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Biofeedback and ADHD
I had a request to present information on research examining biofeedback as a treatment for ADHD. The idea behind this treatment is that biofeedback can be used to train children to produce the type of brain activity that is associated with sustained attention.
In the last 3 years, I was able to locate two published studies on this treatment approach for ADHD. The first was published in March '95 issue of Biofeedback and Self Regulation. In this study 23 children and adolescents from 8-19 years participated in a 2-3 month intensive neurofeedback (i.e. another term for biofeedback) training program. The authors report that children receiving the training showed: improvement on a laboratory test of sustained attention; decreases in parent ratings of ADHD symptoms; and increases in IQ scores.
In a second study, published in the March 96 issue of the same journal, 18 children with ADHD were randomly assigned to a neurofeedback training group or a control group (i.e. subjects in the control group received no treatment.)
Treatment consisted of 40 45 minute sessions of neurofeedback training which occurred over a 6 month period. At the conclusion of treatment, children receiving treatment showed a significant increase in IQ compared to the control group and a significant reduction in inattentive symptoms as rated by parents. No significant reduction in hyperactive/impulsive symptoms or oppositional behavior was found.
These results are certainly promising, but several caveats need to be kept in mind. First, the number of subjects in these studies is quite small - 23 in the first and 18 (9 of whom received the treatment) in the second. As a result, I think it is prudent to regard these as promising pilot studies that need to be replicated with substantially larger samples.
Second, this is a lengthy and expensive treatment approach. In my area, a course of biofeedback treatment for ADHD runs about $3,000, and I doubt that many insurance companies would cover this. I would personally be careful about spending this kind of money for a treatment whose efficacy has not yet been demonstrated more convincingly.
Third, in the study that used a control group, no significant benefits of biofeedback for hyperactive/impulsive symptoms or for oppositional behavior were found. As you are aware, stimulant medication has been clearly shown to help with both of these aspects of ADHD. It may be that biofeedback proves to be helpful for children with the inattentive subtype of ADHD, but is less effective for children who also have hyperactive and impulsive symptoms.
For me, the bottom line is that compared to the hundreds of studies that have demonstrated clear benefits of medication and behavioral therapy for most children with ADHD, the empirical support for biofeedback training is not nearly as clear. This does seem to be a promising approach, however, and hopefully we will be seeing more large scale studies of this method being published in the near future. I will be sure to include such studies in the newsletter if they are published.
Note: This article originally appeared in Attention Research Update, an online newsletter written by Dr. David Rabiner, a Duke University psychologist and former member of CHADD's Professional Advisory Board. You can learn more about Attention Research Update and sign up for a free subscription at www.helpforadd.com.