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Objective The aim of this approach was to conduct a structured electroencephalography-based neurofeedback training program for children and adolescents with attention-deficit hyperactivity disorder (ADHD) using slow cortical potentials with an intensive first (almost daily sessions) and second phase of training (two sessions per week) and to assess aspects of attentional performance. Patients and methods A total of 24 young patients with ADHD participated in the 20-session training program. During phase I of training (2 weeks, 10 sessions), participants were trained on weekdays. During phase II, neurofeedback training occurred twice per week (5 weeks). The patients’ inattention problems were measured at three assessment time points before (pre, T0) and after (post, T1) the training and at a 6-month follow-up (T2); the assessments included neuropsychological tests (Alertness and Divided Attention subtests of the Test for Attentional Performance; Sustained Attention Dots and Shifting Attentional Set subtests of the Amsterdam Neuropsychological Test) and questionnaire data (inattention subscales of the so-called Fremdbeurteilungsbogen für Hyperkinetische Störungen and Child Behavior Checklist/4–18 [CBCL/4–18]). All data were analyzed retrospectively. Results The mean auditive reaction time in a Divided Attention task decreased significantly from T0 to T1 (medium effect), which was persistent over time and also found for a T0–T2 comparison (larger effects). In the Sustained Attention Dots task, the mean reaction time was reduced from T0–T1 and T1–T2 (small effects), whereas in the Shifting Attentional Set task, patients were able to increase the number of trials from T1–T2 and significantly diminished the number of errors (T1–T2 & T0–T2, large effects). Conclusion First positive but very small effects and preliminary results regarding different parameters of attentional performance were detected in young individuals with ADHD. The limitations of the obtained preliminary data are the rather small sample size, the lack of a control group/a placebo condition and the open-label approach because of the clinical setting and retrospective analysis. The value of the current approach lies in providing pilot data for future studies involving larger samples., Video abstract

Background : Neurofeedback (NF) is a physiological method that enables a subject to learn how to regulate his or her own brain activity. NF can be used as an alternative treatment for symptoms of attention deficit hyperactivity disorder (ADHD) via improved cortical self-regulation of brain potentials known to be related to ADHD symptoms such as changed attentional control, impulsive behaviours, and hyperactivity. However, no detailed teaching resources or tutorials are available to date, which allow a thorough teaching approach covering the technical aspects of electroencephalography (EEG)-based NF administration. Methods : To allow a flexible and easily accessible online resource for teaching the administration of NF, an online teaching module was developed (NF-eTutorial). Specifically, this online tutorial module was developed for one of the most commonly used NF systems (TheraPrax EEG-neurofeedback device, NeuroConn, Ilmenau, Germany) currently available. The NF-eTutorial was implemented and made available to medical students who were interested in NF administration via the eMedia Skills lab of RWTH Aachen University ( www.emedia-medizin.rwth-aachen.de/ ). Furthermore, this tutorial was also used as a resource to educate clinicians, patients, and carers about NF. This short article aims to present the development and specific features of the newly developed NF-eTutorial resource in a brief and descriptive manner. Results : The NF-eTutorial comprises the following components: 1) Basic introduction (overview and information on using NF in patients with ADHD, outline of the training schedule, and basic scientific information on NF); 2) Correct handling of the electrodes (electrode and skin preparation, positioning of the electrodes, linking the system to the amplifier of the NF system, disconnecting the electrodes, and cleaning and storing of the electrodes); 3) Using the NF device (detailed guide to specific technical settings); 4) Explanation of specific tasks of the patient when engaging in NF training; 5) Aspects of NF training (checklists and training protocols that can assist the use of NF as a therapeutic application); and 6) Aspects of signal quality (step-by-step guide to troubleshooting and artefact correction). Summary : The NF-eTutorial is the first web-based platform that allows access to detailed and practical information on the administration of EEG-based NF. Future research and development should focus on the practical use of such NF-related web-based tutorials with regard to the administration of NF by different groups of trainers, such as professionals, allied health staff and also lay people. This in turn will facilitate high-quality NF training for young patients with ADHD in non-clinical environments such as home and school. Keywords: web-based tutorial; neurofeedback; teaching; ADHD; children and adolescents; attention; slow cortical potentials

Attention-deficit/hyperactivity disorder (ADHD) rating scales such as the Conners’ Rating Scales (CRS) are valuable adjuncts for diagnosis, since they offer parent, teacher, and self-ratings of children susceptible for ADHD. Even though the scales are widely used internationally, cross-cultural comparability has rarely been verified, and culture and language invariance have only been presumed. The Conners 3(®) rating scales are the updated version of the CRS, though hardly any studies report the psychometric properties apart from the results published in the test edition itself. To our knowledge there are no studies on the various adaptations of the Conners 3(®) in other languages.The German translations of the Conners 3(®) were completed by 745 children, 953 parents, and 741 teachers (children’s age range: 6–18 years, mean: 11.74 years of age). Exploratory and confirmatory factor analyses on content scale items were conducted to obtain the factor structure for the German version and to replicate the factor structure of the original American models. Cronbach’s α was calculated to establish internal consistency.The exploratory analyses for the German model resulted in factor structures globally different from the American model, though confirmatory analyses revealed very good model fi ts with highly satisfying Cronbach’s αs. We were able to provide empirical evidence for the subscale Inattention which had only hypothetically been derived by Conners (2008).Even though the exploratory analyses resulted in different factor structures, the confirmatory analyses have such excellent psychometric properties that use of the German adaptation of the Conners 3(®) is justifi ed in international multicenter studies.

OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) rating scales such as the Conners’ Rating Scales (CRS) are valuable adjuncts for diagnosis, since they offer parent, teacher, and self-ratings of children susceptible for ADHD. Even though the scales are widely used internationally, cross-cultural comparability has rarely been verified, and culture and language invariance have only been presumed. The Conners 3(®) rating scales are the updated version of the CRS, though hardly any studies report the psychometric properties apart from the results published in the test edition itself. To our knowledge there are no studies on the various adaptations of the Conners 3(®) in other languages. METHOD The German translations of the Conners 3(®) were completed by 745 children, 953 parents, and 741 teachers (children’s age range: 6–18 years, mean: 11.74 years of age). Exploratory and confirmatory factor analyses on content scale items were conducted to obtain the factor structure for the German version and to replicate the factor structure of the original American models. Cronbach’s α was calculated to establish internal consistency. RESULTS The exploratory analyses for the German model resulted in factor structures globally different from the American model, though confirmatory analyses revealed very good model fi ts with highly satisfying Cronbach’s αs. We were able to provide empirical evidence for the subscale Inattention which had only hypothetically been derived by Conners (2008). CONCLUSIONS Even though the exploratory analyses resulted in different factor structures, the confirmatory analyses have such excellent psychometric properties that use of the German adaptation of the Conners 3(®) is justifi ed in international multicenter studies.

Objective: The goal of the present study was to assess whether girls with ADHD express similar deficits in various attention tasks to those described in boys. Method: A total of 175 children with the combined subtype of ADHD (89 females) and 132 normal controls (60 females) aged 8 to 14 years participated. Five different tests were conducted: alertness, sustained attention, focused attention, divided attention, and a set-shifting task. Results: The children with ADHD performed worse on all aspects of attention compared with healthy control participants. Several overall general sex differences could be detected, with boys exhibiting faster reaction times and greater response variability. Controlling for ADHD symptom severity and psychiatric comorbidities, no Sex × Diagnosis interaction was found, suggesting that males and females with ADHD experience comparable attentional deficits. Conclusion: These results indicate that deficits in various attentional domains are a robust component of ADHD in males and females.