Since the late 1970s, neurofeedback has been researched, refined, and tested with ADD/ ADHD and learning disabilities. Clinical work by Dr. Joel Lubar and his colleagues (e.g., Lubar, 1995) at the University of Tennessee as well as many others has repeatedly demonstrated that it is possible to retrain the brain. In fact, one randomized controlled study (Levesque, Beauregard, & Mensour, 2006) documented with fMRI neuroimaging the positive changes in brain function in ADHD children that mirrored their behavioral changes following neurofeedback treatment.
This and the research cited next all provide strong support that demonstrate the effectiveness of neurofeedback in treating ADD=ADHD. Whereas the average stimulant medication treatment study follow-up is only 3 weeks long, with only four long-term follow-up medication studies that lasted 14 months or longer, Lubar (1995) published 10-year follow-ups on cases and found that in about 80% of clients, neurofeedback can substantially improve the symptoms of ADD and ADHD and that these changes are maintained.
Rossiter and LaVaque (1995) found that 20 sessions of neurofeedback produced comparable improvements in attention and concentration to taking Ritalin.
Fuchs, Birbaumer, Lutzenberger, Gruzelier, and Kaiser (2003) and Rossiter (2005) likewise demonstrated that neurofeedback produced comparable improvements to Ritalin. Drechsler et al. (2007) found slow cortical potentials training superior to group therapy with ADHD children. Neurofeedback has also been found in randomized controlled studies to be superior to EMG biofeedback (Bakhshayesh, 2007). In a 1-year follow-up, control group study, Monastra, Monastra, and George (2002) found that neurofeedback produced superior improvements compared to Ritalin, not requiring continuation of the medication. In a randomized controlled study, Leins et al. (2007) demonstrated that 30 sessions of slow cortical potentials training or of traditional neurofeedback were both effective in producing cognitive, attentional, behavioral, and IQ improvements, which remained stable 6 months after treatment.
Gevensleben et al. (2009b) in a randomized controlled study documented the superiority of neurofeedback training (effect size¼ .60) compared with computerized attention skills training (which would have placebo control characteristics). Behavioral and attentional improvements were found to be stable on 6-month follow-up in research studies reported by Strehl et al. (2006) and Gevensleben et al. (2010), and the latter found that neurofeedback training produced superior results to computerized attention skills training, as did Holtmann et al. (2009).
Two randomized, double-blind placebo controlled studies (deBeus & Kaiser, 2011; deNiet, 2011) have documented the effectiveness of neurofeedback with ADHD. Other recent, large randomized controlled studies (Gevensleben et al., 2009a; Wrangler et al., 2010) should also do much to dispel concerns that improvements from neurofeedback training simply reflect nonspecific placebo factors. These studies demonstrated protocol-specific changes in electrophysiological brain function using EEG and sophisticated event-related potential measures, replicating some earlier findings (Heinrich, Gevensleben, Freisleder, Moll, & Rothenberger, 2004) and showing distinct neuronal mechanisms involved with different training techniques. A 2-year follow-up (Gani, Birbaumer, & Strehl, 2008) of the Heinrich research found that not only were improvements in attention and behavior stable but that some parent ratings had shown continued improvement during the 2 years. Continuing improvement on 6-week and 12-week followups were also found after the completion of LENS treatment of adult ADD=ADHD by deNiet (2011) in a randomized, double-blind placebo controlled study.
Thus follow-up evaluations ranging from 3 months to 10 years after treatment (Gani et al., 2008; Heinrich et al., 2004; Lubar, 1995; Monastra et al., 2002; Strehl et al., 2006) provide strong support that improvements from neurofeedback with ADD= ADHD should be enduring, unless of course something such as a head injury or drug abuse were to occur to negative alter brain function.
