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Neurofeedback For ADHD: Is It An Effective Treatment?

Neurofeedback is a practice devised to optimize the electrical activity within a person’s brain a.k.a. adjust their brain waves.  It is based on the premise that abnormal electrical activity in certain regions of the brain may contribute to various psychological conditions and may compromise mental performance.  The goal of neurofeedback is to correct electrical abnormalities based on specific brain regions.

The practice has become a popular Adderall alternative for those diagnosed with ADHD.  The evidence suggesting neurofeedback’s efficacy for the treatment of ADHD is mixed and controversial.  Some experts consider neurofeedback to be a total “sham” intervention, while others consider it a highly-effective standalone and/or adjunct treatment for those with attentional deficits and hyperactivity.

Suggesting that brain waves play absolutely zero role in the symptoms of ADHD is relatively short-sighted.  Brain wave abnormalities are likely one of many neurophysiological correlates associated with ADHD; just part of the bigger picture.  That said, it should be hypothesized that by making calculated adjustments to the brain waves of an individual with ADHD, concentration, attentiveness, and cognitive function may improve.

Neurofeedback for ADHD: The Research

Using neurofeedback among those diagnosed with ADHD attempts to correct electrical abnormalities that may be contributing to this disorder.  It is known that electrical activity can alter neurotransmission and influence a person’s state of consciousness.  Therefore conducting a QEEG (quantitative EEG) to assess the brain waves of an individual with ADHD will help a professional get a better understanding of how the electrical activity may be contributing to reported symptoms.

While it is important to consider the studies of neurofeedback’s efficacy for the treatment of ADHD, it is also necessary to understand that not all practitioners utilize the same neurofeedback protocols and practices.  Therefore it is difficult to suggest whether neurofeedback is effective on a large-scale, mainstream basis.

Evidence suggesting neurofeedback may be effective for ADHD

Below are studies suggesting that neurofeedback is effective or may be effective for the treatment of ADHD (attention-deficit/hyperactivity disorder).

2014: Researchers conducted a random effects meta-analysis of published randomized controlled trials (RCTs).  These trials compared semi-active control and sham-neurofeedback groups to determine whether neurofeedback actually improved ADHD symptoms.  They specifically focused on whether the procedure improved inattentiveness, hyperactivity, and impulsivity in children.

The research incorporated a total of 263 children with ADHD with 146 partaking in neurofeedback.  Based on parental assessments, scores of inattentiveness, hyperactivity, and impulsivity significantly improved following neurofeedback compared to control groups.  Among teachers, reports of improvement were significant in regards to the “inattentiveness” measure compared to controls.

Authors of this meta-analysis concluded that neurofeedback training in children with ADHD has potential to improve symptoms – particularly inattentiveness.

  • Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4230047/

2014: Researchers published a report in 2014 discussing studies of neurofeedback for the treatment of ADHD.  They noted that a meta-analysis in 2009 reported large improvements in the measures of: inattentiveness and impulsivity associated with neurofeedback.  The researchers note that it’s difficult to assess neurofeedback for the treatment of ADHD due to lack of treatment specificity.

While this publication doesn’t suggest that neurofeedback is universally effective, it notes that it can be effective in certain cases.  The authors suggest that training theta/beta and/or SMR should be recommended for future research due to demonstrated specificity.  They note that there’s a need for future controlled, clinical trials with known protocols.

My only problem with this suggestion is that each person with ADHD is different.  One person may have optimal activity at the “Cz” site, but have suboptimal activity elsewhere.  It is important to consider utilizing a QEEG for individualized treatment rather than generalizing a neurofeedback “template” for a large-scale study; the former would likely have a greater chance of success compared to the latter.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/24321363

2012: In a 2012 review of literature, researchers sought out studies regarding the efficacy of neurofeedback for the treatment of ADHD.  They were able to find 3 systematic reviews along with 6 randomized-controlled trials that were not included in the reviews.  The authors of this review noted that most non-randomized, controlled trials demonstrated positive results, but evidence for efficacy diminishes significantly in randomized controlled-trials.

