Summary of Evidence for ADHD
Abstracts, links conclusions.
Summary of some evidence supporting the efficacy of biofeedback for ADHD
by Gary Ames, AlertFocus.com
There is the comprehensive bibliography on neurofeedback with
hundreds of references over many indications. The ADHD literature
is about 25% of this list.
See the 2005 white paper for a robust look at the literature and evidence.
These 2 sites have a large bibliography with many abstracts available
Kaiser and Othmer (2000) did a study, with 1,089 patients, which
showed that neurofeedback training of sensorimotor and beta waves led to
significant improvement in attentiveness and impulse control, and
positive changes as measured on the Test Of Variables of Attention
(TOVA). The patients had moderate pre-training deficits.
http://www.haworthpress.com/store/ArticleAbstract.asp?sid=G21WVLM481WT8GTCHJRHH95VBG6D07FA&ID=12758 or see below.
Monastra, et al (2002) worked with 100 children taking Ritalin as
well as having concurrent parent counseling and academic support. Half
also received EEG biofeedback. There were similar improvements on the
TOVA and an ADD evaluation scale. Only those children who had EEG
biofeedback were able to sustain their improvements without Ritalin.
Another study found that 16 of 24 patients taking medication were
able to lower their doses or discontinue medication totally after
successful training (Alhambra et al 1995).
Two small studies have shown EEG biofeedback to be as effective as
Ritalin on numerous measures (Rossiter & LaVaque 1995, Fuchs,
Birbaumer, et al, 2003).
Other studies using similar techniques showed increases in
intelligence scores and academic performance if theta training was added
and was successful. (Lubar et al 1995).
One small study of 16 children compared children trained with
neurofeedback to those on a waiting list. They found increased
intelligence scores and reduced inattentive behaviors as rated by
parents (Linden et al 1996).
Another type of evidence are the improvements in brain functioning
after neurofeedback. A recent fMRI study:
Below is the abstract of 1 summary article and 3 larger studies.
Electroencephalographic Biofeedback in the Treatment of Attention-Deficit/Hyperactivity Disorder
Vincent J. Monastra, Steven Lynn, Michael Linden, Joel F. Lubar, John Gruzelier, and Theodore J. LaVaque
J. Appl Psychophysiol Biofeedback. 2005 Jun;30(2):95-114.
Historically, pharmacological treatments for
attention-deficit/hyperactivity disorder (ADHD) have been considered to
be the only type of interventions effective for reducing the core
symptoms of this condition. However, during the past three decades, a
series of case and controlled group studies examining the effects of EEG
biofeedback have reported improved attention and behavioral control,
increased cortical activation on quantitative electroencephalographic
examination, and gains on tests of intelligence and academic achievement
in response to this type of treatment. This review paper critically
examines the empirical evidence, applying the efficacy guidelines
jointly established by the Association for Applied Psychophysiology and
Biofeedback (AAPB) and the International Society for Neuronal Regulation
(ISNR). On the basis of these scientific principles, EEG biofeedback
was determined to be "probably efficacious" for the treatment of ADHD.
Although significant clinical improvement was reported in approximately
75% of the patients in each of the published research studies,
additional randomized, controlled group studies are needed in order to
provide a better estimate of the percentage of patients with ADHD who
will demonstrate such gains in clinical practice.
The Efficacy of Attention Training For Children with ADHD: A Double-Blind Placebo-Controlled Study
Roger debus, PhD, and J.D. Ball, PhD
Eastern Virginia Medical School, Norfolk, Virginia
This study’s main objectives were to recruit children
with a primary diagnosis of ADHD to participate in an attention
training (EEG biofeedback) paradigm to determine the effect of this
treatment on the cardinal symptoms of ADHD. This was the first study to
utilize a placebo condition and double-blind interface with this type of
The design of the study consisted of a diagnostic workup,
40 sessions (with a crossover after 20 sessions), and pre-, mid-, and
post-assessments. Testing measurements were parent, teacher, and
self-report rating scales, and a continuous performance test. During the
sessions each child played Sony PlayStation games with an active sensor
placed at FZ. The children were randomized into two groups. Group 1
received 20 sessions of brainwave-modulated videogames and then received
20 sessions with the videogames while brainwave activity was monitored.
