The research question:
Is neurofeedback a valid therapeutic approach for children with ADHD? Are the effects sustained long-term after treatment?
The current therapeutic approaches for ADHD are drug-oriented, and include the administration of methylphenidate or other amphetamines, optionally in combination with psychosocial treatments. However, pharmacological interventions are most efficient in the short-term and are accompanied by side effects, rendering the development of novel therapeutic approaches a necessity. Neurofeedback, is a non-pharmacological treatment, which takes advantage of brain-computer interface technologies to reprogram the brain oscillatory patterns, measured by electroencephalography (EEG).
The present study analyzed the results of 10 independent publications assessing the long-term effects of neurofeedback on ADHD patients under 18 years old. The results indicated that neurofeedback is equally or even more effective than pharmacological approaches in the long-term, and ameliorates the inattention and hyperactivity/impulsivity behaviors observed in ADHD. Thus, the researchers propose that neurofeedback should become a primary target for clinical trials aiming to treat ADHD and relative disorders.
They selected studies describing randomized controlled trials with follow-up assessments (2-12 months) in children with ADHD, published in PubMed and Scopus databases. Main inclusion criteria were a DSM-IV/V based rating of inattention, hyper-activity, or hyperactivity/impulsivity and the availability of SEM and SD measures for pre-treatment, post-treatment and follow-up ratings.
Their meta-analysis strategy was based on the direct comparison of neurofeedback treatment with control group and included post-treatment and follow-up versus pre-treatment comparisons, as well as direct follow-up versus post-treatment comparisons. However, because the control conditions were highly heterogeneous, active (receiving pharmacological medication or psychotherapy) and non-active control groups were assessed separately.
Based on the combined evaluation of ten studies, assessing in total 506 participants (256 neurofeedback, 250 control), neurofeedback is an effective treatment with long-lasting effects for ADHD. Within-group analysis showed that neurofeedback had a significantly reduced inattention and hyperactivity/impulsivity both in the post-treatment and in the follow-up rating.
Between group analysis showed that compared with non-active control, neurofeedback is beneficial in the post-treatment and follow-up rating, yet less efficient than active control in the pre- to post-treatment comparison. Interestingly, focusing on the pre-treatment versus follow-up comparison, neurofeedback was superior to non-active control groups and similarly effective for inattention and hyperactivity/impulsivity compared to active treatments.
“Neurofeedback (NF), which aims at improving self-regulation of brain activity (most often the electroencephalogram, EEG) using a brain–computer interface, has gained popularity. A promising aspect of neurofeedback is that it may rely on procedural learning, thereby potentially allowing lasting effects and thus longer clinical benefit after completion of neurofeedback treatment.”
“The significant improvement in symptoms at FU for both inattention and hyperactivity–impulsivity in the neurofeedback conditions indicates that NF results in lasting effects for approximately 6 months and potentially up to 1 year.”
“These contrasting findings suggest that while medication may have some long-term benefits, the adherence of medication intake may be problematic and long-term medication exposure may be related to potential physical side effects”
Van Doren, J., Arns, M., Heinrich, H., Vollebregt, M. A., Strehl, U., & Loo, S. K. (2019). Sustained effects of neurofeedback in ADHD: a systematic review and meta-analysis. European child & adolescent psychiatry, 28(3), 293-305.