Neurofeedback is a type of training in which people can learn to control their brain activity. Typically, electroencephalography (EEG) is used to measure the brain's electrical activity and provide real-time feedback to the person. This approach is suggested as an alternative to taking medication to help people self-regulate ADHD-related brain activity and reduce behavioral symptoms. But can neurofeedback actually significantly reduce ADHD symptoms? This question is explored in the review published in the journal JAMA Psychiatry, which was conducted by King's College London, the University of Southampton and the University of Zurich in addition to the Central Institute of Mental Health (CIMH) in Mannheim. The review included a meta-analysis of 38 randomized controlled trials that examined the results of neurofeedback treatment in people with ADHD. Thus, only studies in which people were randomly assigned to a neurofeedback or control group and in which the reports of symptoms were likely to be “blinded”, which means the assessors did not know who received neurofeedback and who did not, were selected.
No significant reduction in core ADHD symptoms
The meta-analysis showed that neurofeedback overall did not significantly reduce core ADHD symptoms such as inattention and hyperactivity/impulsivity, but that classic (“standard”) neurofeedback led to a small improvement in overall symptoms. There was also no improvement in cognitive performance, apart from a small positive effect on the speed with which participants processed information.
“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” says Dr. Sam Westwood, Lecturer in Psychology Education at King's College London and first author on the paper.
No evidence for the benefits of newer neurofeedback techniques
The researchers also found no differences between neurofeedback and other non-pharmacological treatments, such as physical exercise or cognitive training – although there were few studies investigating or comparing these interventions. There was no evidence for the benefits of newer neurofeedback techniques such as functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS).
“Further research would be useful to identify patients who are more likely to learn and respond to neurofeedback,” says Prof. Dr. Daniel Brandeis, head of the Clinical Neurophysiology of Childhood and Adolescence research group at the CIMH and one of the joint senior authors of the study alongside Prof. Edmund Sonuga-Barke (King's College London) and Prof. Samuele Cortese (University of Southampton).
Developing new approaches for treatment
“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,” says Professor Edmund Sonuga-Barke, Professor of Developmental Psychology, Psychiatry and Neuroscience at King's College London.
“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,” said Professor Samuele Cortese, NIHR Research Professor at the University of Southampton.
The research was conducted as part of the European ADHD Guideline Group (EAGG).
Publication:
Westwood SJ, Aggensteiner PM, Kaiser A, Nagy P, Donno F, Merkl D, Balia C, Goujon A, Bousquet E, Capodiferro AM, Derks L, Purper-Ouakil D, Carucci S, Holtmann M, Brandeis D, Cortese S, Sonuga-Barke EJS; European ADHD Guidelines Group (EAGG): Neurofeedback for Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. In: JAMA Psychiatry. 2024 Dec 11. doi: 10.1001/jamapsychiatry.2024.3702. Online ahead of print. PMID: 39661381. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2827733