ADHD: Is neurofeedback as effective as medication?

New technologies to combat inattention, a paradox? Maybe not. A study (called Newrofeed), funded by the European Union as part of the Horizon 2020 Innovation Research, evaluates a “high-tech” device to fight ADHD, attention deficit disorders with or without hyperactivity in children. Clearly, is neurofeedback – the return of brain activity recorded by an electroencephalogram (EEG) via a tablet application – as effective as the drug traditionally used in these pathologies, methylphenidate?

Regulating brain activity
To find out, the clinicians, coordinated by Prof. Diane Purper Ouakil of the Saint-Eloi Hospital (Montpellier University Hospital), will recruit 179 young people aged between 7 and 13 years, suffering from ADHD with an inattentive component, who have not yet benefited from either medication or neurofeedback, in 9 clinical centres in Europe (spread over France, Belgium, Spain and Switzerland). The children will be randomly divided into two groups: some will receive methylphenidate in a dosage assessed by doctors, others will try neurofeedback. The latter will have to learn to regulate their brain activity themselves, recorded by the EEG and sent back in real time as an image on a tablet. The reward for success is supposed to create a virtuous circle by stimulating individual commitment to this therapeutic rehabilitation.

The use of neurofeedback in the treatment of neurological disorders is not new, and its potential applications are numerous, even if, for the moment, protocols are not standardized and a study published in the Lancet Psychiatry has criticized its effectiveness. Moreover, this technique is already popular – although the results have not yet been scientifically validated – in the treatment of ADHD and hyperactivity. Except that this time, two new developments are to be considered, according to Prof. Diane Purper Ouakil. First, the sessions (or at least part of them) are carried out at home, after an initial phase of course of “training” and support for parents and children in the centre. Then, “the protocol is personalized according to the child’s brain activity,” explains the doctor. The electroencephalogram carried out at the start allows the protocol used to be selected according to the theta/beta ratio,” a biomarker of attentional control.

RESULTS. But how do you then know that the treatment is working? In fact, the precise objective is not to evaluate the absolute effectiveness of neurofeedback but rather to prove (or not) that it works at least as well as methylphenidate on the symptoms of inattention (evaluated by collecting questionnaires from teachers, parents and clinicians). Moreover, the number of participating children was evaluated precisely to show significant differences in this so-called “equivalence-effectiveness” test. In any case, during the 3 months of the study. “We would also like to find funding to do a remote follow-up and see if the potential effectiveness would be maintained over time,” admits Diane Purper Ouakil. But the study is still in its early stages, even though the technique is promising.


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