Scientific Publications: Neurofeedback & ADHD

For a preliminary understanding of neurofeedback as a treatment for ADHD consider reading the following articles which have been made available to download.

This is (to-date) the largest multi-center randomised study on SCP Neurofeedback (using the THERA PRAX®), in 150 children with ADHD. The study confirms the specific efficacy of SCP neurofeedback on the core symptoms of ADHD compared to a semi-active control group. This demonstrates the feasibility and, above all, the efficacy of SCP neurofeedback in children with ADHD, controlling for specific and unspecific effects.

STREHL U., AGGENSTEINER P., WACHTLIN D., BRANDEIS D., ALBRECHT B., BACH C., BANASCHEWSKI T., BOGEN T., FLAIG-RÖHR A., FREITAG C.M., FUCHSENBERGER Y., GEST S., GEVENSLEBEN H., HERDE L., HOHMANN S., LEGENBAUER T., MARX A.-M., MILLENET S., PNIEWSKI B., ROTHENBERGER A., RUCKES C., WÖRZ S., HOLTMANN M. (2017). NEUROFEEDBACK OF SLOW CORTICAL POTENTIALS IN CHILDREN WITH ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD): A MULTICENTER RANDOMIZED TRIAL CONTROLLING FOR UNSPECIFIC EFFECTS. FRONTIERS IN HUMAN NEUROSCIENCE, 11. DOI=10.3389/FNHUM.2017.00135.

This first meta-analysis on neurofeedback in ADHD demonstrates large effect sizes for the domains of inattention and impulsivity in ADHD. Most of the studies included in this meta-analysis concern ‘standard’ neurofeedback protocols such as Theta/Beta (TBR) or Slow Cortical Potential (SCP) neurofeedback.

Arns, M., de Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: A meta-analysis. Clinical EEG and Neuroscience, 40(3), 180-9. doi:10.1177/155005940904000311

The following review is an update to the above meta-analysis which includes studies published since 2009. Furthermore, this review better contextualises the evaluation of neurofeedback, also discussing differences between various neurofeedback approaches and methodological issues.

Arns, M., Heinrich, H., & Strehl, U. (2014). Evaluation of neurofeedback in ADHD: The long and winding road. Biological Psychology, 95, 108-15. doi:10.1016/j.biopsycho.2013.11.013

The following manuscript demonstrates the results of the ‘individualized’ neurofeedback approach – also called QEEG informed neurofeedback – which is employed within neuroCare Clinics / Brainclinics. This manuscript also summarises how personalization of neurofeedback treatment, both within this study and in an earlier study by an independent group, potentially doubles clinical treatment effects.

Arns, M., Drinkenburg, W. H. I. M., & Kenemans, J. L. (2012). The effects of QEEG-informed neurofeedback in ADHD: An open-label pilot study. Applied Psychophysiology and Biofeedback, 37(3), 171-80. doi:10.1007/s10484-012-9191-4

 

Below are several independent mile-stone studies which have been conducted by independent research groups demonstrating the efficacy of SCP and TBR neurofeedback in the treatment of ADHD

The first study describing SCP Neurofeedback in ADHD:

Heinrich, H., Gevensleben, H., Freisleder, F. J., Moll, G. H., & Rothenberger, A. (2004). Training of slow cortical potentials in attention-deficit/hyperactivity disorder: Evidence for positive behavioral and neurophysiological effects. Biological Psychiatry, 55(7), 772-5. doi:10.1016/j.biopsych.2003.11.013 

A second independent controlled study on SCP neurofeedback in ADHD: 

Strehl, U., Leins, U., Goth, G., Klinger, C., Hinterberger, T., & Birbaumer, N. (2006). Self-regulation of slow cortical potentials: A new treatment for children with attention-deficit/hyperactivity disorder. Pediatrics118(5), e1530-40. doi:10.1542/peds.2005-2478

Two-year follow-up results from this SCP neurofeedback study in ADHD children demonstrating clinical effects are maintained after follow-up:

Gani, C., Birbaumer, N., & Strehl, U. (2008). Long term effects after feedback of slow cortical potentials and of theta-beta-amplitudes in children with attentiondeficit/hyperactivity disorder (ADHD). Int J Bioelectromagn10(4), 209-232. 