In a comparative analysis of NF with a “sham-NF” (pseudo-neurofeedback), three studies all found no significant differences.  That said, it was suggested that the training protocols utilized may have been suboptimal for all participants.  Researchers from this review conclude that based on the available evidence, neurofeedback does produce brain wave changes, but its efficacy for ADHD is limited based on differing protocols.

They report that the long-term electrical changes as a result of neurofeedback are sustained.  They suggest that neurofeedback is a valid intervention for ADHD, but the evidence supporting its therapeutic efficacy is limited.  It was also suggested that more research needs to be conducted in regards to specific types of neurofeedback training that are utilized.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/22930416

2012: A study published in 2012 highlights the need to tailor neurofeedback treatment to an individual rather than use a generalized protocol.  Researchers analyzed various EEG biomarkers and conducted a pilot study in attempt to personalize neurofeedback treatment.  They hypothesized that by personalizing treatment based on observable biomarkers, treatment outcomes improve.

A total of 21 patients with ADHD were treated with neurofeedback, but prior to the treatment, they had undergone a QEEG (quantitative EEG).  This allowed researchers to determine individualized EEG biomarkers that may be causing their symptoms.  Post-treatment effects on inattentiveness (ATT), hyperactivity/impulsivity (HI), and comorbid depressive symptoms were evaluated.

The effect size was reported as 1.78 for ATT (inattentiveness) and 1.22 for hyperactivity/impulsivity.  It was noted that those receiving SMR training exhibited increases in N200 and P300 brain wave amplitudes.  This pilot study demonstrated the importance of personalizing neurofeedback treatment based on individual QEEG readings.  Perhaps this is why most of the research on neurofeedback is muddied; the researchers aren’t personalizing treatment based on QEEG and are solely using the same (usually SMR/theta) “protocol” for everyone.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/22446998

2011: A study with 35 children that had been diagnosed with ADHD analyzed the effects of neurofeedback training.  The children were ages 6 to 14 years old, consisting of 26 boys and 9 girls.  Researchers utilized a theta/beta protocol for neurofeedback along with a separate form of EMG biofeedback designed to improve forehead muscle relaxation.

A total of 18 participants were assigned to receive neurofeedback and the remaining 17 served as a control group (receiving the EMG biofeedback).  Both the neurofeedback group and the control group engaged in a total of 30 training sessions.  Baseline symptoms were documented with psychological, behavioral, and psychometric rating scales; parents and teachers were involved in the ratings.

Both groups experienced reductions in theta/beta ratios following the 30 sessions.  Parental ratings noted significant improvements in ADHD symptoms, specifically inattentiveness was reduced significantly among those that had received neurofeedback training compared to the control group.  Furthermore, neurofeedback significantly improved attention and reaction time based on psychometric measures.

That said, there was no evidence suggesting that neurofeedback training improved measures of hyperactivity or impulsivity.  In other words, this study is suggesting that children diagnosed with ADHD characterized primarily by inattentiveness may benefit more than those with a greater degree of hyperactivity or impulsivity.  This study implies that some children with ADHD could derive modest benefit from neurofeedback training.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/21842168

2009:  Researchers noted that neurofeedback has been utilized since the 1970s in attempt to reduce symptoms of ADHD.  They note that many practitioners question whether neurofeedback is an evidenced-based treatment or an unproven intervention for ADHD.  The researchers performed a meta-analysis and selected studies of neurofeedback for the treatment of ADHD.

They mentioned that all studies measuring “pre” and “post” symptoms of ADHD discovered a significant effect of neurofeedback on symptoms.  Specifically, they noted that large effect sizes were reported in the reduction of impulsivity and inattention, while a moderate effect was reported for the reduction of hyperactivity.  Authors of this meta-analysis stated that the clinical effects of neurofeedback for the treatment of ADHD can be considered “clinically meaningful.”

