Neurofeedback may improve cognitive flexibility

Neurofeedback may improve cognitive flexibility in children with epilepsy

Dr Shelley Hyman

Neurofeedback is a non-pharmacological therapy used for the treatment and long-term management of Attention Deficit Hyperactivity Disorder (ADHD). Among children with ADHD, studies have shown neurofeedback provides a sustained effect and is effective in improving executive function. Improvements in executive function can have downstream positive consequences on cognitive flexibility – that is, being mentally flexible and organising one’s behaviour to solve problems.

Neurofeedback may be a promising treatment option for children with ADHD, even if they have epilepsy. This was investigated in a recent study. Bakhtadze and colleagues (2016) aimed to assess the efficacy of neurofeedback on cognitive flexibility in children with ADHD, with and without temporal lobe epilepsy (TLE). 69 children with ADHD aged 9-12 years completed a popular task used to assess cognitive flexibility, the Trail Making Test. Amongst children with ADHD without TLE, 18 children received neurofeedback and 26 children did not. Amongst the 25 children with ADHD and TLE, all children received neurofeedback and they either had lateral TLE or mesial TLE. Regarding the latter, 16 children had hippocampal sclerosis and 9 children had hippocampal atrophy.

The results of this study demonstrated that from before to after neurofeedback, cognitive flexibility significantly improved in children with ADHD with or without epilepsy, except for those with mesial TLE with hippocampal atrophy. Neurofeedback was successful in the former as neurofeedback is known to have an effect on neural networks that support attention, executive function and motor regulation. Neurofeedback was not successful in the latter however, potentially due to the severity of lesions in connections between the hippocampus and other structures of the brain.

It should be noted that the study by Bakhtadze and colleagues (2016) was an initial study with a small number of participants, meaning studies with larger numbers of participants are required in the future. Nevertheless, this study suggests that neurofeedback has the potential to be a successful treatment approach for improving cognitive flexibility inchildren with temporal lobe epilepsy, as long as this is not accompanied with atrophy in the hippocampus.


Sashika de Silva



  • Original article: Backtadze, S., Beridze, M., Geladze, N., Khachapuridze, N., & Bornstein, N. (2016). Effect of EEG Biofeedback on Cognitive Flexibility in Children with Attention Deficit Hyperactivity Disorder With and Without Epilepsy. Applied Psychology and Biofeedback, 41(1), 71-79.
Dr Shelley Hyman

About Dr Shelley Hyman

Senior Clinical Neuropsychologist. BSc (psychol) Hons, MClinNeuropsych, PhD (Med) MAPS CCN. Founder and director of the centre that was founded in 2006.