A Proposed Multisite Double-Blind Randomized Clinical Trial of Neurofeedback for ADHD Neurofeedback in ADHD: a single-blind randomized controlled trial A Randomized Controlled Trial Investigating the Effects of Neurofeedback, Methylphenidate, and Physical Activity on Event-Related Potentials in Children with Attention-Deficit/Hyperactivity Disorder. A randomized controlled trial into the effects of neurofeedback, methylphenidate, and physical activity on EEG power spectra in children with ADHD. A randomized placebo-controlled trial of electroencephalographic (EEG) neurofeedback in children with attention-deficit/hyperactivity disorder. A 6-month follow-up of an RCT on behavioral and neurocognitive effects of neurofeedback in children with ADHD EEG Neurofeedback for ADHD An RCT into the effects of neurofeedback on neurocognitive functioning compared to stimulant medication and physical activity in children with ADHD Neurofeedback and Cognitive Attention Training for Children with Attention-Deficit Hyperactivity Disorder in Schools What future research should bring to help resolving the debate about the efficacy of EEG-neurofeedback in children with ADHD Real‐time fMRI neurofeedback in adolescents with attention deficit hyperactivity disorder Clinical symptoms and performance on the continuous performance test in children with attention deficit hyperactivity disorder between subtypes: a natural follow-up study for 6 months Does EEG-neurofeedback improve neurocognitive functioning in children with attention-deficit/hyperactivity disorder? A systematic review and a double-blind placebo-controlled study. Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. Using a Virtual Classroom environment to describe the attention deficits profile of children with Neurofibromatosis type 1. Neurofeedback, sham neurofeedback, and cognitive-behavioural group therapy in adults with attention-deficit hyperactivity disorder: a triple-blind, randomised, controlled trial. The Effects of Stimulant Therapy, EEG Biofeedback, and Parenting Style on the Primary Symptoms of Attention-Deficit/Hyperactivity Disorder
Objective : Additional treatments with persisting benefit are needed for ADHD . Because ADHD often shows excessive theta electroencephalogram ( EEG ) power , low beta , and excessive theta-beta ratio ( TBR ) , a promising treatment is neurofeedback ( NF ) downtraining TBR . Although several nonblind r and omized clinical trials ( RCTs ) show a medium-large benefit for NF , a well-blinded , sham-controlled RCT is needed to differentiate specific from nonspecific effects . Method : Experts in NF , ADHD , clinical trials , and statistics collaborated to design a double-blind multisite RCT . Results / Conclusion : At four sites , 180 children aged 7 to 10 years with rigorously diagnosed ADHD and TBR ≥ 5 will be r and omized to active TBR-NF versus sham NF of equal duration , intensity , and appearance . Sham , utilizing prerecorded EEGs with participant artifacts superimposed , will keep participants and staff blind . Treatment fidelity will be trained/monitored by acknowledged NF leaders . Multidomain assessment s before , during , and after treatment ( follow-up to 2 years ) will also include tests of blinding and sham inertness Neurofeedback treatment has been demonstrated to reduce inattention , impulsivity and hyperactivity in children with attention deficit/hyperactivity disorder ( ADHD ) . However , previous studies did not adequately control confounding variables or did not employ a r and omized reinforcer-controlled design . This study addresses those method ological shortcomings by comparing the effects of the following two matched biofeedback training variants on the primary symptoms of ADHD : EEG neurofeedback ( NF ) aim ing at theta/beta ratio reduction and EMG biofeedback ( BF ) aim ing at forehead muscle relaxation . Thirty-five children with ADHD ( 26 boys , 9 girls ; 6–14 years old ) were r and omly assigned to either the therapy group ( NF ; n = 18 ) or the control group ( BF ; n = 17 ) . Treatment for both groups consisted of 30 sessions . Pre- and post-treatment assessment consisted of psychophysiological measures , behavioural rating scales completed by parents and teachers , as well as psychometric measures . Training effectively reduced theta/beta ratios and EMG levels in the NF and BF groups , respectively . Parents reported significant reductions in primary ADHD symptoms , and inattention improvements in the NF group were higher compared to the control intervention ( BF , dcorr = −.94 ) . NF training also improved attention and reaction times on the psychometric measures . The results indicate that NF effectively reduced inattention symptoms on parent rating scales and reaction time in neuropsychological tests . However , regarding hyperactivity and impulsivity symptoms , the results imply