Level 5 Efficacy
ADHD Research
Neurofeedback has been ranked as a Level 5 ("Efficacious and Specific") treatment for ADHD!
What “Level 5” Means
This ranking comes from the efficacy rating scale established by the Association for Applied Psychophysiology and Biofeedback (AAPB) and ISNR (International Society for Neuroregulation & Research). In this system:
Level 5 indicates that the treatment is:
Efficacious and specific
Proven in multiple controlled studies
Demonstrates clinically meaningful, replicable results
Equivalent to or better than traditional treatments
Supporting Research
Arns, M., Heinrich, H., & Strehl, U. (2014).
Evaluation of Neurofeedback in ADHD: The Long-Term Effects and Clinical Significance.
Summary: This meta-analysis reviewed randomized controlled trials and concluded that standard neurofeedback protocols (like Theta/Beta, SMR, and SCP) meet the criteria for a "well-established" and efficacious treatment for ADHD, with long-term benefits and effect sizes comparable to medication.
| Feature / Benefit | Neurofeedback | Medication | Behavioral Therapy |
|---|---|---|---|
| How it Works | Trains brainwave patterns to improve focus and self-regulation | Stimulates or balances brain chemicals to reduce symptoms | Uses reinforcement and routines to shape behavior |
| Evidence-Based for ADHD | ✔ Yes (Level 5 – Efficacious & Specific for ADHD) | ✔ Yes, particularly stimulants like methylphenidate | ✔ Yes, especially effective in children |
| Non-Invasive | ✔ Yes | ✘ No – chemical intervention | ✔ Yes |
| Side Effects | Minimal to none | Possible (e.g., appetite loss, sleep issues) | Minimal |
| Addresses Root Brain Patterns | ✔ Yes – targets dysregulated brain activity | ✘ No – manages symptoms, not patterns | ✘ No – modifies behavior, not brain function |
| Duration of Benefits | Long-term with consistent training | Short-term; requires ongoing use | Varies; often needs continuous reinforcement |
| Custom-Tailored | ✔ Yes – guided by brain maps (QEEG) | ✘ Dosage adjustments, but generalized | ✔ Yes – adjusted to individual behaviors |
| Works Well with Other Treatments | ✔ Yes – complements meds and therapy | ✔ Often used with therapy | ✔ Often used with meds or neurofeedback |
| Typical Treatment Duration | 30–40 sessions (2–4 months average) | Ongoing or long-term use | Weekly sessions over several months |
Research Supporting Neurofeedback for ADHD/ADD Therapy
1) Arns, M., et al. (2019). "Neurofeedback as a Treatment Intervention in ADHD: Current Evidence and Practice." Current Psychiatry Reports.
Summary: This review evaluates the efficacy of standard neurofeedback protocols (theta/beta ratio [TBR], sensorimotor rhythm [SMR], and slow cortical potential [SCP]) for ADHD. Based on meta-analyses and large multicenter RCTs, the authors conclude that these protocols are "efficacious and specific" for reducing ADHD symptoms, particularly inattention and impulsivity, with long-term benefits and minimal side effects compared to psychostimulants. The study emphasizes neurofeedback as a viable alternative but notes the need for standardized clinical implementation. The study synthesizes evidence from multiple RCTs and meta-analyses, reporting medium-to-large effect sizes for symptom reduction, particularly with TBR and SCP protocols, and highlights neurofeedback’s non-invasive nature.
Article: Neurofeedback as a Treatment Intervention in ADHD: Current Evidence and Practice
2) Van Doren, J., et al. (2018). "Sustained Effects of Neurofeedback in ADHD: A Systematic Review and Meta-Analysis." European Child & Adolescent Psychiatry.
Summary: This meta-analysis examines the long-term effects of neurofeedback in children with ADHD, focusing on follow-up (FU) assessments 2–12 months post-treatment. It included 10 RCTs with 506 participants and found sustained reductions in inattention (SMD = 0.80 at FU, compared to 0.64 post-treatment) and hyperactivity/impulsivity, with larger effect sizes at follow-up than immediately after treatment. The study suggests that neurofeedback’s effects are durable, likely due to learning principles underlying the treatment. The meta-analysis demonstrates statistically significant, sustained symptom improvements, particularly for inattention, with effect sizes comparable to or exceeding those of behavioral therapies, supporting neurofeedback’s long-term efficacy
Article: Sustained effects of neurofeedback in ADHD: a systematic review and meta-analysis.
3) Arns, M., de Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). "Efficacy of Neurofeedback Treatment in ADHD: The Effects on Inattention, Impulsivity and Hyperactivity: A Meta-Analysis." Journal of Clinical EEG and Neuroscience
Summary: A 2009 meta-analysis by Arns et al., published in Journal of Clinical EEG and Neuroscience, reviewed 15 studies (including 6 RCTs) with 1194 participants to assess neurofeedback’s effectiveness for ADHD. The study found that neurofeedback, using protocols like theta/beta and sensorimotor rhythm training, significantly reduces ADHD symptoms. It showed large improvements in inattention (effect size: 0.81) and moderate improvements in impulsivity (0.69) and hyperactivity (0.46). These results, comparable to medication for inattention, support neurofeedback’s efficacy, with lasting benefits observed up to 6 months. By normalizing brain activity, neurofeedback offers a non-invasive, evidence-based option for managing ADHD, especially for those seeking alternatives to medication. This summary highlights the study’s strong evidence for neurofeedback’s efficacy, particularly for inattention and impulsivity, with effect sizes rivaling medications and sustained benefits.
4) Cheng, Y.-C., et al. (2022). "Additive Effects of EEG Neurofeedback on Medications for ADHD: A Systematic Review and Meta-Analysis." Scientific Reports.
Summary: This meta-analysis of five RCTs (305 participants) investigated the combined effects of EEG neurofeedback and medications (e.g., methylphenidate). It found significant additive benefits of neurofeedback on global ADHD symptoms (Hedges’ g = 0.29, p = 0.0327) and inattention (Hedges’ g = 0.33, p = 0.0210) from parents’ observations, though effects waned at six-month follow-up. The study supports neurofeedback as an adjunctive treatment to enhance medication outcomes. The meta-analysis demonstrates that neurofeedback enhances the effectiveness of pharmacological treatments, offering a synergistic approach for ADHD management.
5) Saif, M. G. M., & Sushkova, L. (2023). "Clinical Efficacy of Neurofeedback Protocols in Treatment of Attention Deficit/Hyperactivity Disorder (ADHD): A Systematic Review." Psychiatry Research Neuroimaging.
Summary: This systematic review of 18 studies from 2017–2022 (916 participants) evaluated neurofeedback protocols (TBR, SMR, SCP) compared to stimulant medications for ADHD. It found that neurofeedback effectively reduces ADHD symptoms, particularly inattention and hyperactivity, with effect sizes approaching those of methylphenidate in some studies. The review suggests neurofeedback as a complementary or alternative treatment, especially for those experiencing medication side effects, highlighting its clinical utility with fewer side effects than pharmacological treatments.
Access: Not open-access, but available via ScienceDirect.