EEG neurofeedback treatments in children with ADHD: an updated meta-analysis of randomized controlled trials

Objective: We undertook a meta-analysis of published Randomized Controlled Trials (RCT) with semi-active control and sham-NF groups to determine whether Electroencephalogram-neurofeedback (EEG-NE) significantly improves the overall symptoms, inattention and hyperactivity/impulsivity dimensions for probably unblinded assessment (parent assessment) and probably blinded assessment (teacher assessment) in children with Attention Deficit Hyperactivity Disorder (ADHD). Data sources: A systematic review identified independent studies that were eligible for inclusion in a random effects meta-analysis. Data extraction: Effect sizes for ADHD symptoms were expressed as standardized mean differences (SMD) with 95% confidence intervals. Results: Five identified studies met eligibility criteria, 263 patients with ADHD were included, 146 patients were trained with EEG NE On parent assessment (probably unblinded assessment), the overall ADHD score (SMD = 0.49 1-0.74, 0.241), the inattention score (SMD = 0.46 1-0.76, 0.151) and the hyperactivity/impulsivity score (SMD = 0.34 1-0.59, 0.091) were significantly improved in patients receiving EEG-NE compared to controls. On teacher assessment (probably blinded assessment), only the inattention score was significantly improved in patients receiving EEG-NF compared to controls (SMD = 0.30 1-0.58, 0.031). Conclusions: This meta-analysis of EEG-NE in children with ADHD highlights improvement in the inattention dimension of ADHD symptoms. Future investigations should pay greater attention to adequately blinded studies and EEG-NF protocols that carefully control the implementation and embedding of training.