Neurofeedback vs Brain Balance for ADHD Treatment
Neurofeedback is not recommended as a treatment for ADHD based on the highest quality evidence, and "Brain Balance" lacks any credible scientific validation—stimulant medications remain the gold standard first-line treatment with 70-80% response rates and effect sizes of 1.0. 1
Evidence Against Neurofeedback
The most rigorous and recent evidence demonstrates neurofeedback lacks specific therapeutic effects for ADHD:
A 2017 triple-blind randomized controlled trial found neurofeedback was not superior to sham neurofeedback or group psychotherapy for adult ADHD. 2 All three treatments showed equivalent symptom reduction, indicating the improvements reflected nonspecific placebo and psychotherapeutic effects rather than specific EEG training effects.
A 2023 double-blind randomized controlled trial with 25-month follow-up (the longest and most rigorous study to date) confirmed that deliberate down-training of theta-beta ratio produced no specific effects beyond nonspecific treatment effects. 3 While both groups improved substantially (effect sizes >1.4), there was no difference between active neurofeedback and sham control, with only 12% of participants receiving additional neurofeedback after the study period.
The American Academy of Pediatrics' 2019 clinical practice guideline explicitly states that EEG biofeedback has "either too little evidence to recommend" or has "been found to have little or no benefit" for ADHD. 1
Historical Context and Current Status
Earlier guidelines from 2016 classified EEG biofeedback as "probably efficacious" for ADHD treatment 1, but this determination preceded the high-quality blinded trials published in 2017 and 2023 that fundamentally undermined this conclusion.
Neurofeedback's efficacy remains "unknown" according to 2022 guidelines, with only pilot studies using complex whole-brain models as targets, and this approach has been applied in only a few studies. 1
The challenge with neurofeedback is identifying the correct brain features for individuals to control, and many symptoms cannot be localized to single regions but rely on distributed brain networks. 1
Brain Balance: Complete Absence of Evidence
"Brain Balance" is a commercial program lacking any peer-reviewed scientific evidence, randomized controlled trials, or guideline recognition. It does not appear in any medical literature, FDA approvals, or professional society recommendations. This program should be considered a marketing enterprise rather than an evidence-based medical intervention.
What Actually Works: Evidence-Based ADHD Treatment
Stimulant medications (methylphenidate and amphetamines) demonstrate:
- 70-80% response rates in properly titrated patients 1, 4
- Effect sizes of 1.0, the largest among all ADHD treatments 1
- Rapid onset of action within 30 minutes to days 1, 4
- Over 161 randomized controlled trials supporting efficacy 4
Non-stimulant alternatives when stimulants fail or are contraindicated:
- Atomoxetine (effect size 0.7, requires 6-12 weeks for full effect) 1, 5
- Extended-release guanfacine or clonidine (effect size 0.7, particularly useful with comorbid sleep disturbances or tics) 1, 5
Behavioral interventions with established efficacy:
- Parent training in behavior management (PTBM) for children 1
- Cognitive-behavioral therapy for adults, most effective when combined with medication 5
- Combined treatment (medication plus behavioral therapy) offers superior outcomes for ADHD with comorbid conditions 4
Critical Clinical Pitfalls
Do not delay evidence-based treatment (stimulants or behavioral therapy) to pursue unproven interventions like neurofeedback or Brain Balance. Untreated ADHD causes cumulative functional impairment across academic, occupational, and social domains. 1, 6
Do not assume that "non-medication" approaches are inherently safer or preferable. The most rigorous evidence shows neurofeedback's benefits reflect nonspecific psychotherapeutic effects that could be achieved more efficiently through established behavioral treatments. 2, 3
Recognize that neurofeedback is expensive, time-consuming (typically 30-38 sessions over 15 weeks), and lacks long-lasting benefits beyond what sham treatment provides. 2, 7
If families insist on trying neurofeedback despite counseling, ensure they understand it should complement, not replace, evidence-based pharmacotherapy and behavioral interventions. 1