EEG Biofeedback: A New Treatment Option For ADD/ADHD

Marabella A. Alhambra, M.D., Timothy P. Fowler, and Antonio A. Alhambra, M.D.

This study explores the efficacy of EEG biofeedback (Neurofeedback) in the treatment of ADD/ADHD. Researchers were interested in finding an alternative to stimulants for treating children with ADD/ADHD due to their short-term efficacy and high risk of negative side effects. Researchers tested 43 patients who had completed 30 sessions of EEG Biofeedback. They found that after 30 sessions, the patients improved as marked by their observed subjective symptoms, improved TOVA scores, and improved QEEG brain maps. Researchers also found improvements in or complete resolution to problems associated with ADD/ADHD, including seizures, bed wetting, headaches, abdominal pain, nightmares, depression, mood swings, teeth grinding, and tics. Researchers also saw a decrease in the dependency to stimulant ADD/ADHD medication in some patients.

The Effects of QEEG-Informed Neurofeedback in ADHD: An Open-Label Pilot Study

Martijn Arns, Wilhelmus Drinkenburg, and J. Leon Kenemans

This study explores the treatment of ADHD with neurofeedback based on EEG biomarkers. Previous research has shown the existence of EEG biomarkers for ADHD in QEEG brain maps, which can help clinicians in developing more personalized treatment protocols for an individual with ADHD. For example, previous research has found that ADHD patients with excess frontal theta and alpha frequencies are more likely to respond to stimulant medication while those with a slowed individual Alpha Peak Frequency (iAPF) do not respond to stimulant medication. Researchers for this study treated 21 ADHD patients with QEEG-informed neurofeedback. After treatment, researchers found significant improvements in patients’ inattentiveness, impulsivity, and comorbid depression. They also found that by tailoring treatment protocols based on a patient’s QEEG, they were more likely to predict treatment outcomes for that patient.

Efficacy of Neurofeedback Treatment in ADHD: the Effects on Inattention, Impulsivity and Hyperactivity: a Meta-Analysis

Arns M., de Ridder S., Strehl U., Breteler M. and Coenen A.

This meta-analysis addressed the findings of multiple studies which cited the efficacy of Neurofeedback for the treatment of ADHD. These researchers addressed potential confounding factors such as small studies, lack of randomization in previous studies, and a lack of adequate control groups. After doing so, they found that the clinical effects of Neurofeedback in the treatment of ADHD can be regarded as clinically meaningful, especially in the treatment of impulsivity and inattention and mildly so for the treatment of hyperactivity.

EEG and behavioral changes following neurofeedback treatment in learning disabled children.

Fernandez, T., Herrera, W., Harmony, T., Diaz-Comas, L., Santiago, E., Sanchez, L., Bosch, J., Fernandez-Bouzas, A., Otero, G., Ricardo-Garcell, J., Barraza, C., Aubert, E., Galan, L., & Valdes, P. (2003). Clinical Electroencephalography, 34(3), 145–150. 

Learning disorders are diagnosed when an individual’s achievement on individually administered, standardized tests covering reading, mathematics, or writing indicate performance substantially below that expected for age, school level, and level of intelligence. Although there is currently no known effective treatment for children with learning disorders involving all three areas (reading, mathematics, and writing), there is some support for the potential of neurofeedback to facilitate improvement.

Learning Disabled children typically have higher values of theta, higher values of delta, and lower values of alpha brainwaves than non-disabled children of the same age. This study aimed to show that LD children whose brainwaves were slower than the norm for their age could learn to modify their brain activity with neurofeedback, and that this modification would be associated with behavioral improvement. Children were assigned to one of two groups, the control or the experimental group. The experimental group received neurofeedback training focused on lowering the theta/alpha ratio. Neurofeedback was applied to the region with the highest ratio, triggering a sound each time the ratio fell below a threshold value. Following 20 sessions, 4 out of 5 children from the experimental group, who originally exhibited abnormal brainwaves, exhibited normal brainwaves after neurofeedback, and the group overall demonstrated improved WISC (Wechsler Intelligence Scale for Children) performance, higher IQ values, and reduced symptoms of ADHD compared to the control group. Though certain EEG changes occur naturally within the developmental process, neurofeedback can produce an important spurt in brain activity maturation, contributing to noteworthy behavioral improvement.

EEG Biofeedback of low beta band components: frequency-specific
effects on variables of attention and event-related brain potentials

T. Egner and J.H. Gruzelier

This study examines the use of SMR and beta1 neurofeedback training in the treatment of ADHD. Previous studies have shown that SMR training assists with impulse control, while beta1 helps improve impulsive response tendencies. The researchers of this experiment aimed to study attention and target P300 event-related potentials, associated with decision making, that were specific to the SMR and beta1 neurofeedback protocols. The experiment tested 25 participants, who were randomly assigned to different training categories including beta1 neurofeedback, SMR neurofeedback, and a control group. The researchers found the SMR training to be associated with increased perceptual sensitivity and the beta1 training to be associated with faster reaction times, although these reactions were not necessarily more accurate, and increased amplitudes of P300 waves.

A Controlled Study of the Effects of EEG Biofeedback on Cognition and Behavior of Children with Attention Deficit Disorder and Learning Disabilities

Michael Linden, Thomas Habib and Vesna Radojevic

This study examines the efficacy of EEG biofeedback involving enhancing beta activity on children with ADD/ADHD. Previous studies found that beta frequencies with lower amplitudes were correlated with underarousal, which is characteristic of children diagnosed with ADD/ADHD. 18 participants were tested and randomly assigned to either 40 sessions of EEG biofeedback, involving an increase of beta activity and decrease of theta activity, or no treatment. Pre- and post-treatment IQ tests and scales for rating behavior were administered to test both groups. After the treatment, researchers saw an increase in IQ and a decrease in inattentive behaviors for the EEG biofeedback treatment group. There were, however, no significant differences between the treatment and control in regards to aggressive behavior.

