Brain Training

Your Guide to Neurofeedback for ADHD

This alternative therapy uses real-time EEG data to help patients work to train their ADHD brains for intense focus, impulse control, and organized executive function. Studies are encouraging, but not conclusive. Here’s what you need to know.

Illustration of a brain with brainwaves before neurofeedback training
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The Science Behind Neurofeedback

The brain is malleable. With frequent, intense practice, we may transform our brainwave activity. Over time, we can work to increase our ratio of faster brain waves, leading to stronger focus and improved impulse control. This is, in essence, the concept of neuroplasticity — and the core principle behind neurofeedback training.

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The Central Benefits

Since the 1970s, patients with ADHD and other neurological disorders have used neurofeedback in hopes of training their brains. According to proponents, the reported benefits of this alternative therapy are twofold:

  • Brainwave alterations are measurable and appear to endure well beyond the therapy’s end.
  • Brainwave improvements may lead to behavior improvements — most notably, sustained focus, diminished impulsivity, and reduced distractibility out in the real world.
Illustration of the connections in the brain that neurofeedback therapy can strengthen
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Real-Time Biofeedback

Neurofeedback is a distinct type of biofeedback. Biofeedback is the process of learning how to change your own physiological activity using real-time monitoring of biological data like breathing rates, muscle activity, and heart function.

In neurofeedback training sessions, practitioners monitor a patient’s brain waves using scalp sensors. These sensors pick up the brain’s activity and relay it so that the therapist and patient can see exactly when and how brain waves reach an optimal level. The trick is then to repeat and practice the behaviors that lead to this ideal brain state until they become second nature.

[Free Resource: Learn the Facts About Neurofeedback]

Mind Modulations Brainwave Infographic. Types of waves that can improve with neurofeedback.
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What Is the Goal?

Many ADHD brains generate an abundance of low-frequency delta or theta brain waves, and a shortage of high-frequency beta brain waves. Over 20 to 40 training sessions, neurofeedback works to reverse that ratio. The end goal is an activated, engaged brain, and an overall reduction in ADHD symptoms.

More specifically, neurofeedback therapy works to increase the brain’s capacity and predisposition for beta waves, which are associated with efficient information processing and problem solving. At the other end of the spectrum are delta and theta waves, which occur in the brain when it is relaxing or daydreaming. When a high proportion of theta waves are present, patients complain of incomplete work, disorganization, and distractibility. Neurofeedback aims to diminish the frequency of delta and theta waves.

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What Does Neurofeedback Therapy Look Like?

Each traditional neurofeedback therapy session lasts no more than 30 minutes, ideally. During that time, the patient wears scalp sensors that measure and broadcast brain-wave activity via an EEG display. The patient works with his or her therapist to recognize when the brain is operating in its optimal beta zone, and to consciously sustain and replicate that state. It’s like strength training for the brain.

Outline of two heads, an illustration that no two neurofeedback programs are the same.
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Step One: Assess

Not all ADHD brains look alike. To effectively tailor treatment to the individual — and his or her innate strengths and weaknesses — the neurofeedback practitioner should first conduct an assessment of the patient’s natural brain wave patterns. This assessment typically uses one or two EEG sensors to obtain a baseline snapshot of the brain. Many practitioners also use standard ADHD rating scales to gauge a patient’s everyday ability to focus, control impulses, and complete tasks.

Doctor showing neurofeedback EEG results to a patient
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Step Two: Personalize

Some patients with ADHD may have an excess of low-frequency brainwave activity, while other have an excess of fast frequency brainwave activity. An effective neurofeedback practitioner customizes a training program based on the brain wave patterns established in the initial assessment in order to target the behaviors to change.

[Free Download: Secrets of Your ADHD Brain]

A doctor runs a test for ADHD on his patient.
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Step Three: Review and Reassess

Frequent benchmarking is key to meaningful neurofeedback treatment. What this means: A therapist should regularly compare each patient’s new EEG readings to his or her baseline assessment. This comparison helps assess the type and scale of changes taking place in brain wave patterns, and helps the practitioner adjust treatment going forward.

Also important is gathering parent or patient feedback about behavior changes reflected at home. Parents should initially commit to no more than 6 to 10 neurofeedback sessions and insist on frequent evaluation. If brain-wave and behavior improvements take place in this time, most experts recommend completing 20 to 40 sessions total in order to achieve lasting changes. Sometimes, children will attend several sessions before seeing positive results. But if treatment is not working after 10 sessions, it’s time to stop.

