Is Neurofeedback an Efficacious Treatment for ADHD? A Randomised Controlled Clinical Trial

Child & Adolescent Psychiatry, University of Göttingen, Germany.
Journal of Child Psychology and Psychiatry (Impact Factor: 6.46). 02/2009; 50(7):780-9. DOI: 10.1111/j.1469-7610.2008.02033.x
Source: PubMed


For children with attention deficit/hyperactivity disorder (ADHD), a reduction of inattention, impulsivity and hyperactivity by neurofeedback (NF) has been reported in several studies. But so far, unspecific training effects have not been adequately controlled for and/or studies do not provide sufficient statistical power. To overcome these methodological shortcomings we evaluated the clinical efficacy of neurofeedback in children with ADHD in a multisite randomised controlled study using a computerised attention skills training as a control condition.
102 children with ADHD, aged 8 to 12 years, participated in the study. Children performed either 36 sessions of NF training or a computerised attention skills training within two blocks of about four weeks each (randomised group assignment). The combined NF treatment consisted of one block of theta/beta training and one block of slow cortical potential (SCP) training. Pre-training, intermediate and post-training assessment encompassed several behaviour rating scales (e.g., the German ADHD rating scale, FBB-HKS) completed by parents and teachers. Evaluation ('placebo') scales were applied to control for parental expectations and satisfaction with the treatment.
For parent and teacher ratings, improvements in the NF group were superior to those of the control group. For the parent-rated FBB-HKS total score (primary outcome measure), the effect size was .60. Comparable effects were obtained for the two NF protocols (theta/beta training, SCP training). Parental attitude towards the treatment did not differ between NF and control group.
Superiority of the combined NF training indicates clinical efficacy of NF in children with ADHD. Future studies should further address the specificity of effects and how to optimise the benefit of NF as treatment module for ADHD.