It was noted that neurofeedback for the treatment of ADHD can be classified (AAPB/ISNR) as “Efficacious and Specific” (Level 5) with greatest benefit in improving inattentiveness and impulsivity.  While it may not be as effective in reducing hyperactivity, it still was suggested to provide moderate improvement.  This evidence was based off of 3 randomized studies that implemented a “sham” neurofeedback control group – all suggesting neurofeedback is effective.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/19715181

2009: A relatively moderate sized study compared the effects of neurofeedback training with that of a computerized attention skills training program for the treatment of ADHD.  A total of 102 children (ages 8 to 12) diagnosed with ADHD participated in the study.  The children were assigned to either 36 sessions of neurofeedback training or 36 sessions of the computerized attention skills training within two “four week” blocks.

The neurofeedback group received one block of theta/beta training and a second block of slow cortical potential (SCP) training.  ADHD symptoms were assessed pre-treatment, during treatment, and post-treatment with scales such as: the German ADHD rating scale and the FBB-HKS – both of which were completed by parents and teachers.  Results as indicated by parent and teacher ratings suggested that the children receiving neurofeedback experienced significant improvement compared to the control group.

This study suggests that neurofeedback training among children diagnosed with ADHD is superior to a placebo.  While researchers didn’t know the specific effects of neurofeedback treatment, they suggested that it should be considered an effective intervention for those with ADHD.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/19207632

2006: A study from 2006 suggested that 30 sessions of neurofeedback can improve attention, intelligence, and behavior among children with ADHD.  This study  incorporated neurofeedback training with a theta-beta protocol and slow cortical potentials (SCPs).  A total of 38 children were included in the study; 19 of which received “theta-beta” neurofeedback and the other 19 of which received slow cortical potential (SCP) neurofeedback.

All children received 30 initial neurofeedback sessions, with a follow-up training session approximately 6 months after their 30th session.  Participants were analyzed prior to the neurofeedback (at baseline) with measures of: attention, intelligence, and behaviors.  The researchers noted that both groups were successful at voluntarily regulating cortical activity (e.g. self-regulation) in accordance with specific tasks and conditions.

In other words, they were able to shift their brain activity to an ideal state of functioning to match an assigned task.  Both groups were noted to increase IQ and attentional measures – results didn’t differ between groups.  Parent and teacher reports highlighted significant behavioral and cognitive improvements.  The effects of neurofeedback training remained after 6 months, suggesting that multiple neurofeedback protocols (theta-beta or slow cortical potential) can significantly improve ADHD symptoms.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/16869483

2005: An extremely small-scale study consisting of 12 children with ADHD analyzed the effects of neurofeedback training on ADHD symptoms.  All of the children had been diagnosed with ADHD based on the ICD-10 and were aged between 7 and 13.  Symptoms were assessed with the WISC-R, QEEG scans, and Conner’s questionnaire for parents and teachers.

All children participated in 5 months of neurofeedback training with 2 sessions per week.  The protocols were documented as “Biograph/ProComp 2.0.” Following the 5 months of neurofeedback training, the children showed significant changes in their EEG patterns – particularly increased activity within the 16 to 20 Hz range (beta waves) and decreased activity in the 4 to 8 Hz range (theta waves).

Researchers noted that children experienced significantly higher scores on the WISC-R following treatment.  They also were reported as taking better notes in school, experiencing improved social adaptability, and having higher self-esteem.  It was concluded that neurofeedback is a good treatment for children with ADHD, especially due to the fact that it is non-invasive.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/16118616

2004: Many non-pharmaceutical treatments for ADHD remain ineffective, but evidence in support of neurofeedback for symptom reduction is promising.  In 2004, researchers published a review of evidence analyzing neurofeedback for the treatment of ADHD.  They noted that in controlled trials, the short-term effect of neurofeedback were equal to those produced by psychostimulant medication.

