Neurofeedback Therapy For ADHD in Toronto

One mechanism suggested for the effects of sensorimotor rhythm (SMR) neurofeedback as well as TBR (Theta-Beta-Ratio) training is that it helps to normalize sleep and thus improves ADHD symptoms such as inattention and hyperactivity/ impulsivity. ADHD patients were compared to a control group to investigate if differences existed in sleep components including Sleep Onset Latency (SOL), Sleep Duration (DUR) and overall reported sleep problems (PSQI). They also examined if ay associations were seen between sleep=parameters and ADHD symptoms. Also, this study investigated the effects of SMR and TBR on symptoms, sleep parameters, and if they were mediated in the treatment outcomes. They found that there was a relationship between self-reported sleep problems (PSQI) and inattention in adults both with and without ADHD. TBE resulted in a small reduction of SOL. This change in SOL didn’t correlate with change in ADHD symptoms, and the reduction in SOL only happened in the latter half of treatment. This effect was not specifically related to TBR neurofeedback. SMR specifically reduced the SOL, and pSQI score and these changes PSQI were strongly correlated with changes in inattention and the reduction in SOL was achieved in the first half of treatment. SMR neurofeedback may have SOL mediated through the course of treatment. TBR and SMR had similar effects of symptoms reduction in ADHD. The effects of training may have different working mechanisms in the amelioration of ADHD symptoms.

This article covers the basics of neurofeedback. ADHD is characterized by hyperactivity, impulsivity, and inattention. This disorder is heterogeneous and often comorbid of associated problems from other psychiatric disorders are prevalent. ADHD can be accompanied by cognitive and motivational problems as well as abnormalities in the resting-state, associated with impaired brain activity in neuronal networks. Multimodal treatments should be utilized with comprising (NF). NF provides brain activity feedback using visual or auditory signals, which allow the participant to gain control over neuronal processes. NF can be used to improve underlying neuronal deficits or establish self-regulatory skills that can help compensate for behavioural difficulties. Most often ODD/ conduct or tic disorders are prevalent as comorbid disorders.

EEG studies often cite that Theta/Beta ratio (TBR) is a specific measure which is characteristic of ADHD. This meta-analysis covers the literature on Theta/Beta Ratio in ADHD. This study analyzed TBR during Eyes Open at location Cz. Individuals between the ages of 6-18 were measured both with and without ADHD. This study identified 1253 individuals with ADHD and 517 without, over nine studies. They found that the mean effect size for 6-14-year-olds were 0.75 and for 6-18-year-olds were 0.62. Heterogeneity is significant within these populations. The Effect Sizes are misleading and may be an overestimation. Throughout the developmental span, TBR tends to decrease. Although excessive TBR is not a reliable diagnostic measure of ADHD; a significant subgroup of ADHD patients were found to have large TBR measures in the study. Thus, excess theta and TBR can potentially be used as a prognostic measure rather than a diagnostic measure.

Neurofeedback for ADHD has multiple protocols including TBR training and training of slow cortical potentials (SCPs). In this article, mechanisms of action are questioned. Frameworks for NF models namely, conditioning-and-repair model and the skill acquisition model are also discussed at length. This underlying model impacts NF application as well as selection and evaluation strategies. Empirical data is presented. It is hypothesized that different models may hold true depending on the process and behaviours to be addressed by the nF protocol. SCP may relate to skill acquisition model.

This meta-analysis is utilized to demonstrate the utility of QEEG theta/beta ratios in the present in ADHD vs. the normal populations. Individuals had to have met criteria from the DSM-IV for diagnosis of ADHD. 9 studies with N=1498) were observed and the theta/beta ratio was summarized. The Effect size found was 3.08 for ADHD versus controls. This encompassed a control group of children adolescents and adults. This indicates that there may be up between 94-98% specificity of using theta/beta ratios for identifying ADHD. Controlled group studies were often limited in the sense that measured among the general population the specificity may be lower. 29/32 studies found in the literature demonstrated results consistent with the meta-analysis. The results are supported by the observation that TBR follows age-related changes in ADHD symptom presentation. TBR is a well-observed trait in ADHD compared to normal controls. Theta/beta ratio may rise with other condition, a study covering differential diagnosis would be required to determine generalization to this protocol to clinical applications. Standardization of QEEG technique is also needed for controlling the mental state, drowsiness, and mediation of participants.

