Using Neurofeedback to Improve ADHD Symptoms in School-Aged Children
AbstractThe diagnosis and treatment of the behaviors associated with attention-deficit/hyperactivity disorder (ADHD) predominantly involves pharmacological interventions. Many children experience significant negative side effects (e.g., appetite suppression, insomnia, headaches, stomachaches, irritability, and impaired height) from the initial and continued use of stimulant medication. Consequently, many parents are motivated to consider alternative treatments for ADHD such as neurofeedback. This paper presents an archival review of the improvements in auditory and visual attention and response control after 40 sessions of artifact-corrected neurofeedback for 51 children ages 6 to 17 with ADHD. Initially, the majority of these clients were identified as having severe to extreme auditory and visual attention impairments. The IVA-2 CPT was administered prior to treatment and after 20 and 40 treatment sessions were completed. After 20 sessions of neurofeedback significant improvements of both auditory and visual attention and response control were found with small to large size effects. The clients continued to improve after an additional 20 sessions, with medium to large size effects after 40 sessions. At completion of treatment the mean of eight of the nine attention and response control scores fell within the “normal” range.
American Academy of Audiology. (2010). Clinical practice guidelines. Diagnosis, treatment and management of children and adults with central auditory processing disorder. Retrieved May 2016 from https://audiology-web.s3.amazonaws.com/migrated/CAPD Guidelines 8-2010.pdf_539952af956c79.73897613.pdf
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author. Retrieved from http://dx.doi.org/10.1176/appi.books.9780890425596
Behavioural Neurotherapy Clinic. (n.d.). Central Auditory Processing Disorder (CAPD). Retrieved May 1, 2016, from http://www.adhd.com.au/CAPD.htm
Brazier, Y. (2015, November 25). “ADHD medication: Is it a good idea?” Medical News Today. Retrieved May 2016 from https://www.medicalnewstoday.com/articles/303090.php
Breslau, J., Miller, E., Chung, W.-J. J., & Schweitzer, J. B. (2011). Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time. Journal of Psychiatry Research, 45(3), 295–301. http://dx.doi.org/10.1016/j.jpsychires.2010.06.014
Cannon, R., & Lubar, J. (2011). Long-term effects of neurofeedback training in anterior cingulate cortex: A short follow-up report, Journal of Neurotherapy, 15(2), 130–150. http://dx.doi.org/10.1080/10874208.2011.570688
Chermak, G. D., & Musiek, F. E. (1997). Central auditory processing disorders: New perspectives. San Diego, CA: Singular Publishing Group, Inc.
Chronis-Tuscano, A., Molina, B. S. G., Pelham, W. E., Applegate, B., Dahlke, A., Overmeyer, M., & Lahey, B. B. (2010). Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Archives in General Psychiatry, 67(10), 1044–1051. http://dx.doi.org/10.1001/archgenpsychiatry.2010.127
Daley, D., van der Oord, S., Ferrin, M., Danckaerts, M., Doepfner, M., Cortese, S., & Sonuga-Barke, E. J. S. (2014). Behavioral interventions in attention-deficit/hyperactivity disorder: A meta-analysis of randomized controlled trials across multiple outcome domains. Journal of the American Academy of Child & Adolescent Psychiatry, 53(8), 835–847.e5. http://dx.doi.org/10.1016/j.jaac.2014.05.013
Doshi, J. A., Hodgkins, P., Kahle, J., Sikirica, V., Cangelosi, M. J., Setyawan, J., … Neumann, P. J. (2012). Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. Journal of the American Academy of Child & Adolescent Psychiatry, 51(10), 990–1002.e2. http://dx.doi.org/10.1016/j.jaac.2012.07.008
Dunlop, A. J., & Newman, L. K. (2016). ADHD and psychostimulants—Overdiagnosis and overprescription. The Medical Journal of Australia, 204(4), 139. http://dx.doi.org/10.5694/mja15.01387
Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., & Schellinger, K. B. (2011). The impact of enhancing students’ social and emotional learning: A meta-analysis of school-based universal interventions. Child Development, 82(1), 405–432. http://dx.doi.org/10.1111/j.1467-8624.2010.01564.x
Ellis, M. (2016, March 3). “ADHD medication and low bone density: Are kids at risk?” Medical News Today. Retrieved May 30, 2016, from https://www.medicalnewstoday.com /articles/307389.php
Epstein, V. (2015, June 17). “Visual processing disorder: Is this what your child has?” Kars4Kids Smarter Parenting. Retrieved May 2016 from http://www.kars4kids.org/blog /visual-processing-disorder-is-this-what-your-child-has
Evans, S. W., Owens, J. S., & Bunford, N. (2014). Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Journal of Clinical Child & Adolescent Psychology, 43(4), 527–551. http://dx.doi.org/10.1080/15374416.2013.850700
Fabiano, G. A., Pelham, W. E., Coles, E. K., Gnagy, E. M., Chronis-Tuscano, A., & O’Connor, B. C. (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29(2), 129–140. http://dx.doi.org/10.1016/j.cpr.2008.11.001
Farrar, R., Call, M., & Maples, W. C. (2001). A comparison of the visual symptoms between ADD/ADHD and normal children. Optometry, 72(7), 441–451.
