Does Neurofeedback Have a Therapeutic Role in Children with ADHD?

Martin T. Stein, MD reviewing Steiner NJ et al. J Dev Behav Pediatr 2014 Jan.

Neurofeedback was associated with greater improvements than cognitive training or a control condition.

Research is limited on nonpharmacologic treatments for children with attention-deficit/hyperactivity disorder (ADHD). Neurofeedback and cognitive training are two forms of computer-based attention training based on brain plasticity and operant conditioning. Researchers in Boston randomly assigned 104 children in second and fourth grade, who had been diagnosed with ADHD by a pediatrician or psychologist based on DSM-4 criteria, to receive neurofeedback, cognitive training, or a control condition.

Neurofeedback trains patients with electroencephalographic sensors embedded in a bicycle helmet to increase their beta waves (an attentive state) and suppress theta waves (a drowsy state) when viewing their brain waves on a computer screen. Patients learn to alter their brain waves to reinforce a state of attention. Cognitive training involves cognitive exercises that focus on attention and working memory with computer feedback to reinforce correct responses. Both neurofeedback and cognitive training groups received three 45-minute intervention sessions per week in the classroom (total, 40 sessions) under the supervision of a research assistant.

Children with ADHD who received neurofeedback showed significant improvements on standardized parent, teacher, and observer behavior scales in attention, executive function, and motor/verbal off-task behavior, compared with both the control group and the cognitive training group. Children in the cognitive training group showed no improvement compared with the control group. Among the 50% of children who received stimulant medication, the cognitive training and controls groups, but not the neurofeedback group, had significant increases in methylphenidate equivalent doses (mean increase, 8.54, 7.05, and 0.29 mg, respectively) during the study.

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