ADHD and Hyperactive / Inattentive Disorders

ADHD in children and adolescents is the area of EEG neurofeedback with really strong research to support the enthusiastic claims of clinicians.  In my opinion, the best review article was published by Vincent Monastra PhD in the January 2005 edition of Child & Adolescent Clinics of North America (volume 14:1, pp. 55-82).

Monastra’s own research includes one of the best clinical studies done so far.  To summarize–which is hardly fair to either the reader’s curiosity or Dr. Monastra’s intricate design–multiple measures demonstrated that neurofeedback was approximately as effective at treating ADHD symptoms and signs as medication, did not have adverse effects, and sustained after treatment over the long-term follow-up which stimulant medication did not.

Monastra’s study was carefully reviewed by David Rabiner PhD in November 2007.  He offers a thoughtful critique of the limitations of the study but concludes, “These results provide compelling evidence that incorporating neurofeedback into a comprehensive treatment approach for ADHD can yield important benefits.”

Dr. Rabiner’s report is available from

Good studies have continued to be published over the years.  I think the one that convinced specialists in ADHD who had been skeptical was a European study by Gevenslaben and colleagues.  They studied 102 children ages 8-12 and used a randomized control group model. Parent and teacher ratings of core ADHD symptoms of inattentive and hyperactive-impulsive symptoms, and parents’ ratings of oppositional and aggressive behavior measures all improved with statistical significance.

Additional comment: It is a matter of considerable concern and frustration to my colleagues and myself that neurofeedback is not an industry and does not have the resources to support either sophisticated coordinated research or major marketing budgets to grab and hold the attention of practicing and academic physicians.  For instance, every week I personally receive at least one or two, often more, publications presented in the format of medical journals or supplements to recognizable publications devoted to some aspect of ADHD.  These are all “educational material” clearly targeted toward increased use of medications.  Yes, they are helpful in raising physician awareness of ADHD and its co-morbidities, but I have never seen an informed comment about neurofeedback and ADHD (very rarely, there will be a highly qualified tag in a section on “other psychological approaches” in which EEG neurofeedback gets a passing mention). I stopped writing letters to the editorial staff about this a couple of years ago.

A particularly annoying example arrived in February 2008. Title, Optimizing Patient Outcomes in Adult ADHD: Current and Emerging Therapies.  It contained two articles in a large-format 4-page supplement to Psychiatric TImes, called Advances in Psychiatric Medicine. At the bottom of the front page was, “Supported in part by an unrestricted educational grant from Shire Pharmaceuticals, Inc.”  Included in the Disclosures statement was the following: “The editors of this educational activity have no financial relationship with the firm providing support in part by an unrestricted educational grant.”  I have nothing against Shire Pharmaceuticals; I write prescriptions for their Adderall XR and Vyvanse because they help my patients.  But I recommend neurofeedback much more frequently because it too is helpful to my patients.  Often remarkably so.  Why isn’t EEG  or brainwave neurofeedback considered by this and so many other publications to be “current and emerging”?  Question asked and answered!