that non-specific factors , such as behavioural contingencies , self-efficacy , structured learning environment and feed-forward processes , may also contribute to the positive behavioural effects induced by neurofeedback training OBJECTIVE Electroencephalographic ( EEG ) neurofeedback ( NF ) is considered a nonpharmacological alternative for medication in attention-deficit/hyperactivity disorder ( ADHD ) . Comparisons of the behavioral efficacy of NF and medication have produced inconsistent results . EEG measures can provide insight into treatment mechanisms , but have received little consideration . In this r and omized controlled trial ( RCT ) , effects of NF were compared with methylpheni date ( MPH ) , and physical activity ( PA ) in children with ADHD on event-related potential ( ERP ) indices of response inhibition , which are involved in ADHD psychopathology . METHODS Using a multicenter three way parallel group RCT design , 112 children with a Diagnostic and Statistical Manual of Mental Disorders , 4th ed . ( DSM-IV ) ( American Psychiatric Association 1994 ) diagnosis of ADHD , between 7 and 13 years of age , were initially included .  NF training consisted of 30 sessions of theta/beta training at Cz over a 10 week period . PA training was a semiactive control group , matched in frequency and duration . MPH was titrated using a double-blind placebo controlled procedure in 6 weeks , followed by a stable dose for 4 weeks . ERP measures of response inhibition , N2 and P3 , were available for 81 children at pre- and postintervention ( n = 32 NF , n = 25 MPH , n = 24 PA ) . RESULTS Only the medication group showed a specific increase in P3 amplitude compared with NF ( partial eta-squared [ ηp(2 ) ] = 0.121 ) and PA ( ηp(2 ) = 0.283 ) , which was related to improved response inhibition . Source localization of medication effects on P3 amplitude indicated increased activation primarily in thalamic and striatal nuclei . CONCLUSIONS This is the first study that simultaneously compared NF with stimulant treatment and a semiactive control group . Only stimulant treatment demonstrated specific improvements in brain function related to response inhibition . These results are in line with recent doubts on the efficacy and specificity of NF as treatment for ADHD . CLINICAL TRIALS REGISTRATION Train Your Brain ? Exercise and Neurofeedback Intervention for ADHD , https:// clinical trials.gov/show/NCT01363544 , Ref . No. NCT01363544 BACKGROUND The clinical and neurophysiological effects of neurofeedback ( NF ) as treatment for children with ADHD are still unclear . This r and omized controlled trial ( RCT ) examined electroencephalogram ( EEG ) power spectra before and after NF compared to methylpheni date ( MPH ) treatment and physical activity ( PA ) - as semi-active control group - during resting and active ( effortful ) task conditions to determine whether NF can induce sustained alterations in brain function . METHODS Using a multicentre three-way parallel group RCT design , 112 children with a DSM-IV diagnosis of ADHD , aged between 7 and 13 years , were initially included . NF training consisted of 30 sessions of theta/beta training at Cz over a 10-week period . PA training was a semi-active control group , matched in frequency and duration . Methylpheni date was titrated using a double-blind placebo controlled procedure in 6 weeks , followed by a stable dose for 4 weeks . EEG power spectra measures during eyes open ( EO ) , eyes closed ( EC ) and task ( effortful ) conditions were available for 81 children at pre- and postintervention ( n = 29 NF , n = 25 MPH , n = 27 PA ) . CLINICAL TRIALS REGISTRATION Train Your Brain ? Exercise and Neurofeedback Intervention for ADHD , https:// clinical trials.gov/show/;NCT01363544 , Ref . No. NCT01363544 . RESULTS Both NF and MPH result ed in comparable reductions in theta power from pre- to postintervention during the EO condition compared to PA ( ηp ( 2 ) = .08 and .12 ) . For NF , greater reductions in theta were related to greater reductions in ADHD symptoms . During the task condition , only MPH showed reductions in theta and alpha power compared to PA ( ηp ( 2 ) = .10 and .12 ) . CONCLUSIONS This study provides evidence for specific neurophysiological effects after theta/beta NF and MPH treatment in children with ADHD . However , for NF these effects did not generalize to an active task condition , potentially explaining reduced behavioural effects of NF in the classroom OBJECTIVE A double-blind , r and omized , placebo-controlled study was design ed to assess the efficacy and safety of electroencephalographic ( EEG ) neurofeedback in children with attention-deficit/hyperactivity disorder ( ADHD ) . The study started in August 2008 and ended in July 2012 and was conducted at Karakter Child and Adolescent Psychiatry University Centre in Nijmegen , The