A Placebo-Control Evaluation of Neurofeedback Efficacy in Adults with ADHD

DESCRIPTION (provided by applicant): ADHD is one of the most frequently diagnosed psychiatric disorders. Although ADHD is most often diagnosed in children it may affect up to three percent of the adult population. Individuals with ADHD are likely to experience problems in academic, employment, and home settings. Adults that are diagnosed with ADHD receive fewer years of formal schooling, achieve lower overall occupational status, and are more likely to have a range of psychiatric problems such as anti-social personality disorder or substance abuse. Stimulant medications used to treat ADHD are of limited effectiveness with respect to their effects on ADHD symptoms, do not cure the underlying disorder, and can cause adverse side effects. Neurofeedback (NFB) is growing in use as an alternative and complementary treatment for ADHD. NFB is a type of biofeedback in which one receives feedback about brain activity recorded by a sensor on the scalp. Operant conditioning principles are employed to train participants to control certain aspects of electroencephalographic (EEG) activity. Computer software processes the EEG signals and tones and images on a monitor to inform the participant about whether they are generating EEG that falls in a target wave frequency. Training contingencies are arranged to train users to increase the EEG frequency bands associated with sustained concentration and cognitive control. Researchers, clinicians, and patients have reported improvement of behavioral control and attention in ADHD patients treated using NFB technology. Critics of NFB argue, however, that studies have not included adequate controls and that ADHD symptom improvements in NFB patients are likely to be placebo effects. The purpose of the proposed study is to conduct a double-blind, placebo- controlled, randomized NFB trial using a convincing sham NFB control condition. A demographically matched non-ADHD group that does not receive NFB will be studied also to analyze potential EEG markers associated with attention. The key innovations in this project are: 1) inclusion of a credible sham placebo-control, 2) randomized assignment, 3) standardized, objective, automated, and repeated measures of cognitive performance at multiple time points, 4) standardized procedures for tailoring NFB training protocols to individual participant ADHD symptom profiles as would be performed under true clinical conditions. The proposed study will provide a scientifically rigorous test of the hypothesis that NFB is an effective treatment for ADHD in young adults and whether the active ingredient in NFB is the contingent relationship between EEG and feedback stimuli. PUBLIC HEALTH RELEVANCE: Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent psychiatric diagnoses. Medical management of ADHD involves the use of stimulant drugs and achieves limited success. The present application evaluates the efficacy of neurofeedback as a treatment for ADHD in adults and uses a randomized placebo control design.