Neurofeedback versus psychostimulants in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a systematic review

Figures & data

Table 1 Overview of 12 RCT publications on the comparison of NF to MPH in treating children and adolescents with ADHD

Studies	n	Age range and means in years	Treatment and control conditions (n)	Number of sessions, duration of treatment, duration per session	Psychiatric comorbidity	Outcome measures	Results
Duric et al (2012, 2014, 2017)^Citation25,Citation32,Citation33	130	6–18 Mean: 11.2±2.8	Treatments: theta/beta (42), theta/beta+MPH (44) Control: MPH (44)	30 sessions, 2.5 months, 40 minutes	Not excluded	Behavioral assessments by parents and teachers, self-reports, with 6-month follow-up	All groups improved significantly on inattention and hyperactivity, with no treatment differences both posttreatment and at 6-month follow-up, although the most marked improvements were observed in the combination group
Li et al (2013)^Citation36	64	7–16 Mean: 10.6±2.8	Treatment: theta/SMR+MPH (32) Control: MPH+non- feedback attention training (32)	40 sessions, 5 months, 25–35 minutes	Not excluded	Behavioral assessments by parents and teachers, self-reports, EEG, with 6-month follow-up	Compared to control, treatment showed significant reduction of ADHD symptoms and improvement on brain and behavioral functions, maintained at 6-month follow-up; 6-month follow-up also showed significant increase in MPH dosage in the control group
Ogrim and Hestad (2013)^Citation27	32	7–16 Means: 10.6±2.0, 11.2±2.7	Treatment: theta/beta (16) Control: medication (16)	30 sessions, 4 months, 45 minutes	Not excluded	Behavioral assessments by parents and teachers, EEG, ERPs	Compared to NF, MPH showed significant improvement on behavioral assessments; both groups did not decrease in theta activity
Bink et al (2014)^Citation29	90	12–24 Mean: 16.1±3.3	Treatment: theta/SMR+TAU (45) Control: TAU (26)	40 sessions, 25 weeks, 30 minutes	Not excluded	Neurocognitive measures	Neurocognitive outcomes improved in both groups with no significant difference between groups
Meisel et al (2014)^Citation26	27	7–14 Means: 9.53±1.8, 8.9±1.53	Treatment: theta/beta (12) Control: MPH (11)	40 sessions, 5 months, 35 minutes	Excluded	Behavioral assessments by parents and teachers, with 6-month follow-up	Both groups improved significantly on ADHD symptoms with no significant differences between groups; 8 of 12 children in the NF group were medicated at 6-month follow-up
Geladé et al (2016, 2017)^Citation30,Citation31	112	7–13 Mean: 9.63±1.76	Treatment: theta/beta (39) Controls: MPH (36), physical activity (37)	29 sessions, 10–12 weeks, 45 minutes	Not excluded	Behavioral assessments by parents and teachers, neurocognitive measures	Compared to NF and physical activity, MPH showed significant improvement on behavioral and neurocognitive assessments, with no difference between NF and physical activity
Janssen et al (2016, 2016)^Citation34,Citation35	112	7–13 Mean: 9.63±1.76	Treatment: theta/beta (39) Controls: MPH (36), physical activity (37)	29 sessions, 10–12 weeks, 45 minutes	Not excluded	EEG power spectra, ERPs	Compared to physical activity, both NF and MPH showed significant reductions in theta power in the “eyes open” condition, but only MPH showed reductions in theta power in the active task condition. Only MPH showed increases in P3 no go ERP amplitudes
Lee and Jung (2017)^Citation28	36	6–12 Mean: 8.75±2.12	Treatment: theta/beta+medication (18) Control: medication (18)	20 sessions, 2.5 months, 50 minutes	Excluded	Behavioral assessments by parents, intelligence measures, EEG	Compared to control, treatment showed significant reduction in ADHD symptoms; both groups did not improve on intelligence measures; treatment showed reductions in theta power

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; EEG, electroencephalography; ERP, event-related potential; MPH, methylphenidate; NF, neurofeedback; RCT, randomized controlled trial; SMR, sensorimotor rhythm; TAU, treatment as usual.

Figure 1 PRISMA flow diagram of study selection.

DuricNSAssmusJGundersenDElgenIBNeurofeedback for the treatment of children and adolescents with ADHD: a randomized and controlled clinical trial using parental reportsBMC Psychiatry201212110722877086

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DuricNSAßmusJElgenIBSelf-reported efficacy of neurofeedback treatment in a clinical randomized controlled study of ADHD children and adolescentsNeuropsychiatr Dis Treat2014101645165425214789

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DuricNSAssmusJGundersenDDuric GolosAElgenIBMultimodal treatment in children and adolescents with attention-deficit/hyperactivity disorder: a 6-month follow-upNord J Psychiatry201771538639428345387

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LiLYangLZhuoCJWangYFA randomised controlled trial of combined EEG feedback and methylphenidate therapy for the treatment of ADHDSwiss Med Wkly201314325

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OgrimGHestadKAEffects of neurofeedback versus stimulant medication in attention-deficit/hyperactivity disorder: a randomized pilot studyJ Child Adolesc Psychopharmacol201323744845723808786

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BinkMvan NieuwenhuizenCPopmaABongersILvan BoxtelGJNeurocognitive effects of neurofeedback in adolescents with ADHD: a randomized controlled trialJ Clin Psychiatry201475553554224922488

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MeiselVServeraMGarcia-BandaGCardoEMorenoIReprint of “Neurofeedback and standard pharmacological intervention in ADHD: a randomized controlled trial with six-month follow-up”Biol Psychol201495111612524055220

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GeladéKBinkMJanssenTWvan MourikRMarasAOosterlaanJAn RCT into the effects of neurofeedback on neurocognitive functioning compared to stimulant medication and physical activity in children with ADHDEur Child Adolesc Psychiatry201726445746827665293

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GeladéKJanssenTWBinkMvan MourikRMarasAOosterlaanJBehavioral effects of neurofeedback compared to stimulants and physical activity in attention-deficit/hyperactivity disorder: a randomized controlled trialJ Clin Psychiatry20167710e1270e127727631143

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JanssenTWBinkMGeladéKvan MourikRMarasAOosterlaanJA randomized controlled trial into the effects of neurofeedback, methylphenidate, and physical activity on EEG power spectra in children with ADHDJ Child Psychol Psychiatry201657563364426748531

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JanssenTWBinkMGeladéKvan MourikRMarasAOosterlaanJA randomized controlled trial investigating the effects of neurofeedback, methylphenidate, and physical activity on event-related potentials in children with attention-deficit/hyperactivity disorderJ Child Adolesc Psychopharmacol201626434435326771913

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LeeEJJungCHAdditive effects of neurofeedback on the treatment of ADHD: a randomized controlled studyAsian J Psychiatr201725162128262140

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