Neurofeedback may not be effective in reducing ADHD symptoms

A review of research led by the University of Southampton, King’s College London and the University of Zurich found little evidence that neurofeedback treatment is beneficial for people with attention deficit hyperactivity disorder (ADHD).

Neurofeedback is a non-invasive technique which typically uses electroencephalography (EEG) to measures electrical activity in the brain and provide real-time feedback to the individual.

This approach is proposed as a non-pharmacological alternative (an intervention which isn’t medication) to help people self-regulate ADHD-related brain activity and reduce behavioural symptoms.

The review, published in JAMA Psychiatry, included a meta-analysis of 38 randomised controlled trials (studies in which people are randomly assigned to different groups to test a specific intervention), investigating the outcome effects of neurofeedback treatment in individuals with ADHD.

It focused on trials where reports of symptoms were likely ‘blinded’, meaning the reporters were unaware of who received neurofeedback and who didn’t.

The study found that overall neurofeedback did not significantly reduce ADHD symptoms like inattention and hyperactivity/ impulsivity. It also did not improve cognitive performance, except for a small beneficial effect on the speed participants processed information.

The research was conducted on behalf of the European ADHD Guidelines Group (EAGG).

Dr Sam Westwood, Lecturer in Psychology Education at King’s College London and first author on the paper, said: “Neurofeedback uses real-time feedback of brain activity to train an individual in self-regulating this activity. It has been increasingly generating more interest in recent years, used instead of or alongside medication, however the effectiveness of this intervention for people with ADHD has been unclear. Our meta-analysis of 38 randomised controlled trials, found insufficient evidence to recommend neurofeedback as a front-line treatment for ADHD.”

The researchers also found no differences between neurofeedback and other non-pharmacological treatments, such as physical exercise or cognitive training – although there were few trials investigating these.

There was no evidence for benefits of new neurofeedback such techniques such as functional Magnetic Resonance Imaging (fMRI) and Functional Near Infrared Spectroscopy (fNIRS) neurofeedback.

Professor Samuele Cortese from the University of Southampton was a joint senior author, with Professors Edmund Sonuga-Barke (King’s College London) and Daniel Brandeis (University of Zurich).

Professor Cortese, NIHR Research Professor at University of Southampton and joint senior author, said: “Even though neurofeedback did not lead to clinically meaningful reductions in overall ADHD symptoms, precision medicine and neuroimaging techniques are rapidly advancing. This may help us identify individuals with ADHD who might be more likely to benefit from neurofeedback in the future.”

Professor Sonuga-Barke, Professor of Developmental Psychology, Psychiatry and Neuroscience at King’s College London and joint senior author on the paper, said: “Despite continuing progress in our scientific understanding of ADHD, little has changed for decades in terms of treatment. Effective alternatives to medication as the front-line treatment for core symptoms are still lacking. The development of new, science driven, and more effective non-pharmacological approaches for the treatment of ADHD, therefore remains a priority for our field.”

Neurofeedback for Attention-Deficit/Hyperactivity Disorder (ADHD): A Meta-analysis of Randomized Controlled Trials ‘Blinded’ and Neuropsychological was published in JAMA Psychiatry.