Neurofeedback training improves ADHD symptoms more than attention skills training.

ED FROM Gevensleben H, Holl B, Albrecht B, et al. Is neurofeedback an effi cacious treatment for ADHD? A randomised controlled clinical trial. J Child Psychol Psychiatry 2009;50:780–9. Correspondence to: Hartmut Heinrich, Heckscher-Klinikum, Deisenhofener Strasse 28, D-81539 Munich, Germany; [email protected] Sources of funding: German Research Foundation. Gevensleben and colleagues describe a multisite randomised controlled trial comparing the effi cacy of neurofeedback with a computerised attentional skills training (AST) in a sample of 102 German children aged between 8 and 12 years of age with a well defi ned diagnosis of ADHD. The study compares the two treatment conditions in a parallel design. In order to control for non-specifi c effects, the two interventions were designed to be as similar as possible with equal task demands, session length, number and timing of sessions. Two types of neurofeedback were used: training of slow cortical potential and theta/beta training. Each child in the neurofeedback group received both types of training given sequentially with the presentation order counterbalanced. The key fi ndings were that children in the neurofeedback group made signifi cantly greater improvements in parent and teacher ratings of ADHD symptoms (effect sizes were in the medium range; parents 0.60, teachers 0.64) and oppositionality (effect size 0.38) compared with the AST group. Interestingly, many parents were unsure which treatment group their children had been in and parental attitude did not differ between the two treatments. Comparable effects were found for the two neurofeedback conditions. This well conducted, well powered and well reported study has the potential to become a pivotal study in the fi eld of non-pharmacological treatment of ADHD. It is superior in design to previous neurofeedback studies, and the use of a comparator that controlled for the training demands and parental expectation makes the results more compelling. It will be important to see the results of the long term follow-up data from this trial to see whether improvements persist over time. While it is probably still too early for neurofeedback to be routinely integrated into everyday practice, it is important that independent research groups conduct similar studies to provide both replication and extension of these important fi ndings. For their part, clinicians should start to develop an understanding of neurofeedback techniques and take note that, although they may not be quite as powerful as stimulant medications, they may have the potential to become a mainstream treatment for ADHD in the not too distant future. David Coghill, MB, ChB, MRCPsych University of Dundee, Dundee, UK Competing interests: DC has been paid by several companies that make medications for treating ADHD. Janssen Cilag, UCB, Shire, Pfi zer, Medice, Flynn Pharma and Lilly for consultancy, research and speaking at and travel to conferences. OM M EN TA RY 17_EBMH1013.indd 21 1/19/2010 7:00:53 PM group.bmj.com on May 27, 2010 Published by ebmh.bmj.com Downloaded from