Is neurofeedback effective for treating ADHD?
Common treatments for children with ADHD include medication, psychotherapy, and lifestyle changes, but these do not work for everyone. Some approaches — particularly medication — can have unpleasant side effects.
Neurofeedback therapy is noninvasive and does not involve medication. Some practitioners believe that it can help manage symptoms of ADHD. Other names for this treatment are biofeedback and neurotherapy.
Below, learn more about whether this therapy is likely to be effective, what it entails, and some of the risks involved.
What is neurofeedback for ADHD?
Neurofeedback involves having electrodes attached to the head and responding to certain stimuli while special technology shows the person's brainwaves.
In a person with ADHD, the brain may display characteristic patterns of behavior, particularly in the frontal lobe. This area is linked with personality, behavior, and learning.
The functioning of the brain and a person's behavior are connected. Changes in behavior can change the brain, and changes in the brain can change behavior.
Neurofeedback aims to change a person's behavior by changing their brain.
The brain produces measurable electrical signals, or waves. A practitioner of neurofeedback measures these waves, usually with a device called an electroencephalograph (EEG).
There are five types of brain wave: alpha, beta, gamma, delta, and theta. Each has a different frequency, which an EEG can measure.
Some research suggests that people with ADHD have more theta waves and fewer beta waves than people without the disorder. In theory, neurofeedback aims to correct this difference.
What to expect
Before the first neurofeedback session, the practitioner will ask questions about the individual's symptoms, treatment history, and lifestyle.
The individual will continue to provide information about their symptoms before each treatment session, as this will allow the practitioner to track improvements over time.
At the start of each session, the practitioner will attach electrodes running from an EEG machine to the person's head. These will measure brain activity.
The number of electrodes varies depending on the practitioner and the session. The electrodes do not hurt, and they will not deliver an electrical current. They are only there to measure the brain's activity.
When the session begins, a real-time scan of the person's brain waves will show up on a screen.
The practitioner will instruct the person to perform a specific task, expecting the task to alter the brain waves.
Activities might involve a video game or other stimuli that encourage the brain to process information in different ways. There may be music involved, or a single tone, or sounds that suddenly stop and start.
As the brain responds to the stimuli, the feedback on the EEG will show how the stimuli interrupt, change, or increase brain activity.
Readings may show significant changes in the brain's activity from session to session.
Proponents claim that the process can slowly alter the brain's waves, impacting a person's behavior and related symptoms of ADHD.
Does neurofeedback work for ADHD?
Does neurofeedback help with attention and impulsivity, or is this a placebo effect?
There have been mixed findings about the effectiveness of neurofeedback for ADHD.
In 2009, researchers published a meta-analysis that looked at the impact of neurofeedback on the disorder's symptoms. They concluded that neurofeedback may lead to:
- large-scale improvements in impulsivity and inattention
- medium-scale improvements in hyperactivity
The authors suggested that neurofeedback might be "efficacious and specific" treatment for symptoms of ADHD.
They conducted a study in which eight young participants aged 8–15 years underwent 30 sessions of neurofeedback, while six others received fake neurofeedback. Both groups experienced similar changes.
A 2013 review of studies included neurofeedback in a list of interventions that may produce "statistically significant" improvements in symptoms of ADHD.
In a pilot study, also from 2013, researchers compared the effects of neurofeedback with those of stimulants, a widely accepted treatment for ADHD.
Sixteen participants aged 7–16 years took the stimulant drugs, and 16 underwent 30 sessions of neurofeedback over a period of 7–11 months. Participants who took the drugs experienced a reduction in ADHD symptoms, while those who underwent neurofeedback did not.
In 2014, researchers published a meta-analysis of results of five previous studies on neurofeedback and ADHD.
They took into account parent and teacher assessments of children who had undergone the treatment. Overall, parents had reported improvements in impulsivity, inattention, and hyperactivity, but teachers saw improvement only in inattention.
The researchers concluded that neurofeedback might be useful for children with ADHD.
In 2016, authors of a meta-analysis found that well-controlled trials had not provided enough evidence to support neurofeedback as an effective treatment for ADHD. The authors called for further research.
Criticisms of neurofeedback
While some studies have shown promising results, critics point out that several of these studies had design flaws. Flaws in a study can make it hard to prove whether a technique is effective.
Many authors have called for further research. Some researchers have criticized neurofeedback as a moneymaking scam, while others have voiced concern about the lack of guidelines.
Authors of a 2016 study noted that, while neurofeedback is noninvasive, available evidence has not proven its effectiveness. In addition, they wrote:
"It is expensive, time-consuming and its benefits are not long-lasting. Also, it might take months to show the desired improvements."
Is it safe?
Neurofeedback is nonintrusive, and proponents claim that it is safe.
However, adverse side effects can include:
- mental fatigue
- old feelings returning, for example in vivid dreams, before they disappear permanently
- dizziness, nausea, and light sensitivity in people who have experienced head trauma
Cost and insurance
Neurofeedback can be costly.
A 2017 article in Bloomberg Businessweek reported that 30 sessions of 40 minutes each might come to a total of $2,200, plus a $250 initial assessment fee.
It can be difficult to get insurance coverage for neurofeedback therapy, and a person should check with their provider before proceeding.
Making the decision
Neurofeedback is expensive and it can take many sessions to see an improvement. People need to find the right person to do the treatment.
Neurofeedback is painless, and the main drawback may be cost. If other treatments for ADHD have been ineffective, neurofeedback may be worth trying.
Questions to ask a practitioner include:
- How much will treatment cost?
- How do you measure improvements?
- How long should it take to see results?
- How many sessions will I need?
- How long will each session take?
- Is there anything I can do to increase the effectiveness of treatment?
Anyone considering changing their ADHD treatment plan should talk it over with a psychiatrist or another healthcare provider.
Neurofeedback might help relieve the symptoms of ADHD, but it can be expensive and more evidence is needed to prove that it is effective.
Anyone considering neurofeedback should also contact the International Society for Neurofeedback and Research to ensure that the practitioner they have in mind is certified.
I would like to try neurofeedback for my son, who is 9 years old and has a diagnosis of ADHD. How do I make sure I find a suitable practitioner?
To begin with, you should know the qualifications of the practitioner. They should have an appropriate license.
Check with state or local licensure boards, and be sure to verify that they are certified with an appropriate organization, such as the Biofeedback Certification International Alliance.
The practitioner should also be prepared to provide you with a description of what to expect during the treatment as well as the risks and benefits associated with the treatment.Timothy J. Legg, PhD, CRNP Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.