Neurofeedback Treatment Of Attention Deficit Hyperactivity Disorder

Review Papers and Meta-Analyses

Efficacy of Neurofeedback Treatment in ADHD: the Effects on Inattention, Impulsivity and Hyperactivity: a Meta-Analysis [pdf]
by Arns M, de Ridder S, Strehl U, Breteler M and Coenen A
Journal of Clinical EEG & Neuroscience, July, 2009

Since the first reports of neurofeedback treatment in Attention Deficit Hyperactivity Disorder (ADHD) in 1976, many studies have investigated the effects of neurofeedback on different symptoms of ADHD such as inattention, impulsivity and hyperactivity. This technique is also used by many practitioners, but the question as to the evidence-based level of this treatment is still unclear. In this study selected research on neurofeedback treatment for ADHD was collected and a meta-analysis was performed.

Both prospective controlled studies and studies employing a pre- and post-design found large effect sizes (ES) for neurofeedback on impulsivity and inattention and a medium ES for hyperactivity. Randomized studies demonstrated a lower ES for hyperactivity suggesting that hyperactivity is probably most sensitive to nonspecific treatment factors.

Due to the inclusion of some very recent and sound methodological studies in this meta-analysis, potential confounding factors such as small studies, lack of randomization in previous studies and a lack of adequate control groups have been addressed, and the clinical effects of neurofeedback in the treatment of ADHD can be regarded as clinically meaningful. Three randomized studies have employed a semi-active control group which can be regarded as a credible sham control providing an equal level of cognitive training and client-therapist interaction. Therefore, in line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude that neurofeedback treatment for ADHD can be considered "Efficacious and Specific" (Level 5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.

Place of EEG Biofeedback for ADHD [pdf]
by Hirshberg LM
Expert Review Neurotherapeutics, 7(4), 315-319

Although methodological weaknesses limited early research into electroencephalograpic (EEG) biofeedback (EBF) for treatment of attention-deficit/hyperacticity disorder (ADHD), recent stronger randomized controlled trials have provided substantial, but not yet conclusive, empirical support. Additional support is found in research on functional magnetic resonance imaging (fMRI) feedback and brain-computer interface (BCI) models which involve feedback-guided learning to achieve control over neural activation.

EEG Biofeedback in the Treatment of Attention Deficit Hyperactivity Disorder [abs.]
by Friel PN
Alternative Medicine Review, Volume 12, #2, June, 2007, pp146-151

Electroencephalogram (EEG) biofeedback, also known as neurofeedback, is a promising alternative treatment for patients with attention deficit/hyperactivity disorder (AD/HD). EEG biofeedback therapy rewards scalp EEG frequencies that are associated with relaxed attention, and suppresses frequencies associated with under- or over-arousal.

Electroencephalographic Biofeedback (Neurotherapy) as a Treatment for Attention Deficit Hyperactivity Disorder: Rationale and Empirical Foundation [abs.]
by Monastra VJ

During the past three decades, electroencephalographic (EEG) biofeedback has emerged as a nonpharmacologic treatment for attention-deficit/hyperactivity disorder (ADHD). This intervention was derived from operant conditioning studies that demonstrated capacity for neurophysiologic training in humans and other mammals and targets atypical patterns of cortical activation that have been identified consistently in neuroimaging and quantitative EEG studies of patients diagnosed with ADHD.

Treatment of Attention Deficit Hyperactivity Disorder with Neurotherapy [abs.]
by Nash JK

Significant public health concerns exist regarding our current level of success in treating ADHD. Medication management is very helpful in 60-70% of patients. Side effects, lack of compliance and the fact that stimulant medications cannot be given late in the day limit the benefits largely to school hours.

Update on Attention-Deficit/Hyperactivity Disorder [abs.]
by Campbell Daley K

In her recent paper, Update on Attention-Deficit/Hyperactivity Disorder, published in Current Opinion in Pediatrics, Katie Campbell Daley reviewed the research and practice standards on treatment of ADHD. Dr. Campbell is on the staff of the Department of Medicine, Children's Hospital Boston and in the Department of Pediatrics of the Harvard Medical School. Her conclusion: "Overall, these findings support the use of multi-modal treatment, including medication, parent/school counseling, and EEG biofeedback, in the long term management of ADHD, with EEG biofeedback in particular providing a sustained effect even without stimulant treatment... Parents interested in non-psychopharmacologic treatment can pursue the use of complementary and alternative therapy. The therapy most promising by recent clinical trials appears to be EEG biofeedback."

