Neurofeedback in ADHD Treatment: A Promising Alternative Approach

The article titled “Place of electroencephalographic biofeedback for attention-deficit/hyperactivity disorder” by Laurence M. Hirshberg, published in Expert Review of Neurotherapeutics, discusses the role of electroencephalographic biofeedback (EEG biofeedback or Neurofeedback) in treating Attention-Deficit/Hyperactivity Disorder (ADHD).

Key Points from the Article:

1. Background and Evolution of NF for ADHD: Early research into EEG biofeedback for ADHD had methodological weaknesses, but recent randomized controlled trials have provided substantial, though not conclusive, empirical support. The article also highlights the relevance of functional magnetic resonance imaging (fMRI) feedback and brain–computer interface (BCI) models in this context.

2. Clinical Reality and NF’s Role: A significant percentage of ADHD patients either do not receive or sustain medical treatment. NF is viewed as an evidence-based treatment typically employed when medical treatment fails or is not accepted by the patient.

3. Research and Efficacy: The article mentions over 20 studies involving more than 700 subjects, including nine controlled trials and five randomized controlled trials. These studies generally show statistically significant improvements in ADHD symptoms for experimental groups using NF, with effect sizes similar to those of stimulant medication.

4. Specific Studies and Findings: The article details specific studies, including double-blind sham-treatment control studies, which demonstrate significant improvements in the NF treatment group but not in control groups. Improvements were noted in behavioral measures, cognitive performance, and neurophysiological measures.

5. Durability and Safety of NF: Limited studies on the durability of NF effects show significant maintenance of treatment effects. No lasting adverse effects of NF have been reported in the research literature.

6. Clinical Practice and NF: In clinical practice, NF is often used where medical treatment is insufficient or not aligned with patients’ preferences. It is seen as making a significant clinical contribution by providing treatment to those who would otherwise remain untreated. NF also offers the potential to reduce or eliminate the need for regular medication.

7. Evidence-Based Practice and NF’s Place: The article argues for a balanced approach to evaluating the efficacy of NF, considering various levels of evidence rather than restricting to randomized controlled trials only. NF is viewed as an alternative approach with substantial but not yet conclusive evidence of efficacy.

In summary, the article presents NF as a significant and promising treatment option for ADHD, especially in cases where traditional medical treatments are not effective or preferred. It emphasizes the need for further research to conclusively establish NF’s efficacy and its role in evidence-based clinical practice.