It was suggested that neurofeedback improves measures of attention, impulsivity, and hyperactivity with no adverse effects.  In addition, abnormal electrocortical activity normalized among those engaged in neurofeedback, whereas those receiving psychostimulants fail to correct electrocortical abnormalities.  Authors noted that neurofeedback appears to be a promising non-pharmaceutical treatment for ADHD.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/15357015

2003:  In 2003, researchers published a study comparing the efficacy of neurofeedback to a psychostimulant for the treatment of ADHD.  Specifically, a total of 34 children diagnosed with ADHD were set to receive either: 3 months of neurofeedback training OR methylphenidate.  A total of 22 children participated in neurofeedback, while 12 received methylphenidate.

The neurofeedback administered was considered SMR (12 to 15 Hz) or beta (15 to 18 Hz).  Results from the study showed that both neurofeedback and methylphenidate significantly improved all measures according to the “Test of Variables of Attention.”  They also improved speed and accuracy on a D2 Attention Endurance Test.

Behavioral improvements were also reported in both groups by teachers and parents (according to the IOWA-Conners Behavior Rating Scale).  Authors suggested that neurofeedback was effective in improving certain symptoms of ADHD in children and may be a viable alternative treatment to pharmaceutical drugs.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/12737092

Evidence suggesting neurofeedback may be ineffective for ADHD

Below are studies suggesting that neurofeedback is an ineffective intervention for the treatment of ADHD.

2014: In 2014, a study was published analyzing the effect of neurofeedback compared with standardized interventions to enhance neurocognitive functioning among adolescents with ADHD.  Researchers set up a study involving a total of 45 individuals engaged in neurofeedback plus standardized treatment for ADHD and compared them with 26 individuals undergoing solely standardized treatment.  All participants were aged between 12 and 24 years and had been diagnosed with ADHD via DSM-IV criteria.

The participants undergoing neurofeedback completed 37 sessions over 25 weeks.  The type of training was considered theta/sensorimotor (SMR) on the “Cz” site of the brain.  Outcomes were measured with various neurocognitive tests such as the D2 Test of Attention, Digit Span backward, the Stroop Color-Word Test, and the Tower of London.  The study lasted from 2009 to 2012.

Evidence suggested that processing speed had improved among both groups (NF + Standardized treatment group and the standalone Standardized treatment group).  Neither group experienced significant improvement in higher executive functioning.  This study suggests that neurofeedback provides no additional value compared to standard treatments.  The results indicate that theta/SMR at the “Cz” site may not improve neurocognitive performance among adolescents with ADHD.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/24922488

2013: In 2013, researchers conducted a double-blind, randomized, placebo-controlled study to determine the efficacy and safety of neurofeedback in children diagnosed with ADHD.  The study spanned from 2008 to 2012 and consisted of 41 children ages 8 to 15 years old.  Researchers measured ADHD symptoms at baseline (pre-treatment), during treatment, and following the study.

A total of 22 children participated in a neurofeedback treatment, while the remaining 19 children were assigned to receive a “sham” (placebo) neurofeedback.  Both the neurofeedback group and the sham-neurofeedback group participated in 2 sessions per week for a total of 30 sessions.  The ADHD symptoms were determined by the ADHD Rating Scale IV, with the CGI-I (Clinical Global Impressions-Improvement) scale being utilized as a secondary measure.

Results suggested that ADHD symptoms improved over time in both the neurofeedback group and “sham” neurofeedback group according to both the ADHD-RS-IV and the CGI-I.  No significant neurofeedback side effects were observed and it was considered safe.  The authors of the study concluded that EEG neurofeedback was not superior to a placebo for improving ADHD symptoms among children diagnosed with the condition.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/24021501

2013: A pilot study compared the effect of 30 neurofeedback sessions with a stimulant medication to treat ADHD symptoms.  The study consisted of 32 ADHD patients ages 7 to 16 with no history of medication usage.  The patients were randomized to receive either neurofeedback or pharmaceutical treatment; with an even split of 16 participants in each group.

