Neurofeedback for ADHD: Newer Research Casts Doubt on Effectiveness

Neurofeedback is a type of noninvasive, nonmedicinal treatment for certain brain based disorders, including ADHD.  It is based on the fact that individuals with ADHD often have differences in the electrical activity of their brain that can be detected with surface electrodes.  Neurofeedback involves several sessions of training, usually by a psychologist or neurologist, of the patient to use certain techniques to normalize the signals from their brain.  The hope is that they learn to use those techniques to normalize their brain function to prevent symptoms of ADHD.

Side Effects are Minimal

The attractiveness of neurofeedback is that it does not involve medication.  Actually, in the decades of research on neurofeedback (not all on ADHD patients), no major side effects have been found.  Unlike research into supplements, which also often find no major side effects, most clinical trials of neurofeedback have been specifically set up to include an assessment of side effects, so this result is noteworthy.

Is it Effective?  Or Isn’t It?  Will Someone Please Decide?

There are many reasons why scientists still aren’t sure if neurofeedback is effective for ADHD. 

Early trials showed that neurofeedback had a decent effectiveness for ADHD.   Unfortunately, it’s really hard to blind a patient or a parent to whether a child is or is not receiving neurofeedback, since neurofeedback involves measuring brainwaves from external electrodes and watching the signal.    Also, it is difficult to separate the effect of neurofeedback from the effect of working with a psychologist once a week.  So many early trials did not have adequate control groups or blinding.  Most metanalyses of studies of neurofeedback have shown that the effect of neurofeedback gets much smaller, or disappears, once trials with inadequate blinding and controls are thrown out.    In fact, a 2016 metanalysis of 23 studies with adequate blinding and suggested that neurofeedback is ineffective for the treatment of ADHD.

Results of a small recent blinded and controlled study suggested that neurofeedback adds nothing to standard care.  In one trial, neurofeedback seemed to cause patients to be able to normalize certain brainwaves, but the effect did not translate into changes in behaviors.

Fortunately, neurofeedback might still be effective in certain circumstances.  For one thing, neurofeedback isn’t a single kind of treatment.  There are many different protocols for treatment, including ones which use different brainwaves, different schedules, and so on.  Some of these have not been adequately assessed. 

And That’s Not All

Further downsides to treatment with neurofeedback include time and cost.  Neurofeedback often involves weekly visits for 6 months or more.  This is a long time to wait to see if a treatment is going to work, and a lot of time to invest in therapy that might be used for other purposes.

The cost of therapy may or may not be covered by insurance, but like any therapy that is done by a professional over the course of months, the expense builds over time. 

Another issue is that the area of neurofeedback is fairly unregulated.  Providers do not need to be licensed medical or psychological doctors.  Any therapist who is able to offer therapy (such as occupational therapy or speech therapy) for ADHD potentially might be able to offer neurofeedback. 

Who Should Try Neurofeedback for ADHD?

There are enough questions that neurofeedback should not be used to delay starting medication in a patient who needs them.  However, for patients who do not absolutely need medication, for those who cannot tolerate medication, or for those for whom medication has failed to deliver adequate relief, neurofeedback provides a safe alternative with possible effectiveness.

Since neurofeedback is pricey, it is obviously going to be a more workable choice for those with insurance coverage.  It’s also important to have therapy done by someone who understands in depth how it works, and where it fits in the big picture of ADHD treatment.  Because neurofeedback is still poorly understood, a university neurology practice would probably be most qualified.

References:

Micoulaud-Franchi, Jean-Arthur, Pierre Alexis Geoffroy, Guillaume Fond, Régis Lopez, Stéphanie Bioulac, and Pierre Philip. "EEG Neurofeedback Treatments in Children with ADHD: An Updated Meta-analysis of Randomized Controlled Trials." Frontiers in Human Neuroscience. Frontiers Media S.A., 13 Nov. 2014. Web. 19 July 2016.