Does neurofeedback really help with ADHD symptoms?

ADHD hits the UK headlines again this week with news of 8 year waiting lists for diagnosis and treatment. ADHD (Attention Deficit Hyperactivity Disorder) is a neurodevelopmental condition that affects millions of individuals worldwide, impacting their ability to focus, control impulses, and regulate activity levels. While the front-line treatment remains to be stimulant medication, many with the condition or parents of children with ADHD do not like the idea of relying on medication for life and are interested in alternative approaches. A growing body of research is shedding light on the potential benefits of neurofeedback as one such complementary or alternative approach.  

Understanding Neurofeedback 

Neurofeedback, also known as EEG biofeedback, is a non-invasive treatment that aims to train individuals to self-regulate their brain activity. The process involves monitoring brain waves in real-time using electroencephalography (EEG) and providing immediate feedback to the individual, allowing them to learn to modify their brain activity patterns. 

In the context of ADHD, neurofeedback typically targets specific brainwave frequencies associated with attention and focus. For instance, individuals with ADHD often exhibit an excess of theta waves (associated with drowsiness) and a deficit in beta waves (associated with focused attention) in certain brain regions. Neurofeedback aims to help these individuals increase their beta wave activity while decreasing theta wave activity, potentially leading to improvements in attention, impulse control, and overall cognitive function. 

The efficacy of neurofeedback for ADHD has been the subject of numerous studies over the past few decades and a growing body of evidence supports its potential benefits: 

It induces Brain Plasticity: 

Research by Beauregard and Lévesque (2006) published in Neuroscience Letters demonstrated that neurofeedback training could induce neuroplastic changes in the brains of individuals with ADHD. Using functional magnetic resonance imaging (fMRI), they observed increased activation in brain regions associated with selective attention and response inhibition following neurofeedback treatment.  

It has long term effects: 

A landmark study by Strehl et al. (2017) published in the Journal of Child Psychology and Psychiatry examined the long-term effects of neurofeedback in children with ADHD. The researchers found that neurofeedback produced sustained improvements in ADHD symptoms, which were still evident six months after the treatment ended. Importantly, these improvements were comparable to those achieved with stimulant medication.  

How it compares with / and enhances medication: 

Meisel et al. (2013) conducted a randomized controlled trial comparing neurofeedback to methylphenidate (a common ADHD medication) in children with ADHD. The study, published in the European Child & Adolescent Psychiatry journal, found that both treatments led to significant improvements in  ADHD symptoms, with neurofeedback showing additional benefits in academic performance. Van Doren et al. (2019) conducted a meta-analysis published in the European Child & Adolescent Psychiatry journal, focusing on the long-term effects of neurofeedback. They found that neurofeedback produced sustained benefits for ADHD symptoms, which were enhanced when combined with medication or other interventions. 

A comprehensive meta-analysis by Arns et al. (2009) published in Clinical EEG and Neuroscience examined 15 studies on neurofeedback for ADHD. The researchers concluded that neurofeedback met the criteria for "efficacious and specific" treatment for ADHD, with large effect sizes for inattention and impulsivity, and a medium effect size for hyperactivity. 

The view from the NHS: 

While neurofeedback is not yet available within the NHS, there are encouraging signs of growing interest and acceptance: 

NICE Guidelines: 

The National Institute for Health and Care Excellence (NICE), which provides evidence-based guidance for the NHS, has acknowledged the potential of neurofeedback in its guidelines for ADHD management. While not yet recommending it as a first-line treatment, NICE has called for further research into neurofeedback as a potential intervention for ADHD. 

Several NHS trusts across the UK have begun piloting neurofeedback programs for ADHD and other conditions. For example, the South London and Maudsley NHS Foundation Trust has been exploring the use of neurofeedback for various mental health conditions, including ADHD. 

NHS-affiliated research institutions, such as the Institute of Psychiatry, Psychology & Neuroscience at King's College London, have been involved in studies investigating the efficacy of neurofeedback for ADHD. These collaborations help bridge the gap between academic research and clinical practice within the NHS. 

Some NHS professionals are receiving training in neurofeedback techniques, indicating a growing recognition of its potential value in clinical practice. The Biofeedback Foundation of Europe, for instance, offers accredited training programs that have been attended by NHS clinicians. 

As awareness of neurofeedback grows, more patients are expressing interest in non-pharmacological treatment options for ADHD. This increased demand may encourage the NHS to explore and potentially incorporate neurofeedback into its range of available treatments. 

Benefits of Neurofeedback for ADHD 

Based on the academic research and growing clinical interest, neurofeedback offers several potential benefits for individuals with ADHD: 

 1. It’s non-invasive and drug-free: 

Unlike medication, neurofeedback does not involve the introduction of chemicals into the body, making it an attractive option for those concerned about potential side effects of ADHD medications. 

 2. It has long-lasting effects: 

Several studies have demonstrated that the benefits of neurofeedback can persist long after the treatment has ended, suggesting that it may lead to sustainable improvements in brain function. 

 3. Improved self-regulation: 

By learning to control their brain activity, individuals with ADHD may develop better self-regulation skills that extend beyond the neurofeedback sessions. 

 4. Personalised approach: 

Neurofeedback protocols can be tailored to address the specific brainwave patterns and symptoms of each individual, allowing for a more personalised treatment approach. 

 5. Potential for Reduced Medication Reliance: 

Some studies suggest that neurofeedback may allow individuals to reduce their reliance on ADHD medications, potentially minimising long-term side effects and costs associated with pharmacological treatments. 

 6. Broader Cognitive Benefits: 

In addition to improving core ADHD symptoms, neurofeedback has been associated with enhancements in overall cognitive function, including working memory, processing speed, and executive functioning. 

Conclusion 

Neurofeedback represents a promising approach to ADHD treatment, offering a non-invasive, drug-free alternative or complement to traditional interventions. The growing body of academic research supporting its efficacy, coupled with increasing interest within the NHS, suggests that neurofeedback may play an increasingly important role in ADHD management in the coming years. 

 As research continues and clinical practice evolves, neurofeedback has the potential to revolutionize the approach to ADHD treatment, offering hope for improved outcomes and quality of life for individuals living with this challenging condition.