The Centers for Disease Control and Prevention (CDC) estimate that in 2011, 11 percent of children in the United States were living with the condition.
Medication, psychotherapy, and lifestyle changes can all relieve symptoms for many children, but they are not effective for everyone and, in some people, the drugs have side effects that the person finds intolerable.
Some parents are reluctant to medicate their children, or they may not have time to attend regular therapy sessions.
For these families, neurofeedback, sometimes called biofeedback or neurotherapy, could be a viable drug-free option for managing symptoms of attention deficit hyperactivity disorder (ADHD).
What is neurofeedback?
Many people with ADHD display differences in brain behavior, particularly in the brain's frontal lobe. The frontal lobe is a brain region linked with personality, behavior, and learning.
Neurofeedback measures the brain's electrical waves. It may be used to treat people with ADHD by training them to use their brains differently.
Brain function and behavior impact each other. Therefore, changes in behavior can change the brain, and changes in the brain can change behavior.
Neurofeedback aims to change behavior by changing the brain.
The brain produces measurable electrical signals. Neurofeedback measures these electrical waves, usually with a device called an electroencephalograph (EEG).
Like other electrical devices, brain waves cycle at specific frequencies. The five different brain waves are alpha, beta, gamma, delta, and theta. They each have different frequencies, and these are measurable by an EEG.
Some research suggests that people with ADHD have too many theta waves, and too few beta waves. Neurofeedback claims to correct this difference by training people with ADHD to use their brains differently.
Neurofeedback practitioners begin by attaching electrodes to the head in order to measure brain activity. This produces an ongoing screen printout of brain waves that can be watched during the session.
Based on brain wave feedback, the neurofeedback provider will instruct the person to perform a specific task.
The process may involve sounds and other stimuli to encourage the brain to process information differently. There might be music or a tone, or sounds that suddenly stop or start.
This approach can interrupt, alter, or amplify brain activity based on feedback from the EEG.
Supporters of neurofeedback claim that this steady feedback can slowly alter brain waves. As brain waves change, so too do the symptoms of ADHD.
The use of neurofeedback is not limited to ADHD. It has been used to treat a range of psychological conditions, and it may help to improve general performance. Studies have suggested that it may help with depression.
Does it work?
Research on the effectiveness of neurofeedback is mixed. In 2009, a meta-analysis involving 467 people with ADHD found medium to large improvements in the symptoms, and suggested that neurofeedback might be "efficacious and specific." A 2013 study indicated that it might reduce symptoms of ADHD.
Studies on neurofeedback's effectiveness in treating people with ADHD are very mixed.
In 2014, parental assessments given in a further meta-analysis indicated that neurofeedback brought improvements in impulsiveness, inattention, and hyperactivity. In the same study, teachers felt that improvements occurred only in inattention.
Neurofeedback appears to improve some symptoms, but the improvement assessments vary according to who is observing.
A larger meta-analysis conducted in 2016 did not conclude that neurofeedback is an effective treatment, and called for further research.
In 2013, researchers compared the effects of neurofeedback with those of stimulants, a widely accepted treatment for ADHD. Sixteen children aged between 7 and 16 years took stimulant drugs, and 16 underwent neurofeedback. Participants who took the drugs experienced a reduction in ADHD symptoms, but those who underwent neurofeedback did not.
A 2011 study looked at how neurofeedback might have a placebo effect. Eight children aged 8 to15 years underwent neurofeedback, and six others received fake neurofeedback. Both groups showed significant improvements in ADHD symptoms, suggesting that the benefits of neurofeedback could be due to a placebo effect.
Criticisms of neurofeedback
Critics of neurofeedback argue that many studies supporting its use have had significant design flaws, making it difficult to prove whether the technique is effective or not. Authors of several studies have called for more research.
In 1990, psychologist Barry L. Beyerstein called neurofeedback a "neuromythology." He argued that the success of neurofeedback was linked to the extent of a recipient's belief that it would work.
