When most people think of treatment for ADHD, they think of Ritalin (methylphenidate) or other similar medications. However, medications for ADHD can have scary side effects, and in about 30% of patients, they do not work at all. Doctors and psychologists, have been working for many years on a type of treatment for ADHD that does not involve medication, called neurofeedback, or EEG biofeedback.
Neurofeedback is based on the fact that people with ADHD have different brainwaves than normal brains. These brainwave differences are the reason EEG can be used to diagnose ADHD. The patient is given some kind of sensory feedback that they are paying attention as a reward. As the patient is rewarded for paying attention, the positive reinforcement causes the patient to become conditioned to pay attention, or to do other cognitive tasks more efficiently. Typically, after a course of treatment is completed, the patient has learned a skill and is expected to retain it over the course of time.
It sounds simple in theory, but does it work? Numerous clinical studies have shown that neurofeedback is promising and possibly effective, but it is actually very hard to tell whether the treatment’s effectiveness is from neurofeedback alone, or some other aspect of the treatment (such as frequent visits with the psychologist, or medication given along with the treatment). Very few studies are done using an “active control”, where neurofeedback is compared to sham neurofeedback. Also, most studies have not been randomized or blinded, so there is significant potential for biased results. Experts in the field are quick to note that the effect size for treatment decreases substantially when randomized, blinded studies are compared to studies with an open design.
Further complicating matters, the term “neurofeedback” is used for a number of somewhat different treatments. Treatments not only differ in the type of brainwaves used, but also in the number and frequency of sessions, the location of treatments (home, school, clinic) and the types of outcomes rewarded (brainwave changes, behavioral changes, classroom changes, medication doses). No one really knows for sure which patients respond best to what kind of treatment.
So far, no negative physical or mental side effects have been identified for neurofeedback, but very few studies have actually examined this aspect of treatment.
Known downsides to neurofeedback are the following:
- Time. A limited number of neurofeedback providers often means long travel times to appointments. Appointments can be as often as twice a week for 3-4 months.
- Price. Cost can be fairly high–usually in the range of thousands of dollars. The cost may be covered by insurance or possibly by a school district if administered in school.
What to look for
If you are still interested in trying neurofeedback, despite the cost and its questionable effectiveness, here are some things to ask a prospective provider.
What research is there that supports your treatment protocol?
What experience do you have in treating ADHD? (Neurofeedback is used for a number of conditions, not just ADHD.)
What experience do you have treating (adults/children)?
How do you determine if treatment has been successful or unsuccessful? (Ideally you want not just brainwave changes, but changes in behavior and in academic and social function.)
Moriyama, Tais S., Guilherme Polanczyk, Arthur Caye, Tobias Banaschewski, Daniel Brandeis, and Luis A. Rohde. “Evidence-Based Information on the Clinical Use of Neurofeedback for ADHD.” Neurotherapeutics 9.3 (2012): 588-98. Print.
Sonuga-Barke, Edmund J.s., D. Brandeis, S. Cortese, D. Daley, M. Ferrin, M. Holtmann, J. Stevenson, M. Danckaerts, S. Van Der Oord, M. Dopfner, R. W. Dittman, E. Simonoff, A. Zudaas, T. Banaschewski, J. Buitelarr, D. Coghill, C. Hollis, E. Konofai, M. Lecendreux, I. C. Wong, J. Sargeant, and European ADHD Guidelines Group. “Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments.”American Journal of Psychiatry 170.3 (2013): 275-89. Print.