Netherl and s. METHOD Forty-one children ( aged 8 - 15 years ) with a DSM-IV-TR diagnosis of ADHD were r and omly assigned to treatment with either EEG neurofeedback ( n = 22 ) or placebo neurofeedback ( n = 19 ) for 30 sessions , given as 2 sessions per week . The children were stratified by age , electrophysiologic state of arousal , and medication use . Everyone involved in the study , except the neurofeedback therapist and the principal investigator , was blinded to treatment assignment . The primary outcome was severity of ADHD symptoms on the ADHD Rating Scale IV , scored at baseline , during treatment , and at study end . Clinical improvement as measured by the Clinical Global Impressions-Improvement scale ( CGI-I ) was a secondary outcome . RESULTS While total ADHD symptoms improved over time in both groups ( F1,39 = 26.56 , P < .001 ) , there was no significant treatment effect , ie , group × time interaction ( F1,39 = 0.36 , P = .554 ) ; the same was true for clinical improvement as measured by the CGI-I ( P = .092 ) . No clinical ly relevant side effects were observed . Among the children and their parents , guessing treatment assignment was not better than chance level ( P = .224 for children , P = .643 for parents ) . CONCLUSION EEG neurofeedback was not superior to placebo neurofeedback in improving ADHD symptoms in children with ADHD . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00723684 Abstract To assess the long-term effects of neurofeedback ( NFB ) in children with attention deficit hyperactivity disorder ( ADHD ) , we compared behavioral and neurocognitive outcomes at a 6-month naturalistic follow-up of a r and omized controlled trial on NFB , methylpheni date ( MPH ) , and physical activity ( PA ) .  Ninety-two children with a DSM-IV-TR ADHD diagnosis , aged 7–13 , receiving NFB ( n = 33 ) , MPH ( n = 28 ) , or PA ( n = 31 ) , were re-assessed 6-months after the interventions . NFB comprised theta/beta training on the vertex ( cortical zero ) . PA comprised moderate to vigorous intensity exercises . Outcome measures included parent and teacher behavioral reports , and neurocognitive measures ( auditory oddball , stop-signal , and visual spatial working memory tasks ) . At follow-up , longitudinal hierarchical multilevel model analyses revealed no significant group differences for parent reports and neurocognitive measures ( p = .058–.997 ) , except for improved inhibition in MPH compared to NFB ( p = .040 ) and faster response speed in NFB compared to PA ( p = .012 ) during the stop-signal task . These effects , however , disappeared after controlling for medication use at follow-up . Interestingly , teacher reports showed less inattention and hyperactivity/impulsivity at follow-up for NFB than PA ( p = .004–.010 ) , even after controlling for medication use ( p = .013–.036 ) . Our findings indicate that the superior results previously found for parent reports and neurocognitive outcome measures obtained with MPH compared to NFB and PA post intervention became smaller or non-significant at follow-up . Teacher reports suggested superior effects of NFB over PA ; however , some children had different teachers at follow-up . Therefore , this finding should be interpreted with caution . Clinical trial registration Train your brain and exercise your heart ? Advancing the treatment for Attention Deficit Hyperactivity Disorder ( ADHD ) , Ref . no. NCT01363544 , https:// clinical trials.gov/show/NCT01363544 Objective : Preparing for a definitive r and omized clinical trial ( RCT ) of neurofeedback ( NF ) for ADHD , this pilot trial explored feasibility of a double-blind , sham-controlled design and adherence/palatability/relative effect of two versus three treatments/week . Method : Unmedicated 6- to 12-year-olds with Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . ; DSM-IV ) ADHD were r and omized to active NF versus sham-NF and to 2X versus 3X/week treatment frequency . Frequency switch was allowed after Treatment 24 . Results : In two school years , 39 participants were recruited and 34 ( 87 % ) completed all 40 treatments . Child/parent guesses about assigned treatment were no better than chance . At Treatment 24 , 38 % chose 2X/week and 62 % chose 3X/week . Both active NF and sham yielded large pre – post improvement on parent ratings  but NF no more than sham . Conclusion : Blinding appears to work , and sham does not prevent recruitment/retention . Treatment frequency of 3X/week seems preferred over 2X/week and was as effective . A large double-blind RCT is feasible and necessary to test specific NF effectiveness Neurofeedback ( NFB ) is a potential alternative treatment for children with ADHD that aims to optimize brain activity . Whereas most studies into NFB have investigated behavioral effects , less attention has been paid to the effects on neurocognitive