The first large multicentre randomized controlled trial demonstrating efficacy of SCP and TBR neurofeedback in ADHD compared with a semi-active control group consisting of attention training:

Gevensleben, H., Holl, B., Albrecht, B., Vogel, C., Schlamp, D., Kratz, O., . . . Heinrich, H. (2009). Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 50(7), 780-9. doi:10.1111/j.1469-7610.2008.02033

The 6-month follow-up data from the above Gevensleben et al. (2009) study demonstrating clinical effects are maintained after 6-month follow-up:

Gevensleben, H., Holl, B., Albrecht, B., Schlamp, D., Kratz, O., Studer, P., . . . Heinrich, H. (2010). Neurofeedback training in children with ADHD: 6-month follow-up of a randomised controlled trial. European Child & Adolescent Psychiatry, 19(9), 715-24. doi:10.1007/s00787-010-0109-5

Clinical results from another multicentre randomized controlled study using TBR neurofeedback from the US with clinical effects sustained after follow-up:

Steiner, N. J., Frenette, E. C., Rene, K. M., Brennan, R. T., & Perrin, E. C. (2014). In-School neurofeedback training for ADHD: Sustained improvements from a randomized control trial. Pediatrics, 133(3), 483-92. doi:10.1542/peds.2013-2059

The first results from a controlled study on SCP neurofeedback in adults with ADHD:

Mayer, K., Blume, F., Wyckoff, S. N., Brokmeier, L. L., & Strehl, U. (2015). Neurofeedback of slow cortical potentials as a treatment for adults with attention deficit-/hyperactivity disorder. Clinical Neurophysiology. doi:10.1016/j.clinph.2015.11.013

Design of the largest multicentre study to date (using TheraPrax) on SCP Neurofeedback in Children with ADHD: Based on conference reports, clinical results are positive and are in the process of being published:

Holtmann, M., Pniewski, B., Wachtlin, D., Wörz, S., & Strehl, U. (2014). Neurofeedback in children with attention-deficit/hyperactivity disorder (ADHD)--a controlled multicenter study of a non-pharmacological treatment approach. BMC Pediatrics14, 202. doi:10.1186/1471-2431-14-202

Comparisons of treatment with neurofeedback with psychostimulant medication:

Two independent RCTs comparing neurofeedback with methylphenidate where nerofeedback demonstrates comparable efficacy as compared to methylphenidate.

Duric, N. S., Assmus, J., Gundersen, D. I., & Elgen, I. B. (2012). Neurofeedback for the treatment of children and adolescents with ADHD: A randomized and controlled clinical trial using parental reports. BMC Psychiatry, 12(1), 107. doi:10.1186/1471-244X-12-107
Meisel, V., Servera, M., Garcia-Banda, G., Cardo, E., & Moreno, I. (2013). Neurofeedback and standard pharmacological intervention in ADHD: A randomized controlled trial with six-month follow-up. Biological Psychology, 94(1), 12-21. doi:10.1016/j.biopsycho.2013.04.015

 

Further reviews on the efficacy of neurofeedback in ADHD

This article reviews the evidence for the efficacy of neurofeedback in psychiatric disorders and also discusses the specific neurofeedback protocols that have been found effective in the treatment of ADHD.

Mayer, K., & Arns, M. (2016). Electroencephalogram Neurofeedback: Application in ADHD and Epilepsy. Psychiatric Annals, 46(10), 594-600.

A review about the efficacy of neurofeedback in ADHD by Gevensleben and colleagues (2012):

Gevensleben, H., Rothenberger, A., Moll, G. H., & Heinrich, H. (2012). Neurofeedback in children with ADHD: Validation and challenges. Expert Review of Neurotherapeutics, 12(4), 447-60. doi:10.1586/ern.12.22

A review about SCP Neurofeedback in ADHD from Mayer, Wyckoff & Strehl:

Mayer, K., Wyckoff, S. N., & Strehl, U. (2013). One size fits all? Slow cortical potentials neurofeedback: A review. Journal of Attention Disorders, 17(5), 393-409. doi:10.1177/1087054712468053

A critical review and meta-analysis by the European ADHD-Guidelines group about neurofeedback in ADHD. This review relied mainly on teacher ratings as more objective indicators for improvement. In consideration of all studies – including some approaches that are known to be ineffective – there were no significant effects based on teacher ratings. However, when limiting the meta-analysis to ‘standard neurofeedback protocols’ as proposed by Arns, Heinrich & Strehl (2014), clinical effects for both parent and teacher rated symptoms were found to be significant, further supporting the neuroCare Group's focus on advocating well-researched neurofeedback protocols such as SCP, TBR and SMR neurofeedback.

Cortese, S., Ferrin, M., Brandeis, D., Holtmann, M., Aggensteiner, P., Daley, D., . . . European ADHD Guidelines Group (EAGG). (2016). Neurofeedback for attention-deficit/hyperactivity disorder: Meta-Analysis of clinical and neuropsychological outcomes from randomized controlled trials. Journal of the American Academy of Child and Adolescent Psychiatry, 55(6), 444-55. doi:10.1016/j.jaac.2016.03.007