title: Slow cortical potential neurofeedback and self-management training in outpatient care for children with ADHD: study protocol and first preliminary results of a randomized controlled trial Multimodal treatment in children and adolescents with attention-deficit/hyperactivity disorder: a 6-month follow-up 1-year follow-up of neurofeedback treatment in adolescents with attention-deficit hyperactivity disorder: randomised controlled trial Neurofeedback training in children with ADHD: 6-month follow-up of a randomised controlled trial Symptomatic improvement in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment. In-School Neurofeedback Training for ADHD: Sustained Improvements From a Randomized Control Trial The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. A 6-month follow-up of an RCT on behavioral and neurocognitive effects of neurofeedback in children with ADHD Training of slow cortical potentials in attention-deficit/hyperactivity disorder: evidence for positive behavioral and neurophysiological effects The Effects of Stimulant Therapy, EEG Biofeedback, and Parenting Style on the Primary Symptoms of Attention-Deficit/Hyperactivity Disorder Neurofeedback and standard pharmacological intervention in ADHD: A randomized controlled trial with six-month follow-up A randomized placebo-controlled trial of electroencephalographic (EEG) neurofeedback in children with attention-deficit/hyperactivity disorder. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. A Randomized Controlled Trial Investigating the Effects of Neurofeedback, Methylphenidate, and Physical Activity on Event-Related Potentials in Children with Attention-Deficit/Hyperactivity Disorder. Behavioral effects of neurofeedback in adolescents with ADHD: a randomized controlled trial A randomised controlled trial of combined EEG feedback and methylphenidate therapy for the treatment of ADHD. Distinct EEG effects related to neurofeedback training in children with ADHD: a randomized controlled trial. Young adult outcomes in the follow‐up of the multimodal treatment study of attention‐deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression
abstract: Background : Treatment for children with attention deficit/hyperactivity disorder ( ADHD ) today is predominantly pharmacological . While it is the most common treatment , it might not always be the most appropriate one . Moreover , long term effects remain unclear . Behavior therapy ( BT ) and non-pharmacological treatments such as neurofeedback ( NF ) are promising alternatives , though there are no routine outpatient care/effectiveness studies yet that have included children with medication or changes in medication . Methods / design : This paper presents the protocol of a r and omized controlled trial to compare the effectiveness of a Slow Cortical Potential ( SCP ) NF protocol with self-management ( SM ) in a high frequent outpatient care setting . Both groups ( NF/SM ) receive a total of 30 high frequent therapy sessions . Additionally , 6 sessions are reserved for comorbid problems . The primary outcome measure is the reduction of ADHD core symptoms according to parent and teacher ratings . Preliminary Results : Untill now 58 children were included in the study ( 48 males ) , with a mean age of 8.42 ( 1.34 ) years , and a mean IQ of 110 ( 13.37 ) . Conners-3 parent and teacher ratings were used to estimate core symptom change . Since the study is still ongoing , and children are in different study stages , pre-post and follow-up results are not yet available for all children included . Preliminary results suggest overall good pre-post effects , though . For parent and teacher ratings an ANOVA with repeated measures yielded overall satisfying pre-post effects ( η2 0.175–0.513 ) . Differences between groups ( NF vs. SM ) could not yet be established ( p = 0.81 ) . Discussion : This is the first r and omized controlled trial to test the effectiveness of a NF protocol in a high frequent outpatient care setting that does not exclude children on or with changes in medication . First preliminary results show positive effects . The rationale for the trial , the design , and the strengths and limitations of the study are discussed . Trial registration : This trial is registered in www . clinical trials.gov as NCT01879644 Abstract Background : Different treatment approaches aim ed at reducing attention-deficit/hyperactivity disorder ( ADHD ) core symptoms are available . However , factors such as intolerance , side-effects , lack of efficacy , high new technology costs , and placebo effect have spurred on an increasing interest in alternative or complementary treatment . Aim : The aim of this study is to explore efficacy of multimodal treatment consisting of st and ard stimulant medication ( methylpheni date ) and neurofeedback ( NF ) in combination , and to compare it with the single treatment in 6-month follow-up in ADHD children and adolescents . Methods : This r and omized controlled trial with 6-month follow-up comprised three treatment arms : multimodal treatment ( NF + MED ) , MED alone , and NF alone .  