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Neurofeedback for ADHD

Neurofeedback could be an effective and enduring nonpharmacologic treatment.

In several small, open-treatment case series starting in the 1970s, children with ADHD benefited from EEG biofeedback. These researchers examined EEG data during biofeedback training of 23 children with DSM-IV ADHD inattentive, hyperactive, or combined types (age range, 8–13; 19 boys). Behavior, cognition, and quality of life were also assessed.

The training involved three phases of 10 sessions each. Phases, which lasted 2 weeks, were separated by 4 to 6 weeks. The children were trained to control event-related slow cortical potentials (SCPs). Initially, both auditory and visual feedback was given (e.g., a computer screen showed a ball moving proportionally with the direction of the SCP, and smiley faces appeared when SCP regulation increased). Cognitive exercises without biofeedback were used for practice between sessions and after training.

At the end of treatment, children improved their regulation of negative SCPs. Teacher- and parent-rated behavioral problems were reduced. The improved regulation and behavior were still evident 6 months after training had ended.

Comment: The concept behind this intriguing work is highly reasonable. The availability of nonpharmacologic modalities for treating the highly prevalent ADHD syndromes would certainly be important. The techniques seem user-friendly -- no child dropped out because of technical adversity. The authors note that similar feedback on both positive and negative cortical potentials has been useful for patients with certain seizure disorders.

The study’s main drawback is the lack of controls and blinded raters. The authors contend these are not possible in this type of research. However, using time with supportive adults and similar cognitive tasks without EEG feedback as controls would be informative.

— Barbara Geller, MD

Published in Journal Watch Psychiatry January 8, 2007

Citation(s):

Strehl U et al. Self-regulation of slow cortical potentials: A new treatment for children with attention-deficit/hyperactivity disorder. Pediatrics 2006 Nov; 118:e1530-40. (http://dx.doi.org/10.1542/peds.2005-2478)

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