Neurofeedback (NF) is an approach for treating ADHD in which individuals receive real-time feedback on their brainwave activity and taught to alter their typical EEG pattern to one that is consistent with a more focused and attentive state.
While considerable research supports the effectiveness of neurofeedback for many children with ADHD, relatively few studies have directly compared neurofeedback to ADHD medication. Because not all children respond well to medication, and many parents have concerns about medicating their child, more data on how these treatments compare is needed.
A study published recently in Pediatrics International offers just such a comparison.
Participants were 40 children in grades 1–6 newly diagnosed with ADHD. Children were randomly assigned to NF or medication treatment with methylphenidate (MPH), i.e., the generic form of Ritalin. The study was conducted in Thailand and MPH was used because it is the only stimulant approved for use in Thailand.
NF participants completed 2–4 NF training sessions per week over 12 weeks; each session lasted 30 minutes. The focus of training was to suppress theta activity and increase beta activity. All children but one completed the treatment as intended.
Children treated with MPH began on a low dose which was increased weekly until the optimum effect was achieved (how this was determined is not clear). After titrating to the optimum dose, children remained on it for 12 weeks.
To evaluate the impact of each treatment, parents and teachers completed the Vanderbilt ADHD rating scale before treatment began and after it ended. It does not appear that parents or teachers were blind to treatment. Although blinding would have been preferable, because this was comparable for the two groups, the potential confound should be minimized.
In the NF group, parents reported significant reductions in both inattentive and hyperactive-impulsive symptoms. The magnitude of the reduction was moderate.
Teachers reported significantly fewer inattentive, but not hyperactive-impulsive symptoms post-treatment; the reduction in inattentive symptoms was large.
For children treated with MPH, parents and teachers reported significant reductions in both types of symptoms; the magnitude was large and replicates what has been reported in numerous studies.
In addition to core ADHD symptoms, the Vanderbilt includes 8 items where parents and teachers rate children’s academic and behavioral performance; these items are summed to create a total performance score.
For NF treated children, parents reported significant improvement in children’s total performance, as did teachers. For MPH treated children, teachers but not parents reported gains in total performance.
When the impact of NF and MPH were directly compared, teacher ratings indicated that MPH was superior for both inattentive and hyperactive-impulsive symptoms; differences in performance items did not reach significance, but tended to favor MPH.
Based on parents’ report, there was no significant difference between the treatments for either core symptoms or the performance items.
Given results from many prior studies, it is hardly surprising that both NF and MPH were effective in reducing core ADHD symptoms in children.
What this study adds to the literature is clear evidence that at least in the short-term, medication is likely to have a greater impact on symptoms than NF treatment, at least in school. Because many children with ADHD struggle especially at school, this is important to know.
How should these results be used when considering medication vs. NF for treating a child with ADHD? First, although there is reason to expect that both treatments will be helpful, medication treatment would be expected to have a greater impact than NF in the school setting.
Thus, for children whose symptoms are more pronounced, results would appear to favor medication. It is also almost certainly the case that medication would produce these benefits faster then NF, as medication tends to impact symptoms immediately while the benefits of NF would accrue over time.
However, as discussed in a recent issue of Attention Research Update, there is evidence that NF benefits tend to persist after treatment ends, and may even increase over time. With medication, in contrast, treatment needs to be ongoing and sustaining such treatment over an extended time frame can be challenging. Thus, the initial superiority of medication may very well diminish.
Additional head-to-head comparisons of NF and medication treatment over more extended time periods will hopefully become available soon.
– Dr. David Rabiner is a child clinical psychologist and Director of Undergraduate Studies in the Department of Psychology and Neuroscience at Duke University. He publishes the Attention Research Update, an online newsletter that helps parents, professionals, and educators keep up with the latest research on ADHD.
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Effectiveness of neurofeedback versus medication for attention deficit/hyperactivity disorder (Pediatrics International). From the abstract:
- BACKGROUND: Neurofeedback (NF) is an operant conditioning procedure that trains participants to self-regulate brain activity. NF is a promising treatment for attention-deficit/hyperactivity disorder (ADHD), but there have been only a few randomized controlled trials comparing the effectiveness of NF with medication with various NF protocols. The aim of this study was therefore to evaluate the effectiveness of unipolar electrode NF using theta/beta protocol compared with methylphenidate (MPH) for ADHD.
- METHODS: Children with newly diagnosed ADHD were randomly organized into NF and MPH groups. The NF group received 30 sessions of NF. Children in the MPH group were prescribed MPH for 12 weeks. Vanderbilt ADHD rating scales were completed by parents and teachers to evaluate ADHD symptoms before and after treatment. Student’s t‑test and Cohen’s d were used to compare symptoms between groups and evaluate the effect size (ES) of each treatment, respectively.
- RESULTS: Forty children participated in the study. No differences in ADHD baseline symptoms were found between groups. After treatment, teachers reported significantly lower ADHD symptoms in the MPH group (P = 0.01), but there were no differences between groups on parent report (P = 0.55). MPH had a large ES (Cohen’s d, 1.30–1.69), while NF had a moderate ES (Cohen’s d, 0.49–0.68) for treatment of ADHD symptoms.
- CONCLUSION: Neurofeedback is a promising alternative treatment for ADHD in children who do not respond to or experience significant adverse effects from ADHD medication.