A total of 130 ADHD children/adolescents participated , and 62 % completed the study .  ADHD core symptoms were recorded pre-/post-treatment , using parents ’ and teachers ’ forms taken from Barkley ’s Defiant Children : A Clinician ’s Manual for Assessment and Parent Training , and a self-report question naire . Results : Significant ADHD core symptom improvements were reported 6 months after treatment completion by parents , teachers , and participants in all three groups , with marked improvement in inattention in all groups . However , no significant improvements in hyperactivity or academic performance were reported by teachers or self-reported by children/adolescents , respectively , in the three groups . Changes obtained with multimodal treatment at 6-month follow-up were comparable to those with single medication treatment , as reported by all participants . Conclusions : Multimodal treatment using combined stimulant medication and NF showed 6-month efficacy in ADHD treatment . More research is needed to explore whether multimodal treatment is suitable for ADHD children and adolescents who showed a poor response to single medication treatment , and for those who want to reduce the use of stimulant medication Background Estimates of the effectiveness of neurofeedback as a treatment for attention-deficit hyperactivity disorder ( ADHD ) are mixed . Aims To investigate the long-term additional effects of neurofeedback ( NFB ) compared with treatment as usual ( TAU ) for adolescents with ADHD . Method Using a multicentre parallel-r and omised controlled trial design , 60 adolescents with a DSM-IV-TR diagnosis of ADHD receiving NFB+TAU ( n=41 ) or TAU ( n=19 ) were followed up .  Neurofeedback treatment consisted of approximately 37 sessions of theta/sensorimotor rhythm (SMR)-training on the vertex ( Cz ) . Outcome measures included behavioural self-reports and neurocognitive measures . Allocation to the conditions was unmasked . Results At 1-year follow-up , inattention as reported by adolescents was decreased ( range ηp2=0.23–0.36 , P<0.01 ) and performance on neurocognitive tasks was faster ( range ηp2=0.20–0.67 , P<0.005 ) irrespective of treatment group . Conclusions Overall , NFB+TAU was as effective as TAU . Given the absence of robust additional effects of neurofeedback in the current study , results do not support the use of theta/SMR neurofeedback as a treatment for adolescents with ADHD and comorbid disorders in clinical practice . Declaration of interest None . Copyright and usage © The Royal College of Psychiatrists 2016 . This is an open access article distributed under the terms of the Creative Commons Non-Commercial , No Derivatives ( CC BY-NC-ND ) licence Neurofeedback ( NF ) could help to improve attentional and self-management capabilities in children with attention-deficit/hyperactivity disorder ( ADHD ) . In a r and omised controlled trial , NF training was found to be superior to a computerised attention skills training ( AST ) ( Gevensleben et al. in J Child Psychol Psychiatry 50(7):780–789 , 2009 ) . In the present paper , treatment effects at 6-month follow-up were studied . 94 children with ADHD , aged 8–12 years , completed either 36 sessions of NF training ( n = 59 ) or a computerised AST ( n = 35 ) . Pre-training , post-training and follow-up assessment encompassed several behaviour rating scales ( e.g. , the German ADHD rating scale , FBB-HKS ) completed by parents . Follow-up information was analysed in 61 children ( ca . 65 % ) on a per- protocol basis . 17 children ( of 33 dropouts ) had started a medication after the end of the training or early in the follow-up period . Improvements in the NF group ( n = 38 ) at follow-up were superior to those of the control group ( n = 23 ) and comparable to the effects at the end of the training . For the FBB-HKS total score ( primary outcome measure ) , a medium effect size of 0.71 was obtained at follow-up . A reduction of at least 25 % in the primary outcome measure ( responder criterion ) was observed in 50 % of the children in the NF group . In conclusion , behavioural improvements induced by NF training in children with ADHD were maintained at a 6-month follow-up . Though treatment effects appear to be limited , the results confirm the notion that NF is a clinical ly efficacious module in the treatment of children with ADHD OBJECTIVE To test the hypotheses that in children with attention-deficit/hyperactivity disorder ( ADHD ) ( 1 ) symptoms of ADHD , oppositional defiant disorder , and overall