Samuele Cortese1, Maite Ferrin2, Daniel Brandeis3, Martin Holtmann4, Pascal Aggensteiner5, David Daley6, Paramala Santosh7, Emily Simonoff7, Jim Stevenson8, Argyris Stringaris7, Edmund J S Sonuga-Barke9. 1. Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK; New York University Child Study Center, New York, and Solent NHS Trust, UK. 2. Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK; Huntercombe Hospital Maidenhead, Maidenhead, UK. 3. Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Psychiatric Hospital, University of Zurich, the Integrative Human Physiology and the Neuroscience Center Zurich, University of Zurich, Switzerland, and ETH Zurich. 4. LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr University Bochum, Germany. 5. Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. 6. School of Medicine and MindTech Institute of Mental Health, University of Nottingham, UK. 7. Institute of Psychiatry, Psychology and Neurosciences, King's College London, and the Maudsley Hospital, London, UK. 8. Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK. 9. Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK; Ghent University, Ghent, Belgium and Aarhus University, Aarhus, Denmark. Electronic address: ejb3@soton.ac.uk.
Abstract
OBJECTIVE: We performed meta-analyses of randomized controlled trials to examine the effects of neurofeedback on attention-deficit/hyperactivity disorder (ADHD) symptoms and neuropsychological deficits in children and adolescents with ADHD. METHOD: We searched PubMed, Ovid, Web of Science, ERIC, and CINAHAL through August 30, 2015. Random-effects models were employed. Studies were evaluated with the Cochrane Risk of Bias tool. RESULTS: We included 13 trials (520 participants with ADHD). Significant effects were found on ADHD symptoms rated by assessors most proximal to the treatment setting, that is, the least blinded outcome measure (standardized mean difference [SMD]: ADHD total symptoms = 0.35, 95% CI = 0.11-0.59; inattention = 0.36, 95% CI = 0.09-0.63; hyperactivity/impulsivity = 0.26, 95% CI = 0.08-0.43). Effects were not significant when probably blinded ratings were the outcome or in trials with active/sham controls. Results were similar when only frequency band training trials, the most common neurofeedback approach, were analyzed separately. Effects on laboratory measures of inhibition (SMD = 0.30, 95% CI = -0.10 to 0.70) and attention (SMD = 0.13, 95% CI = -0.09 to 0.36) were not significant. Only 4 studies directly assessed whether learning occurred after neurofeedback training. The risk of bias was unclear for many Cochrane Risk of Bias domains in most studies. CONCLUSION: Evidence from well-controlled trials with probably blinded outcomes currently fails to support neurofeedback as an effective treatment for ADHD. Future efforts should focus on implementing standard neurofeedback protocols, ensuring learning, and optimizing clinically relevant transfer.
OBJECTIVE: We performed meta-analyses of randomized controlled trials to examine the effects of neurofeedback on attention-deficit/hyperactivity disorder (ADHD) symptoms and neuropsychological deficits in children and adolescents with ADHD. METHOD: We searched PubMed, Ovid, Web of Science, ERIC, and CINAHAL through August 30, 2015. Random-effects models were employed. Studies were evaluated with the Cochrane Risk of Bias tool. RESULTS: We included 13 trials (520 participants with ADHD). Significant effects were found on ADHD symptoms rated by assessors most proximal to the treatment setting, that is, the least blinded outcome measure (standardized mean difference [SMD]: ADHD total symptoms = 0.35, 95% CI = 0.11-0.59; inattention = 0.36, 95% CI = 0.09-0.63; hyperactivity/impulsivity = 0.26, 95% CI = 0.08-0.43). Effects were not significant when probably blinded ratings were the outcome or in trials with active/sham controls. Results were similar when only frequency band training trials, the most common neurofeedback approach, were analyzed separately. Effects on laboratory measures of inhibition (SMD = 0.30, 95% CI = -0.10 to 0.70) and attention (SMD = 0.13, 95% CI = -0.09 to 0.36) were not significant. Only 4 studies directly assessed whether learning occurred after neurofeedback training. The risk of bias was unclear for many Cochrane Risk of Bias domains in most studies. CONCLUSION: Evidence from well-controlled trials with probably blinded outcomes currently fails to support neurofeedback as an effective treatment for ADHD. Future efforts should focus on implementing standard neurofeedback protocols, ensuring learning, and optimizing clinically relevant transfer.
Authors: James J McGough; Alexandra Sturm; Jennifer Cowen; Kelly Tung; Giulia C Salgari; Andrew F Leuchter; Ian A Cook; Catherine A Sugar; Sandra K Loo Journal: J Am Acad Child Adolesc Psychiatry Date: 2019-01-28 Impact factor: 8.829