Neurofeedback for ADHD: Clinical and Neurophysiological Outcomes

Clinical outcomes of neurofeedback (NF) treatment for ADHD range from minimal to large improvement, generally decreasing with control for nonspecific effects and possibly increasing with standard NF quality. Although high quality multicenter randomized controlled trials (RCT) with semi-active control condition can yield medium to large effects on core symptoms in both parent and (probably blinded) teacher raters, others found smaller blinded effects suggesting more unspecific contributions. Initial meta-analyses reported medium to large NF effects on core symptoms comparable to stimulant effects, particularly for uncontrolled designs without blinded ratings. Recent meta-analyses of RCTs draw a more cautious picture due to reduced NF-effects in probably blinded ratings, but also suggest significant controlled NF effects across raters for standard NF protocols [1]. Raters also differ not only regarding blinding or expectations but also in sensitivity and context. Neurophysiological and learning outcomes reveal partly specific effects of NF, but also nonspecific contributions, and limited direct correlations with outcome. Future work should address sensitive blinded outcomes, learning, transfer and delayed effects, and personalized standard protocols.

[1] S. Cortese et al, 2016. Neurofeedback for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. J Am Acad Child Adolesc Psychiat 55, 444–455.

Disclosure statement: D. Brandeis serves as an unpaid scientific advisor for an EU-funded neurofeedback trial unrelated to the present work.