Prior to treatment, ADHD symptom severity was assessed with 2 scales – both of which contained parent and teacher forms.  Neurofeedback training spanned between 7 and 11 months and the same 2 scales were utilized to assess symptom severity.  The primary measure was the “18 symptoms of ADHD” based on the DSM-IV criteria.

Results suggested that outcomes were significantly different between the 16 patients receiving pharmaceutical treatment compared to the 16 receiving neurofeedback.  Specifically, those taking the medication experienced statistically significant symptomatic improvement compared to those engaged in neurofeedback.  Researchers concluded that the research supports usage of pharmaceutical drugs to treat ADHD, but not neurofeedback.

  • Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3779016/

2012:  Researchers published a report in 2012 suggesting that standardized treatments are only effective for 33% of children with ADHD and a large number of children refuse treatment.  They note that a viable alternative to medication may be neurofeedback.  Authors of this publication note that since 2012, data from 8 randomized-controlled trials (RCTs) of neurofeedback have been published.

They note that the mean effect sizes were: 0.42 for ADHD measures, most notably 0.56 for inattentiveness and 0.54 for hyperactivity/impulsivity.  This report notes the fact that benefits from RCTs hasn’t been observed in the blinded studies that have been conducted.  Authors suggest that most neurofeedback research lacks: double-blind testing, large sample sizes, and randomized participant selection.

  • Source: http://www.ncbi.nlm.nih.gov/pubmed/22890816

Based on the research, how should you interpret the efficacy of neurofeedback for ADHD?

Research highlighting (or suggesting) the therapeutic efficacy of neurofeedback for the treatment of ADHD is nearly double the amount suggesting its inefficacy.  That said, the research is limited in that no large scale clinical trials have been conducted.  Results from most studies suggest that neurofeedback is likely to produce some degree of benefit.

While the quality of the studies conducted is far more important than the number of studies conducted, many of the studies suggesting neurofeedback’s efficacy for ADHD have incorporated larger samples and randomized designs than those suggesting a lack of therapeutic efficacy. Multiple meta-analyses suggest that utilizing neurofeedback compared to a pseudo-neurofeedback sham yields clinically significant results for the treatment of ADHD.

Studies suggesting that neurofeedback is ineffective are limited in terms of sample sizes and the fact that they utilize a generalized training protocol rather than one tailored to the individual.  No meta-analyses to date suggest that neurofeedback is likely to be ineffective for the treatment of ADHD.  At this time, most evidence suggests that proper neurofeedback training is likely to yield (at least some) benefit.

Whether the benefit should be considered clinically significant remains unknown and warrants further research.  Various studies have determined that neurofeedback training significantly: reduces inattentiveness, impulsivity, and hyperactivity.  It also has been found to increase intelligence and reduce reaction time.  To imply that neurofeedback is ineffective or “does nothing” is relatively short-sighted and unscientific; it is known that the practice produces lasting changes to the brain waves.

Nonetheless, further research is warranted to confirm the preliminarily touted (or speculative) efficacy of neurofeedback, especially in larger trials.  While many researchers want to test generalized training “protocols” (e.g. SMR/theta training), this strategy should be considered suboptimal.  A more effective neurofeedback training strategy is to personalize sessions based on pre-treatment QEEG recordings – the evidence seems to support QEEG neurofeedback as well.

Due to the fact that each case of ADHD is different, it should not be concluded that a “one size fits all” neurofeedback training approach will provide clinical benefit for everyone; neurofeedback training should be individualized.  Not everyone with ADHD will have the same electrocortical activity and may not need the same protocol (at the same neural site) as others.  At this time, it is logical to conclude that the evidence supporting neurofeedback’s efficacy for the treatment of ADHD outweighs evidence suggesting against its efficacy.

Note: Some believe that neurofeedback can be utilized as a standalone treatment for ADHD, while others think it may be better suited as an adjunct intervention.  The efficacy of neurofeedback for ADHD may also be due to other factors stemming from individual variation such as: age, type of training, and/or ability to understand the training process.