functioning are significantly improved by methylpheni date combined with intensive multimodal psychosocial treatment compared with methylpheni date alone and with methylpheni date plus attention control and ( 2 ) more children receiving combined treatment can be taken off methylpheni date . METHOD One hundred three children with ADHD ( ages 7 - 9 ) , free of conduct and learning disorders , who responded to short-term methylpheni date were r and omized for 2 years to ( 1 ) methylpheni date alone ; ( 2 ) methylpheni date plus psychosocial treatment that included parent training and counseling , social skills training , psychotherapy , and academic assistance , or ( 3 ) methylpheni date plus attention psychosocial control treatment . Assessment s included parent , teacher , and psychiatrist ratings , and observations in academic and gym classes . RESULTS Combination treatment did not lead to superior functioning and did not facilitate methylpheni date discontinuation . Significant improvement occurred across all treatments and continued over 2 years . CONCLUSIONS In stimulant-responsive children with ADHD , there is no support for adding ambitious long-term psychosocial intervention to improve ADHD and oppositional defiant disorder symptoms . Significant benefits from methylpheni date were stable over 2 years OBJECTIVE : To evaluate sustained improvements 6 months after a 40-session , in-school computer attention training intervention using neurofeedback or cognitive training ( CT ) administered to 7- to 11-year-olds with attention-deficit/hyperactivity disorder ( ADHD ) . METHODS : One hundred four children were r and omly assigned to receive neurofeedback , CT , or a control condition and were evaluated 6 months postintervention . A 3-point growth model assessed change over time across the conditions on the Conners 3–Parent Assessment Report ( Conners 3-P ) , the Behavior Rating Inventory of Executive Function Parent Form ( BRIEF ) , and a systematic double-blinded classroom observation ( Behavioral Observation of Students in Schools ) . Analysis of variance assessed community-initiated changes in stimulant medication . RESULTS : Parent response rates were 90 % at the 6-month follow-up . Six months postintervention , neurofeedback participants maintained significant gains on Conners 3-P ( Inattention effect size [ ES ] = 0.34 , Executive Functioning ES = 0.25 , Hyperactivity/Impulsivity ES = 0.23 ) and BRIEF subscales including the Global Executive Composite ( ES = 0.31 ) , which remained significantly greater than gains found among children in CT and control conditions . Children in the CT condition showed delayed improvement over immediate postintervention ratings only on Conners 3-P Executive Functioning ( ES = 0.18 ) and 2 BRIEF subscales . At the 6-month follow-up , neurofeedback participants maintained the same stimulant medication dosage , whereas participants in both CT and control conditions showed statistically and clinical ly significant increases ( 9 mg [ P = .002 ] and 13 mg [ P < .001 ] , respectively ) . CONCLUSIONS : Neurofeedback participants made more prompt and greater improvements in ADHD symptoms , which were sustained at the 6-month follow-up , than did CT participants or those in the control group . This finding suggests that neurofeedback is a promising attention training treatment for children with ADHD OBJECTIVES To determine any long-term effects , 6 and 8 years after childhood enrollment , of the r and omly assigned 14-month treatments in the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder ( MTA ; N = 436 ) ; to test whether attention-deficit/hyperactivity disorder ( ADHD ) symptom trajectory through 3 years predicts outcome in subsequent years ; and to examine functioning level of the MTA adolescents relative to their non-ADHD peers ( local normative comparison group ; N = 261 ) . METHOD Mixed-effects regression models with planned contrasts at 6 and 8 years tested a wide range of symptom and impairment variables assessed by  parent , teacher , and youth report . RESULTS In nearly every analysis , the originally r and omized treatment groups did not differ significantly on repeated measures or newly analyzed variables ( e.g. , grade s earned in school , arrests , psychiatric hospitalizations , other clinical ly relevant outcomes ) . Medication use decreased by 62 % after the 14-month controlled trial , but adjusting for this did not change the results . ADHD symptom trajectory in the first 3 years predicted 55 % of the outcomes . The MTA participants fared worse than the local normative comparison group on 91 % of the variables tested . CONCLUSIONS Type or intensity of 14 months of treatment for ADHD in childhood ( at age 7.0 - 9.9 years ) does not predict functioning 6 to 8 years later . Rather , early ADHD symptom trajectory