See the article here: Neurofeedback and standard pharmacological intervention in ADHD: A randomized controlled trial with six-month follow-up

Disclaimer: The content below was generated with the assistance of AI and then reviewed and edited by BrainMaster Technologies, Inc. It is provided for educational and informational purposes only and does not constitute medical advice.

Overview #

This randomized controlled trial compared EEG-based neurofeedback (NF) with standard methylphenidate treatment in children with ADHD. A total of 23 children (ages 7–14) were assigned to either 40 sessions of theta/beta neurofeedback using BrainMaster Atlantis II or to standard pharmacological care. Follow-ups were conducted at 2 months and 6 months.

1. Study Purpose #

The study aimed to determine whether neurofeedback produces improvements comparable to stimulant medication in reducing ADHD symptoms and functional impairments over time. It is the first RCT to include a 6-month naturalistic follow-up for both interventions.

2. Methods #

Participants #

• Final sample: 23 children (12 NF, 11 medication)

• Diagnosis: ADHD per DSM-IV; no major comorbidities except ODD

• IQ: All participants had an IQ higher than 80

• Setting: University of Balearic Islands and Son Llatzer Hospital

Interventions #

Neurofeedback Protocol #

• Equipment: Atlantis II 2×2, BrainMaster Technologies

• Protocol: Theta (4–7 Hz) inhibition & Beta (15–20 Hz) enhancement

• Electrode sites: Cz (younger children) or FCz (older participants)

• Sessions: 40 total; two per week; ~35 minutes each

• Reinforcement: Adaptive thresholds, visual & auditory feedback

Pharmacological Treatment #

• Medication: Methylphenidate (approx. 1 mg/kg/day)

• Ongoing use: Continued through post-assessment and follow-ups

Outcome Measures #

Collected from mothers, fathers, teachers, and parents (WFIRS):

• ADHD-RS (Inattention, Hyperactivity/Impulsivity)

• Oppositional Defiant Disorder Scale (ODD)

• Weiss Functional Impairment Rating Scale (WFIRS)

• Academic performance (teacher-rated, 5 domains)

3. Key Findings #

3.1 Symptom Reduction #

Both neurofeedback and medication led to significant reductions in:

• Inattention

• Hyperactivity/Impulsivity

• Overall ADHD-RS scores

• Functional impairment (WFIRS)

These improvements were comparable across groups at most timepoints.
Figures and tables (e.g., Table 3, Figure 3) show parallel improvement trajectories.

3.2 Academic Performance #

A major differentiator:

Only the Neurofeedback group showed significant improvements in: #

• Reading

• Reading comprehension

• Writing

• Later gains in math at follow-up
  (See Table 4 & Table 5 for effect sizes.)

The medication group did not demonstrate significant academic gains.

3.3 Long-Term Outcomes #

2-Month Follow-Up #

• NF group largely maintained gains without ongoing NF

• Some NF participants began medication, but excluding them did not change results

6-Month Follow-Up #

• Improvements generally maintained in both groups

• One-third of NF participants required no additional treatment at 6 months

• Mixed NF+medication effects limit interpretation at this timepoint

4. Strengths & Limitations #

Strengths #

• Randomized controlled design

• Two follow-up periods

• Multi-informant (parents + teachers) evaluation

• Detailed academic performance assessment

• Use of standardized BrainMaster NF hardware

Limitations #

• Small sample size (n=23)

• Naturalistic follow-up (some NF participants began medication)

• No neurophysiological results included in this paper

• No specific transfer/generalization training within NF protocol

5. Conclusions #

• Neurofeedback and medication produced similar reductions in core ADHD symptoms.

• Neurofeedback uniquely supported academic performance improvements.

• NF benefits persisted for months after training, even without continued NF sessions.

• NF may serve as a valuable non-pharmacological or complementary option for ADHD clinical management.
  (Full details in Highlights section on p.38.)