functioning . The present r and omized controlled trial ( RCT ) compared neurocognitive effects of NFB to ( 1 ) optimally titrated methylpheni date ( MPH ) and ( 2 ) a semi-active control intervention , physical activity ( PA ) , to control for non-specific effects . Using a multicentre three-way parallel group RCT design , children with ADHD , aged 7–13 , were r and omly allocated to NFB ( n = 39 ) , MPH ( n = 36 ) or PA ( n = 37 ) over a period of 10–12 weeks . NFB comprised theta/beta training at CZ . The PA intervention was matched in frequency and duration to NFB . MPH was titrated using a double-blind placebo controlled procedure to determine the optimal dose . Neurocognitive functioning was assessed using parameters derived from the auditory oddball- , stop-signal- and visual spatial working memory task . Data collection took place between September 2010 and March 2014 . Intention-to-treat analyses showed improved attention for MPH compared to NFB and PA , as reflected by decreased response speed during the oddball task [ ηp2 = 0.21 , p < 0.001 ] , as well as improved inhibition , impulsivity and attention , as reflected by faster stop signal reaction times , lower commission and omission error rates during the stop-signal task ( range ηp2 = 0.09–0.18 , p values < 0.008 ) . Working memory improved over time , irrespective of received treatment ( ηp2 = 0.17 , p < 0.001 ) . Overall , stimulant medication showed superior effects over NFB to improve neurocognitive functioning . Hence , the findings do not support theta/beta training applied as a st and -alone treatment in children with ADHD Objective : To evaluate the efficacy of 2 computer attention training systems administered in school for children with attention-deficit hyperactivity disorder ( ADHD ) . Method : Children in second and fourth grade with a diagnosis of ADHD ( n = 104 ) were r and omly assigned to neurofeedback ( NF ) ( n = 34 ) , cognitive training ( CT ) ( n = 34 ) , or control ( n = 36 ) conditions . A 2-point growth model assessed change from pre-post intervention on parent reports ( Conners 3-Parent [ Conners 3-P ] ; Behavior Rating Inventory of Executive Function [ BRIEF ] rating scale ) , teacher reports ( Swanson , Kotkin , Agler , M-Flynn and Pelham scale [ SKAMP ] ; Conners 3-Teacher [ Conners 3-T ] ) , and systematic classroom observations ( Behavioral Observation of Students in Schools [ BOSS ] ) . Paired t tests and an analysis of covariance assessed change in medication . Results : Children who received NF showed significant improvement compared with those in the control condition on the Conners 3-P Attention , Executive Functioning and Global Index , on all BRIEF summary indices , and on BOSS motor/verbal off-task behavior . Children who received CT showed no improvement compared to the control condition . Children in the NF condition showed significant improvements compared to those in the CT condition on Conners 3-P Executive Functioning , all BRIEF summary indices , SKAMP Attention , and Conners 3-T Inattention subscales . Stimulant medication dosage in methylpheni date equivalencies significantly increased for children in the CT ( 8.54 mg ) and control ( 7.05 mg ) conditions but not for those in the NF condition ( 0.29 mg ) . Conclusion : Neurofeedback made greater improvements in ADHD symptoms compared to both the control and CT conditions . Thus , NF is a promising attention training treatment intervention for children with ADHD In recent years a rising amount of r and omized controlled trials , review s , and meta-analyses relating to the efficacy of electroencephalographic-neurofeedback ( EEG-NF ) in children with attention-deficit/hyperactivity disorder ( ADHD ) have been published . Although clinical reports and open treatment studies suggest EEG-NF to be effective , double blind placebo-controlled studies as well as a rigorous meta- analysis failed to find support for the efficacy of EEG-NF . Since absence of evidence does not equate with evidence of absence , we will outline how future research might overcome the present method ological limitations . To provide conclusive evidence for the presence or absence of the efficacy of EEG-NF  in the treatment of ADHD , there is a need to set up a well- design ed study that ensures optimal implementation and embedding of the training , and possibly incorporates different forms of neurofeedback Abstract Attention Deficit Hyperactivity Disorder ( ADHD ) is associated with poor self‐control , underpinned by inferior fronto‐striatal deficits . Real‐time functional magnetic resonance neurofeedback ( rtfMRI‐NF ) allows participants to gain self‐control over dysregulated brain regions . Despite evidence for beneficial effects of electrophysiological‐NF on ADHD symptoms , no study has applied the spatially superior rtfMRI‐NF neurotherapy to ADHD . A r and omized