Evaluation of neurofeedback in ADHD: The long and winding road

Arns, Martijn; Heinrich, Hartmut; Strehl, Ute

doi:10.1016/j.biopsycho.2013.11.013

Cited by 335 publications

(311 citation statements)

References 75 publications

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“…In addition to presenting control participants with shamfeedback, researchers should also aim to match less obvious factors between control and experimental groups. For example, some neurofeedback practitioners argue that the amount of positive feedback participants receive influences training outcome (Arns, Heinrich, & Strehl, 2014).…”

Section: Future Stepsmentioning

confidence: 99%

“…While EEG-nf proponents purport to effectively treat a range of psychological and neurological disorders (Arns, Heinrich, & Strehl, 2014;Cannon, 2015;Hammond, 2011;Tan et al, 2009), it appears that influences other than the feedback itself bring about improvements in clinical endpoints across a range of disorders (Thibault, Lifshitz, Birbaumer, et al, 2015). For example, in the most researched application of EEG-nf -treatment of attention deficit hyperactivity disorder (ADHD) -all double-blind (Arnold et al, 2013;Lansbergen et al, 2011;Vollebregt, van Dongen-Boomsma, Buitelaar, et al, 2014), and multiple single-blind (PerreauLinck et al, 2010;Van Dongen-Boomsma et al, 2013), sham-controlled studies demonstrate comparable clinical outcomes in patients receiving veritable-feedback compared with shamfeedback.…”

Section: Introductionmentioning

confidence: 99%

“…A number of reviews and meta-analyses have addressed the literature regarding EEG-nf treatment for ADHD (Arns et al, 2014;Arns, Ridder, & Strehl, 2009;Lofthouse et al, 2012;Sonuga-Barke et al, 2013), epilepsy (Tan et al, 2009), depression and anxiety (Hammond, 2005), Parkinson's disease (Esmail & Linden, 2014), and a slew of other disorders (Hammond, 2011). Some of these accounts highlight the dearth of convincing evidence (Esmail & Linden, 2014;Lofthouse et al, 2012;Sonuga-Barke et al, 2013) while others rely on single-blinding, subpar control groups, non-peer-reviewed publications, and case studies to support EEG-nf (see Thibault et al, 2015 for a more in-depth exposition).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Thibault

Lifshitz

Raz

2016

Cortex

215

198

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Neurofeedback, one of the primary examples of self-regulation, designates a collection of techniques that train the brain and help to improve its function. Since coming on the scene in the 1960s, electroencephalography-neurofeedback has become a treatment vehicle for a host of mental disorders; however, its clinical effectiveness remains controversial. Modern imaging technologies of the living human brain (e.g., real-time functional magnetic resonance imaging) and increasingly rigorous research protocols that utilize such methodologies begin to shed light on the underlying mechanisms that may facilitate more effective clinical applications. In this paper we focus on recent technological advances in the field of human brain imaging and discuss how these modern methods may influence the field of neurofeedback. Toward this end, we outline the state of the evidence and sketch out future directions to further explore the potential merits of this contentious therapeutic prospect.

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Section: Future Stepsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Thibault

Lifshitz

Raz

2016

Cortex

215

198

View full text Add to dashboard Cite

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“…The third examined the effect of co-treatment with medication and was restricted to studies with no/low levels of medication (< 30% of participants on medication, as per EAGG protocol). The final sensitivity analysis included only studies meeting the criteria defining a standard neurofeedback methodology described by Arns et al 19 (see Supplemental Text 2, available online). Meta-regression was conducted to assess the effects of number of training sessions.…”

Section: Data Extraction and Statistical Analysismentioning

confidence: 99%

“…Fourth, we addressed the crucial question of whether neurofeedback-related learning at the neural level was investigated and/or demonstrated in available trials 9 . Fifth, we examined whether the neurofeedback protocols employed in these studies could be considered "standard" in terms of the criteria discussed by Arns et al 19 , which include elements related to EEG bands/measures, electrode placement and type and feedback following learning. Finally, we applied, for the first time in a meta-analysis of neurofeedback for ADHD, a rigorous assessment of study bias, i.e., the Cochrane risk of bias tool (RoB) 20 .…”

Section: Introductionmentioning

confidence: 99%

The European ADHD Guidelines Group replies:

Cortese

Brandeis

Holtmann

et al. 2016

Journal of the American Academy of Child & Adolescent Psych

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Neurofeedback for Attention-Deficit/Hyperactivity Disorder

Westwood,

Aggensteiner,

Kaiser

et al. 2024

JAMA Psychiatry

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ImportanceNeurofeedback has been proposed for the treatment of attention-deficit/hyperactivity disorder (ADHD) but the efficacy of this intervention remains unclear.ObjectiveTo conduct a meta-analysis of randomized clinical trials (RCTs) using probably blinded (ie, rated by individuals probably or certainly unaware of treatment allocation) or neuropsychological outcomes to test the efficacy of neurofeedback as a treatment for ADHD in terms of core symptom reduction and improved neuropsychological outcomes.Data SourcesPubMed (MEDLINE), Ovid (PsycInfo, MEDLINE, Embase + Embase Classic), and Web of Science, as well as the reference lists of eligible records and relevant systematic reviews, were searched until July 25, 2023, with no language limits.Study SelectionParallel-arm RCTs investigating neurofeedback in participants of any age with a clinical ADHD or hyperkinetic syndrome diagnosis were included.Data Extraction and SynthesisStandardized mean differences (SMDs) with Hedges g correction were pooled in random effects meta-analyses for all eligible outcomes.Main Outcomes and MeasuresThe primary outcome was ADHD total symptom severity assessed at the first postintervention time point, focusing on reports by individuals judged probably or certainly unaware of treatment allocation (probably blinded). Secondary outcomes were inattention and/or hyperactivity-impulsivity symptoms and neuropsychological outcomes postintervention and at a longer-term follow-up (ie, after the last follow-up time point). RCTs were assessed with the Cochrane risk of bias tool version 2.0.ResultsA total of 38 RCTs (2472 participants aged 5 to 40 years) were included. Probably blinded reports of ADHD total symptoms showed no significant improvement with neurofeedback (k = 20; n = 1214; SMD, 0.04; 95% CI, −0.10 to 0.18). A small significant improvement was seen when analyses were restricted to RCTs using established standard protocols (k = 9; n = 681; SMD, 0.21; 95% CI, 0.02 to 0.40). Results remained similar with adults excluded or when analyses were restricted to RCTs where cortical learning or self-regulation was established. Of the 5 neuropsychological outcomes analyzed, a significant but small improvement was observed only for processing speed (k = 15; n = 909; SMD, 0.35; 95% CI, 0.01 to 0.69). Heterogeneity was generally low to moderate.Conclusions and RelevanceOverall, neurofeedback did not appear to meaningfully benefit individuals with ADHD, clinically or neuropsychologically, at the group level. Future studies seeking to identify individuals with ADHD who may benefit from neurofeedback could focus on using standard neurofeedback protocols, measuring processing speed, and leveraging advances in precision medicine, including neuroimaging technology.

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Evaluation of neurofeedback in ADHD: The long and winding road

Cited by 335 publications

References 75 publications

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

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

The European ADHD Guidelines Group replies:

Neurofeedback for Attention-Deficit/Hyperactivity Disorder

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