regardless of treatment type is prognostic . This finding implies that children with behavioral and sociodemographic advantage , with the best response to any treatment , will have the best long-term prognosis . As a group , however , despite initial symptom improvement during treatment that is largely maintained after treatment , children with combined-type ADHD exhibit significant impairment in adolescence . Innovative treatment approaches targeting specific areas of adolescent impairment are needed Abstract To assess the long-term effects of neurofeedback ( NFB ) in children with attention deficit hyperactivity disorder ( ADHD ) , we compared behavioral and neurocognitive outcomes at a 6-month naturalistic follow-up of a r and omized controlled trial on NFB , methylpheni date ( MPH ) , and physical activity ( PA ) .  Ninety-two children with a DSM-IV-TR ADHD diagnosis , aged 7–13 , receiving NFB ( n = 33 ) , MPH ( n = 28 ) , or PA ( n = 31 ) , were re-assessed 6-months after the interventions . NFB comprised theta/beta training on the vertex ( cortical zero ) . PA comprised moderate to vigorous intensity exercises . Outcome measures included parent and teacher behavioral reports , and neurocognitive measures ( auditory oddball , stop-signal , and visual spatial working memory tasks ) . At follow-up , longitudinal hierarchical multilevel model analyses revealed no significant group differences for parent reports and neurocognitive measures ( p = .058–.997 ) , except for improved inhibition in MPH compared to NFB ( p = .040 ) and faster response speed in NFB compared to PA ( p = .012 ) during the stop-signal task . These effects , however , disappeared after controlling for medication use at follow-up . Interestingly , teacher reports showed less inattention and hyperactivity/impulsivity at follow-up for NFB than PA ( p = .004–.010 ) , even after controlling for medication use ( p = .013–.036 ) . Our findings indicate that the superior results previously found for parent reports and neurocognitive outcome measures obtained with MPH compared to NFB and PA post intervention became smaller or non-significant at follow-up . Teacher reports suggested superior effects of NFB over PA ; however , some children had different teachers at follow-up . Therefore , this finding should be interpreted with caution . Clinical trial registration Train your brain and exercise your heart ? Advancing the treatment for Attention Deficit Hyperactivity Disorder ( ADHD ) , Ref . no. NCT01363544 , https:// clinical trials.gov/show/NCT01363544 BACKGROUND Learned self-control of slow cortical potentials ( SCPs ) may lead to behavioral improvement in attention-deficit/hyperactivity disorder ( ADHD ) . Hence , training effects should also be reflected at the neurophysiological level . METHODS Thirteen children with ADHD , aged 7 - 13 years , performed 25 SCP training sessions within 3 weeks . Before and after training , the German ADHD rating scale was completed by parents , and event-related potentials were recorded in a cued continuous performance test ( CPT ) . For a waiting-list group of nine children with ADHD , the same testing was applied . RESULTS ADHD symptomatology was reduced by approximately 25 % after SCP training . Moreover , a decrease of impulsivity errors and an increase of the contingent negative variation were observed in the CPT task . CONCLUSIONS This study provides first evidence for both positive behavioral and specific neurophysiological effects of SCP training in children with ADHD One hundred children , ages 6–19 , who were diagnosed with attention-deficit/hyperactivity disorder ( ADHD ) , either inattentive or combined types , participated in a study examining the effects of Ritalin , EEG biofeedback , and parenting style on the primary symptoms of ADHD . All of the patients participated in a 1-year , multimodal , outpatient program that included Ritalin , parent counseling , and academic support at school ( either a 504 Plan or an IEP ) . Fifty-one of the participants also received EEG biofeedback therapy . Posttreatment assessment s were conducted both with and without stimulant therapy . Significant improvement was noted on the Test of Variables of Attention ( TOVA ; L. M. Greenberg , 1996 ) and the Attention Deficit Disorders Evaluation Scale ( ADDES ; S. B. McCarney , 1995 ) when participants were tested while using Ritalin . However , only those who had received EEG biofeedback sustained these gains when tested without Ritalin . The results of a Quantitative Electroencephalographic Scanning Process ( QEEG-Scan ; V. J. Monastra et al. , 1999 ) revealed significant reduction in cortical slowing only in patients who had received EEG biofeedback . Behavioral measures indicated that parenting style exerted a significant moderating effect on the expression of behavioral symptoms at home but not at school The present study is a r and omized controlled trial that aims to evaluate the efficacy of Neurofeedback compared to st and ard pharmacological intervention in the treatment of attention deficit/hyperactivity disorder ( ADHD ) . The final sample consisted of 23 children with ADHD ( 11 boys and 12 girls , 7 - 14 years old ) . Participants carried out 40 theta/beta training sessions or received methylpheni date .  