Meta-Analysis Finds Little Support for Neurofeedback for ADHD
Neurofeedback did not show meaningful clinical or neuropsychological benefit for individuals with attention-deficit/hyperactivity disorder (ADHD), according to results from a systematic review and meta-analysis published in JAMA Psychiatry.
“[A]fter decades of research, we found no group-level evidence supporting neurofeedback as a stand-alone treatment for ADHD,” wrote corresponding author Edmund J. S. Sonuga-Barke, PhD, of King’s College London, in London, England, and study coauthors. “Future studies should therefore weigh the cost and benefits of administering neurofeedback over other treatments.”
The investigation included 38 randomized clinical trials (RCTs) spanning a total 2472 participants between the ages of 5 and 40 years with a clinical ADHD or hyperkinetic syndrome diagnosis. RCTs used “probably blinded” outcomes (“rated by individuals probably or certainly unaware of treatment allocation,” researchers explained) or neuropsychological outcomes to gauge the efficacy of stand-alone neurofeedback for ADHD.
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An analysis of 20 studies involving 1214 participants with probably blinded reports found no significant improvement in ADHD total symptoms with neurofeedback. Researchers reported a standardized mean difference (SMD) of just 0.04.
When analysis was limited to 9 RCTs with well-established standard neurofeedback protocols, however, total ADHD symptoms showed a small but statistically significant improvement with neurofeedback, with a SMD of 0.21, according to the study.
“Results remained similar with adults excluded or when analyses were restricted to RCTs where cortical learning or self-regulation was established,” researchers added.
The meta-analysis also considered neurofeedback’s effect on 5 specific neuropsychological symptoms: attention, inhibition, verbal working memory, visual working memory, and processing speed. Among them, processing speed alone showed a small but significant improvement with neurofeedback, with a SMD of 0.35.
“Future studies seeking to identify individuals with ADHD who may benefit from neurofeedback could focus on using standard neurofeedback protocols, measuring processing speed, and leveraging advances in precision medicine, including neuroimaging technology,” researchers wrote.
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