Jørgen Axelsen, Ph.D. Neurofeedback as a treatment against ADHD
19.12.2023 19:30


Neurofeedback as a treatment against ADHD – evidence from the international scientific literature

by Jørgen Axelsen, Chairman of Stronger Brains Science and Education, Danmark

Neurofeedback has received more and more attention as a treatment for ADHD in recent years. A search on the worldwide scientific database Web of Science with combinations of "neurofeedback" or "EEG" with "ADHD" or "Attention-Deficit/Hyperactivity Disorder" yielded no less than 41,294 articles in 2022. It was overwhelming. When you look at how the number of articles has developed since the early start in 1987 with one article, you will see a steady increase until 2020, after which there was a slight decrease in 2021 (figure 1). At the time of writing, 6 January 2022, there are already 42 articles registered for 2022. The many articles make it very difficult to create an overview of what they show. Fortunately, many authors have made overview articles - so-called reviews or meta-analyses. If you only search for reviews on the above keywords, an overwhelming 4675 come up.

I have tried to derive conclusions from some of these reviews, and luckily there are even researchers who have made reviews of reviews. One of those who have compiled an overview from several other review articles is Arns et al. (2020), who conclude that standard neurofeedback protocols for the treatment of ADHD is a well-established treatment that is both effective and specific. Arns et al. (2020) also conclude that there are medium to large effects with improvement rates of 32 – 47% and that there were sustained effects measured after 6 to 12 months. This is supported by Micoulaud-Franchi et al. (2014) whose review only included studies that were conducted with random control subjects. The positive effects of neurofeedback for the treatment of ADHD are further supported by Riesco-Matias et al. (2021) in a review of meta-analyses, but they conclude that neurofeedback is not quite as effective as medication, but that the combination of neurofeedback and medication gave the best results. The positive effects of neurofeedback are supported by Enriquez-Geppert et al. (2019), who concluded in a meta-analysis that neurofeedback based on standard protocols should be considered a viable alternative to medical treatment and that more research should be done on how specific protocols will work, i.e. personalized treatment courses. Piementa et al (2021) have looked at this in a recent review, and they conclude that personal and multimodal neurofeedback interventions clearly have better clinical effects than both standard neurofeedback and medication. Personalized EEG training courses can be achieved as the therapist (EEG trainer) gets to know the client, but a shortcut to this is to perform qEEG analysis as the start of a treatment course (Krepel et al. 2020). In terms of treatment efficiency, it appears that a high treatment intensity gives the best results (Busalb et al, 2019) and that the quality of the equipment is also decisive for the outcome (Busalb et al, 2019).

It can be concluded that neurofeedback is a useful treatment for ADHD, a treatment that some analyzes find more effective than medication and others find slightly less effective. However, the great advantage of neurofeedback is that it has no negative side effects. Finally, it can be concluded that personal specific treatment courses can produce better effects than medication.



Arns, M, Clark, CR, Trullinger, M, deBeus, R, Mack, M, Aniftos, M. 2020. Neurofeedback and Attention‑Deficit/Hyperactivity‑Disorder (ADHD) in Children: Rating the Evidence and Proposed Guidelines. Applied Psychophysiology and Biofeedback, 45:39–48 https://doi.org/10.1007/s10484-020-09455-2

Aurore Bussalb, A, Congedo, M, Barthélemy, Q, Ojeda, D, Acquaviva, E, Delorme, R, Mayaud, L., 2019. Clinical and Experimental Factors Influencing the Efficacy of Neurofeedback in ADHD: A

Meta-Analysis. Frontiers in Psychiatry 10:35. doi: 10.3389/fpsyt.2019.00035

Enriquez-Geppert, S, Smit, D, Pimenta, MG, Arns, M, 2019. Neurofeedback as a Treatment Intervention in ADHD: Current Evidence and Practice. Current Psychiatry Reports (2019) 21: 46


Krepel, N, Egtberts, T, Sack, AT, Heinrich, H, Ryan, M, Arns, M, 2020. A multicenter effectiveness trial of QEEG-informed neurofeedback in ADHD: Replication and treatment prediction. NeuroImage: Clinical 28, 102399

Micoulaud-Franchi, J-A, Geoffroy, PA, Fond, G, Lopez, R, Bioulac, S, Philip, P, 2014. EEG neurofeedback treatments in children with ADHD: an updated meta-analysis of randomized controlled trials. Frontiers in Human Neuroscience, 2014, 1-7

Pimenta, MG, Brown, T, Arns, M, Enriquez- Geppert, S, 2021. Treatment Efficacy and Clinical Effectiveness of EEG Neurofeedback as a Personalized and Multimodal Treatment in ADHD: A Critical Review. Neuropsychiatric Disease and Treatment, 17, 637–648

Riesco-Matías, P, Yela-Bernabé, JR, Crego, A, Sánchez-Zaballos, E, 2021. What Do Meta-Analyses Have to Say About the Efficacy of Neurofeedback Applied to Children With ADHD? Review of Previous Meta-Analyses and a New Meta-Analysis. Journal of Attention Disorders, 25(4), 473–485




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