Research Papers

Comparisons of Neurofeedback with Stimulant Medication

Neurofeedback Treatment for Attention Deficit/Hyperactivity Disorder in Children: A Comparison with Methylphenidate [abs.]
by Fuchs T, Birbaumer N, Lutzenberger W, Gruzelier J. H., & Kaiser J

Clinical trials have suggested that neurofeedback may be efficient in treating attention-deficit/hyperactivity disorder (ADHD). We compared the effects of a 3-month electroencephalographic feedback program providing reinforcement contingent on the production of cortical sensorimotor rhythm (12-15 Hz) and betal activity (15-18 Hz) with stimulant medication.

The Effectiveness of Neurofeedback and Stimulant Drugs in Treating AD/HD: Part I. Review of Methodological Issues [abs.]
by Rossiter T.R.

The paper examines major criticisms of AD/HD (Attention Deficit/Hyperactivity Disorder) neurofeedback research using T. R. Rossiter and T. J. La Vaque (1995) as an exemplar and discusses relevant aspects of research methodology.

The Effectiveness of Neurofeedback and Stimulant Drugs in Treating AD/HD: Part II. Replication [abs.]
by Rossiter T.R.

This study replicated T. R. Rossiter and T. J. La Vaque (1995) with a larger sample, expanded age range, and improved statistical analysis. Thirty-one ADIHD patients who chose stimulant drug (MED) treatment were matched with 31 patients who chose a neurofeedback (EEG) treatment program.

The Effects of Stimulant Therapy, EEG Biofeedback, and Parenting Style on the Primary Symptoms of Attention-Deficit/Hyperactivity Disorder [abs.]
by Monastra VJ, Monastra DM, George S

One hundred children, ages 6-19, who were diagnosed with attention-deficit/hyperactivity disorder (ADHD), either inattentive or combined types, participated in a study examining the effects of Ritalin, EEG biofeedback, and parenting style on the primary symptoms of ADHD.

Neurofeedback for ADHD using Slow Cortical Potentials

Neurofeedback for Children with ADHD: A Comparison of SCP with Theta/Beta Protocols [abs.]
by Leins U, Goth G, Hinterberger T, Klinger C, Rumpf N, Strehl U

This study fills a niche in the research to date in that it compares two neurofeedback techniques that rely on very different challenges to the brain. The capacity for learned self-regulation was demonstrated once again with both techniques. Significantly, there was no difference between them in terms of cognitive and behavioral outcomes. Measured improvement in IQ was both statistically and clinically significant. Results held up over a six-month follow-up period.

Controlled Evaluation of a Neurofeedback Training of Slow Cortical Potentials in Children with Attention Deficit/Hyperactivity Disorder (ADHD) [abs.]
by Drechsler R, Straub M, Doehnert M, Heinrich H, Steinhausen H, Brandeis D

To evaluate the specificity of a neurofeedback training of slow cortical potentials, a twofold strategy was pursued: First, the efficacy of neurofeedback training was compared to a group training program for children with ADHD. Secondly, the extent of improvements observed in the neurofeedback group in relation to successful regulation of cortical activation was examined. Parents and teachers rated children's behaviour and executive functions before and after treatment. In addition, children underwent neuropsychological testing before and after training.

Biofeedback Produced Slow Brain Potentials and Task Performance [abs.]
by Lutzenberger W, Elbert T, Rockstroh B, Birbaumer N

Twenty subjects learned to control slow potential (SP) shifts of the brain by means of a biofeedback procedure. Depending upon the pitch of a signal tone, negative SP shifts had to be increased or reduced during intervals of 6 sec each.

Operant Conditioning of Left-Hemispheric Slow Cortical Potentials and Its Effect on Word Processing [abs.]
by Pulvermöller F, Mohr B, Schleichert H, Veit R

This study investigated whether language-related cognitive processes can be modified by learned modulation of cortical activity.

