Neurofeedback, a specialized type of biofeedback, is a training technique that helps individuals learn to self-regulate their brain function. This non-invasive approach uses real-time monitoring of brain activity to teach people how to voluntarily shift their mental state. For those managing Attention-Deficit/Hyperactivity Disorder (ADHD), neurofeedback has emerged as a non-pharmacological option for improving focus and reducing behavioral symptoms. This article reviews the scientific evidence for its use in managing ADHD symptoms.
How Neurofeedback Targets ADHD Symptoms
The theory behind neurofeedback for ADHD rests on the concept of brain dysregulation, where the electrical patterns of the brain deviate from typical norms. Individuals with ADHD often exhibit an elevated ratio of slow-wave Theta activity compared to faster Beta waves, especially in the frontal regions. This excess of slower activity correlates with symptoms like inattention, distractibility, and mental fogginess. The goal of the Theta/Beta Ratio (TBR) training is to decrease these slow waves while simultaneously increasing the faster, attentive Beta waves.
Another approach targets the Sensory-Motor Rhythm (SMR), a specific brain wave frequency associated with a calm yet focused state of mind. SMR training aims to increase this frequency, which helps promote better impulse control and reduced hyperactivity. By offering immediate feedback, the brain learns through operant conditioning to produce the desired electrical patterns, effectively strengthening its capacity for self-regulation. This training encourages neuroplasticity, helping the brain adopt more efficient and balanced electrical patterns.
What Happens During a Neurofeedback Session
Neurofeedback treatment begins with an initial assessment, often including a Quantitative Electroencephalogram (QEEG) mapping to measure the brain’s baseline electrical activity. This assessment helps the practitioner identify specific areas of dysregulation and tailor the training protocol to the individual’s unique profile. During a typical session, small sensors, or electrodes, are placed on the scalp to monitor brain activity. These sensors only record electrical signals and do not administer any current to the head.
The recorded brainwave data is processed by a computer and presented back to the individual in real-time, often as a visual display like a video game or a movie. The person is instructed to keep the display progressing smoothly by maintaining the desired brainwave state, such as increasing SMR or decreasing Theta waves. If the brain produces the target pattern, a race car might speed up or a movie screen might brighten, providing an immediate reward. This continuous feedback allows the brain to gradually learn and internalize the successful self-regulation strategy.
The Scientific Evidence on Effectiveness
The scientific evidence regarding neurofeedback’s effectiveness for ADHD is complex, reflecting a range of findings across multiple studies and meta-analyses. Some systematic reviews demonstrate a significant positive impact on core ADHD symptoms, particularly inattention, when compared to non-active control groups like a waitlist. These reviews report medium to large effect sizes for inattention and hyperactivity/impulsivity, suggesting a meaningful clinical benefit. Furthermore, some research indicates that the benefits achieved may be sustained, with effects sometimes increasing at follow-up assessments conducted six to twelve months after training concluded.
However, other comprehensive meta-analyses yield more cautious conclusions, finding no statistically significant advantage for neurofeedback when compared to active control conditions or sham treatments. These studies suggest that while improvements are often seen, they might be influenced by non-specific factors, such as the attention received during therapy, which is common in many psychological interventions. Comparisons with stimulant medication frequently show that medication is superior in symptom reduction. Professional organizations have acknowledged neurofeedback, with some categorizing it as having substantial empirical support, yet the debate over its efficacy relative to established treatments continues.
Practical Guide to Starting Treatment
Individuals considering neurofeedback for ADHD should prepare for a commitment of both time and resources. A complete course of treatment typically requires between 30 and 40 sessions, though some patients may need more, and positive results may not be noticeable until at least 15 to 20 sessions have been completed. Sessions are usually scheduled two to three times per week, with each session lasting approximately 30 to 60 minutes.
The cost of neurofeedback can be substantial, and it is often not covered by standard health insurance plans, meaning payment is usually out-of-pocket. To ensure a high standard of care, it is advisable to seek a qualified practitioner who holds certification from the Biofeedback Certification International Alliance (BCIA). This certification indicates the practitioner has met rigorous training and educational standards in the field. Neurofeedback is generally considered a low-risk intervention, being non-invasive and non-pharmacological, with few adverse side effects reported.