50(7) 615 –622
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Training in the Schools for
Children With Attention
A Preliminary Trial
Naomi J. Steiner, MD1, Radley Christopher Sheldrick, PhD1,
David Gotthelf, PhD2, and Ellen C. Perrin, PhD1
Objective. This study examined the efficacy of 2 computer-based training systems to teach children with attention
deficit/hyperactivity disorder (ADHD) to attend more effectively. Design/methods. A total of 41 children with ADHD
from 2 middle schools were randomly assigned to receive 2 sessions a week at school of either neurofeedback (NF)
or attention training through a standard computer format (SCF), either immediately or after a 6-month wait (waitlist
control group). Parents, children, and teachers completed questionnaires pre- and postintervention. Results. Primary
parents in the NF condition reported significant (P < .05) change on Conners’s Rating Scales–Revised (CRS-R) and
Behavior Assessment Scales for Children (BASC) subscales; and in the SCF condition, they reported significant
(P < .05) change on the CRS-R Inattention scale and ADHD index, the BASC Attention Problems Scale, and on the
Behavioral Rating Inventory of Executive Functioning (BRIEF). Conclusion. This randomized control trial provides
preliminary evidence of the effectiveness of computer-based interventions for ADHD and supports the feasibility
of offering them in a school setting.
ADHD, neurofeedback, biofeedback, computer attention training
Attention deficit/hyperactivity disorder (ADHD) is a
neurologically based behavioral disorder whose core
symptoms include hyperactivity, impulsivity, and dis-
tractibility/inattention. Prevalence estimates range from
4% to 10%. Comorbidities commonly include externaliz-
ing, internalizing, and/or specific learning disabilities,1-5
as well as trouble maintaining relationships with family
and peers.6-8 Approximately 60% of children with ADHD
continue to have symptoms in adolescence and into adult-
hood, leading to high risks of academic and vocational
underachievement, interpersonal difficulties, substance
abuse, and motor vehicle accidents.9
A great deal of research has demonstrated the effi-
cacy of medication for treating the core symptoms of
ADHD.10 However, about 30% of children experience
adverse side effects,11 such as appetite suppression,
insomnia, anxiety/irritability, rare but potentially serious
cardiac problems,12 and psychotic reactions,13 or they
do not respond to medication. Long-term adherence to
medication regimens is poor, with most estimates sug-
gesting that fewer than 50% of children with ADHD
maintain prescribed dosages over 6 months.13 Psycho-
social interventions are time consuming, expensive, and
have demonstrated limited effectiveness.14 Only about a
third of primary care physicians believe that their com-
munity has adequate mental health resources to support
these children and families.15
1Floating Hospital for Children, Boston, MA, USA
2Newton Public Schools, Newton, MA, USA
Naomi J. Steiner, Floating Hospital for Children,
800 Washington Street #334, Boston, MA 02111, USA
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