Behavioral effects of neurofeedback in adolescents with ADHD: a randomized controlled trial

Abstract

Neurofeedback has been proposed as a potentially effective intervention for reducing Attention Deficit Hyperactivity Disorder (ADHD) symptoms. However, it remains unclear whether neurofeedback is of additional value to treatment as usual (TAU) for adolescents with clinical ADHD symptoms. Using a multicenter parallel-randomized controlled trial design, adolescents with ADHD symptoms were randomized to receive either a combination of TAU and neurofeedback (NFB + TAU, n = 45) or TAU-only (n = 26). Randomization was computer generated and stratified for age group (ages 12 through 16, 16 through 20, 20 through 24). Neurofeedback treatment consisted of approximately 37 sessions of theta/sensorimotor rhythm (SMR)-training on the vertex (Cz). Primary behavioral outcome measures included the ADHD-rating scale, Youth Self Report, and Child Behavior Checklist all assessed pre- and post-intervention. Behavioral problems decreased equally for both groups with medium to large effect sizes, range of partial η2 = 0.08-0.31, p < 0.05. Hence, the combination of NFB + TAU was not more effective than TAU-only on the behavioral outcome measures. In addition, reported adverse effects were similar for both groups. On behavioral outcome measures, the combination of neurofeedback and TAU was as effective as TAU-only for adolescents with ADHD symptoms. Considering the absence of additional behavioral effects in the current study, in combination with the limited knowledge of specific treatment effects, it is questionable whether theta/SMR neurofeedback for adolescents with ADHD and comorbid disorders in clinical practice should be used. Further research is warranted to investigate possible working mechanisms and (long-term) specific treatment effects of neurofeedback.

The European ADHD Guidelines Group replies:

“…In one study 29 there was a partial learning effect. In Heinrich et al 32 there was indirect evidence of learning: the increase of the contingent negative variation (a slow cortical potential) suggests that children learned what was trained.…”

“…Thirteen trials [24][25][26][27][28][29][30][31][32][33][34][35][36] met entry criteria. Figure 1 presents the PRISMA selection flowchart.…”

“…Direct evidence that neurofeedback training led to learning was gathered in only four trials 27,29,33,36 and was positive for just one 27 . In one study 29 there was a partial learning effect.…”

“…Indeed, the current set of 13 trials, taken as whole, had a number of methodological short-comings. First, only four studies tested 27,29,33,36 , and then just one 27 reported directly and positively, whether neurofeedback training had actually led to learning as indexed by changes/improvement at the electrophysiological level. In the one positive trial 27 , the mediating role of changes in the electrophysiological signature leading to changes at symptom level was not investigated.…”

Attention deficit hyperactivity disorder and current possibilities of its treatment by the method of neurofeedback training

“…Со-гласно данным литературы [17,18], у пациентов с СДВГ отмечается чрезмерная выраженность θ-ритма (4-7 Гц) на ЭЭГ, что характерно для состояния дремоты, и сниже-ние β-активности (13-30 Гц), которая в норме характери-зует состояния бодрствования и внимания. Поэтому соот-ношение θ/β считается общепринятым ЭЭГ-биомарке-ром СДВГ [19], а наиболее эффективным и специфичным вариантом НБУ при лечении СДВГ являются процедуры, направленные на подавление θ-и увеличение β-актив-ности [20].…”