Abstract
Attention Deficit/Hyperactivity Disorder (ADHD) is a chronic syndrome characterized by deficits in executive functions and attentional processes. Persons diagnosed with ADHD have significant deficits in self-regulation evidenced by difficulty staying focused, controlling impulsive behaviors, and for many, restraining hyperactive motor activity. These symptoms typically create problems in academic, social, and familial contexts as well as in the planning and organization skills needed for daily functioning. Additionally, comorbid syndromes that can mimic the symptoms of ADHD and confound differential diagnosis are commonly present (e.g., anxiety, depression, learning disorders).ADHD is the most frequently diagnosed pediatric disorder with 11% of American school-aged children (and nearly 20% of teenage boys) having been medically diagnosed with ADHD according to the latest report from the Centers for Disease Control (Schwarz & Cohen, 2013). Stimulant medication (SM) and behavior therapy (BT) are the two most widely accepted treatments for ADHD, with approximately 70% of those diagnosed prescribed medication (Schwarz, 2013). Although both interventions are considered to meet the highest standards for the evidence-based treatment of ADHD, and have been recognized as such by the American Academy of Child and Adolescent Psychiatry (AACAP) and Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), the leading ADHD advocacy group, the actual evidence is that these treatments fail to result in sustained benefit for the vast majority of children who receive them and, therefore, do not warrant being the first option for treating ADHD.The article reviews the evidence for making neurofeedback the first line treatment for ADHD.
Highlights
Attention Deficit/Hyperactivity Disorder (ADHD) is the most frequently diagnosed pediatric disorder with 11% of American school-aged children having been medically diagnosed with ADHD according to the latest report from the Centers for Disease Control (Schwarz & Cohen, 2013)
Stimulant medication (SM) and behavior therapy (BT) are the two most widely accepted treatments for ADHD, with approximately 70% of those diagnosed prescribed medication (Schwarz, 2013). Both interventions are considered to meet the highest standards for the evidence-based treatment of ADHD, and have been recognized as such by the American Academy of Child and Adolescent Psychiatry (AACAP) and Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), the leading ADHD advocacy group, the actual evidence is that these treatments fail to result in sustained benefit for the vast majority of children who receive them and, do not warrant being the first option for treating ADHD
The Multimodal Treatment of ADHD (MTA) trial was an open-label study and relied primarily on non-blinded parent and teacher rating scales to evaluate outcomes with these raters systematically involved in the delivery of BT, systematic stimulant medication management (SSMM), and combined SSMM/BT treatments, thereby biasing the reports of outcomes based on these measures when compared to community care (CC) (Hammond, 2011)
Summary
Attention Deficit/Hyperactivity Disorder (ADHD) is a chronic syndrome characterized by deficits in executive functions and attentional processes. The fact that the children referred to the randomness of community/hodgepodge care improved substantially more on the blinded measure of ADHD than those who received BT adds new evidence to the conclusion that 14 months of ―spare-no-expense‖ BT had only a small beneficial effect This conclusion regarding BT’s relative ineffectiveness is supported further by Hodgson et al.’s (2012) meta-analytic finding that behavior modification, school-based behavior therapy, behaviorally-based parent training, and behavioral self-monitoring treatments each had negative effect sizes compared to the control group conditions prompting the authors to conclude that these four commonly-utilized BT treatments for ADHD ―cannot be deemed to be efficacious.‖ Sonuga-Barke et al.’s 2013 meta-analysis published in the American Journal of Psychiatry found that BT had a non-significant effect size of only .02; demonstrating again that BT has, at best, only a minuscule benefit for the ADHD children receiving it. This AACAP claim was only true for the biased non-blinded ratings in which both parents and teachers were deeply involved for 14 months in the delivery of SSMM care (see Table 1)
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