Ghaziri, J., Tucholka, A., Larue, V., Blanchette-Sylvestre, M., Reyburn, G., Gilbert, G., … Beauregard, M. (2013). Neurofeedback training induces changes in white and gray matter. Clinical EEG and Neuroscience, 44(4), 265–272. http://dx.doi.org/10.1177/1550059413476031
Gleason, M. M. (2013). Finding the tools for effective early intervention for preschool attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 52(3), 228–230. http://dx.doi.org/10.1016/j.jaac.2012.12.008
Grohol, J. M., (2013). Is ADHD overdiagnosed? Yes & no. Retrieved May 2016 from http://psychcentral.com/blog /archives/2013/11/21/is-adhd-overdiagnosed-yes-no/
Gyldenkærne, P., Dillon, H., Sharma, M., & Purdy, S. C. (2014). Attend to this: The relationship between auditory processing disorders and attention deficits. Journal of the American Academy of Audiology, 25(7), 676–687. http://dx.doi.org /10.3766/jaaa.25.7.6
Hagen, H., Moore, K., Wickham, G., & Maples, W. C. (2008). Effect on the EYEPORT system of visual function in ADHD children: A pilot study. Journal of Behavioral Optometry, 19(2), 37–41.
Hammond, D.C. (2011). What is neurofeedback: an update. Journal of Neurotherapy, 15(4), 305–336, http://dx.doi.org/10.1080/10874208.2011.62309
Hinshaw, S. P., & Ellison, K. (2016). ADHD: What everyone needs to know. New York, NY: Oxford University Press.
Hinshaw, S. P., Owens, E. B., Zalecki, C., Huggins, S. P., Montenegro-Nevado, A. J., Schrodek, E., & Swanson, E. N. (2012). Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: Continuing impairment includes elevated risk for suicide attempts and self-injury. Journal of Consulting and Clinical Psychology, 80(6), 1041–1051. http://dx.doi.org/10.1037/a0029451
Hinshaw, S. P., & Scheffler, R. M. (2014). The ADHD explosion: Myths, medication, money, and today's push for performance. New York, NY: Oxford University Press.
Huang-Storms, L., Bodenhamer-Davis, E., Davis, R., & Dunn, J. (2007). QEEG-guided neurofeedback for children with histories of abuse and neglect: Neurodevelopmental rationale and pilot study. Journal of Neurotherapy, 10(4), 3–16. http://dx.doi.org/10.1300/J184v10n04_02
International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Diagnosis Codes F90: Attention-deficit hyperactivity disorders. Retrieved April 2016 from https://www.icd10data.com/ICD10CM/Codes/F01-F99/F90-F98/F90-
La Marca, J. P., Cruz, D., Fandino, J., Cacciaguerra, F. R., Fresco, J. J., & Guerra, A. T. (2018). Journal of Neural Transmission, 125(7), 1087–1097. http://dx.doi.org/10.1007/s00702-018-1877-1
La Marca, J. P., & O’Connor, R. E. (2016). Neurofeedback as an Intervention to improve reading achievement in students with attention-deficit/hyperactivity disorder, inattentive subtype. NeuroRegulation, 3(2), 55–77. http://dx.doi.org/10.15540/nr.3.2.55
Lee, S. S., Lahey, B. B., Owens, E. B., & Hinshaw, S. P. (2008). Few preschool boys and girls with ADHD are well-adjusted during adolescence. Journal of Abnormal Child Psychology, 36(3), 373–383. http://dx.doi.org/10.1007/s10802-007-9184-6
Lubar, J. F. (1995). Neurofeedback for the management of attention-deficit/hyperactivity disorders. In M. S. Schwartz (Ed.), Biofeedback: A practitioner’s guide (pp. 493–522). New York, NY: Guilford Press.