controlled trial tested the efficacy of rtfMRI‐NF of right inferior prefrontal cortex ( rIFG ) , a key region that is compromised in ADHD and upregulated with psychostimulants , on improvement of ADHD symptoms , cognition , and inhibitory fMRI activation . To control for region‐specificity , an active control group received rtfMRI‐NF of the left parahippocampal gyrus ( lPHG ) . Thirty‐one ADHD boys were r and omly allocated and had to learn to upregulate their target brain region in an average of 11 rtfMRI‐NF runs over 2 weeks . Feedback was provided through a video‐clip of a rocket that had to be moved up into space . A transfer session without feedback tested learning retention as a proximal measure of transfer to everyday life . Both NF groups showed significant linear activation increases with increasing number of runs in their respective target regions and significant reduction in ADHD symptoms after neurotherapy and at 11‐month follow‐up . Only the group targeting rIFG , however , showed a transfer effect , which correlated with ADHD symptom reductions , improved at trend level in sustained attention , and showed increased IFG activation during an inhibitory fMRI task . This proof‐of‐concept study demonstrates for the first time feasibility , safety , and shorter‐ and longer‐term efficacy  of rtfMRI‐NF of rIFG in adolescents with ADHD . Hum Brain Mapp 38:3190–3209 , 2017 . © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals , Background The aims of this study were to determine the time course of improvements in attention deficit hyperactivity disorder ( ADHD ) clinical symptoms and neurocognitive function in a realistic clinical setting , and the differences in ADHD symptom improvement using different classifications of ADHD subtypes . Methods The Child Behavior Checklist ( CBCL ) was completed by parents of ADHD children at the initial visit . The  computerized Continuous Performance Test ( CPT ) , Swanson , Nolan , and Pelham , and Version IV Scale for ADHD ( SNAP-IV ) , and  ADHD Rating Scale ( ADHD-RS ) were performed at baseline , one month , three months , and six months later , respectively . Patient care including drug therapy was performed at the discretion of the psychiatrist . The ADHD patients were divided into DSM-IV subtypes ( Inattentive , Hyperactive-impulsive and Combined type ) , and were additionally categorized into aggressive and non-aggressive subtypes by aggression scale in CBCL for comparisons . Results There were 50 ADHD patients with a mean age of 7.84 ± 1.64 years ; 15 of them were inattentive type , 11 were hyperactive-impulsive type , and 24 were combined type . In addition , 28 of the ADHD patients were grouped into aggressive and 22 into non-aggressive subtypes . There were significant improvements in clinical symptoms of hyperactivity and inattention , and impulsivity performance in CPT during the 6-month treatment . The clinical hyperactive symptoms were significantly different between ADHD patients sub-grouping both by DSM-IV and aggression . Non-aggressive patients had significantly greater changes in distraction and impulsivity performances in CPT from baseline to month 6 than aggressive patients . Conclusions We found that ADHD symptoms , which included impulsive performances in CPT and clinical inattention and hyperactivity dimensions , had improved significantly over 6 months under pragmatic treatments . The non-aggressive ADHD patients might have a higher potential for improving in CPT performance than aggressive ones . However , it warrant further investigation whether the different classifications of ADHD patients could be valid for predicting the improvements in ADHD patients ' clinical symptoms and neurocognitive performance BACKGROUND The number of placebo-controlled r and omized studies relating to EEG-neurofeedback and its effect on neurocognition in attention-deficient/hyperactivity disorder ( ADHD ) is limited . For this reason , a double blind , r and omized , placebo-controlled study was design ed to assess the effects of  EEG-neurofeedback  on neurocognitive functioning in children with ADHD , and a systematic review on this topic was performed . METHODS Forty-one children ( 8 - 15 years ) with a DSM-IV-TR diagnosis of ADHD were r and omly allocated to EEG-neurofeedback or placebo-neurofeedback treatment for 30 sessions , twice a week . Children were stratified by age , electrophysiological state of arousal , and medication use . Neurocognitive tests of attention , executive functioning , working memory , and time processing were administered before and after treatment . Research ers , teachers , children and their parents , with the exception of the neurofeedback-therapist , were all blind to treatment assignment . Outcome measures were the changes in neurocognitive performance before and after treatment . CLINICAL TRIAL