ADHD and Neuorfeedback

Someone recently asked the following question

I visited your web site and noticed a section called How to Read a Scientific Article. I was quite impressed with this article.

This special report on your web site is vitally important for treatment providers and treatment seekers. It is important for all of us who value the use of the scientific method in making decisions about what kinds of services to seek and what kinds of services to provide.

What you mention in that article can serve as reminder to what many of us learned as undergraduates and graduate students in science based programs. It can serve as a simplified and easy to remember scientifically based evaluation tool to help sort out the different types of interventions.

Within the context of that special report on your web site about learning to evaluate and to interpret what is true and expose what is hype, how would you rate the evidence presented for Neurofeedback compared to other types of interventions?"

Here is my reply:

I am glad you enjoyed How to Read a Scientific Article. Feel free to download it and distribute it to your patients and colleagues.

As for your question about Neurofeedback:

There are many leading ADHD researchers who come out very strongly against Neurofeedback as a treatment for ADHD. Their main complaint against Neurofeedback is that the research is not well done.

There are numerous studies available, but they all have weaknesses. Most studies lack the proper controls to prove that Neurofeedback works. In many studies, Neurofeedback was used in conjunction with other modalities, so it isn't clear why the children in these studies got better.

So scientifically, I would have to conclude that Neurofeedback has not been proven to be an effective treatment for ADHD.

Thank God, I am a clinician and not a scientist!

In my opinion, based upon the evidence that we have available, Neurofeedback works very well for ADHD as well as a number of other conditions.

It's true that the research does not rule out other possible explanations for the effectiveness of neurofeedback in ADHD. Researchers have not yet proven that the placebo effect is causing the results. No one has proven that it is not the extra therapeutic interaction.

However, in my opinion, these other explanations are not very likely. We do not see any other placebo getting the results that Neurofeedback gets. We do not find that intense levels of therapeutic attention deliver similar results in other scenarios.

To the best of my knowledge, there has never been a study that shows or even suggests that it Neurofeedback does not work. The worst complaint the antagonists can level is that it has not yet been proven to work.

It is true that the studies on Neurofeedback have not proven that it works. I want to stress, however, that not proven does not mean disproved.

Although in the pure scientific sense there is something lacking from the Neurofeedback literature, we are dealing with patients' lives.

It is not fair to our patients not to use what is most probably a very effective treatment modality just because we would like more elegant research. With that in mind we have to evaluate neurofeedback based upon the evidence that is in front of us.

I agree that neurofeedback needs more scientific work to be proven an effective modality. However, as a clinician I feel that I have all the evidence that I need in order to advise patients to use it.

I still have a lot of questions about it. It is not really clear to me how effective it is. What percentage of patients fail? What percentage achieves only partial success? I have heard claims of success ranging in the 95+%. I don't know how accurate these claims really are.

I personally don't have enough information to discern between the effectiveness of different neurofeedback techniques. I feel we need more investigation in these areas.

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