Potential Benefits of Neurofeedback for ADHD

Below is a list of potential benefits that you may derive from neurofeedback if you have ADHD.

  • Attention span: Most studies documenting the efficacy of neurofeedback for individuals with ADHD have found it effective for improving attention. In some studies, the measure of inattentiveness improved more substantially than hyperactivity or impulsivity.  The attentional improvements may result from uptraining faster frequencies (beta waves).
  • Blood flow: It is possible that neurofeedback training alters blood flow to the brain. Perhaps the training increases blood flow to certain regions (e.g. prefrontal cortex), which in turn improves concentration.  There are forms of biofeedback known to increase blood flow (i.e. HEG), but neurofeedback may have similar effects.
  • Brain wave regulation: Neurofeedback can teach you how to consciously “shift” your brain waves. In other words, the training teaches you how to produce more beta waves for tasks requiring more cognitive horsepower.  If you have ADHD, the ability to regulate brain waves improves efficiency of brain functioning and helps you adapt based on environmental demands.
  • Concentration improvement: Many individuals with ADHD are unable to concentrate because their brain is producing too many theta waves. Without neurofeedback training, their brain runs on unconscious autopilot, increasing theta rhythms whenever the person attempts to concentrate.  Theta waves are associated with sleep and day-dreaming – resulting in brain fog.  Neurofeedback can teach a person how to decrease (downtrain) theta when they need to concentrate and increase beta waves.
  • Hyperactivity reduction: The symptom of hyperactivity is generally reduced following neurofeedback training. Researchers speculate that reduced hyperactivity may be a byproduct of a structured “learning” platform that neurofeedback provides.  Additionally, training certain frequencies (e.g. beta) may correct certain hyperactive tendencies as a result of altering arousal.
  • Intelligence boost: One study found that individuals experienced a boost in intelligence following neurofeedback training. Most measures of intelligence are associated with complex thinking and may require beta waves for optimal performance.  Since individuals with ADHD often lack beta waves, they may fail to express their full potential in regards to intelligence.
  • Less reliant on medication: There have been reports suggesting that those engaging in neurofeedback often become less reliant on their ADHD medications. Someone taking a psychostimulant may notice that after they engage in neurofeedback, they no longer need their medication to focus or perform.  By correcting electrical abnormalities, individuals may not require as much pharmaceutical treatment.
  • Neurotransmission: Electrical activity (brain waves) in the brain may influence neurotransmission. High levels of CNS stimulation are associated with increases in beta frequencies and production of stimulatory neurotransmitters like dopamine, norepinephrine, and epinephrine.  By increasing faster brain waves, a cascade effect of increased CNS stimulation and production of stimulatory neurotransmitters may occur – further reducing ADHD symptoms.
  • Reduced impulsivity: It can be speculated that some cases of impulsivity may be linked to deficient fast-wave activity. Adequate beta waves help a person “think” before they act rather than engaging in impulsive behavior.  By correcting excess slow wave activity, impulsivity may be replaced with conscious thinking before acting.

Why it’s difficult to interpret research of neurofeedback for ADHD…

It’s difficult to research neurofeedback for the treatment of ADHD because study designs are inconsistent as is the type of neurofeedback conducted.  In addition, it cannot be assumed that SMR/theta training protocols will be effective for all cases of ADHD; yet most researchers only test this protocol.  Failing to account for individualized differences based on pre-training QEEG recordings is a recipe for poorer outcomes.

