Is Neurofeedback an Effective Treatment for ADHD?
By Dr. Mary Rooney, Ph.D.Neurofeedback (also known as EEG biofeedback) is marketed as an alternative treatment for ADHD. Parents who are looking for a medication-free treatment option often hear about neurofeedback and wonder if it can help their child. However, neurofeedback can be expensive, costing between $3,000 - $6,000 for a course of treatment and is often not covered by insurance. It is also time intensive, requiring weekly sessions for a few months or longer. So, before signing your child up for sessions, learn what neurofeedback entails and what the research says about its effectiveness.
What is Neurofeedback?
Neurofeedback is based on the premise that the brain emits different patterns of brain-waves depending on whether a person is in a focused state or a distracted state. The goal of neurofeedback is to train the brain to produce and sustain more brain-waves associated with focus and concentration and fewer brain-waves associated with distraction or daydreaming. Neurofeedback treatment begins with brain mapping. The patient wears a cap lined with electrodes and is instructed to perform cognitive tasks (like simple math or reading). During these tasks a computer program reads the signals transmitted by the electrodes and identifies areas where the brain appears to be underactive or overactive. These areas of brain-wave underactivity or overactivity become the targets of the tailored neurofeedback treatment plan. During weekly treatment sessions the patient wears an electrode cap while playing a video game filled with challenging cognitive tasks. Brain-wave activity is measured, and if the electrode signals indicate that a child or teen has lost focus then the game stops. The game resumes when “focused” brain-wave activity picks up again. The patients goal is to keep the game running without interruption by staying engaged and encouraging sustained “focused” brain-wave activity.
What the Research Says
Unbiased research published by scientists without affiliations with the neurofeedback programs themselves provides the most reliable source of information about the treatment’s effectiveness. Locating results from these studies can be challenging, since the findings are published in academic journals and aren’t always described on the neurofeedback websites that appear in a Google search. A number of randomized controlled trials comparing neurofeedback to ADHD medication treatment and/or a control condition have been published. Some of these studies show that neurofeedback leads to changes in brain-wave patterns and improved performance on computer tasks. However, in studies where medication was included as a comparison treatment, the medication group always outperformed the neurofeedback group. When these studies examined the impact of neurofeedback on the child “real-world” ADHD symptoms at school or at home (rated by teachers and parents), there were no effects or very limited effects on symptoms. In addition, clinical scientists are concerned that there may be a placebo effect. In a recently published meta-analysis researchers combined and analyzed the data from 13 randomized controlled studies of neurofeedback. The results showed that when studies compared neurofeedback to a “sham” or placebo neurofeedback condition, there were no differences in computer task performance or ADHD symptoms between the placebo group and the actual neurofeedback group.1
Being an Educated Consumer
The current research suggests that parents should be cautious about enrolling their children in neurofeedback for ADHD. Of course, there are children who have received neurofeedback whose parents report an improvement in ADHD symptoms, and there are also many children whose parents say they saw no change in symptoms. It is possible that some children do in fact see some benefit. If ADHD medication is not effective or if symptoms that persist even after other evidence-based treatments have been tried, then neurofeedback may be an alternative treatment to explore for your child.
If you choose to seek out neurofeedback treatment, remember that the goal of treatment should be to see “real world” improvement in ADHD symptoms at school and at home and not only improvement on a handful of computer tasks or a change in brain-wave patterns. Ask the neurofeedback practitioner how they will monitor real world symptom improvement. Will they be obtaining rating scales from parents and teachers at regular intervals? Also ask how soon should you expect to see improvement, and at what point should you stop the treatment if there is no observable change in ADHD symptoms or behavior.
Neurofeedback requires a significant investment of time and money. Before enrolling, make sure you have explored evidence-based behavioral treatments and medication options first. Also, consider your child’s specific challenges and look for interventions with proven track records that target the areas where your child needs help the most. These can be academic interventions, social interventions, programs that help kids learn to manage their emotions, or behavioral treatments that target ADHD symptoms specifically. Targeted interventions with a history of proven outcomes are most likely to lead to real-world results for your child or teen with ADHD.
1 Cortese, S., Ferrin, M., Brandeis, D., Holtmann, M., Aggensteiner, P., Daley, D., Santosh, P., Simonoff, E., Stevenson, J., Stringaris, A., Sonuga-Barke, E., on behalf of the European ADHD Guidelines Group (EAGG) (2016). Neurofeedback for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes from Randomized Controlled Trials. J Am Acad Child Adolesc Psychiatry, 55(6), 444-455.
ABOUT DR. MARY ROONEY
Mary Rooney, Ph.D., is a licensed clinical psychologist in the Department of Psychiatry at the University of California San Francisco. Dr Rooney is a researcher and clinician specializing in the evaluation and treatment of ADHD and co-occurring behavioral, anxiety, and mood disorders. A strong advocate for those with attention and behavior problems, Dr. Rooney is committed to developing and providing comprehensive, cutting edge treatments tailored to meet the unique needs of each child and adolescent. Dr. Rooney's clinical interventions and research avenues emphasize working closely with parents and teachers to create supportive, structured home and school environments that enable children and adolescents to reach their full potential. In addition, Dr. Rooney serves as a consultant and ADHD expert to Huntington Learning Centers.
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