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EEG Biofeedback for ADHD

Research findings limited by small study size and methodological problems

This is the 5th in a series of blog posts on ADHD. The focus of this post is electroencephalographic (EEG) biofeedback, sometimes called neurofeedback.

What it is and how it works

Many individuals diagnosed with ADHD have abnormal patterns of brain electrical activity, including ‘under-arousal’ in frontal and mid-line cortical regions and frontal ‘hyper-arousal’ that is more frequent in individuals who do not respond to stimulant medications. EEG biofeedback is aimed at normalizing EEG activity in order to correct the brain’s state of relative under-arousal and improve cognitive and behavioural functioning. Two EEG biofeedback protocols have been extensively evaluated as treatments of ADHD. Sensorimotor rhythm (SMR) training reinforces EEG activity in the faster ‘beta’ frequency range (16–20 Hz) in the midline cortical regions with the goal of reducing symptoms of impulsivity and hyperactivity. ‘Theta suppression’ reduces EEG activity in the slower ‘theta’ frequency range (4–8 Hz) and is primarily used to treat symptoms of inattention. An EEG biofeedback protocol directed at suppressing theta activity (4–8 Hz) over the midline regions is probably the most effective strategy when treating primarily symptoms of distractibility and inattention.

What the research shows

Controlled studies comparing EEG biofeedback to a stimulant medication versus a waitlist report positive clinical effects and EEG normalization with some protocols; however, it has not yet been established whether improved alertness is associated with increased or decreased alpha activity (12–18 Hz). Sessions are typically 30 to 60 minutes in duration and are administered 2 to 5 times weekly for 2 to 3 months depending on symptom severity and response. A review of 14 randomized EEG biofeedback trials in children diagnosed with ADHD found consistent beneficial effects for all outcome measures.

Limitations of findings and future research directions

The significance of findings from EEG biofeedback studies in ADHD is limited by small study sizes, heterogeneous populations, absence of a control group, inconsistent outcome measures and limited or absent follow-up. The potential benefits of EEG biofeedback are limited by the fact that treatments are often expensive and seldom covered by insurance. Further studies in which patients are randomly allocated to true versus sham EEG biofeedback are needed to rule out group expectation effects. The use of sophisticated quantitative electroencephalographic (QEEG) analysis with reference to a normative database may help future clinicians select the most efficacious treatment protocols for a particular ADHD symptom pattern.

To learn more about the evidence for EEG biofeedback and other non-medication treatments of ADHD read my e-book "ADHD--the Integrative Mental Health Solution."


Attention-deficit Hyperactivity Disorder: The Integrative Mental Health Solution, by James Lake MD


About the Author

James Lake, M.D., a clinical assistant professor at the University of Arizona College of Medicine, works to transform mental health care through the evidence-based uses of alternative therapies.