REGISTRATION www . clinical trials.gov : NCT00723684 . RESULTS No significant treatment effect on any of the neurocognitive variables was found . A systematic review of the current literature also did not find any systematic beneficial effect of EEG-neurofeedback on neurocognitive functioning . CONCLUSION Overall , the existing literature and this study fail to support any benefit of neurofeedback on neurocognitive functioning in ADHD , possibly due to small sample sizes and other study limitations BACKGROUND For children with attention deficit/hyperactivity disorder ( ADHD ) , a reduction of inattention , impulsivity and hyperactivity by neurofeedback ( NF ) has been reported in several studies . But so far , unspecific training effects have not been adequately controlled for and /or studies do not provide sufficient statistical power . To overcome these method ological shortcomings we evaluated the clinical efficacy of neurofeedback in children with ADHD in a multisite r and omised controlled study using a computerised attention skills training as a control condition . METHODS 102 children with ADHD , aged 8 to 12 years , participated in the study . Children performed either 36 sessions of NF training or a computerised attention skills training within two blocks of about four weeks each ( r and omised group assignment ) . The combined NF treatment consisted of one block of theta/beta training and one block of slow cortical potential ( SCP ) training . Pre-training , intermediate and post-training assessment encompassed several behaviour rating scales ( e.g. , the German ADHD rating scale , FBB-HKS ) completed by parents and teachers . Evaluation ( ' placebo ' ) scales were applied to control for parental expectations and satisfaction with the treatment . RESULTS For parent and teacher ratings , improvements in the NF group were superior to those of the control group . For the parent-rated FBB-HKS total score ( primary outcome measure ) , the effect size was .60 . Comparable effects were obtained for the two NF protocol s ( theta/beta training , SCP training ) . Parental attitude towards the treatment did not differ between NF and control group . CONCLUSIONS Superiority of the combined NF training indicates clinical efficacy of NF in children with ADHD . Future studies should further address the specificity of effects and how to optimise the benefit of NF as treatment module for ADHD The objectives of this study were to describe the nature of the attention deficits in children with Neurofibromatosis type 1 ( NF1 ) in comparison with typically developing ( TD ) children , using the Virtual Classroom ( VC ) , and to assess the utility of this instrument for detecting attention deficits . Twenty-nine NF1 children and 25 age- and gender-matched controls , aged 8 - 16 , were assessed in a VC . Parents ' ratings on the  Conners ' Parent Rating Scales-Revised : Long ( CPRS-R : L ) question naire were used to screen for Attention Deficit-Hyperactivity Disorder ( ADHD ) . Significant differences were found between the NF1 and the control groups on the number of targets correctly identified ( omission errors ) and the number of commissions ( commission errors ) in the VC , with poorer performance by the NF1 children ( p < 0.005 ) . Significant correlations were obtained between the number of targets correctly identified , the number of commission errors , and the reaction time . Significant correlations were also found between the total correct hits and the cognitive problems/inattention scale , as well as two other indexes of the CPRS-R : L : the DSM-IV Symptoms Subscale and the ADHD Index . The VC results support the hypothesis that NF1 is marked by inattention and impulsivity and that participants with NF1 are more inattentive ( omission errors ) and impulsive ( commission errors ) than normal controls . The VC appears to be a sensitive and ecologically valid assessment tool for use in the diagnosis of attention deficits among children with NF1 BACKGROUND Many studies suggest that electroencephalographic ( EEG ) neurofeedback might be beneficial in the treatment of attention-deficit hyperactivity disorder ( ADHD ) . However , numbers of well controlled studies are low and neurofeedback techniques are regarded as highly controversial . The present trial examined the efficacy ( compared with sham neurofeedback ) and efficiency ( compared with meta-cognitive therapy ) of a st and ard EEG neurofeedback protocol in adults with ADHD . METHODS We did a concurrent , triple-blind , r and omised , controlled trial using authorised deception in adults with ADHD from one centre ( University of Tübingen ) in Tübingen , Germany . Participants were eligible if they fulfilled the DSM-IV-TR criteria for ADHD , were aged between 18 years and 60 years , and had no or stable use of medication for at least 2 months with no