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

Abstract

WHAT'S KNOWN ON THIS SUBJECT: An estimated 9.5% of children are diagnosed with attention-deficit/hyperactivity disorder (ADHD), which affects academic and social outcomes. We previously found significant improvements in ADHD symptoms immediately after neurofeedback training at school. WHAT THIS STUDY ADDS:This randomized controlled trial included a large sample of elementary school students with ADHD who received in-school computer attention training with neurofeedback or cognitive training. Students who received neurofeedback were reported to have fewer ADHD symptoms 6 months after the intervention. abstract OBJECTIVE: To evaluate sustained improvements 6 months after a 40-session, in-school computer attention training intervention using neurofeedback or cognitive training (CT) administered to 7-to 11-year-olds with attention-deficit/hyperactivity disorder (ADHD). METHODS:One hundred four children were randomly assigned to receive neurofeedback, CT, or a control condition and were evaluated 6 months postintervention. A 3-point growth model assessed change over time across the conditions on the Conners 3-Parent Assessment Report (Conners 3-P), the Behavior Rating Inventory of Executive Function Parent Form (BRIEF), and a systematic double-blinded classroom observation (Behavioral Observation of Students in Schools). Analysis of variance assessed community-initiated changes in stimulant medication.RESULTS: Parent response rates were 90% at the 6-month follow-up. Six months postintervention, neurofeedback participants maintained significant gains on Conners 3-P (Inattention effect size [ES] = 0.34, Executive Functioning ES = 0.25, Hyperactivity/Impulsivity ES = 0.23) and BRIEF subscales including the Global Executive Composite (ES = 0.31), which remained significantly greater than gains found among children in CT and control conditions. Children in the CT condition showed delayed improvement over immediate postintervention ratings only on Conners 3-P Executive Functioning (ES = 0.18) and 2 BRIEF subscales. At the 6-month follow-up, neurofeedback participants maintained the same stimulant medication dosage, whereas participants in both CT and control conditions showed statistically and clinically significant increases (9 mg [P = .002] and 13 mg [P , .001], respectively).CONCLUSIONS: Neurofeedback participants made more prompt and greater improvements in ADHD symptoms, which were sustained at the 6-month follow-up, than did CT participants or those in the control group. This finding suggests that neurofeedback is a promising attention training treatment for children with ADHD. Pediatrics 2014;133:483-492 AUTHORS:

Neurofeedback for ADHD

“…Although blinding of participants, parents, and teachers was not attempted in this study, blinded behavioral classroom observations indicated a significant reduction (ES 5 0.43) of verbal-motor ADHD (off-task) behaviors corresponding to hyperactivity/impulsivity after the intervention, 47 as well as at follow-up when using a nonlinear model of change. 48 The advantage of neurofeedback was also maintained for blinded classroom observation when compared with an active computer training, including attention and working memory games of similar duration and intensity. However, when teacher ratings were used as the best blinded outcome for, 25,45 and when the classroom observations of inattention were included for, 49 following the protocol of, 11 these moderate effects were reduced substantially and no longer significant.…”

“…However, interpretation of these findings is complicated by the fact that most ratings of long-term effects (except for the behavioral observation measure in Ref. 48 ) were not blinded and thus subject to bias.…”

Real‐time fMRI neurofeedback in adolescents with attention deficit hyperactivity disorder

“…Meta‐analyses of randomized controlled trials (RCT) of EEG‐NF show medium effect sizes for symptom improvements [Arns et al, 2009], reduced to trends when only “probably” blinded raters are included [Holtmann et al, 2014; Sonuga‐Barke et al, 2013]. Crucially, unlike psychostimulant treatment, NF effects seem stable and longer‐lasting (up to 2 years), with no side effects [Arns and Kenemans, 2014; Gani et al, 2008; Gevensleben et al, 2010; Leins et al, 2007; Mayer et al, 2016; Steiner et al, 2014; Strehl et al, 2006]. …”

The Crisis in Psychopharmacology Provides an Opportunity for NeuroRegulation Treatments to Gain Widespread Acceptance

“…More importantly, no other ADHD treatment has demonstrated credible evidence of sustained benefit following treatment termination, whereas this is the consistent finding of NFB studies that included follow-up assessments at 6 months (Gevensleben et al, 2010;Leins et al, 2007;Meisel, Servera, Garcia-Banda, Cardo, & Moreno, 2013;Steiner, Frenette, Rene, Brennan, & Perrin, 2014;Strehl et al, 2006) and 2 years (Gani, Birbaumer, & Strehl, 2008;Monastra, 2005).…”