During a typical neurofeedback session, a patient sits in front of a computer while wearing headgear fitted with electrodes that attach to the scalp. The EEG records brain wave patterns as the patient undergoes a series of interactive training exercises designed to produce and reinforce particular types of brain electrical activity.
Through repetitive training and positive reinforcement, patients try to learn how to generate the desired brain waves automatically. The first randomized controlled study published about neurofeedback for ADHD involved 18 youths, ages 5 to 15, who were not receiving medication or psychotherapy. The investigators randomly assigned nine children to neurofeedback training and the others to a waiting list, which served as a control.
Children who underwent neurofeedback training improved significantly in IQ and in parent ratings of attention. However, because the study did not include a comparison intervention, it provided no control for the benefits of attention training. Parents knew that their children were receiving treatment, so they may have expected the children to improve. Most important, the study did not include data on EEG recordings before and after treatment, and the authors acknowledged that this makes it impossible to determine whether the children improved because neurofeedback altered their brain wave patterns or for some other reason.
The second study involved 20 children, ages 8 to 12, who were all unmedicated. Investigators randomly assigned 15 to neurofeedback training and five to a waiting list control. Before and after the intervention, all children underwent functional MRI scans while performing a task involving attention and response inhibition, to determine which areas of their brains were active. Children who underwent neurofeedback training showed significant improvement on two neuropsychological tests of attention and in parent ratings of attention and hyperactivity.
Intriguingly, following neurofeedback training, their brain scans also revealed increased activation of an area of the cerebral cortex that other research has suggested is underactive in people with ADHD. In contrast, children on the waiting list did not improve on the psychological tests or parent ratings, and their MRIs revealed no change in brain activity. Because this study did not involve a comparison intervention to control for extra therapist attention or skills training, however, the authors concluded that it is possible that the children improved because of the placebo effect, or because of the extra time and attention they received.
The most recent study, conducted by researchers at the University of Gttingen, Germany, was designed to address the weaknesses and criticisms of the earlier research.
The study involved 94 children with ADHD, ages 8 to 12, who were not taking medication. The investigators randomly assigned 59 children to a combined neurofeedback intervention and 35 others to an attention skills training program. This last point is crucial, because it provided a way to control for any benefits gained from therapist time and attention training. The study's primary outcome was improvement in attention and reduced hyperactivity, as rated by parents and teachers using a standard clinical instrument.
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A controlled study of EEG biofeedback as a treatment for attention-deficit disorders. Sheer, D. Biofeedback training of Hz EEG and behavior. Chapter in N. Altshuler Eds.
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