching reading to poor readers in the intermediate grades: A comparison of text difficulty. Journal of Educational Psychology, 94(3), 474–485. http://dx.doi.org/10.1037//0022-06188.8.131.524
Orlando, P. C., & Rivera, R. O. (2004). Neurofeedback for elementary students with identified learning problems. Journal of Neurotherapy, 8(2), 5–19. http://dx.doi.org/10.1300 /j184v08n02_02
Rossiter, T. (2002). Neurofeedback for AD/HD: A ratio feedback case study and tutorial. Journal of Neurotherapy, 6(3), 9–35. http://dx.doi.org/10.1300/j184v06n03_03
Sandford, J. A. (2012). SmartMind Pro. Richmond, VA: BrainTrain, Inc.
Sandford, J. A., & Turner, A. (2007). Integrated Visual and Auditory Continuous Performance Test (IVA+Plus). Richmond, VA: BrainTrain, Inc.
Sandford, J. A., & Turner, A. (2009). Integrated Visual and Auditory Continuous Test: Interpretation manual. Richmond, VA: BrainTrain, Inc.
Schuck, S. E. B. (2008). Reading comprehension and the role of oral and silent reading: Comparing children with and without attention deficit hyperactivity disorder (Doctoral dissertation). University of California, Riverside.
Shanahan, T. (2005). [Review of the DIBELS: Dynamic Indicators of Basic Early Literacy Skills, Sixth Edition]. In R. A. Spies & B. S. Plake (Eds.), The sixteenth mental measurements yearbook (pp. 310-312). Lincoln, NE: Buros Institute of Mental Measurements.
Shinn, M. R., & Shinn, M. M. (2002a). AIMSweb training workbook: Administration and scoring of Reading Curriculum-Based Measurement (R-CBM). Eden Prairie, MN: Edformation, Inc.
Shinn, M. R., & Shinn, M. M. (2002b). AIMSweb training workbook: Administration and scoring of reading maze for use in general outcome measurement. Eden Prairie, MN: Edformation, Inc.
Snyder, S. M., & Hall, J. R. (2006). A meta-analysis of quantitative EEG power associated with attention-deficit hyperactivity disorder. Journal of Clinical Neurophysiology, 23(5), 441–456. http://dx.doi.org/10.1097/01.wnp.0000221363.12503.78
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), 18–27. http://dx.doi.org/10.1097 /DBP.0000000000000009
Still, G. F. (1902a). Some abnormal psychical conditions in children: Lecture 1. The Lancet, 159(4102), 1008–1012. http://dx.doi.org/10.1016/s0140-6736(01)74984-7
Still, G. F. (1902b). Some abnormal psychical conditions in children: Lecture 2. The Lancet, 159(4103), 1077–1082. http://dx.doi.org/10.1016/S0140-6736(01)70022-0
Still, G. F. (1902c). Some abnormal psychical conditions in children: Lecture 3. The Lancet, 159(4104), 1163–1168. http://dx.doi.org/10.1016/S0140-6736(01)74901-X
Swanson, J. M., Posner, M., Potkin, S. G., Bonforte, S., Youpa, D. Fiore, C., … Crinella, F. (1991). Activating tasks for the study of visual-spatial attention in ADHD children: A cognitive anatomic approach. Journal of Child Neurology, 6(1), S119–S127. http://dx.doi.org/10.1177/0883073891006001121
U.S. Department of Education, Office of Special Education and Rehabilitative Services, & Office of Special Education Programs. (2008). Identifying and treating attention deficit hyperactivity disorder: A resource for school and home. Washington, DC: Author.
University of OregonCenter on Teaching and Learning. (2012). DIBELS benchmark goals: Three assessment periods per year. Retrieved from https://dibels.uoregon.edu/docs /benchmarkgoals.pdf
Vernon, D., Egner, T., Cooper, N., Compton, T., Neilands, C., Sheri, A., & Gruzelier, J. (2003). The effect of training distinct neurofeedback protocols on aspects of cognitive performance. International Journal of Psychophysiology, 47(1), 75–85. http://dx.doi.org/10.1016/S0167-8760(02)00091-0
Volkow, N. D., Wang, G.-J., Newcorn, J. H., Kollins, S. H., Wigal, T. L., Telang, F., ... Swanson, J. M. (2011). Motivation deficit in ADHD is associated with dysfunction of the dopamine reward pathway. Molecular Psychiatry, 16(11), 1147–1154. http://dx.doi.org/10.1038/mp.2010.97
Wadhwani, S., Radvanski, D. C., & Carmody, D. P. (1998). Neurofeedback training in a case of attention deficit hyperactivity disorder. Journal of Neurotherapy, 3(1), 42–49. http://dx.doi.org/10.1300/J184v03n01_05
Wechsler, D. (2011). Wechsler Abbreviated Scale of Intelligence–Second Edition Manual. Bloomington, MN: Pearson Education, Inc.
Weiler, M. D., Bernstein, J. H., Bellinger, D. C., & Waber, D. P. (2000). Processing speed in children with attention deficit/hyperactivity disorder, inattentive type. Child Neuropsychology, 6(3), 218–234. http://dx.doi.org/10.1076 /chin.184.108.40.20656
Wiederholt, J. L., & Bryant, B. R. (2001). Gray Oral Reading Test–Fourth Edition (GORT-4). Austin, TX: Pro-Ed.
Wiederholt, J. L., & Bryant, B. R. (2012a). Gray Oral Reading Test–Fifth Edition (GORT-5). Austin, TX: Pro-Ed.
Wiederholt, J. L., & Bryant, B. R. (2012b). Gray Oral Reading Test–Fifth Edition (GORT-5): Examiner’s manual (5th ed.). Austin, TX: Pro-Ed.
Willcutt, E. G., & Pennington, B. F. (2000). Comorbidity of reading disability and attention-deficit/hyperactivity disorder: Differences by gender and subtype. Journal of Learning Disabilities, 33(2), 179–191. http://dx.doi.org/10.1177 /002221940003300206
Woodcock, R. (2011). Woodcock Reading Mastery Tests, Third Edition. San Antonio, TX: Pearson Education, Inc.
Woodcock, R. W., McGrew, K. S., & Mather, N. (2007). Woodcock-Johnson III Tests of Achievement. Rolling Meadows, IL: Riverside Publishing.
Copyright (c) 2016 Jeffry P. La Marca, Rolanda E. O'Connor
This work is licensed under a Creative Commons Attribution 4.0 International License.Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).