Neurofeedback treatment & ADHD
Dr Shelley Hyman
Neurofeedback is a recently developed method by using the mechanisms of learning to change brainwave activity which can improve overall well-being and performance by giving video or audio feedback. (Lofthouse, McBurnett, Arnold & Hurt, 2011) This form of treatment has been used when children with ADHD do not seem to respond to other forms of treatments such as behavioural or cognitive therapy.
ADHD is characterized by hyperactivity, inattention and impulsivity which are a result of changing wave activity in the brain. If it was possible to alter certain activity in the brain consciously using neurofeedback, it would help improve ADHD patients with their concentration and attention.
Much of the research has shown that neurofeedback is a “promising” form of treatment for children with ADHD and has been considered “clinically meaningful.” A meta-analysis by Arns and colleagues (2009) looked at 15 studies on how neurofeedback can affect the youth with ADHD. Results showed that there was a significant improvement in attention and impulsivity. Many other studies produce similar results. Fuschs and colleagues (2003) conclude that “Neurofeedback was efficient in improving some of the behavioural components of ADHD in children.” Arns and colleagues conclude that Neurofeedback treatment is “effective and specific” when treating ADHD patient.
Long term follow-ups were not undertaken in this meta-analysis however previous research said that “follow-up scores in impulsivity, inattention and hyperactivity were shown to improve even further…” (Strehl and colleagues, 2006) and after a 2 year follow up, “all improvements in behavior and attention turned out to be stable.” (Gani and colleagues, 2008) Having said that, children in the long term may have naturally improved in their ADHD condition which means neurofeedback treatment may have nothing to do with the improvement in attention or impulsivity in the future.
However because Arns and colleagues were unable to address any long term effects, it questions whether it is an effective method of improving attention and concentration skills and whether that is maintained in the future. Also, the improvements in inattention and impulsivity may not generalise to real world skills such as concentration on tasks as that may require more than just attention or impulsivity alone.
Lofthouse and colleagues (2012) reviewed a number of studies and they actually tend to disagree with the meta-analysis by Arns and colleagues. They believed that neurofeedback treatment was only “probably effective” because there may be some bias in the procedure of the studies they reviewed such as not having a double or triple “blind” study – whereby the researcher and those who carry out the experiment were unknown to which group (control or neurofeedback group) the children were assigned to.
The review by Lofthouse and colleagues also mention that there are also many tests and measures involved in neurofeedback, many of which may not give different results for different patients. This may be due to the biases in the sample size of the study and whether it is a “blind” study or not. If future research can resolve this, neurofeedback may be a more reliable treatment as it is able to pinpoint which measures are effective in treating ADHD in children.
Also what is missing between neurofeedback and treating children with ADHD is whether the treating three characteristics – impulsivity, inattention and hyperactivity – individually would improve general concentration skills (which may require other skills) in other settings outside the clinic. So if further research addresses this area, neurofeedback may be seen as a more effective method of improving not only components of ADHD in children but also future developing skills.
Overall, based on the recent reviews and meta-analyses, neurofeedback is not completely effective and is not recommended as the only form of treatment for children with ADHD. It can be considered a “powerful adjunction” to other treatment processes. Although it was considered time consuming and quite costly, recent advances in technology have now lowered the cost considerably and have resulted in very cost effective home-based programs.