New research shows: Neurofeedback is an ‘Evidence-Based’ treatment for ADHD.
Nijmegen, July 16th 2009 – Neurofeedback – also called EEG Biofeedback – is a method used to train brain activity in order to normalize Brain function and treat psychiatric disorders. This treatment method has gained interest over the last 10 years, however the question whether this treatment should be regarded as an Evidence-Based treatment was unanswered until now. Tomorrow a study will be published in the scientific journal ‘Clinical EEG and Neuroscience’ demonstrating that Neurofeedback can indeed be regarded as an evidence-based treatment for Attention Deficit- / Hyperactivity Disorder (ADHD).
Neurofeedback is a treatment where real-time feedback is provided for specific brain activity (most often EEG) in order to learn the brain to suppress or produce specific brain activity. This method was initially discovered for the treatment of Epilepsy and from 1976 investigated further for the treatment of ADHD. This technique has become more popular by clinicians worldwide, and is currently provided for the treatment of several disorders. Critics have often questioned the efficacy of Neurofeedback and whether it can be considered an Evidence Based treatment or not.
In collaboration with researchers from Tübingen University (Germany), Radboud University (Nijmegen, the Netherlands), Brainclinics and EEG Resource Institute a so-called meta-analysis was conducted on all published research about Neurofeedback treatment in ADHD. This meta-analysis included 15 studies and 1194 ADHD patients. Based on this study – which will be published in the July issue of Clinical EEG and Neuroscience – it could be concluded that Neurofeedback can indeed be considered an Evidence-Based treatment for ADHD. The results show that neurofeedback treatment has large and clinically significant effects on Impulsivity and Inattention and a modest improvement of Hyperactivity. See below the abstract of this study.
These findings apply to Neurofeedback treatment for ADHD, but do not automatically imply that Neurofeedback can be considered evidence based for any disorder. The efficacy of Neurofeedback has to be assessed separately for each disorder. For example, a meta-analysis of EEG biofeedback in Epilepsy is published in the same issue of EEG and Clinical Neuroscience demonstrating clinical efficacy in the treatment of epilepsy.
Interested clients are advised to make an informed choice regarding Neurofeedback therapists, since there is a large heterogeneity in neurofeedback treatment approaches and clinicians. It is advised to look for psychologists or physicians who are at least a member of a professional organization such as the International Society for Neurofeedback and Research (ISNR: www.isnr.org) or other professional organizations and who use investigated methods.
- Arns, M. (2011). Personalized medicine in ADHD and depression: A quest for EEG treatment predictors. PhD thesis, Utrecht University.
- Arns, M., de Ridder, S., Strehl, U., Breteler, M. & Coenen, A. Efficacy of Neurofeedback Treatment in ADHD: The effects on Inattention, Impulsivity and Hyperactivity: a Meta-Analysis. Clinical EEG and Neuroscience; 40(3), 180-189.
- Arns, M. (2008) Personalized Medicine: Nieuwe ontwikkelingen in de diagnostiek en behandeling van Depressie en ADHD. De Psycholoog, September 2008.
Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: A meta-analysis.
Martijn Arns 1,2,*, Sabine de Ridder 2, Ute Strehl 3, Marinus Breteler 4, 5 & Anton Coenen 5
- 1 Brainclinics Diagnostics, Nijmegen, The Netherlands
- 2 Brainclinics Treatment, Nijmegen, The Netherlands
- 3 University of Tuebingen, Germany
- 4 EEG Resource Institute, Nijmegen, The Netherlands
- 5 Radboud University, Nijmegen, The Netherlands
Since the first reports of neurofeedback treatment in ADHD in 1976 many studies have been carried out investigating the effects of neurofeedback on different symptoms of ADHD such as inattention, impulsivity and hyperactivity. This technique is also used by many practitioners, but the question as to the evidence-based level of this treatment is still unclear. In this study selected research on neurofeedback treatment for ADHD was collected and a meta-analysis was performed.
Both prospective controlled studies and studies employing a pre- and post-design found large effect sizes (ES) for neurofeedback on impulsivity and inattention and a medium ES for hyperactivity. Randomized studies demonstrated a lower ES for hyperactivity suggesting that hyperactivity is probably most sensitive to non-specific treatment factors.
Due to the inclusion of some very recent and sound methodological studies in this meta-analysis potential confounding factors such as small studies, lack of randomization in previous studies and a lack of adequate control groups have been addressed and the clinical effects of neurofeedback in the treatment of ADHD can be regarded as clinically meaningful. Three randomized studies have employed a semi-active control group which can be regarded as a credible sham control providing an equal level of cognitive training and client-therapist interaction. Therefore, in line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude that neurofeedback treatment for ADHD can be considered ‘Efficacious and Specific’ (Level 5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.
Keywords: Neurofeedback, EEG Biofeedback, ADHD, meta-analysis, inattention, impulsivity, hyperactivity.
We wish to acknowledge the following people for providing us with additional information for the meta-analysis : Hartmut Heinrich, Petra Studer, Jochen Kaiser, David Kaiser, Michael Linden, Johanne Lévesque, Martin Holtmann, Ulrike Leins, Domenic Greco, André Achim, Geneviève Moreau and Ali Reza Bakhshayesh. We also wish to acknowledge the support of Desiree Spronk in the preparation of this manuscript.