Maddux, C. D. (2010). [Review of the IVA+Plus: Integrated Visual and Auditory Continuous Performance Test]. In R. A. Spies, J. F. Carlson, & K. F. Geisinger (Eds.), The eighteenth mental measurements yearbook (pp. 434–437). Lincoln, NE: Buros Institute of Mental Measurements.
McCallum, W. C. (2015). Attention. Encyclopædia Britannica. Encyclopædia Britannica, Inc. Retrieved from http://www.britannica.com/science/attention/The-neurophysiology-of-attention
McReynolds, C. J., Bell, J., & Lincourt, T. M. (2017). Neurofeedback: A noninvasive treatment for symptoms of posttraumatic stress disorder in veterans. NeuroRegulation, 4(3–4), 114–124. http://dx.doi.org/10.15540/nr.4.3-4.114
Moore, D. R., Ferguson, M. A., Edmondson-Jones, A. M., Ratib, S., & Riley, A. (2010). Nature of auditory processing disorder in children. Pediatrics, 126(2), e382–e390. http://dx.doi.org/10.1542/peds.2009-2826
MTA Cooperative Group. (2004). National Institute of Mental Health multimodal treatment study of ADHD follow-up: Changes in effectiveness and growth after the end of treatment. Pediatrics, 113(4), 762–769.
New Brunswick Department of Education. (1999). Resource for the identification and teaching of students with specific learning disability. Retrieved from https://www2.gnb.ca /content/dam/gnb/Departments/ed/pdf/K12/ResourceForIdentificationTeachingStudentsSpecificLearningDisability.pdf
Norman, D. A. (1982). Memory and attention: An introduction to human information processing (2nd ed.). New York, NY: Wiley.
Owens, E. B., Hinshaw, S. P., Lee, S. S. & Lahey, B. B. (2009). Few girls with childhood attention-deficit/hyperactivity disorder show positive adjustment during adolescence. Journal of Clinical Child & Adolescent Psychology, 38(1), 132–143. http://dx.doi.org/10.1080/15374410802575313
Pingault, J.-B., Tremblay, R. E., Vitaro, F., Carbonneau, R., Genolini, C., Falissard, B., & Côté, S. M. (2011). Childhood trajectories of inattention and hyperactivity and prediction of educational attainment in early adulthood: A 16-year longitudinal population-based study. The American Journal of Psychiatry, 168(11), 1164–1170. http://dx.doi.org/10.1176/appi.ajp.2011.10121732
Poulton, A. S., Melzer, E., Tait, P. ., Garnett, S. P., Cowell, C. T., Baur, L. A., & Clarke, S. (2013). Growth and pubertal development in adolescent boys on stimulant medication for attention deficit hyperactivity disorder. The Medical Journal of Australia, 198(1), 29–32. http://dx.doi.org/10.5694/mja12.10931
Prasad, V., Brogan, E., Mulvaney, C., Grainge, M., Stanton, W., & Sayal, K. (2013). How effective are drug treatments for children with ADHD at improving on-task behaviour and academic achievement in the school classroom? A systematic review and meta-analysis. European Child & Adolescent Psychiatry, 22(4), 203–216. http://dx.doi.org/10.1007/s00787-012-0346-x
Riddle, M. A., Yershova, K., Lazzaretto, D., Paykina, N., Yenokyan, G., Greenhill, L., … Posner, K. (2013). The preschool attention-deficit/hyperactivity disorder treatment study (PATS) 6-year follow-up. Journal of the American Academy of Child & Adolescent Psychiatry, 52(3), 264–278.e2. http://dx.doi.org/10.1016/j.jaac.2012.12.007
Robb, J. A., Sibley, M. H., Pelham, W. E., Foster, E. M., Molina, B. S. G., Gnagy, E. M., & Kuriyan, A. B. (2011). The estimated annual cost of ADHD to the U.S. education system. School Mental Health, 3(3), 169–177. http://dx.doi.org/10.1007/s12310-011-9057-6
Sandford, J. A., & Sandford, S. E. (2014). IVA-2: Integrated Visual and Auditory Continuous Performance Test Manual. North Chesterfield, VA: Brain Train, Inc.