intention to change . We excluded participants who had comorbid schizophrenia or schizoaffective disorder , bipolar disorder , borderline personality disorder , epilepsy , or traumatic brain injury ; substance abuse or dependence ; or current or planned other psychological treatment . Those eligible were r and omly assigned to three groups : a neurofeedback group which received 30 verum θ-to-β neurofeedback sessions over 15 weeks , a sham neurofeedback group which received 15 sham followed by 15 verum θ-to-β neurofeedback sessions over 15 weeks , or a meta-cognitive group therapy group which received 12 sessions over 12 weeks . Participants were assigned equally to one of the three interventions through a computerised minimisation r and omisation procedure stratified by sex , age , and baseline symptom severity of ADHD . Participants were masked as to whether they were receiving neurofeedback or sham neurofeedback , but those receiving meta-cognitive therapy were aware of their treatment . Clinical assessors ( ie , those assessing outcomes ) and research staff who did the neurofeedback training were masked to participants ' r and omisation status only for neurofeedback and sham neurofeedback . The primary outcome was symptom score on the Conners ' adult ADHD rating scale , assessed before treatment , at midtreatment ( after 8 weeks ) , after treatment ( after 16 weeks ) , and 6 months later . All individuals with at least one observation after r and omisation were included in the analyses . This trial is registered with Clinical Trials.gov , number NCT01883765 . FINDINGS Between Feb 1 , 2013 , and Dec 1 , 2015 , 761 people were assessed for eligibility . 656 ( 86 % ) were excluded and 118 ( 15 % ) were eligible for participation in this study . Eligible participants were r and omly assigned to neurofeedback ( 38 [ 32 % ] ) , sham neurofeedback ( 39 [ 33 % ] ) , or meta-cognitive therapy ( 41 [ 35 % ] ) . 37 ( 97 % ) individuals for neurofeedback , 38 ( 97 % ) for sham neurofeedback , and 38 ( 93 % ) for meta-cognitive therapy were included in analyses . Self-reported ADHD symptoms decreased substantially for all treatment groups ( B=-2·58 [ 95 % CI -3·48 to -1·68 ] ; p<0·0001 ) between pretreatment and the end of 6 month follow-up , independent of treatment condition ( neurofeedback vs sham neurofeedback B=-0·89 [ 95 % CI -2·14 to 0·37 ] , p=0·168 ; neurofeedback vs meta-cognitive therapy -0·30 [ -1·55 to 0·95 ] , p=0·639 ) . No treatment-related or trial-related serious adverse events were reported . INTERPRETATION Our findings suggest that neurofeedback training is not superior to a sham condition or group psychotherapy . All three treatments were equivalently effective in reducing ADHD symptoms . This first r and omised , sham-controlled trial did not show any specific effects  of neurofeedback  on ADHD symptoms in adults . FUNDING German Research Foundation One hundred children , ages 6–19 , who were diagnosed with attention-deficit/hyperactivity disorder ( ADHD ) , either inattentive or combined types , participated in a study examining the effects of Ritalin , EEG biofeedback , and parenting style on the primary symptoms of ADHD . All of the patients participated in a 1-year , multimodal , outpatient program that included Ritalin , parent counseling , and academic support at school ( either a 504 Plan or an IEP ) . Fifty-one of the participants also received EEG biofeedback therapy . Posttreatment assessment s were conducted both with and without stimulant therapy . Significant improvement was noted on the Test of Variables of Attention ( TOVA ; L. M. Greenberg , 1996 ) and the Attention Deficit Disorders Evaluation Scale ( ADDES ; S. B. McCarney , 1995 ) when participants were tested while using Ritalin . However , only those who had received EEG biofeedback sustained these gains when tested without Ritalin . The results of a Quantitative Electroencephalographic Scanning Process ( QEEG-Scan ; V. J. Monastra et al. , 1999 ) revealed significant reduction in cortical slowing only in patients who had received EEG biofeedback . Behavioral measures indicated that parenting style exerted a significant moderating effect on the expression of behavioral symptoms at home but not at school
Conclusions : This meta- analysis of EEG-NF in children with ADHD highlights improvement in the inattention dimension of ADHD symptoms .
Objective : We undertook a meta- analysis of published R and omized Controlled Trials ( RCT ) with semi-active control and sham-NF groups to determine whether Electroencephalogram-neurofeedback ( EEG-NF ) significantly improves the overall symptoms , inattention and hyperactivity/impulsivity dimensions for probably unblinded assessment ( parent assessment ) and probably blinded assessment ( teacher assessment ) in children with Attention Deficit Hyperactivity Disorder ( ADHD ) .