Foundational Studies on Neurofeedback for ADHD

Evaluation of the Effectiveness of EEG Neurofeedback Training for ADHD in a Clinical Setting as Measured by Changes in T.O.V.A. Scores, Behavioral Ratings, and WISC-R Performance [abs.]
by Lubar JF, Swartwood MO, Swartwood JN, O'Donnell PH

A study with three component parts was performed to assess the effectiveness of Neurofeedback treatment for Attention Deficit/Hyperactivity Disorder (ADHD). The subject pool consisted of 23 children and adolescents ranging in age from 8 to 19 years with a mean of 11.4 years who participated in a 2- to 3-month summer program of intensive Neurofeedback training.

A Controlled Study of the Effects of EEG biofeedback on Cognition and Behavior of Children with Attention Deficit Disorder and Learning Disabilities [abs.]
by Linden M, Habib T, Radojevic V

Eighteen children with ADD/ADHD, some of whom were also LD, ranging in ages from 5 through 15 were randomly assigned to one of two conditions. The experimental condition consisted of 40 45-minute sessions of training in enhancing beta activity and suppressing theta activity, spaced over 6 months.

Electroencephalographic Biofeedback of SMR and Beta for Treatment of Attention Deficit Disorders in a Clinical Setting [abs.]
by Lubar JO and Lubar JF

Six children were provided with long-term biofeedback and academic treatment for attention deficit disorders. Their symptoms were primarily specific learning disabilities, and, in some cases, there were varying degrees of hyperkinesis. The training consisted of two sessions per week for 10 to 27 months, with a gradual phase-out.

Neocortical Dynamics: Implications for Understanding the Role of Neurofeedback and Related Techniques for the Enhancement of Attention [pdf]
by Lubar JF Ph.D.

This presentation will consist of two parts. The first portion will provide both the scientific basis and a model for understanding neocortical dynamics and the EEG. The second portion will show how EEG biofeedback and related methodologies that modify the EEG and behavior can be explained by neocortical dynamics.

EEG and Behavioral Changes in a Hyperkinetic Child Concurrent with Training of the Sensorimotor Rhythm (SMR): A Preliminary Report [abs.]
by Lubar JF and Shouse MN

Reduced seizure incidence coupled with voluntary motor inhibition accompanied conditioned increases in the sensorimotor rhythm (SMR), a 12- 14 Hz rhythm appearing over rolandic cortex.

Operant Conditioning of EEG Rhythms and Ritalin in the Treatment of Hyperkinesis [abs.]
by Shouse MN and Lubar JF

Enhanced voluntary motor inhibition regularly accompanies conditioned increases in the sensorimotor rhythm (SMR), a 12--14-Hz Rolandic EEG rhythm in cats.

EEG Biofeedback for Attention Deficit Hyperactivity Disorder [pdf]
by Othmer S Ph.D. and Othmer SF B.A.

Attention Deficit Hyperactivity Disorder, (ADHD) is characterized by impulsivity, hyperactivity, and distractibility. These symptoms may be present in varying degrees. For example, hyperactivity may not necessarily be obtrusive in order to diagnose the condition. ADHD is not a disease.

Neurofeedback Combined with Training in Metacognitive Strategies: Effectiveness in Students with ADD [abs.]
by Thompson L and Thompson M

A review of records was carried out to examine the results obtained when people with Attention Deficit Disorder (ADD) received 40 sessions of training that combined neurofeedback with the teaching of metacognitive strategies.

Efficacy of Neurofeedback on Adults with Attentional Deficit and Related Disorders [pdf]
by Kaiser DA

Attention Deficit Hyperactivity Disorder (ADHD) is a lifelong disorder that affects as many as one in every twenty adults. Whereas ADHD in childhood is commonly associated with poor school performance and academic achievement, in adulthood this disorder can be especially disruptive to social and vocational relationships.

Electroencephalographic Biofeedback of SMR and Beta for Treatment of Attention Deficit Disorders in a Clinical Setting [abs.]
by Lubar JO and Lubar JF

Six children were provided with long-term biofeedback and academic treatment for attention deficit disorders. Their symptoms were primarily specific learning disabilities, and, in some cases, there were varying degrees of hyperkinesis.

