Neurofeedback is also an effective treatment for ADHD, according to a new quantitative review that used benchmark studies to measure efficacy and effectiveness against stimulant medication and behavior therapy.
Neurofeedback treatments for attention deficit hyperactivity disorder (ADHD) are well-established and effective, according to a new study from Applied Psychophysiology and Biofeedback1 that found medium to large effect sizes and remission rates between 32% and 47% with the natural therapy.
Neurofeedback is a non-pharmacological therapy that uses real-time EEG data to help patients train their brains to improve focus, impulse control, and executive function. The use of neurofeedback to treat ADHD has been controversial. The American Psychological Association (APA) has established two constructs for establishing treatment guidelines:
- Treatment Efficacy: the systematic and scientific evaluation of whether a treatment works, with efficacy graded from high (‘efficacious and specific’) to low.
- Effectiveness: a reflection of the applicability, feasibility, and usefulness of the intervention.
For this study, researchers employed a stricter version of these APA guidelines, focusing on efficacy and effectiveness while also factoring in effect-sizes (ES) and remission rates. The study included only recent systematic reviews and meta-analyses with more than two independent randomized controlled trials.
In two meta-analyses, standard neurofeedback protocols demonstrated significant efficacy for parent- and teacher-rated symptoms, with a medium effect size and sustained benefits that lasted at least 6 to 12 months. Four multi-center randomized controlled trials showed that subjects participating in standard neurofeedback protocols experienced significantly superior results compared to semi-active control groups, with medium-large pre-post effect sizes at the end of treatment or during follow-up. Remission rates ranged from 32% to 47%.
Three open-label studies demonstrated similar or better efficacy, suggesting that the effects of neurofeedback translate well into clinical practice. No publication bias was found, and no neurofeedback-specific side effects were reported with this natural ADHD treatment.
These findings relate to standard neurofeedback protocols, not “unconventional” ones, for which significant evidence was not found. Researchers concluded that “it is important that the clinical application of neurofeedback in clinics also more closely follows these recommendations, and that neurofeedback organizations more formally recommend and educate this more strictly.”
1Arns, M., Clark, C.R., Trullinger, M. et al. Neurofeedback and Attention-Deficit/Hyperactivity-Disorder (ADHD) in Children: Rating the Evidence and Proposed Guidelines. Appl Psychophysiol Biofeedback (2020). https://doi.org/10.1007/s10484-020-09455-2
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