A recent meta-analysis (Arns, de Ridder, Strehl, Breteler, & Coenen, 2009) concluded that neurofeedback treatment of ADD/ADHD meets criteria for being classified as an efficacious and specific treatment—the highest level of scientific validation (La Vaque et al., 2002). In comparison to neurofeedback, a meta-analysis (Schachter, Pham, King, Langford, & Hoher, 2001) of randomized controlled studies of medication treatment for ADD/ADHD concluded that the studies were of poor quality, had a strong publication bias (meaning that drug company funded studies that failed to support the effectiveness of their product tended to never be submitted for publication), and often produced side effects. They further indicated that long-term effects (beyond placebo effects) for longer than a 4-week follow-up period were not demonstrated.
A recent comprehensive review (Drug Effectiveness Review Project, 2005) of medication treatment for ADD/ADHD concluded that there was no evidence on the long-term safety of the medications used in ADD/ADHD treatment and that good quality evidence is lacking that drug treatment improves academic performance or risky behaviors on a long-term basis, or in adolescents or adults. The latter conclusions were also reached by Joughin and Zwi (1999). The largest randomized controlled multisite study compared medication treatment, ‘‘routine community care,’’ and behavior therapy. Outcome raters were not blinded, introducing a bias, and most subjects in community care were also on medications. At 14-month follow-up (MTA Cooperative Group, 1999), all groups showed improvements, and medication produced better improvements in attention and hyperactivity (the latter only on parent ratings), but not in aggression, social skills, grades, or parent–child relations. The ratings provided by the only blinded rater (a classroom observer), however, showed no difference between groups, and on 3-year follow-up (Swanson et al., 2007) there was no difference on any outcome measures between groups, findings that were confirmed on 8 year follow-up (Molina et al., 2009). Studies (e.g., Swanson et al., 2007) have confirmed loss of appetite and growth suppression as a side effect of medication treatment, along with other side effects such as increased heart rate and blood pressure, insomnia, loss of emotional responsiveness, dizziness, headache, and stomachache. In the MTA study, 64% of children reported side effects, 11% of them moderately severe and 3% severe. Side effects associated with ADD= ADHD medications are also so common that less than 50% of children maintain prescribed dosages for more than 6 months (Hoagwood, Jensen, Feil, Vitiello, & Blatara, 2000).
In light of these findings, neurofeedback seems well validated as providing a noninvasive and relatively side effect free treatment alternative for ADD/ADHD. In the long run it is also very cost effective. Some individuals express concern about the cost of neurofeedback being greater than the expense involved in drug treatment. Research has shown, however, that the costs associated with medication treatment are actually quite sizable. For instance, a study (Marchetti et al., 2001) of six different medications for ADD/ADHD treatment found that the average cost per school-aged patient was $1,678 each year.
Another study (Swensen et al., 2003) examined the health care costs in more than 100,000 families where ADHD was either present or not present. They found that in families where a member had ADHD, the direct costs of health care expenditures plus indirect costs (such as work loss) averaged $1,288 per year higher for the other family members (who had not been diagnosed as having ADD/ADHD) in comparison with members of families where ADHD was not present. This would mean that the cost of medication just cited, combined with indirect costs each year for a family with two children, one of whom had ADHD, would be $5,542.
Neurofeedback training for ADD/ADHD is commonly found to be associated with decreased impulsiveness/hyperactivity, increased mood stability, improved sleep patterns, increased attention span and concentration, improved academic performance, and increased retention and memory, and with a much lower rate of side effects. It is fascinating to note that ADD/ADHD or learning disability studies that have evaluated IQ pre- and posttreatment have commonly found IQ increases following neurofeedback training. These improvements ranged from an average of 9 IQ points improvement in one study (Linden, Habib, & Radojevic, 1996), to an average improvement of 12 IQ points in a study by L. Thompson and Thompson (1998), a mean of 19 IQ points in another study (Tansey, 1991b), and even up to an average increase of 23 IQ points in a study by Othmer, Othmer, and Kaiser (1999).
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