Skip to main content

Advertisement

SpringerLink
Log in

Neurofeedback in ADHD: a single-blind randomized controlled trial

  • Original Contribution
  • Published:
European Child & Adolescent Psychiatry Aims and scope Submit manuscript

Abstract

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 randomized reinforcer-controlled design. This study addresses those methodological shortcomings by comparing the effects of the following two matched biofeedback training variants on the primary symptoms of ADHD: EEG neurofeedback (NF) aiming at theta/beta ratio reduction and EMG biofeedback (BF) aiming at forehead muscle relaxation. Thirty-five children with ADHD (26 boys, 9 girls; 6–14 years old) were randomly 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, d corr = −.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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Doepfner M (2002) Hyperkinetische Störungen. In: Esser G (ed) Lehrbuch der klinischen Psychologie und Psychotherapie des Kindes- und Jugendalters, pp 172–196. Thieme, Stuttgart

  2. Scahill L, Schwab-Stone M (2000) Epidemiology of ADHD in school-age children. Child Adolesc Psychiatr Clin N Am 9(3):541–555

    PubMed  CAS  Google Scholar 

  3. MTA Cooperative Group (1999) A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 56(12):1073–1086

    Article  Google Scholar 

  4. Pelham WE, Gnagy EM (1999) Psychological and combined treatments for ADHD, mental retardation and developmental disabilities. Res Rev 5(3):225–236

    Google Scholar 

  5. Taylor E, Döpfner M, Seargant J et al (2004) European clinical guidelines for hyperkinetic disorder—first upgrade. Eur Child Adolesc Psychiatry 13(Suppl 1):17–30

    Google Scholar 

  6. Barkley RA (2006) Attention-deficit hyperactivity disorder: a handbook of diagnosis and treatment. Guilford Press, New York

    Google Scholar 

  7. Greenhill LL (2002) Stimulant medication treatment of children with attention deficit hyperactivity disorder. In: Jensen PS, Cooper JR (eds) Attention deficit hyperactivity disorder: state of the science—best practices. Civic Research Institute, Kingston, pp 9.1–9.27

    Google Scholar 

  8. Swanson JM (1993) Effect of stimulant medication on hyperactive children: a review of reviews. Except Child 60:154–162

    Google Scholar 

  9. Jensen PS, Hinshaw SP, Swanson JM et al (2001) Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): implications and applications for primary care providers. Dev Behav Pediatr 22:60–73

    Article  CAS  Google Scholar 

  10. National Institutes of Health Consensus Statement (1998) Diagnosis and treatment of attention deficit hyperactivity disorder

  11. Heinrich H, Gevensleben H, Strehl U (2007) Annotation: neurofeedback—train your brain to train behaviour. J Child Psychol Psychiatry 48(1):3–16

    Article  PubMed  Google Scholar 

  12. Lubar JF, Shouse MN (1976) EEG and behavioural changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR): a preliminary report. Biofeedback Self Regul 1:293–306

    Article  PubMed  CAS  Google Scholar 

  13. Barry RJ, Clarke AR, Johnstone SJ (2003) A review of electro-physiology in attention-deficit/hyperactivity disorder: II. Event-related potentials. Clin Neurophysiol 114:184–198

    Article  PubMed  Google Scholar 

  14. Chabot RJ, Serfontein G (1996) Quantitative electroencephalographic profiles of children with deficit disorder. Biol Psychiatry 40:951–963

    Article  PubMed  CAS  Google Scholar 

  15. Clarke AR, Barry RJ, McCarthy R, Selikowitz M (2001) Age and sex effects in the EEG: differences in two subtypes of attention deficit hyperactivity disorder. Clin Neurophysiol 112:815–826

    Article  PubMed  CAS  Google Scholar 

  16. Clarke AR, Barry RJ, McCarthy R, Selikowitz M (2001) Electroencephalogram differences in two subtypes of attention-deficit/hyperactivity disorder. Psychophysiology 38:212–221

    Article  PubMed  CAS  Google Scholar 

  17. El-Sayed E, Larsson JO, Persson HE, Rydelius PA (2002) Altered cortical activity in children with attention deficit/hyperactivity disorder during attentional load task. J Am Acad Child Adolesc Psychiatry 41:811–819

    Article  PubMed  Google Scholar 

  18. Hill RW, Castro E (2002) Getting rid of Ritalin: how neurofeedback can successfully treat attention deficit disorder without drugs. Hampton Roads Publishing Company, USA

