Evidence Base for Neurofeedback to Become a Reimbursable Service

Evidence Base for Neurofeedback to Become a Reimbursable Service

Posted on: February 2nd, 2018 by Neurohealth Associates

The International Society for Neurofeedback and Research is by and large one the leading authorities on research information. The following extract is from a 8-year long study.

ADHD is the most frequently diagnosed pediatric behavioral health disorder with 11% of American school-aged children (and nearly 20% of all high school boys) having been medically diagnosed with ADHD according to the latest report from the Centers for Disease Control and Prevention. Stimulant medication and behavior therapy (BT) are the two most widely accepted treatments for ADHD and these treatments are commonly reimbursed by healthcare insurers. While both are considered to meet the highest standards for the ‘evidence-based treatment’ of ADHD, and been recognized as such by the American Academy of Child and Adolescent Psychiatry and CHADD, the leading ADHD advocacy group, the actual evidence is that these treatments fail to result in sustained benefit for the vast majority of children who receive them as demonstrated in the NIMH-funded MTA Cooperative study, the gold standard study in ADHD treatment effectiveness research. As documented by the eight-year long NIMH-funded MTA Cooperative study, optimal versions of stimulant medication and BT failed to result in sustained benefit for the majority of children. Surprisingly, in this study’s 22-month follow-up assessment of the currently recognized best treatments for ADHD, no sustained benefit was evident for any of these treatments as compared to those ADHD children who had simply been referred to community-based professionals and may or may not have actually followed through with treatment from them. Even after 14 months of free intensive multi-component behavior therapy combined with systematic medication management followed by referral to community-based treatment professionals for continuing care, ADHD was found to be an ongoing debilitating illness and the societal costs that are associated with it included 10.4% of such ‘optimally-treated’ children requiring psychiatric hospitalization one or more times during follow-up. The psychiatric hospitalization rate for those receiving intensive multi-component behavior therapy without medication was even higher at 12.3% compared to only 8.3% of those who had simply been referred to community-based professionals. The MTA study results dramatically demonstrate that more effective treatments for ADHD are desperately needed and as such treatments are identified, they warrant reimbursement by healthcare insurers to improve outcomes for ADHD children and their families.

NFB is an evidence-based treatment for ADHD that has been built on the combination of basic neuroscience research and operant conditioning thanks to the pioneering efforts of neuroscientists such as Maurice Sterman and Joel Lubar. Building on Sterman’s research, in 1976 Lubar and Bahler published a study demonstrating SMR training’s effectiveness with 8 severely epileptic subjects, 25 one of whom was a boy with a co-occurring diagnosis of hyperkinetic syndrome (aka: ADHD) whose excess motor activity significantly decreased during treatment. 40 Due to the known effects from animal studies of the functional relationship between SMR training and motor inhibition, combined with this serendipitous finding, Lubar and Shouse conducted a study of SMR training with 4 boys diagnosed with hyperkinetic syndrome with no other comorbid disorders. 41,42 The study used a within subject reversal design to assess the impact of SMR training on ADHD’s core symptoms with both the subjects and raters blind to the experimental conditions thereby minimizing the possible role of extraneous factors on the observed outcomes. When NFB was used to increase SMR (reward increased 12-14 Hz & decreased 4-7Hz over the sensory motor cortex), the rate of SMR increased and the subjects’ core ADHD symptoms decreased. These improvements were reversed during the counterconditioning phase when NFB was used to decrease SMR (reward decreased 12-14 Hz & increased 4-7Hz) with the subjects’ rate of SMR decreasing and ADHD symptoms increasing. The improvement in core ADHD symptoms returned when SMR training was reintroduced and these gains in classroom behavior were maintained when Ritalin was withdrawn in the final phase of the study

In addition to our review of the evidence, a 2012 meta-analysis published in the Journal of Attention Disorders found NFB to be more than twice as effective in treating the core symptoms of ADHD with an average weighted effect size of .21 compared to effect sizes of only .09 or less for the other six treatments with working memory training, behavior modification, school-based behavior therapy, behaviorally-based parent training, and behavioral self-monitoring treatments having negative effect sizes compared to the control group conditions. The negative effect size findings prompted the authors to conclude that these five commonly-utilized—and often insurance reimbursed—treatments for ADHD “cannot be deemed to be efficacious.” This analysis did not even include four rigorously controlled NFB studies, each finding NFB to be a highly effective treatment for ADHD and involving a total of 301 ADHD child and adolescent subjects, because these studies were published after the cutoff date for study inclusion. Furthermore in October 2012, PracticeWise, the company that maintains the American Academy of Pediatrics’ ranking of research support for child and adolescent psychosocial treatments, awarded biofeedback/neurofeedback the highest level of evidence-based support for the treatment of ADHD.

Read the full study on the ISNR Website

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