Effects of Neurofeedback Versus Stimulant Medication in Attention-Deficit/Hyperactivity Disorder: A Randomized Pilot Study

Abstract

Objective: The purpose of this pilot study was to compare the effects of 30 sessions of neurofeedback (NF) with stimulant medication on attention-deficit/hyperactivity disorder (ADHD) patients. Methods: Thirty-two medication-naïve ADHD patients, ages 7-16, from a neuropsychiatric clinic, were randomized to NF (n = 16) or drug treatment (n = 16). Other actions, such as parent management training, information, or support in school were given as needed, with no differences between the groups. All participants were assessed before treatment on two rating scales, each with parent and teacher forms. In addition, quantitative electroencephalogram (QEEG) and event-related potentials (ERPs), which included behavioral data from a go/no go test were administered. NF training took place in the clinic over a period of 7-11 months, and was followed by a repeat of the same assessment tools. The mean time interval between pre-and postassesment was not significantly different in the two groups. The 18 symptoms of ADHD (American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV)) were used as the primary outcome measure. Results: Analysis of covariance revealed a significant difference between the groups at evaluation in favor of medication, with a large effect size. This picture was confirmed by other outcome measures. The QEEG spectral power in the theta and beta bands did not change in either group. In ERP, the P3 no go component increased significantly in 8 of 12 patients who had a clinically relevant medication effect, but did not increase in the medication nonresponders or the NF group. Conclusions: Our study supports effects for stimulants, but not for NF. Effects of NF may require thorough patient selection, frequent training sessions, a system for excluding nonresponders, and active transfer training. The P3 no go ERP component may be a marker for treatment response.

Neurofeedback for ADHD

“…Several randomized controlled trial studies have since compared neurofeedback to medication alone or in combination (see Table 2). Although one of them 54 found neurofeedback effects inferior to medication effects, the other 2 studies 55,56 found no differences between medication and neurofeedback effects, and one study 55 reported that neurofeedback or medication alone was as effective as the combination.…”

The self-regulating brain and neurofeedback: Experimental science and clinical promise

“…(Arnold et al, 2013), 13. (Ogrim & Hestad, 2013), 14. (Vollebregt, van Dongen-Boomsma, Buitelaar, & Slaats-Willemse, 2014, 15.…”

When can neurofeedback join the clinical armamentarium?

“…[8][9][10][11] Two of these experiments reported comparable improvements in attention between the neurofeedback and medication groups yet shied away from collecting neurological measures; 8,9 one showed similar changes in resting-state EEG activity yet neglected to ascertain whether attention actually improved; 10 the other suggested superiority of medication over EEG-neurofeedback in terms of both behaviour and neural activity. 11 Notably, these studies scantily report whether participants learned to modulate the brain signal of interest and thus provide little insight into the neural underpinnings of these effects. To promote EEGneurofeedback as a brain-regulation therapy, researchers will need to conduct high-quality clinical trials that confirm the alleged underlying neurological mechanisms and highlight an advantage over sham neurofeedback.…”