    Google Scholar 

  19. Loo SK, Barkley RA (2005) Clinical utility of EEG in attention deficit hyperactivity disorder. Appl Neuropsychol 12(2):64–76

    Article  PubMed  Google Scholar 

  20. Lubar JF (1991) Discourse on the development of EEG diagnostics and biofeedback treatment for attention deficit/hyperactivity disorders. Biofeedback Self Regul 16:202–225

    Google Scholar 

  21. Lubar JF (2003) Neurofeedback for the management of attention deficit disorders. In: Schwartz MS, Andrasik F (eds) Biofeedback: a practitioner’s guide, 3rd ed. Guilford Press, New York, pp 409–437

  22. Mann CA, Lubar JF, Zimmermann AW, Miller CA, Muenchen RA (1992) Quantitative analysis of EEG in boys with attention-deficit hyperactivity disorder: controlled study with clinical implications. Pediatr Neurol 8(1):30–36

    Article  PubMed  CAS  Google Scholar 

  23. Chabot RJ, Orgill AA, Crawford G, Harris MJ, Serfontein G (1999) Behavioral and electrophysiologic predictors of treatment response to stimulants in children with attention disorders. J Child Neurol 14(6):343–351

    Article  PubMed  CAS  Google Scholar 

  24. Clarke AR, Barry RJ, McCarthy R, Selikowitz M (2001) Excess beta activity in children with attention-deficit/hyperactivity disorder: an atypical electro-physiological group. Psychiatry Res 103:205–218

    Article  PubMed  CAS  Google Scholar 

  25. Monastra VJ (2005) Electroencephalographic biofeedback (neurotherapy) as a treatment for attention deficit hyperactivity disorder: rationale and empirical foundation. Child Adolesc Psychiatr Clin N Am 14:55–82

    Article  PubMed  Google Scholar 

  26. Monastra VJ, Lynn S, Linden M, Lubar JF, Gruzelier J, LaVaque T (2005) Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder. Appl Psychophysiol Biofeedback 30(2):95–114

    Article  PubMed  Google Scholar 

  27. Vernon DJ (2005) Can neurofeedback training enhance performance? An evaluation of the evidence with implications for future research. Appl Psychophysiol Biofeedback 30(4):347–364

    Article  PubMed  Google Scholar 

  28. Sterman MB (1996) Physiological origins and functional correlates of EEG rhythmic activities: implications for self-regulation. Biofeedback Self Regul 21(1):3–49

    Article  PubMed  CAS  Google Scholar 

  29. Thompson L, Thompson M (1998) Neurofeedback combined with training in metacognitive strategies: effectiveness in students with ADD. Appl Psychophysiol and Biofeedback 23(4):243–263

    Article  CAS  Google Scholar 

  30. Carmody DP, Radvanski DC, Wadhwani S, Sabo MJ, Vergara L (2001) EEG biofeedback training and attention-deficit/hyperactivity disorder in an elementary school setting. J Neurotherapy 4(3):5–27

    Article  Google Scholar 

  31. Drechsler R, Straub M, Doehnert M, Heinrich H, Steinhausen HC, Brandeis D (2007) Controlled evaluation of a neurofeedback training of slow cortical potentials in children with attention-deficit/hyperactivity disorder (ADHD). Behav Brain Funct 3:35–48

    Article  PubMed  Google Scholar 

  32. Heinrich H, Gevensleben H, Freisleder FJ, Moll GH, Rothenberger A (2004) Training of slow cortical potentials in attention-deficit/hyperactivity disorder: evidence for positive behavioral and neurophysiological effects. Biol Psychiatry 55:772–775

    Article  PubMed  Google Scholar 

  33. Linden M, Gevirtz R, Isenhart R, Fisher T (1996) Event related potentials of subgroup of children with attention deficit hyperactivity disorder and the implications for EEG biofeedback. J Neurotherapy 1(3):40–49

    Article  Google Scholar 

  34. Strehl U, Leins U, Goth G, Klinger C, Hinterberger T, Birbaumer N (2006) Self-regulation of slow cortical potentials: a new treatment for children with attention-deficit/hyperactivity disorder. Pediatrics 118:1530–1540

