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Eur Child Adolesc Psychiatry. 2019 Mar;28(3):293-305. doi: 10.1007/s00787-018-1121-4. Epub 2018 Feb 14.

Sustained effects of neurofeedback in ADHD: a systematic review and meta-analysis.

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Department of Child and Adolescent Mental Health, University Hospital Erlangen, Erlangen, Germany.
Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands.
neuroCare Group, Munich, Germany.
Research Institute Brainclinics, Bijleveldsingel 34, 6524 AD, Nijmegen, The Netherlands.
kbo-Heckscher-Klinikum, Munich, Germany.
Research Institute Brainclinics, Bijleveldsingel 34, 6524 AD, Nijmegen, The Netherlands.
Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
Institute for Medical Psychology, University of Tuebingen, Tuebingen, Germany.
Department of Psychiatry and Biobehavioral Science, David Geffen School of Medicine, University of California, Los Angeles, USA.


Neurofeedback (NF) has gained increasing interest in the treatment of attention-deficit/hyperactivity disorder (ADHD). Given learning principles underlie NF, lasting clinical treatment effects may be expected. This systematic review and meta-analysis addresses the sustainability of neurofeedback and control treatment effects by considering randomized controlled studies that conducted follow-up (FU; 2-12 months) assessments among children with ADHD. PubMed and Scopus databases were searched through November 2017. Within-group and between-group standardized mean differences (SMD) of parent behavior ratings were calculated and analyzed. Ten studies met inclusion criteria (NF: ten studies, N = 256; control: nine studies, N = 250). Within-group NF effects on inattention were of medium effect size (ES) (SMD = 0.64) at post-treatment and increased to a large ES (SMD = 0.80) at FU. Regarding hyperactivity/impulsivity, NF ES were medium at post-treatment (SMD = 0.50) and FU (SMD = 0.61). Non-active control conditions yielded a small significant ES on inattention at post-treatment (SMD = 0.28) but no significant ES at FU. Active treatments (mainly methylphenidate), had large ES for inattention (post: SMD = 1.08; FU: SMD = 1.06) and medium ES for hyperactivity/impulsivity (post: SMD = 0.74; FU: SMD = 0.67). Between-group analyses also revealed an advantage of NF over non-active controls [inattention (post: SMD = 0.38; FU: SMD = 0.57); hyperactivity-impulsivity (post: SMD = 0.25; FU: SMD = 0.39)], and favored active controls for inattention only at pre-post (SMD = - 0.44). Compared to non-active control treatments, NF appears to have more durable treatment effects, for at least 6 months following treatment. More studies are needed for a properly powered comparison of follow-up effects between NF and active treatments and to further control for non-specific effects.


ADHD; EEG biofeedback; Follow-up; Meta-analysis; Neurofeedback; Sustainability


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