Neurofeedback training in children with ADHD: 6-month follow-up of a randomised controlled trial

Abstract

Neurofeedback (NF) could help to improve attentional and self-management capabilities in children with attention-deficit/hyperactivity disorder (ADHD). In a randomised controlled trial, NF training was found to be superior to a computerised attention skills training (AST) (Gevensleben et al. in J Child Psychol Psychiatry 50(7):780–789, 2009). In the present paper, treatment effects at 6-month follow-up were studied. 94 children with ADHD, aged 8–12 years, completed either 36 sessions of NF training (n = 59) or a computerised AST (n = 35). Pre-training, post-training and follow-up assessment encompassed several behaviour rating scales (e.g., the German ADHD rating scale, FBB-HKS) completed by parents. Follow-up information was analysed in 61 children (ca. 65%) on a per-protocol basis. 17 children (of 33 dropouts) had started a medication after the end of the training or early in the follow-up period. Improvements in the NF group (n = 38) at follow-up were superior to those of the control group (n = 23) and comparable to the effects at the end of the training. For the FBB-HKS total score (primary outcome measure), a medium effect size of 0.71 was obtained at follow-up. A reduction of at least 25% in the primary outcome measure (responder criterion) was observed in 50% of the children in the NF group. In conclusion, behavioural improvements induced by NF training in children with ADHD were maintained at a 6-month follow-up. Though treatment effects appear to be limited, the results confirm the notion that NF is a clinically efficacious module in the treatment of children with ADHD.

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

“…Two years after the end of the study, the behavioral and attentional improvements were maintained and some additional benefits could be seen, suggesting that patients were still improving even after the end of treatment. Gevensleben et al [60] found similar results in the 6-month follow-up of their randomized controlled trial comparing NF to CAST. Sixtyfive percent of participants were followed, and improvements in the NF group were superior to the control group and comparable to that of the end of the active treatment phase.…”

“…Gevensleben et al [60] defined response ratio as a reduction of at least 25 % in symptoms, and found 50 % of participants to respond to NF, suggesting that some individuals may benefit from NF, whereas others may not. Wangler et al [61] found baseline EEG patterns, specifically, an increase of the CNV in an attention task, to be a predictor of good response to SCP training.…”

Neurofeedback for ADHD

“…A major advantage of neurofeedback and other neurotherapeutic approaches 63 over typical pharmacologic interventions (as for other behavioral, learning-based interventions) is the potential for sustained, long-term benefits after successful completion of treatment. Investigations 36 indeed found positive effects on ADHD symptoms being stable 6 months after training.…”

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]. …”