Emerging brain-based interventions for children and adolescents: overview and clinical perspective

https://doi.org/10.1016/j.chc.2004.07.011Get rights and content

Section snippets

Technology and psychiatry

The use of sophisticated technology to intervene and improve brain function is just beginning. It promises a transformation in practice in many fields: rehabilitation, neurology, psychiatry, and psychology. The science fiction fantasy of brain chip implants is getting ever closer to realization. Neuroscientists in several university centers recently demonstrated the viability of brain-computer interfaces and the capacity, with relative ease, to control external devices by the brain through

Multiple pathways for intervention in psychiatry

Not too long ago, clinical bias toward treating psychiatric disorders was based on the assertion that interventions required direct effects on the brain through medications that modulate neurotransmitters at the receptor or transporter level because this was the only scientifically measurable change in the brain in response to treatment. New research and treatment options challenge those assumptions and present new alternatives to traditional medications. For example, the US Food and Drug

Overview of three emerging approaches: electroencephalographic biofeedback, repetitive transcranial magnetic stimulation, and vagal nerve stimulation

Each of the articles that follows in this issue reviews in detail the research and clinical experience to date with these three new approaches, including critical review of the extant research, case presentations, and discussion of limitations and future directions. In some instances, there is little experience to date with child and adolescent populations, requiring inferences about application to this group. What follows herein is a summary of the most salient and interesting findings for

Summary of articles on feedback strategies

If the domain of brain electrophysiology, as revealed in the EEG, is meaningfully associated with psychiatric dysfunction, then this domain seems to be a fertile ground for intervention, such that EEG change would map onto functional change in behavior. This is the avenue of entry of EBF into psychiatry. The capacity of individuals to use real-time feedback of the EEG to alter it through operant conditioning or learning has been established for many years. Numerous studies have shown that EBF,

Summary of articles on stimulation strategies

VNS, reviewed by Martinez et al, represents a novel but invasive method for controlling epilepsy. Case and controlled trial studies demonstrate efficacy with adults with treatment refractory epilepsy. Studies of VNS with adolescents show seizure reduction of 23%, 32%, 37%, and 44% at 3, 6, 12, and 18 months, respectively. Similar benefit is seen in a case series of patients younger than age 12.

Consideration of the mechanism of action of VNS and reports of mood improvement when used for epilepsy

Clinical considerations in evaluating new treatments modalities

The articles in this issue describe new treatment modalities outside of the conventional psychiatric practices of medication management and psychotherapy. With increasing emphasis on evidence-based practice and the empirical validation of clinical methods, it is widely accepted that all such new approaches should be evaluated carefully as to the level of evidence base or degree of formal, controlled empirical support available. The highest standard of such empirical support is that from RCTs.

American Academy of Child and Adolescent Psychiatry guideline ratings for feedback strategies

EBF meets the AACAP criteria for “Clinical Guidelines” for treatment of ADHD, seizure disorders, anxiety (eg, obsessive-compulsive disorder, GAD, posttraumatic stress disorder, phobias), depression, reading disabilities, and addictive disorders. This finding suggests that EBF always should be considered as an intervention for these disorders by the clinician. Clearly there is stronger evidence of efficacy—the strongest among the three new approaches being considered in this issue—for the use of

American Academy of Child and Adolescent Psychiatry guidelines ratings for stimulation strategies

Turning to neurostimulation strategies covered in this issue, VNS meets the AACAP standards for “Clinical Guidelines” as an intervention for treatment refractory epilepsy because a significant number of published open trials and case studies exist that show efficacy. This suggests that VNS should be considered in the treatment of epilepsy. Until further improvements in VNS safety and efficacy occur and research is published on efficacy for specific psychiatric disorders with child and

Future directions

Much additional research is needed for all of the strategies reviewed in this issue. Work is in the early stages with VNS and rTMS for child and adolescent psychiatric disorders, and further investigation is needed at every level.

EBF has a greater body of empirical support, but for several types of disorders, this work is also at early stages. Unlike VNS and rTMS, little research on EBF has been conducted to date in major medical centers, and none has been conducted in psychiatry settings.

First page preview

First page preview
Click to open first page preview

References (34)

  • Blecker C., Stark R., Weygandt W., Vaitl D. Neurofeedback with functional magnetic resonance imaging [poster]....
  • Year 2000 position statement: principles and guidelines for early hearing detection and intervention programs

    Pediatrics

    (2000)
  • G. Winterer et al.

    Prefrontal broadband noise, working memory, and genetic risk for schizophrenia

    Am J Psychiatry

    (2004)
  • J.D. Lewine

    Abnormal stimulus-response intensity functions in posttraumatic stress disorder: an electrophysiological investigation

    Am J Psychiatry

    (2002)
  • N. Akshoomoff et al.

    The neurobiological basis of autism from a developmental perspective

    Dev Psychopathol

    (2002)
  • J.D. Kropotov et al.

    Neurophysiological mechanisms of action selection and its impairment in ADHD

    Hum Physiol

    (1999)
  • E.A. Iakovenko et al.

    Electrophysiological correlates of attentional disorders in adolescents aged 12–13 years

    Fiziol Cheloveka

    (2003)
  • Cited by (37)

    • Feedback of real-time fMRI signals: From concepts and principles to therapeutic interventions

      2017, Magnetic Resonance Imaging
      Citation Excerpt :

      EEG biofeedback has been used in the treatment of attention deficit hyperactivity disorder (ADHD) [17]. Many randomized controlled trials have been reported in the treatment of ADHD using EEG based neurofeedback [19]. Other treatment areas are in epilepsy [20] and mood disorders such as anxiety disorder [21].

    • Optimizing real time fMRI neurofeedback for therapeutic discovery and development

      2014, NeuroImage: Clinical
      Citation Excerpt :

      Likewise, changes in fMRI response after EEG neurofeedback have been shown in targeted neural networks after a single 30-minute EEG training session (Ros et al., 2013) and in specific symptom-related brain regions of interest (ROIs) after multiple training sessions (Levesque et al., 2006). There have been several randomized controlled trials (RCTs) using EEG-based feedback, primarily in patients with attention deficit hyperactivity disorder (ADHD) (Hirshberg et al., 2005). A recent meta-analysis of existing RCTs indicates that EEG feedback training is associated with a reduction of ADHD symptoms with a large effect size (Arns et al., 2009) and a large randomized, sham-controlled trial is currently underway (LH, personal communication).

    • Neurofeedback for Seizure Disorders: Origins, Mechanisms and Best Practices

      2013, Clinical Neurotherapy: Application of Techniques for Treatment
    • QEEG and neurofeedback for assessment and effective intervention with attention deficit hyperactivity disorder (ADHD)

      2008, Introduction to Quantitative EEG and Neurofeedback: Advanced Theory and Applications, Second Edition
    View all citing articles on Scopus
    View full text