  • ADHD evaluation: When testing neurofeedback for the treatment of ADHD, it is important to evaluate ADHD symptoms with the same scale. A good scale to utilize is the ADHD Rating Scale (ADHD-RS).  A considerable amount of research differs in terms of the scales utilized, which may influence outcomes.  Interpreting results based solely upon “parent ratings” and/or “teacher ratings” is not necessarily helpful.
  • Participants: Most participants involved in neurofeedback training for the treatment of ADHD are children. Many reports have suggested that success rates with neurofeedback increase with age.  In other words, those that are younger children may have less success with neurofeedback training than those who are older.  The age variation of participants may skew the results of a study – indicating greater efficacy of those who are older.  This may be due to the fact that neurofeedback requires some effort – younger children may be unable to consciously learn the process.
  • Sample sizes: Most studies analyzing the efficacy of neurofeedback for the treatment of ADHD have small or modest sample sizes. There is a need for studies with large-scale samples to better understand the efficacy of neurofeedback for attention-deficit/hyperactivity disorders.
  • Training protocols: There is significant variation in the neurofeedback protocols utilized for the treatment of ADHD. While the most common protocol administered is the SMR/theta some studies incorporate beta/theta training.  It is also unknown as to whether the neural location of neurofeedback training differs among the studies; it likely does.  Both the “brain waves” and the “neural site” for training necessitate consistency to interpret results.
  • Study designs: Ideally, studies should be randomized, double-blind, and placebo-controlled. Unfortunately the research of neurofeedback for the treatment of ADHD is limited and most studies weren’t designed this way.  Some studies that found neurofeedback effective were not randomized and others were not placebo-controlled.  It’s more difficult to interpret the efficacy when the designs may be flawed.
  • Types of neurofeedback: There are different types of neurofeedback utilized for the treatment of ADHD. Some are designed to help you learn how to consciously regulate brain waves, while others are designed to enhance the efficiency of your nervous system.  Examples include: fMRI neurofeedback, QEEG neurofeedback, and NeurOptimal.

Source: http://www.ncbi.nlm.nih.gov/pubmed/22449216

Why neurofeedback is likely to help those with ADHD…

Although the evidence is inconclusive regarding the efficacy of neurofeedback for the treatment of ADHD, neurofeedback training is very likely to provide benefit.  The reason neurofeedback is beneficial for those with ADHD is due to the fact that it addresses abnormal electrocortical activity (brain waves).  Utilizing a QEEG, a professional can determine electrocortical abnormalities that may be contributing to various ADHD symptoms.

For example, it is common among those with ADHD to produce excessive theta waves when they attempt to concentrate and decreased beta waves.  This leaves a person with slowed cognitive function, inattentiveness, hyperactivity, and impulsivity; they are stuck in a day-dreamy state.  It is also thought that the brain waves may influence neurotransmission and blood flow throughout the brain.

By correcting one component in a complex (individualized) manifestation of ADHD, it is thought that symptoms should improve.  The degree of symptomatic improvement will be subject to significant individual variation – based on the specific neurofeedback training (brain wave protocol and neural sites) and number of sessions.  The correction of brain wave abnormalities in certain regions has potential to (at the very least) reduce some ADHD symptoms.

Correction of brain wave abnormalities via neurofeedback should not be thought of as a cure for ADHD, but may serve as a sustainable long-term non-pharmaceutical treatment for some individuals.  Clearly certain people will get better results with neurofeedback than others, but most will derive marginal benefit from working with a competent QEEG neurofeedback practitioner.

Will neurofeedback cure your ADHD?

Neurofeedback is unlikely to “cure” you of your ADHD – especially if your ADHD is rooted in genetics.  If you developed ADHD as a result of suboptimal lifestyle choices (e.g. diet, behavior, sleep, etc.) – neurofeedback training may correct brain waves caused by poor choices.  The correction of these brain waves may result in you making better lifestyle choices and ultimately healing from your exogenously-induced ADHD.

That said, regardless of whether your ADHD was inherited or induced by complex factors, neurofeedback has potential to alleviate symptoms to a significant extent.  Some people will find the treatment more beneficial than others.  The severity of ADHD, factors influencing its manifestation, and type of neurofeedback may dictate whether you experience significant benefit, moderate benefit, or no benefit at all from training.