Clinical Use of SMR-Beta Training on Post Traumatic Stress Disorder and Adult Attention Deficit Disorder: A Case Study [pdf]
by Putman JA

After 20 sessions of SMR- Beta training, the patient's TOVA revealed dramatic improvement on all 4 scales (Std scores ranged from 83 to 110). Additionally, she was much less reactive and felt more emotionally "stable." Her sleep patterns had improved a great deal as well. Although she was still having nightmares, they had become less frequent and had decreased in their intensity. Her depression lifted and she became considerably more animated and less irritable. Shortly after starting college, she reported that she was able to read whole chapters at a time without frustration or anxiety and was actually enjoying and retaining what she had read. She completed her first semester in college with a B average and has not used cocaine in over a year.

Related Research

The Electroencephalogram in Attention Deficit-Hyperactivity Disorder: Emphasis on Epileptiform Discharges [abs.]
by Hughes JR, DeLeo AJ, Melyn MA

This study dealt with the electroencephalograms (EEGs) of 176 children with attention deficit-hyperactivity disorder (ADHD). Of special interest were the patients who had in their EEG some type of spike activity (spike group), in contrast with those without such activity (control group).

Volumetric Asymmetries in Late-Onset Mood Disorders: An Attenuation of Frontal Asymmetry with Depression Severity [abs.]
by Kumar A, Bilker W, Lavretsky H, Gottlieb G

The purpose of the study was to examine global and regional volumetric asymmetries in patients with late-onset mood disorders and non-depressed control subjects.

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Recent Research

Mind over chatter: Plastic up-regulation of the fMRI salience network directly after EEG neurofeedback.
Ros T, Théberge J, Frewen PA, Kluetsch R, Densmore M, Calhoun VD, and Lanius RA
NeuroImage, 65, 2013, pp 324-35

Improving Visual Perception through Neurofeedback.
Scharnowski F, Hutton C, Josephs O, Weiskopf N, and Rees G
Journal of Neuroscience, 32, 2012, pp 17830-41

The effectiveness of neurofeedback training on EEG coherence and neuropsychological functions in children with reading disability.
Nazari MA, Mosanezhad E, Hashemi T, and Jahan A
Clinical EEG and Neuroscience, 43, 2012, pp 315-22

Self-regulation of brain oscillations as a treatment for aberrant brain connections in children with autism.
Pineda JA, Juavinett A, and Datko M
Medical Hypotheses, 79, 2012, pp 790-8

Evidence-based information on the clinical use of neurofeedback for ADHD.
Moriyama TS, Polanczyk G, Caye A, Banaschewski T, Brandeis D, and Rohde LA
Neurotherapeutics, 9, 2012, pp 588-98

Current status of neurofeedback for attention-deficit/hyperactivity disorder.
Lofthouse N, Arnold LE, and Hurt E
Current Psychiatry Reports, 14, 2012, pp 536-42

Individual alpha neurofeedback training effect on short term memory.
Nan W, Rodrigues JP, Ma J, Qu X, Wan F, Mak PI, Mak PU, Vai MI, and Rosa A
International Journal of Psychophysiology, 86, 2012, pp 83-7

Neurotherapy of traumatic brain injury/posttraumatic stress symptoms in OEF/OIF veterans.
Nelson DV, and Esty ML
Journal of Neuropsychiatry and Clinical Neurosciences, 24, 2012, pp 237-40

Schizophrenia and the efficacy of qEEG-guided neurofeedback treatment: a clinical case series.
Surmeli T, Ertem A, Eralp E, and Kos IH
Clinical EEG and Neuroscience, 43, 2012, pp 133-44

Which attention-deficit/hyperactivity disorder children will be improved through neurofeedback therapy?
Ahmadlou M, Rostami R, and Sadeghi V
Neuroscience Letters, 516, 2012, pp 156-60

Neurofeedback in children with ADHD: validation and challenges.
Gevensleben H, Rothenberger A, Moll GH, and Heinrich H
Expert Review of Neurotherapeutics, 12, 2012, pp 447-60

Taking back the brain: could neurofeedback training be effective for relieving distressing auditory verbal hallucinations in patients with schizophrenia?
McCarthy-Jones S
Schizophrenia Bulletin, 38, 2012, pp 678-82

A review of neurofeedback treatment for pediatric ADHD.
Lofthouse N, Arnold LE, Hersch S, Hurt E, and DeBeus R
Journal of Attention Disorders, 16, 2012, pp 351-72