Neurofeedback as an Intervention to Improve Reading Achievement in Students with Attention Deficit Hyperactivity Disorder, Inattentive Subtype
Keywords:academic achievement, attention deficit, interventions, neurofeedback, public schools, reading comprehension
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//0022-0618.104.22.1684
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.22.214.171.12456
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.
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