Improvements in Spelling after QEEG-based Neurofeedback in Dyslexia: A Randomized Controlled Treatment Study

Marinus H. M. Breteler, Martijn Arns, Sylvia Peters, Ine Giepmans and Ludo Verhoeven

This study examines the effects of neurofeedback in improving reading and spelling in children diagnosed with dyslexia. 19 participants were randomly assigned to either an experimental group that underwent qEEG neurofeedback training or a control group. Along with the training for the experimental group, both groups also completed sessions of remedial teaching. The researchers found no significant difference between the two groups in regards to reading; however, there was a 16% improvement in spelling for the experimental group, while the control group only saw a 6% improvement. This significant improvement of the experimental group may be due to improved attention in the neurofeedback group. Neuropsychological tests including memory recall and recognition, word interference test, tapping test, timing test, and switching of attention test were also conducted. There were, however, no significant differences between the experimental and control groups for these tests.

The Effectiveness of Neurofeedback Training on EEG Coherence and Neuropsychological Functions in Children With Reading Disability

Mohammad Ali Nazari, Elnaz Mosanezhad, Tooraj Hashemi and Ali Jahan

This study examines the effects of neurofeedback on children with reading disabilities. Six children with dyslexia underwent neurofeedback training. The researchers measured the children’s reading abilities, specifically looking at the number of errors made by the participant and reading length, through the use of a phonological awareness test. After the treatment, children with the neurofeedback intervention were found to have decreased their reading mistakes, as well as having decreased their reading time. After the treatment, the children had also improved their phonological awareness, and tests showed behavioral improvements in these participants. These results suggest an improvement in dyslexic patients from neurofeedback training. Specifically, cerebral maturity and sensory-motor integration may have been improved, allowing for the phonological and reading improvements seen in the experiment.

Evaluation of the Effectiveness of EEG Neurofeedback Training for ADHD in a Clinical Setting as Measured by Changes in TOVA Scores, Behavioral Ratings, and WISC-R Performance

Joel Lubar, Michie Swartwood, Jeffery Swartwood, and Phyllis O’Donnell

This study used 23 participants with ADHD to examine the effect of neurofeedback training in treating ADHD. Effectiveness was evaluated by assessing Test of Variable of Attention (TOVA) performance, EEG activity, behavioral assessments (according to the  McCarney Attention Deficit Disorder Evaluation Scale, which measures impulsivity, inattention, and hyperactivity), and Wechsler Intelligence Scale for Children – Revised (WISC-R) performance. Results from the study showed that there were significant improvements in behavioral assessments, which were completed by parents of the participants, after the neurofeedback training. There were also significant improvement in TOVA performance for participants who decreased theta activity and in WISC-R scores after neurofeedback training.

Efficacy of Neurofeedback Versus Pharmacological Support in Subjects with ADHD

P. González-CastroM. Cueli, C. Rodríguez, T. García, L. Álvarez (2015)

This study examined the effects of neurofeedback vs. a pharmacological treatment for ADHD patients. They took 131 children between the ages of 8 and 11 and split them into four different groups: control (no treatment), neurofeedback treatment only, pharmacological treatment only, and both neurofeedback and pharmacological treatments. They underwent pre and post assessments before and after the treatments were finished. The assessments used were the EDAH, TOVA and QEEG. The neurofeedback training consisted of three 15 minute sessions per week for three months, while the pharmacological treatment was methylphenidate as prescribed by their neuropediatricians. They found that all three options lead to statistically significant improvements over the control, but the combined neurofeedback and pharmacological treatment group showed the most improvement. This suggests that the combination of treatments won’t counteract each other, and they may actually cause an even greater improvement than each does individually. The drawbacks to this study were that it was not completely random because parents preferences factored into which group their children were assigned to. To draw further conclusion, they must repeat the study with it being completely double blind.

Neurofeedback of Slow Cortical Potentials in Children with Attention-Deficit/Hyperactivity Disorder: A Multicenter Randomized Trial Controlling for Unspecific Effects

U. Strehl, P. Aggensteiner, D. Wachtlin, D. Brandeis, B. Albrecht, M. Arana, C. Bach, T. Banaschewski, T. Bogen, A. Flaig-Rohr, C. Freitag, Y. Fuchsenberger, S. Gest, H. Gevensleben, L. Herde, S. Hohmann, T. Legenbauer, A. Marx, S. Millenet, B. Pniewski, A. Rothenberger, C. Ruckes, S. Worz, M. Holtmann

This study examined the effects of neurofeedback on children with ADHD. It’s one of the first neurofeedback studies to actually control for unspecific effects of treatment, eliminating some of the methodological weaknesses of past studies. They took 150 children, between the ages of 7 and 9, who had been diagnosed with ADHD and gave them either 25 sessions of neurofeedback or feedback regulating coordination of supraspinatus muscle (EMG), which served as the placebo. Having EMG be the placebo allowed them to create a truly double blind placebo study, something which was difficult in the past. They tested the participants’ ADHD symptom severity, as well as IQ, parental ratings, teacher ratings and many more both before and after the 25 neurofeedback sessions. They found that a larger number of children in the neurofeedback group had reduced ADHD core symptoms versus those in the EMG group (52% to 35%), and this difference was statistically significant. This supports the findings of many studies on neurofeedback that have been done previously, giving even more evidence that neurofeedback is an effective treatment for ADHD.