Treatment Efficacy and Clinical Effectiveness of EEG Neurofeedback as a Personalized and Multimodal Treatment in ADHD: A Critical Review

Abstract

Purpose Recent reviews have proposed that scientifically validated standard EEG neurofeedback (NF) protocols are an efficacious and specific treatment for attention-deficit hyperactivity disorder (ADHD). Here, we review the current evidence for the treatment efficacy and clinical effectiveness of NF in ADHD to investigate whether NF treatment personalization (standard protocols matched to the electrophysiological features of ADHD) and combination with other interventions (psychosocial, sleep hygiene and nutritional advice) might yield superior long-term treatment outcomes relative to non-personalized NF and medication monotreatments. Methods The electronic databases PubMed and PsycINFO were systematically searched using our key terms. Of the 38 resulting studies, 11 randomized controlled trials (RCTs) and open-label studies were eligible for inclusion. Studies were analyzed for effect sizes and remission rates at the end of treatment and at follow-up. The effects of personalized and multimodal NF treatments were compared to non-personalized NF monotreatments and with two benchmark medication studies. Results The analysis of RCTs indicated that the long-term effects of personalized NF interventions were superior to non-personalized NF and comparable to those of medication alone or in combination with behavioral intervention. The analysis of open-label trials further indicates that the interaction of NF with parental interventions, sleep and nutritional advice might yield superior clinical effectiveness relative to NF and medication monotreatments. Conclusion Personalized and multimodal NF interventions seem to yield superior treatment efficacy relative to NF alone and superior clinical effectiveness relative to medication. We propose that treatment outcomes may be further enhanced by adjusting NF non-specific factors (eg, reinforcement contingencies) to specific ADHD characteristics (eg, reward sensitivity). Future NF research should focus on the systematic evaluation of the treatment outcomes of personalized and multimodal treatments.

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

“…However, so far evidence suggests that fMRI-NF learning can be achieved in relatively fewer sessions than EEG-NF [96] . For ADHD, EEG-NF typically requires 25-40 sessions of 45-60 min (Arns et al, 2009), and full treatment costs for 30-40 sessions have been estimated at USD4000-6000, similar to pharmacotherapy over 5-10 years [201] (Garcia Pimenta et al, 2021). This means higher costs for the administering therapist as opposed to fMRI-NF, which requires fewer sessions.…”

A Multivariate Randomized Controlled Experiment about the Effects of Mindfulness Priming on EEG Neurofeedback Self-Regulation Serious Games

“…While priming protocols lack some consistency and are not yet ready to be implemented on final products like SR serious games, they potentially provide an essential layer of personalization and mutual game-player adaptation. Actually, a review of attention-deficit hyperactivity disorder (ADHD) randomized control trials indicated that the long-term effects of personalized NF interventions were superior to non-personalized NF [97]. To optimize self-regulation learning, future work will also address the use of neural networks to learn the sequence of stimuli that leads the subject towards their personalized "optimal" state (e.g., using reinforcement learning, deep learning for time series forecasting with long short-term memory networks, multilayer perceptron's, convolutional neural networks, between others).…”

The more, the better? Learning rate and self-pacing in neurofeedback enhance cognitive performance in healthy adults

“…In their review the authors further discussed heightened reward sensitivity in children diagnosed with ADHD as a non-specific factor contributing to the training effect on clinical outcomes (Garcia Pimenta et al, 2021). While neurofeedback applications in clinical populations have focused on restoring cognitive and behavioral functionality, studies with non-clinical samples have concentrated on enhancing cognitive performance.…”