    Article  Google Scholar 

  35. Gevensleben H, Holl B, Albrecht B, Schlamp D, Kratz O, Studer P, Wangler S, Rothenberger A, Moll GH, Heinrich H (2010) Distinct EEG effects related to neurofeedback training in children with ADHD: a randomized controlled trial. Int J Psychophysiol 74:149–157

    Article  Google Scholar 

  36. Fuchs T, Birbaumer N, Lutzenberger W, Gruzelier JH, Kaiser J (2003) Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: a comparison with methylphenidate. Appl Psychophysiol Biofeedback 28(1):1–12

    Article  PubMed  Google Scholar 

  37. Monastra V, Monastra D, George S (2002) The effects of stimulant therapy, EEG-biofeedback and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder. Appl Psychophysiol Biofeedback 27:231–249

    Article  PubMed  Google Scholar 

  38. Rossiter TR, La Vaque TJ (1995) A comparison of EEG biofeedback and psychostimulants in treating attention deficit/hyperactivity disorders. J Neurotherapy 1(1):48–59

    Article  Google Scholar 

  39. Holtmann M, Stadler C, Leins U, Strehl U, Birbaumer N, Poustka F (2004) Neurofeedback in der Behandlung der Aufmerksamkeits-Hyperaktivitätsstörung (ADHS) im Kindes- und Jugendalter. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 32(3):187–200

    Article  PubMed  Google Scholar 

  40. Holtmann M, Stadler C (2006) Electroencephalographic biofeedback for the treatment of attention-deficit/hyperactivity disorder in childhood and adolescence. Expert Rev Neurother 6:533–540

    Article  PubMed  Google Scholar 

  41. Arns M, de Ridder S, Strehl U, Breteler M, Coenen A (2009) Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis. Clin EEG Neurosci 40:180–189

    PubMed  Google Scholar 

  42. Gevensleben et al. (2009) Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. J Child Psychol Psychiatry. doi:10.1111/j.1469-7610.2008.02033.x

  43. Gevensleben H, Holl B, Albrecht B, Schlamp D, Kratz O, Studer P, Rothenberger A, Moll GH, Heinrich H (2010) Neurofeedback training in children with ADHD: 6-month follow-up of a randomized controlled trial. J Eur Child Adolesc Psychiatry 19:715–724

    Article  Google Scholar 

  44. Holtmann M, Grasmann D, Cionek-Szpak E et al (2009) Spezifische Wirksamkeit von Neurofeedback auf die Impulsivität bei ADHS. Kindheit und Entwicklung. 18(2):95–104

    Article  Google Scholar 

  45. Oosterlaan J, Sergeant JA (1998) Effects of reward and response cost on response inhibition in AD/HD, disruptive, anxious and normal children. J Abnorm Child Psychol 26:161–174

    Article  PubMed  CAS  Google Scholar 

  46. Doehnert M, Brandeis D, Straub M, Steinhausen H-C, Drechsler R (2008) Slow cortical potential neurofeedback in attention deficit hyperactivity disorder: is there neurophysiological evidence for specific effects? J Neural Transm 115:1145–1456

    Article  Google Scholar 

  47. Esser G, Blanz B, Geisel B, Laucht M (1989) Mannheimer Elterninterview, MEI, Beltz Test. GmbH, Weinheim

    Google Scholar 

  48. Doepfner M, Lehmkuhl G (2000) Diagnostik- System für psychische Störungen im Kindes- und Jugendalter (DISYPS- KJ) nach ICD-10 und DSM-IV, klinische Diagnostik- Elternurteil- Erzieher- und Lehrerurteil- Selbsturteil, Manual. Huber, Bern

  49. Kratzmeier H, Horn R (1988) Standard progressive matrices (SPM) manual. Beltz Test Gesellschaft, Weinheim

    Google Scholar 

  50. Rasey HW, Lubar JF, McIntyre A, Zoffuto AC, Abbott PL (1996) EEG biofeedback for the enhancement of attentional processing in normal college students. J Neurotherapy 1(3):15–31

    Article  Google Scholar 

  51. Lubar JF, Lubar JO (1999) Neurofeedback assessment and treatment for attention deficit/hyperactivity disorder. In: Evans JR, Abarbanel A (eds) Introduction to quantitative EEG and Neurofeedback. Academic Press Inc, San Diego, pp 103–143

