Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that presents with inattention, hyperactivity, and impulsivity. These characteristics can affect daily functioning, including academic and social interactions. Neurofeedback has emerged as a potential intervention for managing these symptoms.
What Neurofeedback Is
Neurofeedback is a form of biofeedback that helps individuals control their brain activity. Sensors on the scalp measure brainwave patterns via electroencephalography (EEG), displaying them visually or audibly in real-time. Neurofeedback’s core principle is that brainwave patterns correlate with mental states. Real-time feedback allows individuals to consciously adjust their brain activity. Through operant conditioning, desired brainwave changes are rewarded, training the brain to produce more optimal patterns and improve self-regulation.
How Neurofeedback Targets ADHD
Individuals with ADHD often have dysregulated brainwave patterns. Many brains with ADHD generate an abundance of slow delta or theta waves and a shortage of high beta waves. This imbalance, especially an elevated theta-to-beta ratio, correlates with inattention and distractibility. Sensorimotor rhythm (SMR), a specific brainwave frequency between 12-15 Hz, is also a common target.
Protocols train these specific patterns. A common approach suppresses slow theta waves while enhancing faster beta waves. Another protocol increases SMR activity, linked to improved attention and reduced hyperactivity. Repeated training aims to normalize these ratios, improving attention, impulse control, and reducing hyperactivity.
Scientific Evidence for ADHD
Scientific evidence for neurofeedback’s effectiveness in ADHD is subject to ongoing research and varying interpretations. Early studies and some meta-analyses suggested neurofeedback could improve ADHD symptoms, with some finding medium effect sizes for inattention and hyperactivity/impulsivity. This led organizations like the American Academy of Pediatrics (AAP) to previously classify neurofeedback as a “Level 1 – Best Support” intervention for attention and hyperactivity, indicating strong efficacy.
More recent, comprehensive meta-analyses present a different perspective. A 2022 systematic review and meta-analysis of randomized controlled trials found neurofeedback showed no significant benefit for core ADHD symptoms compared to other treatments or control conditions. Similarly, a 2024 meta-analysis of 38 randomized clinical trials found no meaningful benefits for ADHD symptoms or most neuropsychological outcomes. While a small improvement in processing speed was noted, it did not correlate with real-world ADHD symptoms.
Newer analyses suggest previous positive findings may have been influenced by study design limitations or unblinded assessments. Current evidence, especially from rigorously designed studies, indicates neurofeedback may not provide significant benefits for core ADHD symptoms compared to control conditions or other interventions. This evolving understanding means that while neurofeedback is non-pharmacological, its clinical impact on ADHD symptoms remains debated.
Considering Neurofeedback Treatment
Understanding the typical neurofeedback treatment process for ADHD can be helpful. A treatment course involves multiple sessions, with improvements often observed after 20 to 40 sessions, though some protocols recommend up to 60. Each session lasts 30 to 45 minutes, typically scheduled one to three times per week for consistent progress.
Before starting, an initial assessment of brain activity and symptoms tailors the treatment. During sessions, scalp sensors are used while the individual engages in activities, like watching a video or playing a game, that respond to their brainwave activity. This provides feedback for learning brain self-regulation. Neurofeedback is often part of a comprehensive ADHD treatment plan, which may include other therapies.