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What Symptoms Does It Address?

Numerous studies, although none blind, show that neurofeedback therapy can result in improved attention, diminished hyperactivity, and enhanced executive functions, including working memory.

In 2012, researchers studied 14 randomized trials and calculated the following effect sizes: a 0.8 reduction in inattention and 0.7 reduction in hyperactivity for participants with ADHD. In the scientific community, these are considered fairly robust results, though not as high as the approximate effect size of 1.0 that is typical of stimulant medications.

A bar graph demonstrating the brain's growth during neurofeedback training
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Who Does Neurofeedback Help the Most?

The brain remains plastic throughout life, but younger brains can more quickly change and adapt than can older brains. In other words, adults can use neurofeedback to treat ADHD. But children often require fewer sessions, are less skeptical of the treatment, and make improvements more quickly.

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What Makes a Good Neurofeedback Practitioner?

The results of neurofeedback therapy are positively correlated with the skill of the clinician, especially for children. Hyperactive, fidgety children may require four, five, or even six sessions before settling down, engaging, and truly training their brains.  Seek out an experienced clinician who knows techniques for focusing a child with ADHD and who is certified by the Biofeedback Certification International Alliance. Qualified practitioners are designated by the letters “BCN” on BCIA.org.

An illustration indicating how expensive neurofeedback can be
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What Is the Cost?

Each neurofeedback session costs $40-$150, and this treatment is not typically covered by insurance. Since 20 to 40 sessions are recommended for achieving lasting change, the cost of treatment can reach as much as $6,000.

Computer-based, at-home alternatives do exist. These headset systems typically cost less than $100, however research linking these home-based alternatives to sustained brain-wave improvement does not yet exist.

An illustration of brain waves to represent the scientific research on neurofeedback
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So, Does It Work?

Neurofeedback is a promising treatment for ADHD, but the current research suggests it's best considered as a complement to medication and/or behavior therapy rather than as a standalone treatment.  Research support for both stimulant medication therapy and behavior therapy is stronger than for neurofeedback at the moment.

Many studies provide parents with reason to expect benefits from neurofeedback training. However, some of the most important researchers in the ADHD field would argue that the efficacy of neurofeedback for ADHD has not been conclusively established.

[Meta-Analysis: Can Neurofeedback Effectively Treat ADHD?]

4 Related Links

  1. We tried neurofeedback for our son (at the time was 11) for about 3-4 months. Saw little to no improvement in his ADHD symptoms. Spent about $5K. Be careful as this is clearly a very expensive treatment without any real studies of effectiveness.

    1. Does neurofeedback work for ADD also? My son is struggling and various medications do not seem to work because he forgets to take his medication each day. He starts school and then drops classes even though he has accomodations, he doesn’t make it to the weekly/monthly Counselor meeting or follow-up session. My son is bright and kind but cannot survive in our world if he cannot focus.

      I would appreciate any suggestions. Thank you.
      Anne

  2. Full disclosure, I have been a neurofeedback provider for the last 10 years and have seen very positive outcomes for my clients with ADHD. Yes it is expensive but the results are permanent and most importantly drug free.

    I’m so sorry neurofeedback was not successful for your son, it doesn’t work for everyone, however our success rate is quite high >80%.

    Here is a link to a meta analysis of research into neurofeedback for ADHD which goes back to the 1970’s and includes almost 50 published studies.

    http://journals.sagepub.com/doi/abs/10.1177/155005940904000311

    The major conclusion drawn from the analysis is this:

    “Therefore, in line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude that neurofeedback treatment for ADHD can be considered “Efficacious and Specific” (Level 5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.”

    The American Academy of Pediatrics gives it a Level 2 “Good Support” recommendation as well. Here’s a link to their document.

    http://pediatrics.aappublications.org/content/pediatrics/125/Supplement_3/S128.full.pdf

    1. It’s interesting that the AAP continues to use the 2010 copyright version of these recommendations on their website, which was created by Practicewise (an advisory panel to AAP), which shows biofeedback as “only level 2”, when there is a more recent version – from 2014 – that shows it as a level 1 intervention. That can be found here…

      https://docs.wixstatic.com/ugd/efd4cf_0642f976940041f8af83ddbc61829773.pdf

      And in the fine print, you will see, “This report is intended to guide practitioners, educators, youth, and families in developing appropriate plans using psychosocial interventions. This version appeared on the AAP website for the first year, but then I first noticed it replaced with this older version about 2.5 years ago…

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