  52. Van Leeuwen TH, Steinhausen HC, Overtoom CC, Pascual-Marqui RD, van’t Klooster B, Rothenburger A, Sergeant JA, Brandeis D (1998) The continuous performance test revisited with neuroelectric mapping: impaired orienting in children with attention deficits. Behav Brain Res 94:243–263

    Google Scholar 

  53. Knye M, Roth N, Westhus W, Heine A (2004) Continuous Performance Task (CPT)-manual. Hogrefe, Göttingen

    Google Scholar 

  54. Esser G, Wyschkon A, Ballaschk K (2008) Basisdiagnostik Umschriebener Entwicklungsstörungen im Grundschulalter. Hogrefe, Göttingen

    Google Scholar 

  55. Brickenkamp R (2002) Test d2, Aufmerksamkeits-Belastungs-Test, 9th edn. Hogrefe, Göttingen

    Google Scholar 

  56. Esser G, Geisel B (1978) Test zur Erfassung der Konzentrationsfähigkeit 8jähriger Kinder bp-Test. Kurzfassung

  57. Klauer K (1993) Denktraining für Jugendliche. Ein Programm zur intellektuellen Förderung. Handanweisung. Hogrefe, Göttingen

  58. Leins U (2004) Train your brain: neurofeedback für Kinder mit einer Aufmerksamkeits-/Hyperaktivitätsstörung (ADHS). Dissertation, Universität Tübingen

  59. Monastra VJ, Lubar JF, Linden M (2001) The development of a quantitative electroencephalographic scanning process for attention deficit- hyperactivity disorder: reliability and validity studies. Neuro-psychology 15(1):136–144

    CAS  Google Scholar 

  60. Arnold LE (2001) Alternative treatments for adults with attention-deficit hyperactivity disorder (ADHD). Ann N Y Acad Sci 931:310–341

    Article  PubMed  CAS  Google Scholar 

  61. Lee SW (1991) Biofeedback as a treatment for childhood hyperactivity: a critical review of the literature. Psychol Report 68(1):163–192

    CAS  Google Scholar 

  62. Cobb DE, Evans JR (1981) The use of biofeedback techniques with school-aged children exhibiting behavioural and/or learning problems. J Abnorm Child Psychol 9:251–281

    Article  PubMed  CAS  Google Scholar 

  63. Omizo MM, Michael WB (1982) Biofeeback-induced relaxation training and impulsivity, attention task, and locus of control among hyperactive boys. J Learn Disabil 15:414–416

    Article  PubMed  CAS  Google Scholar 

  64. Heywood C, Beale I (2003) EEG biofeedback vs placebo treatment for attention-deficit/hyperactivity disorder: a pilot study. J Atten Disord 7(1):43–55

    Article  PubMed  CAS  Google Scholar 

  65. Logemann HNA, Lansbergen MM, Van Os TWDP, Böcker KBE, Kenemans JL (2010) The effectiveness of EEG-feedback on attention, impulsivity and EEG: a sham feedback controlled study. Neurosci Lett 479:49–53

    Article  PubMed  CAS  Google Scholar 

  66. Baydala L, Wikman E (2001) The efficacy of neurofeedback in the management of children with attention deficit/hyperactivity disorder. Paediatr Child Health 6(7):451–455

    PubMed  CAS  Google Scholar 

  67. Braud LW, Lupin MN, Braud WG (1975) The use of electromyographic biofeedback in the control of hyperactivity. J Learn Disabil 8:21–26

    Article  Google Scholar 

  68. G-Power http://www.psycho.uni-duesseldorf.de/aap/projects/gpower.de

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Psychology, Faculty of Humanities, Yazd University, Yazd, Iran

    Ali Reza Bakhshayesh & Mohammad Javad Rezai

  2. Department of Clinical Psychology/Psychotherapy and Academy of Psychotherapy and Intervention Research of Potsdam University, Karl-Liebknecht-Straße 24/25, OT Golm, 14476, Potsdam, Germany

    Sylvana Hänsch, Anne Wyschkon & Günter Esser

Authors
  1. Ali Reza Bakhshayesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sylvana Hänsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anne Wyschkon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammad Javad Rezai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Günter Esser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Günter Esser.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bakhshayesh, A.R., Hänsch, S., Wyschkon, A. et al. Neurofeedback in ADHD: a single-blind randomized controlled trial. Eur Child Adolesc Psychiatry 20, 481–491 (2011). https://doi.org/10.1007/s00787-011-0208-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00787-011-0208-y

Keywords

Search

Navigation