Neurofeedback is a promising non-pharmacologicaltreatment for managing ADHDsymptoms. By training individuals to modulate specific brain wave patterns associated with attention,impulsivity, and hyperactivity, neurofeedback can help improve self-regulation and reduce ADHD symptoms.
This article explores the mechanisms behind neurofeedback, its effectiveness in treating ADHD based on current research, and important considerations for those interested in pursuing this treatment option.
What is neurofeedback?
Neurofeedback, also known as EEG biofeedback or neurotherapy, is a non-invasive treatment that aims to improve brain function through the self-regulation of brain activity.
Neurofeedback is increasingly being used as a treatment option for children and adults with Attention Deficit Hyperactivity Disorder (ADHD) as an alternative or complement to medication.
How does neurofeedback therapy work?
The goal is to teach the individual to modulate their brain activity in a desired direction, such as increasing beta waves (associated with attention and focus) or decreasing theta waves (associated with drowsiness and inattention).
A typical neurofeedback session lasts 30-60 minutes and involves the individual sitting in front of a computer screen while their brain activity is monitored.
The therapist sets specific thresholds for the desired brain wave patterns, and the individual is rewarded when their brain activity meets these thresholds. For example, in a video game-based neurofeedback session, the character may move faster or earn points when the individual’s brain activity is in the desired range.
Over the course of multiple sessions, typically 20-40, the individual learns to recognize and control their brain activity patterns, leading to improved self-regulation and reduced ADHD symptoms.
The therapist may adjust the thresholds and difficulty of the training as the individual progresses to ensure a challenging but achievable experience.
How can neurofeedback be used to treat ADHD?
Children and adults with ADHD often exhibithigher levels of theta waves and lower levels of beta waves compared to neurotypical individuals.This imbalance is thought tocontribute to the inattention, impulsivity, and hyperactivity symptoms characteristic of ADHD.
During neurofeedback training for ADHD, the individual learns to decrease theta wave activity and increase beta wave activity in specific brain regions, such as the central andfrontal lobes. This is typically achieved throughoperant conditioning,where the desired brain wave patterns are reinforced with positive feedback.
The two most common neurofeedback protocols for treating ADHD are theta/beta ratio training and slow cortical potential (SCP) training.
Theta/beta ratio training aims to decrease the ratio of theta to beta waves, while SCP training focuses on teaching the individual to regulate the excitability of theircortex. Both protocolshave been shown to be effectivein reducing ADHD symptoms and improving cognitive function.
How effective is neurofeedback for ADHD?
The effectiveness of neurofeedback for treating ADHD has been investigated in numerous studies, with generally positive results.
A meta-analysisfound that neurofeedback had large effect sizes for reducing inattention and impulsivity symptoms and a medium effect size for hyperactivity. The authors concluded that neurofeedback could be considered an “efficacious and specific” treatment for ADHD.
A more recent meta-analysisinvestigated the long-term effects of neurofeedback for ADHD. The authors found that the improvements in inattention and hyperactivity/impulsivity were maintained at an average follow-up of 6 months after treatment completion. This suggests that neurofeedback may have lasting benefits for individuals with ADHD.
However, it is important to note that not all studies have found significant effects of neurofeedback for ADHD.
Some researchers have arguedthat the positive results may be due to non-specific factors, such as the additional attention and support provided during treatment, rather than the specific effects of neurofeedback on brain activity.
Additionally,some studies have foundthat neurofeedback may be less effective than medication for reducing ADHD symptoms.
Despite these limitations, the overall evidence suggests that neurofeedback can be an effective treatment option for ADHD, particularly for individuals who do not respond well to or cannot tolerate medication.
Further research is needed to establish the optimal neurofeedback protocols and treatment durations for different subgroups of individuals with ADHD.
Considerations and Side Effects
While neurofeedback is generally considered a safe and non-invasive treatment for ADHD, there are some considerations and potential side effects to be aware of.
One of the main limitations of neurofeedback is the time and cost involved. A typical course of treatment may involve 20-40 sessions, each lasting 30-60 minutes, which can be a significant time commitment for families.
Another consideration is that neurofeedback requires active engagement and cooperation from the individual receiving treatment. Children with ADHD may find it challenging to sit still and focus on the training tasks for extended periods, which can impact the effectiveness of the treatment.
Some researchers have suggestedthat combining neurofeedback with other treatments, such as cognitive-behavioral therapy or parent training, may help to address these challenges and improve outcomes.
In terms of side effects, neurofeedback is generally well-tolerated, with few reported adverse events. Some individuals may experience mild side effects such as fatigue, headaches, or sleep disturbances, butthese are typically short-lived and resolve independently.
However, it is important for individuals to work with a qualified and experienced neurofeedback practitioner to minimize the risk of any potential adverse effects.
References
Arns, M., De Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis.Clinical EEG and neuroscience,40(3), 180-189.https://doi.org/10.1177/155005940904000311
Arns, M., Heinrich, H., & Strehl, U. (2014). Evaluation of neurofeedback in ADHD: the long and winding road.Biological psychology,95, 108-115.https://doi.org/10.1016/j.biopsycho.2013.11.013
Arns, M., Conners, C. K., & Kraemer, H. C. (2013). A decade of EEG theta/beta ratio research in ADHD: a meta-analysis.Journal of attention disorders,17(5), 374-383.https://doi.org/10.1177/1087054712460087
Cortese, S., Ferrin, M., Brandeis, D., Holtmann, M., Aggensteiner, P., Daley, D., … & Zuddas, A. (2016). Neurofeedback for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials.Journal of the American Academy of Child & Adolescent Psychiatry,55(6), 444-455.https://doi.org/10.1016/j.jaac.2016.03.007
Enriquez-Geppert, S., Smit, D., Pimenta, M. G., & Arns, M. (2019). Neurofeedback as a treatment intervention in ADHD: current evidence and practice.Current psychiatry reports,21, 1-7.https://doi.org/10.1007/s11920-019-1021-4
Gevensleben, H., Holl, B., Albrecht, B., Vogel, C., Schlamp, D., Kratz, O., Studer, P., Rothenberger, A., Moll, G. H., & Heinrich, H. (2009). Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial.Journal of Child Psychology and Psychiatry, 50(7), 780-789.https://doi.org/10.1111/j.1469-7610.2008.02033.x
Micoulaud-Franchi, J. A., Geoffroy, P. A., Fond, G., Lopez, R., Bioulac, S., & Philip, P. (2014). EEG neurofeedback treatments in children with ADHD: an updated meta-analysis of randomized controlled trials.Frontiers in human neuroscience,8, 906.https://doi.org/10.3389/fnhum.2014.00906
Monastra, V. J., Lynn, S., Linden, M., Lubar, J. F., Gruzelier, J., & La Vaque, T. J. (2006). Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder.Journal of neurotherapy,9(4), 5-34.https://doi.org/10.1007/s10484-005-4305-x
Razoki, B. (2018). Neurofeedback versus psychostimulants in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a systematic review.Neuropsychiatric disease and treatment, 2905-2913.https://doi.org/10.2147/NDT.S178839
Van Doren, J., Arns, M., Heinrich, H., Vollebregt, M. A., Strehl, U., & K. Loo, S. (2019). Sustained effects of neurofeedback in ADHD: a systematic review and meta-analysis.European child & adolescent psychiatry,28(3), 293-305.https://doi.org/10.1007/s00787-018-1121-4
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