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Available from: Hartmut Heinrich, Feb 24, 2015
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    • "Neurofeedback training is considered as one of the most effective and salient treatments for children with attention deficit/hyperactivity disorder (ADHD). The clinical efficacy of using NFB for ADHD treatments was supported by several meta-analyses of randomized clinical trials recently conducted (Lubar, 2003, 2004; Arns et al., 2009; Gevensleben et al., 2009; Sokhadze et al., 2009; Lofthouse et al., 2010). Since many autistic children also show signs of attention-deficit and hyperactivity some attempts have been made to use this technique as a treatment modality for ASD (Linden et al., 1996; Coben and Padolsky, 2007; Coben, 2008, 2013; Kouijzer et al., 2009a,b, 2010; Coben and Myers, 2010; Coben et al., 2010; Sherlin et al., 2010; Thompson et al., 2010a,b; Linden and Gunkelman, 2013). "
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    ABSTRACT: Neurofeedback is a mode of treatment that is potentially useful for improving self-regulation skills in persons with autism spectrum disorder. We proposed that operant conditioning of EEG in neurofeedback mode can be accompanied by changes in the relative power of EEG bands. However, the details on the change of the relative power of EEG bands during neurofeedback training course in autism are not yet well explored. In this study, we analyzed the EEG recordings of children diagnosed with autism and enrolled in a prefrontal neurofeedback treatment course. The protocol used in this training was aimed at increasing the ability to focus attention, and the procedure represented the wide band EEG amplitude suppression training along with upregulation of the relative power of gamma activity. Quantitative EEG analysis was completed for each session of neurofeedback using wavelet transform to determine the relative power of gamma and theta/beta ratio, and further to detect the statistical changes within and between sessions. We found a linear decrease of theta/beta ratio and a liner increase of relative power of gamma activity over 18 weekly sessions of neurofeedback in 18 high functioning children with autism. The study indicates that neurofeedback is an effective method for altering EEG characteristics associated with the autism spectrum disorder. Also, it provides information about specific changes of EEG activities and details the correlation between changes of EEG and neurofeedback indexes during the course of neurofeedback. This pilot study contributes to the development of more effective approaches to EEG data analysis during prefrontal neurofeedback training in autism. Key word: Electroencephalography, Neurofeedback, Autism Spectrum Disorder, Gamma activity, EEG bands’ ratios
    Full-text · Article · Jan 2016 · Frontiers in Human Neuroscience
    • "With a larger CNV amplitude, the amount of cognitive energy is rising and leads to faster reaction times, better stimulus selection, short-term memory and attention (Birbaumer et al., 1990). After SCP-NF for children with ADHD, third-party rated symptom improvements of more than 25% are reported (Heinrich et al., 2004; Strehl et al., 2006; Drechsler et al., 2007; Gevensleben et al., 2009b). Furthermore, changes in neuropsychological measures, such as increased reaction time (RT) and decreased error rates, were observed (Heinrich et al., 2004; Strehl et al., 2006; Drechsler et al., 2007). "
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    ABSTRACT: Objective: Attention Deficit-/Hyperactivity Disorder (ADHD) has been treated successfully in children with neurofeedback (NF). In this study, for the first time NF is investigated in adults with ADHD. To answer the question of specificity the relationship between treatment outcome and self-regulation ability is assessed. Methods: Twenty-four participants underwent 30 sessions of slow cortical potential NF. Measurements of ADHD and comorbid symptoms, as well as neurophysiological data (reaction time (RT) and RT variability (RTV) and contingent negative variation (CNV)) were performed before and after treatment, and again six months after sessions were completed. Participants were categorized into self-regulation learners and non-learners. Results: Significant improvements on all symptom scales were observed with medium to large effect sizes after treatment and six months post treatment. RT and RTV decreased significantly and there was a trend for an increased CNV. Half of the participants successfully learned to regulate their brain activity. In the long-term, symptoms in the group of learners improved more than in non-learners with large effect sizes. Conclusion: NF is effective in treating adult ADHD long-term. The impact of self-regulation ability and possible unspecific effects still require further investigation. Significance: This study is the first to investigate the effects of NF in adults with ADHD, relating clinical outcome to self-regulation performance.
    No preview · Article · Nov 2015 · Clinical Neurophysiology
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    • "The third meta-analysis of Micoulaud-Franchi et al. (2014) found an ES that was significantly higher than in the control group in randomized and blinded trials for the inattention dimension of ADHD [65]. In these two last meta-analyses, teacher assessment was chosen if the control group performed a cognitive remediation [34] [94] [104], and assessment by parents and teachers was chosen if the control group performed a placebo NF protocol [12] [54]. It should be noted that efficacy with regards to the inattention dimension was proportional to the number of neurofeedback sessions [9] and seemed to be maintained over time [57]. "
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    ABSTRACT: The technique of electroencephalographic neurofeedback (EEG NF) emerged in the 1970s and is a technique that measures a subject's EEG signal, processes it in real time, extracts a parameter of interest and presents this information in visual or auditory form. The goal is to effectuate a behavioural modification by modulating brain activity. The EEG NF opens new therapeutic possibilities in the fields of psychiatry and neurology. However, the development of EEG NF in clinical practice requires (i) a good level of evidence of therapeutic efficacy of this technique, (ii) a good practice guide for this technique. Firstly, this article investigates selected trials with the following criteria: study design with controlled, randomized, and open or blind protocol, primary endpoint related to the mental and brain disorders treated and assessed with standardized measurement tools, identifiable EEG neurophysiological targets, underpinned by pathophysiological relevance. Trials were found for: epilepsies, migraine, stroke, chronic insomnia, attentional-deficit/hyperactivity disorder (ADHD), autism spectrum disorder, major depressive disorder, anxiety disorders, addictive disorders, psychotic disorders. Secondly, this article investigates the principles of neurofeedback therapy in line with learning theory. Different underlying therapeutic models are presented didactically between two continua: a continuum between implicit and explicit learning and a continuum between the biomedical model (centred on "the disease") and integrative biopsychosocial model of health (centred on "the illness"). The main relevant learning model is to link neurofeedback therapy with the field of cognitive remediation techniques. The methodological specificity of neurofeedback is to be guided by biologically relevant neurophysiological parameters. Guidelines for good clinical practice of EEG NF concerning technical issues of electrophysiology and of learning are suggested. These require validation by institutional structures for the clinical practice of EEG NF.
    Full-text · Article · Nov 2015 · Neurophysiologie Clinique/Clinical Neurophysiology
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