Abstract
Neurofeedback (NF) has gained increasing interest in the treatment of attention-deficit/hyperactivity disorder (ADHD). Given learning principles underlie NF, lasting clinical treatment effects may be expected. This systematic review and meta-analysis addresses the sustainability of neurofeedback and control treatment effects by considering randomized controlled studies that conducted follow-up (FU; 2–12 months) assessments among children with ADHD. PubMed and Scopus databases were searched through November 2017. Within-group and between-group standardized mean differences (SMD) of parent behavior ratings were calculated and analyzed. Ten studies met inclusion criteria (NF: ten studies, N = 256; control: nine studies, N = 250). Within-group NF effects on inattention were of medium effect size (ES) (SMD = 0.64) at post-treatment and increased to a large ES (SMD = 0.80) at FU. Regarding hyperactivity/impulsivity, NF ES were medium at post-treatment (SMD = 0.50) and FU (SMD = 0.61). Non-active control conditions yielded a small significant ES on inattention at post-treatment (SMD = 0.28) but no significant ES at FU. Active treatments (mainly methylphenidate), had large ES for inattention (post: SMD = 1.08; FU: SMD = 1.06) and medium ES for hyperactivity/impulsivity (post: SMD = 0.74; FU: SMD = 0.67). Between-group analyses also revealed an advantage of NF over non-active controls [inattention (post: SMD = 0.38; FU: SMD = 0.57); hyperactivity–impulsivity (post: SMD = 0.25; FU: SMD = 0.39)], and favored active controls for inattention only at pre-post (SMD = − 0.44). Compared to non-active control treatments, NF appears to have more durable treatment effects, for at least 6 months following treatment. More studies are needed for a properly powered comparison of follow-up effects between NF and active treatments and to further control for non-specific effects.
Highlights
Clinical guidelines for attention-deficit/hyperactivity disorder (ADHD) recommend multimodal treatment approaches, with current evidence suggesting that medication, including methylphenidate and various amphetamine formulations, in5 kbo-Heckscher-Klinikum, Munich, Germany 6 Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands 7 Institute for Medical Psychology, University of Tuebingen, Tuebingen, Germany 8 Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, University of California, Los Angeles, USA1 3 Vol.:(0123456789)European Child & Adolescent Psychiatry (2019) 28:293–305 conjunction with psychosocial treatment are most effective in the short-term [1]
Inclusion criteria were: (1) randomized controlled EEG neurofeedback trials published in peer-reviewed journals; (2) primary diagnosis of ADHD; (3) mean child age < 18 years old; (4) available data at a follow-up (FU) time point for 2 to 12 months post-treatment; (5) standardized mean and standard deviations (SD) for all three assessments for at least one of the following domains had to be available: inattention, hyperactivity, or hyperactivity/impulsivity ratings from a DSMIV/5-based rating scale; (6) publication available in English; (7) total study sample larger than N = 10; 8) less than 50% of participants began or stopped taking medication between post and FU assessments
Included studies resulted in a total of 506 participants with ADHD (256 neurofeedback, 250 control)
Summary
Clinical guidelines for attention-deficit/hyperactivity disorder (ADHD) recommend multimodal treatment approaches, with current evidence suggesting that medication, including methylphenidate and various amphetamine formulations, in. Medication treatments have large effect size in the acute treatment of ADHD [2] and, when combined with psychosocial treatments, large effects up to 2 years of treatment were observed [3, 4]. Arns and Kenemans [6] found that the clinical effects of neurofeedback were maintained across 6 and 24-month follow-up periods, with a trend for larger symptom decreases for hyperactivity/impulsivity after 24 months than after 6 months, albeit only based on two randomized studies at 6 months and only one at the 24-month follow-up, limiting the generalizability of the findings. A systematic review and meta-analysis that assess the sustainability of clinical effects of NF studies is, desirable
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