Group 2 received treatment in the opposite order.
Results are based on 53 seven- to 11-year-old children.
The primary analysis used in this study was Hierarchical Multivariate
Linear Modeling (HMLM). The outcome measures used to determine the
efficacy of this intervention (experimental vs. placebo-control) were
divided into five domains: (a) ADHD Symptoms (b) Aggression &
Conduct Problems, (c) Internalizing Symptoms, (d) Adaptive Skills, and
(e) Academic Performance. There were ten significant findings (p <
.000) across all the domains for the experimental group compared to the
In summary, the attention training via EEG biofeedback
showed many significant improvements in the experimental versus the
placebo-control condition. Some of the measured improvements included:
(a) reduced hyperactivity and improved attention, (b) less aggressive
behaviors, (c) better adaptability to change, interacting more
successfully with others, and improved organizational skills; and (d)
children showed improved responding and attention on a computerized
Efficacy of EEG Biofeedback for Attentional Processes
David A. Kaiser, Siegfried Othmer
Los Angeles, CA
Presented at American Psychiatric Electrophysiological Association, San Diego, 1997.
Attention Deficit Disorder is often assessed with tools which include
a continuous performance test (CPT of vigilance and focused attention.
CPTs are particularly useful in titrating medication due to the absence
of practice effects. In the present work, a CPT test was employed to
assess progress with EEG biofeedback training for 408 children and 122
adults referred for attentional deficits and affective complaints.
training protocol consisted of rewarding enhanced EEG amplitudes at the
sensorimotor strip (site C3 or C4) in the 12-18 Hz frequency range,
while simultaneously inhibiting excessive low frequency (4-7 Hz) and
high-frequency (22-30 Hz) activity.
Significant improvement was
found for measures of inattention, impulsivity and response variability
after 20 training sessions, p < .001. Inattention and response
variability in particular were restored to the normal range of
functioning from pre-training deficit levels (Greenberg,1987). No effect
of age or gender was found.
Of the 530 subjects, 62 opted to
continue training after 20 sessions. Impulse control and response
variability was found to improve with additional sessions, p < .01.
extraordinary success rate of EEG biofeedback in remediating
attentional problems, in the present and previous studies, suggests that
profound effects on neurobiological mechanisms may be responsible for
Kaiser and Othmer (2000)
Background: Neurofeedback studies have been
criticized for including small numbers of subjects. The effect of
SMR-beta neurofeedback training on the Test of Variables of Attention
was evaluated in more than 1,000 subjects from thirty-two clinics.
Methods: 1089 subjects (726 children, 324 females, 186 with ADHD or ADD
diagnoses) underwent twenty or more sessions of SMR-beta neurofeedback
training for attentional and behavioral complaints at thirty-two
clinical settings affiliated with EEG Spectrum, Inc. Subjects were
evaluated prior to training and at training completion. One hundred and
fifty-seven subjects who elected extensive training (forty sessions or
more) were tested after both twenty and forty training sessions.
Results: Neurofeedback training produced significant improvement in
attentiveness, impulse control, and response variability. Significant
clinical improvement in one or more measures was seen in eighty-five
percent of those subjects with moderate pre-training deficits.
Neurofeedback training is effective in remediating attentional
dysfunction. Nevertheless, large-scale studies with greater control
(e.g., wait-list designs) are sorely needed.
Gary Ames conclusion. We have a remedy for ADHD with numerous advantages.
· Biofeedback in general, is accepted by academia as scientifically sound.
· Neurofeedback works on
the site of the disorder to reverse the mechanism of action.
Diverse imaging studies show that the ADHD is no longer
· Effectiveness literature for ADHD consistently shows a 75-80% success rate.
· Broad benefits.
Neurofeedback remediates all the symptoms of ADHD. Medications can
be withdrawn, improved attention, academic success, etc.
· Enduring results. Follow ups have been tracked for months, years and decades.
· Adverse reactions are
rare, minor and self-limiting. It is relaxing and pleasant.