Behavioral rating scales were completed by fathers , mothers , and teachers at pre- , post-treatment , two- , and six-month naturalistic follow-up . In both groups , similar significant reductions were reported in ADHD functional impairment by parents ; and in primary ADHD symptoms by parents and teachers . However , significant academic performance improvements were only detected in the Neurofeedback group . Our findings provide new evidence for the efficacy of Neurofeedback , and contribute to enlarge the range of non-pharmacological ADHD intervention choices . To our knowledge , this is the first r and omized controlled trial with a six-month follow-up that compares Neurofeedback and stimulant medication in ADHD OBJECTIVE A double-blind , r and omized , placebo-controlled study was design ed to assess the efficacy and safety of electroencephalographic ( EEG ) neurofeedback in children with attention-deficit/hyperactivity disorder ( ADHD ) . The study started in August 2008 and ended in July 2012 and was conducted at Karakter Child and Adolescent Psychiatry University Centre in Nijmegen , The Netherl and s. METHOD Forty-one children ( aged 8 - 15 years ) with a DSM-IV-TR diagnosis of ADHD were r and omly assigned to treatment with either EEG neurofeedback ( n = 22 ) or placebo neurofeedback ( n = 19 ) for 30 sessions , given as 2 sessions per week . The children were stratified by age , electrophysiologic state of arousal , and medication use . Everyone involved in the study , except the neurofeedback therapist and the principal investigator , was blinded to treatment assignment . The primary outcome was severity of ADHD symptoms on the ADHD Rating Scale IV , scored at baseline , during treatment , and at study end . Clinical improvement as measured by the Clinical Global Impressions-Improvement scale ( CGI-I ) was a secondary outcome . RESULTS While total ADHD symptoms improved over time in both groups ( F1,39 = 26.56 , P < .001 ) , there was no significant treatment effect , ie , group × time interaction ( F1,39 = 0.36 , P = .554 ) ; the same was true for clinical improvement as measured by the CGI-I ( P = .092 ) . No clinical ly relevant side effects were observed . Among the children and their parents , guessing treatment assignment was not better than chance level ( P = .224 for children , P = .643 for parents ) . CONCLUSION EEG neurofeedback was not superior to placebo neurofeedback in improving ADHD symptoms in children with ADHD . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT00723684 OBJECTIVE In the Multimodal Treatment Study of ADHD ( MTA ) , the effects of medication management ( MedMgt ) and behavior modification therapy ( Beh ) and their combination ( Comb ) and usual community comparison ( CC ) in the treatment of attention-deficit/hyperactivity disorder ( ADHD ) differed at the 14-month assessment as a result of superiority of the MTA MedMgt strategy ( Comb or MedMgt ) over Beh and CC and modest additional benefits of Comb over MedMgt alone . Here we evaluate the persistence of these beneficial effects 10 months beyond the 14 months of intensive intervention . METHODS Of 579 children who entered the study , 540 ( 93 % ) participated in the first follow-up 10 months after the end of treatment . Mixed-effects regression models explored possible persisting effects of the MTA medication strategy , the incremental benefits of Comb over MedMgt alone , and the possible superiority of Beh over CC on 5 effectiveness and 4 service use domains . RESULTS The MTA medication strategy showed persisting significant superiority over Beh and CC for ADHD and oppositional-defiant symptoms at 24 months , although not as great as at 14 months . Significant additional benefits of Comb over MedMgt and of Beh over CC were not found . The groups differed significantly in mean dose ( methylpheni date equivalents 30.4 , 37.5 , 25.7 , and 24.0 mg/day , respectively ) . Continuing medication use partly mediated the persisting superiority of Comb and MedMgt . CONCLUSION The benefits of intensive MedMgt for ADHD extend 10 months beyond the intensive treatment phase only in symptom domains and diminish over time OBJECTIVE Electroencephalographic ( EEG ) neurofeedback ( NF ) is considered a nonpharmacological alternative for medication in attention-deficit/hyperactivity disorder ( ADHD ) . Comparisons of