REVIEW OF: Neurofeedback Collaborative Group, J Am Acad Child Adolesc Psychiatry 2021;60(7):841–855

STUDY TYPE: Randomized controlled trial

Does neurofeedback (NF) reduce symptoms of ADHD? A meta-analysis of small studies demonstrated gains for inattention and hyperactivity-impulsivity that persisted at six-month follow-up (Van Doren J et al, Eur Child Adolesc Psychiatry 2019;28(3):293–305). A randomized controlled trial found that NF was more effective than computerized attention skills training; however, it did not use a standard protocol (Gevensleben H et al, J Child Psychol Psychiatry 2009;50(7):780–789). The authors of the present study wanted to give NF a more thorough test.

In this randomized, double-blind, placebo-controlled trial, researchers assigned 84 children with ADHD to the active NF group and 58 to the control group. Subjects were 7–10 years old, and 111 were male. They were allowed to be on stimulants but no other psychiatric medication.

The treatment group received the theta/beta ratio protocol, one of several NF protocols for ADHD. Control group participants received sham NF. Both groups had a target of 38 treatments and received counseling on sleep and nutrition.

The primary outcome was parent and teacher Conners scores. Both groups had significant improvement from baseline, but there were no statistically significant differences between the active and sham groups at the end of the protocol or at 13-month follow-up.

The authors speculate that both groups may have benefitted from consistent attention to diet and sleep, the EMG biofeedback component that both received, or the reinforcement for an activity requiring attention. They plan to follow up again at 25 months.

Carlat Take

This is the first large-scale randomized clinical trial of NF for ADHD, and the results were disappointing. Some families may try it, but we don’t recommend referring your ADHD patients to this expensive treatment until studies show clearer benefit.