Evidence-Based Information on the Clinical Use of Neurofeedback for ADHD

Abstract

Summary Neurofeedback (NF) is a training to enhance selfregulatory capacity over brain activity patterns and consequently over brain mental states. Recent findings suggest that NF is a promising alternative for the treatment of attention-deficit/hyperactivity disorder (ADHD). We comprehensively reviewed literature searching for studies on the effectiveness and specificity of NF for the treatment of ADHD. In addition, clinically informative evidence-based data are discussed. We found 3 systematic review on the use of NF for ADHD and 6 randomized controlled trials that have not been included in these reviews. Most nonrandomized controlled trials found positive results with medium-to-large effect sizes, but the evidence for effectiveness are less robust when only randomized controlled studies are considered. The direct comparison of NF and sham-NF in 3 published studies have found no group differences, nevertheless methodological caveats, such as the quality of the training protocol used, sample size, and sample selection may have contributed to the negative results. Further data on specificity comes from electrophysiological studies reporting that NF effectively changes brain activity patterns. No safety issues have emerged from clinical trials and NF seems to be well tolerated and accepted. Follow-up studies support long-term effects of NF. Currently there is no available data to guide clinicians on the predictors of response to NF and on optimal treatment protocol. In conclusion, NF is a valid option for the treatment for ADHD, but further evidence is required to guide its use.

In-School Neurofeedback Training for ADHD: Sustained Improvements From a Randomized Control Trial

“…The specific neurofeedback system used (Play Attention, Unique Logic and Technology, Fletcher, NC) detects 2 frequency ranges, 1 in the low-frequency theta brainwave range (4)(5)(6)(7)(8) and another in the high-frequency beta brainwave range (12)(13)(14)(15). 29 The brainwaves are measured by an EEG sensor embedded in a standard bicycle helmet centrally located on the top of the skull, and 2 other EEG sensors one a grounding sensor and the other a reference, on the chin straps located bilaterally on the mastoids.…”

“…10 Neurofeedback therefore trains users to monitor and change their brainwave patterns, leading to behavioral changes. 11 Some studies have found that neurofeedback can decrease symptoms of ADHD, [12][13][14][15][16][17] including improved attention, 18 behavior, 19 and cognitive improvements 20 up to 6 months postintervention as well as at 2 years postintervention. 21 However, the evidence for its sustainability remains unclear, because there are limited studies examining follow-up data, and those that do have small sample sizes or no control condition.…”

“…21 However, the evidence for its sustainability remains unclear, because there are limited studies examining follow-up data, and those that do have small sample sizes or no control condition. [13][14][15] In contrast, CT uses specifically designed exercises to train attention, working memory, and impulsivity through ongoing feedback to reinforce correct responses. Several studies suggest that CT improves performance on working memory tasks and decreases inattentiveness, hyperactivity, and disruptive behaviors.…”

Training Cognition in ADHD: Current Findings, Borrowed Concepts, and Future Directions

“…This article will not review the literature associated with the previous use of the term "cognitive training" for ADHD. This article also will not review neurofeedback training techniques (see Loo and Makeig [23] and Moriyama et al [24]). …”

New Directions for Therapeutics in ADHD

“…In their assessment of EEG-based neurofeedback (NF) to treat ADHD, they suggest that EEG approaches may have some utility as adjunctive treatments (but not as monotherapy) in some individuals with ADHD. A complementary review from Moriyama et al [11] (this issue) focuses on the treatment outcome literature. They conclude that NF may be an effective alternative treatment for ADHD, although more data are available from studies that used it as an adjunctive treatment.…”