Electroencephalographic biofeedback (neurotherapy) as a treatment for attention deficit hyperactivity disorder: rationale and empirical foundation.

During the past three decades, electroencephalographic (EEG) biofeedback has emerged as a nonpharmacologic treatment for attention-deficit/hyperactivity disorder (ADHD). This intervention was derived from operant conditioning studies that demonstrated capacity for neurophysiologic training in humans and other mammals and targets atypical patterns of cortical activation that have been identified consistently in neuroimaging and quantitative EEG studies of patients diagnosed with ADHD. This article presents the rationale for EEG biofeedback and examines the empirical support for this treatment using efficacy guidelines established by the Association for Applied Psychophysiology and Biofeedback and the International Society for Neuronal Regulation. Based on these guidelines, EEG biofeedback is considered to be "probably efficacious" for the treatment of ADHD and merits consideration as a treatment for patients who are stimulant "nonresponders." Although research findings published to date indicate positive clinical response in approximately 75% of patients treated in controlled group studies, additional randomized, controlled trials are needed to provide a better estimate of the robustness of this treatment.