17 May 2022

Roy S et al. Asian J Psychiatr 2022; 103133

Neurofeedback has been found to be effective in the overall reduction of hyperactivity and inattention in a child’s behaviour (Marzbani et al, 2016). However, it is not yet known whether neurofeedback is as effective as behavioural management or pharmacological treatment for ADHD. The objective of this study was to investigate the effectiveness of neurofeedback training in treating children with ADHD when compared with behavioural therapy and pharmacological treatment.

A 12-month repeated-measure interventional study was conducted in children aged 6–12 years with ADHD as per Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5TM) criteria. Following baseline assessment by Conners 3–Parent Short scale, patients were randomly assigned to one of three groups: neurofeedback,* behavioural therapy or pharmacological treatment. Following 3 months of treatment, patients were followed up using the Conners 3–Parent Short scale to assess the improvement in the symptoms.

Of the 90 randomised patients, 84 were included in the full analysis set (neurofeedback, n=29; behavioural therapy, n=27; pharmacological treatment, n=28); median age in each group was 8 years and 82.8%, 77.8% and 85.7% were boys, respectively. At baseline, no significant differences in Conners 3–Parent rating scale T-scores were observed in the different domains of inattention, hyperactivity/impulsivity, learning problems, executive functions, aggression/defiance or peer relation.

After 3 months of treatment, all three interventions led to an overall improvement in ADHD symptoms (p=0.000). Pairwise comparisons between treatments revealed that pharmacological treatment was more effective in improving inattention (neurofeedback, p=0.014; behavioural therapy, p<0.001) and hyperactivity/impulsivity (neurofeedback, p<0.001; behavioural therapy, p=0.000); however, no significant differences were observed between neurofeedback and behavioural therapy (inattention: p=0.057; hyperactivity/impulsivity: p=1.000). Pharmacological treatment also showed significant improvement in executive functioning versus behavioural therapy (p=0.001) but not neurofeedback (p=0.248) and no differences were observed between neurofeedback and behavioural therapy (p=0.208).

Neurofeedback was found to be more effective than behavioural therapy in improving learning problems (p=0.001) and peer relations (p=0.015); however, no significant difference was observed between neurofeedback and pharmacological treatment (learning problems: p=0.400; peer relations: p=1.000). Similar effectiveness in improving aggression/defiance was reported for all three interventions.

There were several limitations to this study. Firstly, the sample size was small. Secondly, a maximum of 1 mg/kg/day methylphenidate was used, which was considered moderate at best. In addition, blinding clinicians to treatment was not possible. Finally, treatment effects were assessed by parent-reported data only; however, a teacher report alongside this could have informed about treatment effects in a better way.

The authors concluded that improvement in core ADHD symptoms was observed with all three interventions, with pharmacological treatment showing the greatest improvement for core symptoms and executive functioning. However, neurofeedback and behavioural therapy were similar. Neurofeedback produced the best results for learning problems and peer relations; although these were not significantly better than pharmacological treatment, they were better than behavioural therapy.

Read more about neurofeedback training, behaviour therapy and pharmacological treatment in children with ADHD

 

*Neurofeedback training utilised BioTrace+ software with NeXus-10 and a single-channel monopolar electrode. Two 40-minute sessions were conducted per week.
Behavioural interventions included psychoeducation and behavioural management, positive reinforcement, physical games and exercise, and attention enhancement tasks. Two 40-minute sessions were conducted per week.
Patients in the pharmacological treatment group received methylphenidate 5 mg once daily in the morning, titrated as per symptoms of the child up to a maximum dose of 1 mg/kg/day in two divided doses.

Disclaimer: The views expressed here are the views of the author(s) and not those of Takeda.

Marzbani H, Marateb HR, Mansourian M. Neurofeedback: A comprehensive review on system design, methodology and clinical applications. Basic Clin Neurosci 2016; 7: 143-158.

Roy S, Mandal N, Ray A, et al. Effectiveness of neurofeedback training, behaviour management including attention enhancement training and medication in children with attention-deficit/hyperactivity disorder – A comparative follow up study. Asian J Psychiatr 2022; 103133.

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