Brain waves are just ONE (potential) component of ADHD

It is important to remember that brain waves are just one neurophysiological manifestation of ADHD.  Sometimes it is helpful to target brain wave abnormalities, while other times it may be futile or dangerous.  Determining whether to engage in neurofeedback is a personal decision and should be based heavily on QEEG recordings.

Should an individual have a significantly abnormal QEEG recording – neurofeedback training may provide substantial benefit.  However, if a person’s QEEG appears relatively normal, pharmaceutical interventions such as psychostimulants may provide more benefit.  For other individuals, it may be helpful to target both brain waves via neurofeedback and simultaneously address neurochemicals via pharmaceutical treatment.

Assuming that ADHD is caused solely by brain waves fails to understand the complexity of the condition.  ADHD is likely to have significant heritable genetic influences as well as epigenetic influences.  Understand that correcting overt brain wave abnormalities with neurofeedback could be helpful, but may not completely ameliorate symptoms in every case.

Are all neurofeedback interventions the same for ADHD?

Not all neurofeedback protocols for ADHD should be the same.  In other words, you shouldn’t go to any practitioner that fails to conduct a QEEG prior to treatment.  While certain frequencies and training sites are “safer” than others, you don’t want to “guess” what’s going on under the hood without actually looking.

In order to improve your treatment outcome, you’ll want to work with a professional that conducts a QEEG.  This will show exactly what’s going on with your brain waves when your eyes are “open” and when your eyes are “closed.”  Think of a QEEG as a person’s unique brain wave signature.  If you have ADHD, there’s a chance that your QEEG may be similar to that of another person with ADHD – but this is not guaranteed.

There are many different types of ADHD, each characterized by specific brain waves activity in specific regions.  Therefore, not all neurofeedback treatment should be the same for every person with ADHD.  Your treatment may involve uptraining (increasing) SMR and downtraining (decreasing) theta, while another person’s may involve uptraining gamma or downtraining type-2 beta.

  • Gamma waves: Individuals deficient in gamma waves may experience cognitive deficits and/or retardation.  The less gamma activity a person has, the more difficult it is for them to process information.  Some individuals with ADHD may have deficits in the gamma band and may benefit from uptraining gamma frequencies.
  • Beta waves: Many people with ADHD are deficient in various beta frequencies.  By increasing these frequencies, the person’s ability to focus improves.  That said, in rare cases, a person may have excess beta waves (type-2) in certain regions as a result of hyperarousal.  This hyperarousal may result in poor attentional capacity and cognitive function.
  • Theta waves: A majority of those diagnosed with ADHD produce excess theta waves.  These theta waves result in less conscious thinking, more impulsive reacting, and promote inattentiveness.  Those who are inattentive and prone to daydreaming may have too much theta, particularly in the prefrontal cortex – making it impossible to concentrate.

Can neurofeedback reduce tolerance of ADHD medications?

Some neurofeedback practitioners have suggested that proper neurofeedback training has been noted to reduce the need for ADHD medications.  In other words, these practitioners tell their patients that they may require less of their medication to function.  When the patient takes their normal dose, they may report feeling a more significant “jolt” almost as if their tolerance had been reduced.

Despite claims that neurofeedback reduces tolerance, this isn’t very believable.  However, it is believable that more potent responses occur with medication treatment.  These are likely to stem from the fact that alteration of brain waves among those with ADHD may naturally increase stimulation, focus, and production of certain neurotransmitters.

This increased stimulation, focus, and production of stimulatory neurotransmitters leads to an increased “jolt” from a psychostimulant or other medication.  It’s unlikely that the person’s tolerance had been reduced and more likely that their neurofeedback training is having a synergistic effect with the medication.

Have you used neurofeedback to treat ADHD?

If you’ve engaged in neurofeedback to treat ADHD, feel free to share a comment below documenting your experience.  What was the degree of symptomatic improvement following the neurofeedback sessions?  To help others get a better understanding of your situation, mention whether a QEEG was conducted prior to treatment, the brain region(s) targeted, and the brain waves that were uptrained or downtrained.

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