What is the efficacy of neurofeedback therapy as a treatment for Attention Deficit Hyperactivity Disorder (ADHD)?

From the Guidelines

Neurofeedback therapy is not recommended as a primary treatment for Attention Deficit Hyperactivity Disorder (ADHD) due to limited evidence of its efficacy and safety. The American Academy of Pediatrics recommends FDA-approved medications and evidence-based behavioral interventions as the primary treatments for ADHD, with a strong emphasis on educational interventions and individualized instructional supports 1. While neurofeedback therapy may be considered as a complementary treatment, its benefits are not well-established, and it should not replace first-line treatments.

Key Points to Consider

• The current evidence supporting neurofeedback therapy for ADHD is sparse and does not approach the robust strength of evidence documented for established medication and behavioral treatments 1.
• Neurofeedback therapy may have some benefits, but its effects are generally modest, and it requires a significant time commitment and can be expensive, with limited insurance coverage.
• A comprehensive treatment approach that includes medication, behavioral therapy, and educational accommodations is recommended for best results.
• Patients should be aware that neurofeedback therapy is not a replacement for established treatments and should be used under the guidance of a qualified healthcare professional.

Recommendations for Treatment

• FDA-approved medications and evidence-based behavioral interventions should be the primary treatments for ADHD 1.
• Educational interventions and individualized instructional supports, including school environment, class placement, instructional placement, and behavioral supports, are a necessary part of any treatment plan 1.
• Neurofeedback therapy may be considered as a complementary treatment, but its use should be carefully evaluated and monitored by a qualified healthcare professional.

From the Research

Efficacy of Neurofeedback Therapy for ADHD

• Neurofeedback therapy has been studied as a potential treatment for Attention Deficit Hyperactivity Disorder (ADHD) in several studies 2, 3, 4, 5, 6.
• The evidence suggests that neurofeedback can be an effective treatment for ADHD, with some studies showing significant improvements in attention, impulsivity, and hyperactivity 2, 4, 6.
• A meta-analysis of randomized controlled trials found that neurofeedback had a large effect size for inattention and impulsivity, and a medium effect size for hyperactivity 4.
• Another study found that neurofeedback was associated with significant improvements in ADHD symptoms, including inattention, impulsivity, and hyperactivity, with no adverse side effects 6.
• However, a more recent systematic review and meta-analysis found that neurofeedback did not appear to meaningfully benefit individuals with ADHD, clinically or neuropsychologically, at the group level 5.
• The use of standard neurofeedback protocols and the measurement of processing speed may be important factors in determining the efficacy of neurofeedback for ADHD 5.

Standard Neurofeedback Protocols

• Several standard neurofeedback protocols have been identified as efficacious for ADHD, including theta/beta (TBR), sensori-motor rhythm (SMR), and slow cortical potential (SCP) training 2.
• These protocols have been shown to be specific and efficacious in regulating brain functions in ADHD 2.
• The use of standard protocols may be important in determining the efficacy of neurofeedback for ADHD, as some studies have found that the use of non-standard protocols may be associated with negative results 3.

Limitations and Future Directions

• While the evidence suggests that neurofeedback can be an effective treatment for ADHD, there are several limitations to the current research, including the need for further studies with larger sample sizes and longer follow-up periods 2, 3, 5.
• Additionally, there is a need for more research on the predictors of response to neurofeedback and the optimal treatment protocol for ADHD 3, 5.
• Future studies may focus on using standard neurofeedback protocols, measuring processing speed, and leveraging advances in precision medicine, including neuroimaging technology, to identify individuals with ADHD who may benefit from neurofeedback 5.