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Neurofeedback for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials

Neurofeedback for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials
Neurofeedback for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials
Objective: We performed meta-analyses of randomized controlled trials to examine the effects of neurofeedback on attention-deficit/hyperactivity disorder (ADHD) symptoms and neuropsychological deficits in children/adolescents with ADHD.

Method: We searched Pubmed, Ovid, Web of Science, ERIC and CINAHAL through August 30, 2015. Random-effects models were employed. Studies were evaluated with the Cochrane Risk of Bias (RoB) tool.

Results: We included 13 trials (520 participants with ADHD). Significant effects were found on ADHD symptoms rated by assessors most proximal to the treatment setting, i.e., the least blinded outcome measure (standardized mean difference [SMD]: ADHD total symptoms=0.35, 95% CI=0.11-0.59; inattention=0.36, 95% CI=0.09-0.63; hyperactivity/impulsivity=0.26, 95% CI=0.08-0.43). Effects were not significant when probably blinded ratings were the outcome or in trials with active/sham controls. Results were similar when only frequency band training trials, the most common neurofeedback approach, were analysed separately. Effects on laboratory measures of inhibition (SMD=0.30, 95% CI= -0.10-0.70) and attention (SMD=0.13, 95% CI= -0.09-0.36) were not significant. Only four studies directly assessed if learning occurred after neurofeedback training. The risk of bias was unclear for many RoB domains in most studies.

Conclusion: Evidence from well-controlled trials with probably blinded outcomes currently fails to support neurofeedback as an effective treatment for ADHD. Future efforts should focus on implementing standard neurofeedback protocols, ensuring learning, and optimizing clinically relevant transfer.
0890-8567
444-445
Cortese, Sam
53d4bf2c-4e0e-4c77-9385-218350560fdb
Ferrin, Maite
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Brandeis, Daniel
58d13628-f513-4af5-822c-7401cf5dbfd4
Holtmann, Martin
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Aggensteiner, Pascal
c282d188-6646-43e4-8432-a8ceeb6e838b
Daley, David
651d0b29-8790-4a13-aa18-ad9a499d34e8
Santosh, Paramala
c1ac98e0-83b9-4583-a3ce-ca82085ffde4
Simonoff, Emily
f47d91a8-3d57-4183-bf24-80352c55eedc
Stevenson, Jim
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Stringaris, Argyris
b813012e-7b67-432b-9799-2187bf675c30
Sonuga-Barke, Edmund
bc80bf95-6cf9-4c76-a09d-eaaf0b717635
European ADHD Guidelines Group
Cortese, Sam
53d4bf2c-4e0e-4c77-9385-218350560fdb
Ferrin, Maite
65c4c0b6-2a91-4343-8ef0-688ad2b1ba85
Brandeis, Daniel
58d13628-f513-4af5-822c-7401cf5dbfd4
Holtmann, Martin
511fa11b-f2cb-413f-880e-50c3b04ad9d3
Aggensteiner, Pascal
c282d188-6646-43e4-8432-a8ceeb6e838b
Daley, David
651d0b29-8790-4a13-aa18-ad9a499d34e8
Santosh, Paramala
c1ac98e0-83b9-4583-a3ce-ca82085ffde4
Simonoff, Emily
f47d91a8-3d57-4183-bf24-80352c55eedc
Stevenson, Jim
0c85d29b-d294-43cb-ab8d-75e4737478e1
Stringaris, Argyris
b813012e-7b67-432b-9799-2187bf675c30
Sonuga-Barke, Edmund
bc80bf95-6cf9-4c76-a09d-eaaf0b717635

European ADHD Guidelines Group (2016) Neurofeedback for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. Journal of the American Academy of Child & Adolescent Psychiatry, 55 (6), 444-445. (doi:10.1016/j.jaac.2016.03.007).

Record type: Article

Abstract

Objective: We performed meta-analyses of randomized controlled trials to examine the effects of neurofeedback on attention-deficit/hyperactivity disorder (ADHD) symptoms and neuropsychological deficits in children/adolescents with ADHD.

Method: We searched Pubmed, Ovid, Web of Science, ERIC and CINAHAL through August 30, 2015. Random-effects models were employed. Studies were evaluated with the Cochrane Risk of Bias (RoB) tool.

Results: We included 13 trials (520 participants with ADHD). Significant effects were found on ADHD symptoms rated by assessors most proximal to the treatment setting, i.e., the least blinded outcome measure (standardized mean difference [SMD]: ADHD total symptoms=0.35, 95% CI=0.11-0.59; inattention=0.36, 95% CI=0.09-0.63; hyperactivity/impulsivity=0.26, 95% CI=0.08-0.43). Effects were not significant when probably blinded ratings were the outcome or in trials with active/sham controls. Results were similar when only frequency band training trials, the most common neurofeedback approach, were analysed separately. Effects on laboratory measures of inhibition (SMD=0.30, 95% CI= -0.10-0.70) and attention (SMD=0.13, 95% CI= -0.09-0.36) were not significant. Only four studies directly assessed if learning occurred after neurofeedback training. The risk of bias was unclear for many RoB domains in most studies.

Conclusion: Evidence from well-controlled trials with probably blinded outcomes currently fails to support neurofeedback as an effective treatment for ADHD. Future efforts should focus on implementing standard neurofeedback protocols, ensuring learning, and optimizing clinically relevant transfer.

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Accepted/In Press date: 28 March 2016
e-pub ahead of print date: 1 April 2016
Published date: June 2016
Organisations: Clinical Neuroscience

Identifiers

Local EPrints ID: 393080
URI: http://eprints.soton.ac.uk/id/eprint/393080
ISSN: 0890-8567
PURE UUID: d77c84d3-712c-4ce6-a57c-6797c6ed5fae
ORCID for Sam Cortese: ORCID iD orcid.org/0000-0001-5877-8075

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Date deposited: 21 Apr 2016 08:00
Last modified: 15 Mar 2024 05:30

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Contributors

Author: Sam Cortese ORCID iD
Author: Maite Ferrin
Author: Daniel Brandeis
Author: Martin Holtmann
Author: Pascal Aggensteiner
Author: David Daley
Author: Paramala Santosh
Author: Emily Simonoff
Author: Jim Stevenson
Author: Argyris Stringaris
Author: Edmund Sonuga-Barke
Corporate Author: European ADHD Guidelines Group

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