Neurofeedback for the treatment of children and adolescents with ADHD: a randomized and controlled clinical trial using parental reports

Abstract

BackgroundA randomized and controlled clinical study was performed to evaluate the use of neurofeedback (NF) to treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents.MethodsThe ADHD population was selected from an outpatient clinic for Child and Adolescent Mental Health in Norway. Ninety-one of the 275 children and adolescents ranging in age from 6 to 18 years (10.5 years) participated in 30 sessions of an intensive NF program. The reinforcement contingency was based on the subjects’ production of cortical beta1 activity (15–18 Hz). The ADHD participants were randomized into three groups, with 30 in the NF group, 31 controls in a group that was given methylphenidate, and 30 in a group that received NF and methylphenidate. ADHD core symptoms were reported by parents using the parent form of the Clinician’s Manual for Assessment by Russell A. Barkley.ResultsNinety-one children and adolescents were effectively randomized by age, sex, intelligence and distribution of ADHD core symptoms. The parents reported significant effects of the treatments, but no significant differences between the treatment groups were observed.ConclusionsNF was as effective as methylphenidate at treating the attentional and hyperactivity symptoms of ADHD, based on parental reports.Trial registrationCurrent Controlled Trials NCT01252446

Closed-loop brain training: the science of neurofeedback

“…Subsequent studies in children showed that neurofeedback-mediated decreases in low-frequency amplitudes were associated with improvements in ADHD symptoms [98][99][100] . Some recent RCTs have provided evidence that the clinical effect size of neurofeedback can be superior to computerized attention training 101,102 or match the one of standard pharmacotherapy 103,104 . Importantly, improvements in the neurofeedback group at 6-month follow-up remained larger than those in the computerized attention group and were comparable to the effects at the end of the training 64 .…”

Neurofeedback for ADHD

“…Also, most of these finding were obtained for groups including a considerable proportion of medicated ADHD patients, and most support the use of neurofeedback only in multimodal treatment schemes (but see Ref. 55 ). However, the best blinded controlled effects were nonsignificant in the small group studies and remained considerably reduced when compared with more proximal ratings.…”

“…Several randomized controlled trial studies have since compared neurofeedback to medication alone or in combination (see Table 2). Although one of them 54 found neurofeedback effects inferior to medication effects, the other 2 studies 55,56 found no differences between medication and neurofeedback effects, and one study 55 reported that neurofeedback or medication alone was as effective as the combination.…”

Neurofeedback is the Best Available First-Line Treatment for ADHD: What is the Evidence for this Claim?

“…While two of these studies relied on parental preference versus randomization to determine treatment group assignment, this reflects real-world practice and thereby strengthens the relevance of the results (Fuchs et al, 2003;Rossiter, 2004). The two most recent randomized trials (combined N = 153) found NFB equivalent to stimulant medication in treating ADHD's core symptoms (Duric et al, 2012), with Meisel et al (2013) reporting sustained improvement for NFB in their 6-month follow-up assessment, and unlike stimulants, only the NFB group achieved significant improvements in academic performance.…”

“…4) Besides lowering muscular tension, EMG biofeedback teaches attention, which may further reduce the difference in outcomes. Duric et al, 2012 130 ADHD children and adolescents, ages 6 to 18, were randomly assigned to receive either 1) NFB, 2) methylphenidate, or 2) combined NFB/medication. After randomization, 39 dropped out (36 immediately after randomization) 13 from the NFB group, 15 from the medication group, 11 from the combined group resulting in 91 completing the study; NFB (n = 30), methylphenidate (n = 31), and combined (n = 30).…”