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Friday, June 13, 2014

Does Neurofeedback Work for ADHD / ADD? (Biofeedback)

UPDATE [September 23, 2016]:
Recently, a couple of people were surprised to hear me tell them that Neurofeedback, Biofeedback (or whatever other scientific-sounding names people are using these days) is "experimental," and in my opinion people should be informed of this prior to trying it, and the cost should be much less that I hear people are charging for it, for two reasons: (1) it's experimental; when something is experimental, the patient it taking a risk of wasting their time and money and potential harm from an unknown procedure; and (2) there's not skill necessary on the part of the practitioner; it's not like heart surgery, for example.
People are still be told that Neurofeedback "cures" ADHD, but it does not, and, people are being referred to Neurofeedback as though it is a Standard of Care, but it is not. There are only two scientifically supported treatments for ADHD: behavior modification and stimulants or amphetamines. You can read more about ADHD on this blogs under several posts. It's a highly controversial syndrome concept. So, consumers beware.
You can read this official Medical Policy of Blue Cross Blue Shield of Illinois regarding why Neurofeedback is considered experimental: BCBSIL Medical Policy PSY311.011.

_______________ Original Post ________________

There have been several studies of comparing Neurofeedback to a placebo for ADHD. Up until 2012, it was not clear if Neurofeedback (also called Biofeedback) was helpful. Other issues were not addressed by most studies, for example, if a particular child did show improvement, how long did their improvement last? 


Neurofeedback has no predictable benefit for ADHD
or any other mental health problem.

In 2013, an independent group of researchers from the Netherlands published a study in the Journal of Clinical Psychiatry, in the United States, showing that biofeedback did not work better than a placebo (The Journal of Clinical Psychiatry 


Many parents are being told that neurofeedback will "cure" ADHD
in a certain percentage of cases, but, this is completely false.

To begin with, there is no known cure for ADHD, only different therapies (please refer to other posts on ADHD for more information about this complicated issue). Also, neurofeedback has no clear benefit for any other mental health problem; however, it is being used to treat many different type of issues, especially anxiety and even autism. With regards to anxiety, it seems to be a distraction and relaxation technique more than a treatment, and there are no generally effective treatments or cures for autism (regardless of what Jennifer McCarthy says on TV). You might as well use mindfulness, at least that's free.

ADHD is not a disease in a medical sense. Psychiatry is that branch of medicine that includes diagnosis that are not diseases. For example, depression is a state of consistent sadness combined with other problems, like problems with diet, sleep, or motivation. There are no lab tests or scans that can be done to determine if a child has ADHD, or any other psychiatric disorder because, ADHD is a set-of behavior problems. 

In their prestigious 2003 publication, Child Psychopathology, by Eric J. Mash, and Russell A. Barkley (2nd edition), the authors state on page 93, that ADHD is a real disorder because children who are diagnosed with ADHD often have behavior problems later in life and have differences in brain scans.  It's strange enough that the authors find it necessary to state that ADHD is a "real disorder," but moreover, their logic is embarrassingly flawed with regards to cause and effect (i.e., an abnormal brain scan, therefore, these abnormalities cause ADHD; or, problems later in life, therefore, ADHD is a real disorder). The fact is that brain scans of children with ADHD are full of inconsistencies, and no clear conclusions about the meaning of these inconsistencies can be made at this point. Some psychiatrists have come to what I see as spurious conclusions about these inconsistencies, like Dr. Daniel Amen and his 7 types of ADHD (if there were 4 categories of inconsistencies of brain scans, then there probably would of been 4 types of ADHD - get it?). There are still many technical problems with using brain scan technology that make the data derived from these methods unreliable (fMRI, Spect, etc...) (see my post about Spect scans, but there are more current articles by scientists as well, see Neuroskeptic at Discover Magazine).





Children who have behavior problems when they are young may have behavior problems when they are older for many other reasons. In fact, psychiatrists and many psychologists have failed to adequately study or have omitted many environmental factors when trying to understand causes of ADHD. For example, failing to adequately analyse the relationship between corporal punishment and ADHD, poverty and ADHD, parent mental health and ADHD, gender and ADHD (boys are diagnosed 5:1 compared to girls) and many other factors. Neuro-psychologists and psychiatrists spend plenty of time developing fancy guesses about why the results of a different brain scan would result in "attentional problems," but do not spend enough, or any, trying to figure out how and why corporal punishment, permissive parenting, or poverty might contribute to the same behavior problems. Paying lip-service to these factors or mentioning them at face-value does not help anyone understand the relationship between these factors and ADHD, perpetuates the labeling of children as ADHD, misses the opportunity to address serious systemic problems in primary education, and address ineffective parenting rooted in cultural ignorance (e.g., continued use of corporal punishment in many States and about 50% of homes, as well as other permissive or authoritarian parenting techniques).


Many parents look for simple and easy explanations and solutions to ADHD. So, neurofeedback or drug therapies with their pseudo-medical explanations are very appealing, but they're also very spurious and sometimes just patently false. In the end, it's unlikely that your child will derive any long term benefit from neurofeedback, so proceed with caution.

Mental Health Advice Disclaimer: The information included in this post and blog are for educational purposes only. It is not intended nor implied to be a substitute for professional mental health treatment or medical advice. The reader should always consult his or her mental health provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a mental health or medical condition or treatment plan. Reading the information on this website does not create a therapist-patient relationship.

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