Neurofeedback and ADHD

ADHD (attention deficit hyperactivity disorder) is a neuro-behavioral disorder characterized by an ongoing pattern of inattention and/or hyperactivity/impulsivity.

Neurofeedback has been used as a treatment for ADHD in clinics for over 40 years, and in some studies, it has even been found to be as effective as medication in treating symptoms of inattention and impulsivity. It can be used together with other treatment options, such as behavioral therapy or medication.

The Neural Imbalance

People with ADHD often have more theta activity than usual and less beta activity than others.

This ADHD-related brainwave dysregulation shows in people with hyperactive/impulsive type ADHD as a need for constant movement. They often fidget, squirm, and struggle to stay seated. While people with inattentive type ADHD often have difficulty sustaining attention, following detailed instructions, and organizing tasks and activities.

The Protocol

Based on meta-analyses and large multicenter randomized controlled trials (RCTs), two frequency neurofeedback protocols have been shown efficacious and specific for ADHD:

  • Theta-beta ratio (TBR) protocol which aims to decrease theta and/or increase beta power in central and frontal locations. The goal is to reduce the high theta-beta ratios, high theta power, and/or low beta power characteristic of children and adults with ADHD.

  • Enhance SMR, which is known to heighten attention and has been applied to improve cognitive performance.

The Evidence

RCTs suggest that 30–40 sessions of TBR neurofeedback are as effective as methylphenidate (a central nervous system stimulant) in alleviating inattentive and hyperactivity symptoms and are even associated with superior post-treatment academic performance (studies by Duric and colleagues, Meisel and colleagues).

In a recent meta-analysis, focusing on long-term maintenance found that after an average 6 months from completion of neurofeedback, the beneficial effects of neurofeedback were superior to semi-active control groups and methylphenidate. These findings demonstrate that whereas medication efficacy diminishes over time, neurofeedback efficacy increases.

Nonetheless, the best evidence for efficacy comes from double-blind placebo-controlled RCTs. One of the largest and most comprehensive such trials is currently being carried out (International Collaborative ADHD Neurofeedback; ICAN; Arnold et al., 2013; 2018; 2019), with conclusive results anticipated soon.


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