Saul, R. (2014). ADHD Does Not Exist. New York, NY: HarperCollins Publishers.
Sharma, M., Purdy, S. C., & Kelly, A. S. (2009). Comorbidity of auditory processing, language, and reading disorders. Journal of Speech, Language, and Hearing Research, 52, 706–722. http://dx.doi.org/10.1044/1092-4388(2008/07-0226)
Sonuga-Barke, E. J. S., Brandeis, D., Cortese, S., Daley, D., Ferrin, M., Holtmann, M., … European ADHD Guidelines Group. (2013). Nonpharmacological interventions for ADHD: Systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. The American Journal of Psychiatry, 170(3), 275–289. http://dx.doi.org/10.1176/appi.ajp.2012.12070991
Steiner, N. J., Sheldrick, R. C., Gotthelf, D., & Perrin, E. C. (2011). Computer-based attention training in the schools for children with attention deficit/hyperactivity disorder: A preliminary trial. Clinical Pediatrics, 50(7), 615–622. http://dx.doi.org/10.1177/0009922810397887
Swanson, J. M., Arnold, L. E., Molina, B. S. G., Sibley, M. H., Hechtman, L. T., Hinshaw, S. P., … for the MTA Cooperative Group. (2017). Young adult outcomes in the follow-up of the multimodal treatment study of attention-deficit/hyperactivity disorder: Symptom persistence, source discrepancy, and height suppression. The Journal of Child Psychology and Psychiatry, 58(6), 663–678. http://dx.doi.org/10.1111/jcpp.12684
Swanson, J. M., & Volkow, N. D. (2009). Psychopharmacology: Concepts and opinions about the use of stimulant medications. The Journal of Child Psychology and Psychiatry, 50(1–2), 180–193. http://dx.doi.org/10.1111/j.1469-7610.2008.02062.x
Swingle, P. G. (2015). When the ADHD diagnosis is wrong: Understanding other factors that affect attention in children. Santa Barbara, CA: Praeger.
Tomlin, D., Dillon, H., Sharma, M., & Rance, G. (2015). The impact of auditory processing and cognitive abilities in children. Ear and Hearing, 36(5), 527–542. http://dx.doi.org/10.1097/AUD.0000000000000172
Visser, S. N., Zablotsky, B., Holbrook, J. R., Danielson, M. L., & Bitsko, R. H. (2015). Diagnostic experiences of children with attention-deficit/hyperactivity disorder. National Health Statistics Reports; 81, 1–7. Hyattsville, MD: National Center for Health Statistics.
Woliver, R., & Ibrahim, M. (2012). Auditory processing disorder: The hidden disability. Long Island Press. Retrieved May 2016 from http://newideas.net/auditory-processing-disorder
Zhonggui, X., Shuhua, S., & Haiqing, X. (2005). A controlled study of the effectiveness of EEG biofeedback training on children with attention deficit hyperactivity disorder. Journal of Huazhong University of Science and Technology, 25(3), 368–370. http://dx.doi.org/10.1007/BF02828171
Copyright (c) 2018 Connie J McReynolds, Lelah Lelah Villalpando, Cynthia Britt
This work is licensed under a Creative Commons Attribution 4.0 International License.Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).