Page "Neurofeedback" Paragraph 9

Some ADHD researchers were unconvinced by the early studies on neurofeedback, including the clinical neuropsychologist, professor of psychiatry, and author of several books on ADHD, Russell Barkley.

Barkley and Loo reviewed the available literature in 2005 on neurotherapy's effectiveness in treating ADHD and concluded that most early studies were uncontrolled case studies, failed to use any control groups, did not use blinded methods to insure that parents, teachers, and clinicians were not aware of treatment assignments of the patients, and thus could have results largely if not entirely due to the placebo effect.

Other studies used improper techniques for statistical analysis of their data and most failed to show if changes occurred in the EEG as a consequence of training which is critical if one is claiming that any resulting improvements in ADHD are due to the training itself.

One also needs to show whether such changes in the EEG were statistically related to the improvements reported in ADHD symptoms.

The authors concluded that evidence for the effectiveness of neurofeedback for ADHD was far from definitive and far more rigorous research was needed.

Subsequent studies of this treatment for ADHD have now been published using larger samples, more appropriate control groups receiving alternative, attention placebo, or even sham neurofeedback control treatments as well as better assessment methods for ADHD symptoms.

These more recent studies along with any early ones using appropriate scientific methods and published through 2010 were recently reviewed by Nicholas Lofthouse, Ph. D. and colleagues and discussed in a separate paper that concluded that neurofeedback was probably efficacious but that the available evidence was hardly conclusive.

Neither of these reviews included the results of his own rigorously conducted randomized trial of neurofeedback against sham feedback reported at a recent scientific meeting that found no benefits of biofeedback compared to the sham control condition.

Of two studies published in 2010-2011 that both used attention placebo or sham control treatment groups, one found evidence of specific treatment effects only on inattention but not hyperactive or impulsive symptoms while the other smaller study found chiefly placebo effects.

A separate meta-analysis by Arns and colleagues in 2009 found a larger magnitude of treatment effects on ADHD symptoms than did the Lofthouse review but this was mainly due to Arns and colleagues including many of the earlier poorly controlled studies that did not meet the methodological requirements for inclusion in the Lofthouse review.

Further research on the benefits of neurofeedback for ADHD is clearly warranted given this history of mixed results, especially in the more recent and better conducted studies.

As Lofthouse and colleagues admonished in their reviews, future research on this treatment needs to employ appropriate sham neurofeedback or other attention-placebo control groups, double-blinded procedures to insure that parents, teachers ( and clinicians reporting on outcomes ) are not aware of treatment group assignment, and measures of ADHD collected both in school and at home to better evaluate the efficacy of this treatment for ADHD.