Meta-Analysis: Neurofeedback Works Best When Paired with Stimulant Medication
A meta-analysis of randomized controlled trials suggests that neurofeedback is an effective treatment for children with ADHD when used in combination with stimulant medication. Does it work alone? More research is needed.
March 7, 2019
New research published in the Journal of Attention Disorders1 suggests that neurofeedback paired with stimulant medication is the most effective treatment for children with ADHD, but neurofeedback alone does not deliver significant improvement in hyperactive or impulsive symptoms.
Researchers analyzed 17 existing studies, which charted symptoms before and after treatment, and organized participants into the following data sets: control group treatments without enough efficacy to reduce ADHD symptoms, stimulant treatment control group, and nonpharmacological and efficacious treatment control groups.
As in past studies, researchers found that non-blind evaluations of post-treatment symptoms (mostly by parents) suggest that neurofeedback is an effective treatment for ADHD symptoms of inattention and/or hyperactivity and impulsivity. However, when blind ratings are used to compare post-treatment with pre-treatment symptoms, neurofeedback does not appear effective at treating ADHD symptoms of hyperactivity and impulsivity.
In other words, if you know that your child has been undergoing neurofeedback treatment, you are likely to report symptom improvements. But if you are blindly evaluating pre- and post-treatment rating scales for a child unknown to you, you are less likely to see the impact of neurofeedback on hyperactive and impulsive symptoms, specifically. This conclusion mirrors those of previous meta-analyses when comparable effect size analyses were used, although this research occasionally incorporated more than two times as many studies.
Also similar is the observation in this meta-analysis that children using stimulant medication experienced greater symptom control than did those using neurofeedback alone. Furthermore, the researchers found that combined treatment (non-pharmacological treatment plus stimulant medication) appeared more effective than pharmacological treatment alone.
Before making strong conclusions, study researchers expressed a need for additional data — including blinded rating scales for children with ADHD using stimulant medication, neurofeedback, and a combination of the two.
1 Riesco-Matías, P., Ramón, J., Crego, A., & Sánchez-Zaballos, E. What Do Meta-Analyses Have to Say About the Efficacy of Neurofeedback Applied to Children With ADHD? Review of Previous Meta-Analyses and a New Meta-Analysis. Journal of Attention Disorders. (Jan. 2019). https://doi.org/10.1177/1087054718821731″>https://doi.org/10.1177/1087054718821731″>https://doi.org/10.1177/1087054718821731