Effects of neurofeedback versus methylphenidate for the treatment of ADHD: systematic review and meta-analysis of head-to-head trials

Abstract

BackgroundThe comparative efficacy and tolerability of methylphenidate (MPH) and neurofeedback (NF) in individuals with attention-deficit/hyperactivity disorder (ADHD) remains uncertain. This study aimed to fill this gap by means of a systematic review/meta-analysis.MethodsPubMed, OVID, ERIC, Web of Science, ClinialTrials.gov and a set of Chinese databases were searched until 22 August 2018. Standardised mean differences (SMD) were pooled using comprehensive meta-analysis software.Results18 randomised controlled trials (RCTs) were included (778 individuals with ADHD in the NF arm and 757 in the MPH group, respectively; 13 studies in Chinese, five in English). At the study first endpoint, MPH was significantly more efficacious than NF on ADHD core symptoms (ADHD symptoms combined: SMD=−0.578, 95% CI (−1.063 to –0.092)) and on two neuropsychological parameters (inattention:−0.959 (-1.711 to –0.208); inhibition:−0.469 (-0.872 to –0.066)). Dropouts were significantly lower in NF versus MPH (OR=0.412, 0.186 to 0.913). Results were robust to sensitivity analyses, with two important exceptions: removing Chinese studies and non-funded studies, no differences emerged between MPH and NF, although the number of studies was small. At the study follow-up, MPH was superior to NF in some outcomes, but results were inconsistent across raters.ConclusionsDue to the risk of bias of included studies, the results of the sensitivity analysis excluding Chinese and non-funded studies, and the mixed findings on at the follow-up endpoint, further high quality studies are needed to assess the comparative efficacy and acceptability of NF and MPH in individuals with ADHD.Trial registration numberCRD42018090256.

Neurotherapeutics for Attention Deficit/Hyperactivity Disorder (ADHD): A Review

“…More than ten years and more than ten meta-analyses later [76,78,[80][81][82][83][84][85][86][87][88] Hodgson et al, 2014), the latest comprehensive meta-analysis to date reported significant albeit small to medium effect sizes and inferiority compared to stimulants [83] (Riesco-Matías et al, 2021). This drop of more than half of the effect size (for a historical/chronological viewpoint, see Figure 1) is interesting and probably related to the growing research using stricter control conditions and improved scientific standards for EEG-NF studies, which will be discussed in the following.…”

Acceptability of transcranial direct current stimulation in children and adolescents with ADHD: The point of view of parents

“…Several reviews have been conducted to understand and compare the acceptability of pharmaceuticals with behavioral/psychosocial (Bennett et al, 1996; Johnston et al, 2008; Stuhec et al, 2015), with NFB (Catalá-López et al, 2017; Yan et al, 2019), and with other interventions for ADHD. In each of these studies the non-pharmacological approaches were found to be more acceptable despite often being less effective.…”

Does cognitive-behavioral therapy reduce internet addiction? Protocol for a systematic review and meta-analysis

“…Just as previous studies, [39,40] We will search PubMed, Web of Knowledge, OVID, Chongqing VIP, Wanfang, and China National Knowledge Infrastructure database without language/date/type of document restrictions to find any relevant references. Based on previous search strategy, [3] we constructed a combination of the following terms.…”