Neurofeedback and Cognitive Attention Training for Children with Attention-Deficit Hyperactivity Disorder in Schools

Naomi J. Steiner, MD,* Elizabeth C. Frenette, MPH,* Kirsten M. Rene, MA,* Robert T. Brennan, EdD,† Ellen C. Perrin, MD*

ABSTRACT: Objective: To evaluate the efficacy of 2 computer attention training systems administered in school for children with attention-deficit hyperactivity disorder (ADHD). Method: Children in second and fourth grade with a diagnosis of ADHD (n 5 104) were randomly assigned to neurofeedback (NF) (n 5 34), cognitive training (CT) (n 5 34), or control (n 5 36) conditions. A 2-point growth model assessed change from pre-post intervention on parent reports (Conners 3-Parent [Conners 3-P]; Behavior Rating Inventory of Executive Function [BRIEF] rating scale), teacher reports (Swanson, Kotkin, Agler, M-Flynn and Pelham scale [SKAMP]; Conners 3-Teacher [Conners 3-T]), and systematic classroom observations (Behavioral Observation of Students in Schools [BOSS]). Paired t tests and an analysis of covariance assessed change in medication. Results: Children who received NF showed significant improvement compared with those in the control condition on the Conners 3-P Attention, Executive Functioning and Global Index, on all BRIEF summary indices, and on BOSS motor/verbal off-task behavior. Children who received CT showed no improvement compared to the control condition. Children in the NF condition showed significant improvements compared to those in the CT condition on Conners 3-P Executive Functioning, all BRIEF summary indices, SKAMP Attention, and Conners 3-T Inattention subscales. Stimulant medication dosage in methylphenidate equiv- alencies significantly increased for children in the CT (8.54 mg) and control (7.05 mg) conditions but not for those in the NF condition (0.29 mg). Conclusion: Neurofeedback made greater improvements in ADHD symptoms compared to both the control and CT conditions. Thus, NF is a promising attention training treatment intervention for children with ADHD.

(J Dev Behav Pediatr 35:18–27, 2014) Index terms: neurofeedback, ADHD, classroom observations, computer attention training, school intervention, growth modeling. 

Category: ADHD, children, medication

Do stimulant medications improve educational and behavioral outcomes for children with ADHD?

Janet Currie (a)∗, Mark Stabile (b), Lauren Jones (c)

(a) Princeton University and NBER, United States  (b) University of Toronto and NBER, Canada  (c) Cornell University, United States

Received 7 January 2014

Received in revised form 8 May 2014 Accepted 9 May 2014


We examine the effects of a policy change in the province of Quebec, Canada which greatly expanded insurance coverage for prescription medications. We show that the change was associated with a sharp increase in the use of stimulant medications commonly prescribed for ADHD in Quebec relative to the rest of Canada. We ask whether this increase in medication use was associated with improvements in emotional functioning or academic outcomes among children with ADHD. We find little evidence of improvement in either the medium or the long run. Our results are silent on the effects on optimal use of medication for ADHD, but suggest that expanding medication in a community setting had little positive benefit and may have had harmful effects given the average way these drugs are used in the community.