Some critics have criticized neurofeedback as a money-making scam. Others argue that there are no accepted neurofeedback protocols.
It is unclear for how long or how frequently a person must undergo neurofeedback to see results. A neurofeedback recipient could be throwing away money, endlessly chasing an improvement that never comes.
What to expect
A person who is going to participate in a neurofeedback session will start by answering a number of questions about their symptoms, treatment history, and lifestyle.
They will continue to provide information about their symptoms before each treatment session, as this will allow the provider to track improvements over time.
During each session, a provider will attach the patient to an EEG machine by placing electrodes on their heads. 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 into the brain.
When the session begins, a real-time scan of the person's brain waves will be visible on a screen. Based on this feedback, the provider will give instructions for adjusting the brain waves.
Activities might involve a video game, music, or listening to a tone.
As the session progresses, this input should change the brain waves. Across sessions, there may be more significant changes in the brain's output. This should translate into changes in thought and behavior.
Making the decision
Neurofeedback is painless, and there is no evidence of negative side effects. If other treatments for ADHD are not effective, neurofeedback may be worth trying.
The primary drawback is cost.
Questions to ask a provider include:
- How much will treatment cost?
- How do you measure improvements?
- How long should it take to see results?
- How many treatment sessions will I need?
- How long will each treatment session take?
- Is there anything I can do to increase the effectiveness of treatment?
It is always a good idea for people to discuss any treatment plan, or change in treatment plan, with a psychiatrist or healthcare provider.
Is neurofeedback safe?
Neurofeedback is nonintrusive and supporters claim that it is safe, although adverse effects are possible.
- mental fatigue
- a return of old feelings, for example, in vivid dreams, before these feelings go away
- dizziness, nausea, and light sensitivity in those who have experienced a head trauma
They also claim that it can change the way the brain works, and yet a neurofeedback practitioner is not a neurosurgeon, and they do not have to be a mental health professional. A person does not need a license to use the equipment.
As of 2009, only around 500 out of an estimated 6,000 practitioners in the U.S. had undergone the recommended 136 hours of training, mentoring and practice. In addition, the Food and Drug Administration (FDA) at that time had only licensed the equipment for the purposes of relaxation, not for the treatment of mental health issues, ADHD, or other conditions.
Some people also find it effective, although this may be due to a placebo effect.
Cost and insurance
It can also be costly. In 2017, an article in Bloomberg Business suggested that 30 sessions of 40 minutes each might cost $2,200, plus a $250 initial assessment fee.
It can be difficult to get insurance coverage for neurofeedback therapy. You should check with your insurance provider first.
Anyone who is considering neurofeedback should first check with the International Society for Neurofeedback and Research (ISNR) to ensure that their practitioner is certified.
Symptoms of ADHD include inattentiveness and hyperactivity.
Symptoms of ADHD can include being easily distracted and struggling to concentrate.
Inattentiveness can lead to:
- Making careless mistakes
- Difficulty concentrating
- Frequently losing things
- Difficulty completing tasks or following through on instructions
- Difficulty listening
- Frequent distraction
- Struggling with tasks that require sustained attention
Hyperactivity can mean:
- Difficulty remaining seated or sitting still, including frequent fidgeting
- Hyperactive behavior such as inappropriately running, climbing, or moving
- Excessive talking and difficulty keeping quiet
- Impatience and restlessness
- Frequently interrupting others or calling out answers to questions
ADHD is classified as a neurodevelopmental disorder in the new edition of the Diagnostic and Statistical Manual of Mental Disorders. Although it is often diagnosed in children, the disorder sometimes continues into adulthood, or in some cases, the diagnosis may not even be made until adulthood.
Children and adults with ADHD may experience frustration, difficulties sustaining relationships, academic challenges, and conflict at work and at home. Sometimes, these issues can lead to depression and underachievement.
There is no cure for ADHD, but psychotherapy, stimulant medications, and some lifestyle changes, such as keeping a regular schedule, may help to relieve symptoms.