the behavioral efficacy of NF and medication have produced inconsistent results . EEG measures can provide insight into treatment mechanisms , but have received little consideration . In this r and omized controlled trial ( RCT ) , effects of NF were compared with methylpheni date ( MPH ) , and physical activity ( PA ) in children with ADHD on event-related potential ( ERP ) indices of response inhibition , which are involved in ADHD psychopathology . METHODS Using a multicenter three way parallel group RCT design , 112 children with a Diagnostic and Statistical Manual of Mental Disorders , 4th ed . ( DSM-IV ) ( American Psychiatric Association 1994 ) diagnosis of ADHD , between 7 and 13 years of age , were initially included .  NF training consisted of 30 sessions of theta/beta training at Cz over a 10 week period . PA training was a semiactive control group , matched in frequency and duration . MPH was titrated using a double-blind placebo controlled procedure in 6 weeks , followed by a stable dose for 4 weeks . ERP measures of response inhibition , N2 and P3 , were available for 81 children at pre- and postintervention ( n = 32 NF , n = 25 MPH , n = 24 PA ) . RESULTS Only the medication group showed a specific increase in P3 amplitude compared with NF ( partial eta-squared [ ηp(2 ) ] = 0.121 ) and PA ( ηp(2 ) = 0.283 ) , which was related to improved response inhibition . Source localization of medication effects on P3 amplitude indicated increased activation primarily in thalamic and striatal nuclei . CONCLUSIONS This is the first study that simultaneously compared NF with stimulant treatment and a semiactive control group . Only stimulant treatment demonstrated specific improvements in brain function related to response inhibition . These results are in line with recent doubts on the efficacy and specificity of NF as treatment for ADHD . CLINICAL TRIALS REGISTRATION Train Your Brain ? Exercise and Neurofeedback Intervention for ADHD , https:// clinical trials.gov/show/NCT01363544 , Ref . No. NCT01363544 Neurofeedback has been proposed as a potentially effective intervention for reducing Attention Deficit Hyperactivity Disorder ( ADHD ) symptoms . However , it remains unclear whether neurofeedback is of additional value to treatment as usual ( TAU ) for adolescents with clinical ADHD symptoms . Using a multicenter parallel-r and omized controlled trial design , adolescents with ADHD symptoms were r and omized to receive either a combination of TAU and neurofeedback ( NFB + TAU , n = 45 ) or TAU-only ( n = 26 ) . R and omization was computer generated and stratified for age group ( ages 12 through 16 , 16 through 20 , 20 through 24 ) .  Neurofeedback treatment consisted of approximately 37 sessions of theta/sensorimotor rhythm (SMR)-training on the vertex ( Cz ) . Primary behavioral outcome measures included the ADHD-rating scale , Youth Self Report , and Child Behavior Checklist all assessed pre- and post-intervention . Behavioral problems decreased equally for both groups with medium to large effect sizes , range of partial η2 = 0.08–0.31 , p < 0.05 . Hence , the combination of NFB + TAU was not more effective than TAU-only on the behavioral outcome measures . In addition , reported adverse effects were similar for both groups . On behavioral outcome measures , the combination of neurofeedback and TAU was as effective as TAU-only for adolescents with ADHD symptoms . Considering the absence of additional behavioral effects in the current study , in combination with the limited knowledge of specific treatment effects , it is question able whether theta/SMR neurofeedback for adolescents with ADHD and comorbid disorders in clinical practice should be used . Further research is warranted to investigate possible working mechanisms and ( long-term ) specific treatment effects of neurofeedback PURPOSE To evaluate the efficacy of combined methylpheni date and EEG feedback treatment for children with ADHD . METHODS Forty patients with ADHD were r and omly assigned to the combination group ( methylpheni date therapy and EEG feedback training ) or control group ( methylpheni date therapy and non-feedback attention training ) in a 1:1 ratio using the double-blind method . These patients , who met the DSM-IV diagnostic criteria and were aged between 7 and 16 years , had obtained optimal therapeutic effects by titrating the methylpheni date dose prior to the trial . The patients were assessed using multiple parameters at baseline , after 20 treatment sessions , after 40 treatment sessions , and in 6-month follow-up studies . RESULTS Compared to the control group , patients in the combination group had reduced ADHD symptoms and improved in related behavioural and brain functions . CONCLUSION The combination of EEG feedback and methylpheni date treatment is more effective