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Neurofeedback versus psychostimulants in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a systematic review

Authors Razoki B

Received 1 July 2018

Accepted for publication 24 September 2018

Published 30 October 2018 Volume 2018:14 Pages 2905—2913

DOI https://doi.org/10.2147/NDT.S178839

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 4

Editor who approved publication: Dr Roger Pinder


Bashar Razoki

Department of Psychology, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, the Netherlands

Abstract: This systematic review aimed to evaluate the efficacy of neurofeedback (NF) compared to stimulant medication in treating children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Included in this review are eight randomized controlled trials that compared an NF condition, either alone or combined with medication, to a medication condition, which was mainly methylphenidate. Outcome measures included behavioral assessments by parents and teachers, self-reports, neurocognitive measures, electroencephalogram power spectra and event-related potentials. When only trials are considered that include probably blinded ratings or those that are sham-NF or semi-active controlled or those that employed optimally titration procedures, the findings do not support theta/beta NF as a standalone treatment for children or adolescents with ADHD. Nevertheless, an additive treatment effect of NF was observed on top of stimulants and theta/beta NF was able to decrease medication dosages, and both results were maintained at 6-month follow-up. This review concludes that the present role of NF in treating children diagnosed with ADHD should be considered as complementary in a multimodal treatment approach, individualized to the needs of the child, and may be considered a viable alternative to stimulants for a specific group of patients. Particularly patients with the following characteristics may benefit from NF treatment: low responders to medication, intolerable side effects due to medication, higher baseline theta power spectra and possibly having no comorbid psychiatric disorders. Future research should prioritize the identification of markers that differentiate responders from nonresponders to NF treatment, the potential of NF to decrease stimulant dosage, the standardization of NF treatment protocols and the identification of the most favorable neurophysiological treatment targets.

Keywords: ADHD, EEG, biofeedback, theta/beta training, methylphenidate, randomized trials

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