Evaluation of neurofeedback in ADHD: The long and winding road

Biological Psychology 95 (2014) 1–3

Martijn Arnsa,b,∗, Hartmut Heinrichc,d, Ute Strehle

a Research Institute Brainclinics, Nijmegen, The Netherlands
b Utrecht University, Dept. Experimental Psychology, Utrecht, The Netherlands
c Dept. of Child and Adolescent Mental Health, University Hospital of Erlangen, Erlangen, Germany d Heckscher-Klinikum, d München, Germany
e University of Tuebingen, Tuebingen, Germany

abstract

Among the clinical applications of neurofeedback, most research has been conducted in ADHD. As an introduction a short overview of the general history of neurofeedback will be given, while the main part of the paper deals with a review of the current state of neurofeedback in ADHD. A meta-analysis on neurofeedback from 2009 found large effect sizes for inattention and impulsivity and medium effects sizes for hyperactivity. Since 2009 several new studies, including 4 placebo-controlled studies, have been published. These latest studies are reviewed and discussed in more detail. The review focuses on studies employing (1) semi-active, (2) active, and (3) placebo-control groups. The assessment of speci- ficity of neurofeedback treatment in ADHD is discussed and it is concluded that standard protocols such as theta/beta, SMR and slow cortical potentials neurofeedback are well investigated and have demon- strated specificity. The paper ends with an outlook on future questions and tasks. It is concluded that future controlled clinical trials should, in a next step, focus on such known protocols, and be designed along the lines of learning theory.

Attention-Deficit/Hyperactivity Disorder (ADHD) has become one of the most common neurodevelopmental and psychiatric dis- orders of childhood. The general rate of prevalence is reported between 3% and 7% of school age children (Cormier, 2008). In 40–60% of all cases ADHD persists into adolescence and adult- hood (Faraone, Biederman, & Mick, 2006). Currently, the disorder is primarily diagnosed by referring to the criteria of the Diagnos- tic and Statistical Manual of Mental Disorders (DSM-IV) or the International Statistical Classification of Mental Disorders (ICD- 10). According to the DSM-IV, the disorder presents itself in three primary subtypes: predominantly inattentive type, predominantly hyperactive-impulsive type and the combined type. Therefore the core symptoms of ADHD consist of inattention, impulsivity and hyperactivity.

Currently, both stimulant medication and behaviour ther- apy are the most often applied and accepted treatments for ADHD. However, recent large-scale studies and meta-analyses have demonstrated limitations of these treatments. For example, limited long-term effects of stimulant medication (possibly the result of an up-regulation of the Dopamine Transporter (DAT) (Wang et al., 2013)) and behaviour therapy have been reported (Molina et al.)