than methylpheni date alone . The combined therapy is especially suitable for children and adolescents with ADHD who insufficiently respond to single drug treatment or experience drug side effects In a r and omized controlled trial , neurofeedback ( NF ) training was found to be superior to a computerised attention skills training concerning the reduction of ADHD symptomatology ( Gevensleben et al. , 2009 ) . The aims of this investigation were to assess the impact of different NF protocol s ( theta/beta training and training of slow cortical potentials , SCPs ) on the resting EEG and the association between distinct EEG measures and behavioral improvements . In 72 ( of initially 102 ) children with ADHD , aged 8 - 12 , EEG changes after either a NF training ( n=46 ) or the control training ( n=26 ) could be studied . The combined NF training consisted of one block of theta/beta training and one block of SCP training , each block comprising 18 units of 50 minutes ( balanced order ) .  Spontaneous EEG  was recorded in a two-minute resting condition before the start of the training , between the two training blocks and after the end of the training . Activity in the different EEG frequency b and s was analyzed . In contrast to the control condition , the combined NF training was accompanied by a reduction of theta activity . Protocol -specific EEG changes ( theta/beta training : decrease of posterior-midline theta activity ; SCP training : increase of central -midline alpha activity ) were associated with improvements in the German ADHD rating scale . Related EEG-based predictors were obtained . Thus , differential EEG patterns for theta/beta and SCP training provide further evidence that distinct neuronal mechanisms may contribute to similar behavioral improvements in children with ADHD BACKGROUND The Multimodal Treatment Study ( MTA ) began as a 14-month r and omized clinical trial of behavioral and pharmacological treatments of 579 children ( 7 - 10 years of age ) diagnosed with attention-deficit/hyperactivity disorder (ADHD)-combined type . It transitioned into an observational long-term follow-up of 515 cases consented for continuation and 289 classmates ( 258 without ADHD ) added as a local normative comparison group ( LNCG ) , with assessment s 2 - 16 years after baseline . METHODS Primary ( symptom severity ) and secondary ( adult height ) outcomes in adulthood were specified . Treatment was monitored to age 18 , and naturalistic subgroups were formed based on three patterns of long-term use of stimulant medication ( Consistent , Inconsistent , and Negligible ) . For the follow-up , hypothesis-generating analyses were performed on outcomes in early adulthood ( at 25 years of age ) . Planned comparisons were used to estimate ADHD-LNCG differences reflecting persistence of symptoms and naturalistic subgroup differences reflecting benefit ( symptom reduction ) and cost ( height suppression ) associated with extended use of medication . RESULTS For ratings of symptom severity , the ADHD-LNCG comparison was statistically significant for the parent/self-report average ( 0.51 ± 0.04 , p < .0001 , d = 1.11 ) , documenting symptom persistence , and for the parent/self-report difference ( 0.21 ± 0.04 , p < .0001 , d = .60 ) , documenting source discrepancy , but the comparisons of naturalistic subgroups reflecting medication effects were not significant . For adult height , the ADHD group was 1.29 ± 0.55 cm shorter than the LNCG ( p < .01 , d = .21 ) , and the comparisons of the naturalistic subgroups were significant : the treated group with the Consistent or Inconsistent pattern was 2.55 ± 0.73 cm shorter than the subgroup with the Negligible pattern ( p < .0005 , d = .42 ) , and within the treated group , the subgroup with the Consistent pattern was 2.36 ± 1.13 cm shorter than the subgroup with the Inconsistent pattern ( p < .04 , d = .38 ) . CONCLUSIONS In the MTA follow-up into adulthood , the ADHD group showed symptom persistence compared to local norms from the LNCG . Within naturalistic subgroups of ADHD cases , extended use of medication was associated with suppression of adult height but not with reduction of symptom severity
target: Compared to non-active control treatments , NF appears to have more durable treatment effects , for at least 6 months following treatment .
background: Neurofeedback ( NF ) has gained increasing interest in the treatment of attention-deficit/hyperactivity disorder ( ADHD ) .
  Given learning principles underlie NF , lasting clinical treatment effects may be expected .
  This systematic review and meta- analysis addresses the sustainability of neurofeedback and control treatment effects by considering r and omized controlled studies that conducted follow-up ( FU ; 2–12 months ) assessment s among children with ADHD .