Two fMRI experiments were conducted to measure the effects of neurofeedback training (NFT) in ADHD children on neural areas of selective attention and response inhibition. 15 children were randomly assigned to the experimental (Neurofeedback) group while five were randomly assigned to the control (CON) group. The experiment group trained to increase Beta (15-18 Hz) and decrease Theta (4-7Hz). The fMRI was conducted one week before beginning NFT and at the end of NFT. Significant activation was seen for the experimental group in areas associated with attention. No changes in activation were seen in the control group. This suggests that NFT can help continually normalize brain systems as well as functional areas associated with selective attention and response inhibition.

This study attempted to conduct a randomized control trial in which they evaluated sustained improvements after six months of 40 neurofeedback sessions which occurred in school. Individuals received either neurofeedback or Cognitive Training (CT). Participants were between 7-11 years old with diagnosed ADHD. 104 children were randomly assigned to receive either neurofeedback, CT, or a control condition. Neurofeedback participants maintained significant gains on inattention, executive functioning, and hyperactivity.

This study looks at using biofeedback with EEG neurofeedback in a single-blind randomized control trial design to evaluate the efficacy of neurofeedback. EMG biofeedback (BF) and theta/beta ratio reduction training were used in this study. 35 children with ADHD are randomly assigned to either therapy group (18) or control group (17) treatment for both groups utilize 30 sessions. Teachers and parents completed behaviour rating scales as well as psychometric measures. Training reduced theta/beta ratios. Parents reported a reduction in ADHD symptoms and inattention. Improvements in NF groups were higher than BF groups. NF groups also improved on psychometric measures; the NF group showed a reduction inattention symptoms and reaction time on neuropsychological tests.

One of the first studies which utilized a randomized control trial compares Neurofeedback to stimulant medication for the amelioration of ADHD symptoms. In this study, 23 children (11 boys and 12 girls) between the ages of (7-14 years old) were randomly assigned either 40 sessions of theta/beta training or received methylphenidate. They utilized behavioural rating scales completed by parents and educators pre and post treatments. This was tested at both two and six-month follow-ups. Though similar significant reductions were reported in both treatment conditions for both functional and primary ADHD symptoms, only the Neurofeedback group had demonstrated significant academic improvements.

100 children ages 6-19 who had ADHD, inattentive, or combined participated in this study which aimed to examine the effects of Ritalin, EEG biofeedback, and parenting styles on ADHD symptoms. All patients participated in the 1-year multimodal program that included Ritalin, parent counselling, and academic support at school. 51 of the participants received EEG biofeedback as well. In the post-treatment assessments, individuals were assessed with both stimulant and stimulants. Individual completed T.O.V.A and ADDES scales. Those who had received EEG biofeedback sustained the gains when tested without Ritalin.

Analysis of EEG output at the prefrontal location (Cz) was conducted on 482 individuals between the ages of 6-30 years old. The study attempted to test that cortical slowing in a prefrontal region can help differentiate patients with attention deficit hyperactivity disorder (ADHD) from nonclinical control groups. Participants were divided into 3 groups (ADHD, Inattentive; ADHD, Combined; and control group) on the basis of results of the standardized clinical interview, behavioural rating scales, and a CPT continuous performance task. Overall, a relation between theta/beta ratios being evaluated in ADHD patients were found.

Prevalence is reported to be 3-7 % for ADHD in school age children. Three subtypes: predominantly inattentive, predominantly hyperactive-impulsive and combined type. Core symptoms of ADHD consist of inattention, impulsivity, and hyperactivity. Limitations exist for medication and behaviour therapy. Neurofeedback helps teach or improve self-regulation of brain activity. Principles of classical conditioning and operant conditioning can be applied to help individuals gain self-regulatory skills. SMR treatments conducted by Sterman found improvements in sleep quality. Lubar employed A-B-A designs to find that symptoms of ADHD increased when training protocols were reversed. Protocol training, specifically training Theta/Beta (4-8 Hz/13-21 Hz) led to improvements in cognitive measures (attention and IQ). Studies since then have found that Theta/Beta ratio (TBR) training has comparable results to stimulant medication. Semi-active control conditions find that neurofeedback useful for inattention and impulsivity. Randomized control trials find that these effects are consistency at follow-up and a reduction in hyperactivity and impulsivity is also seen. 40 sessions lead to stronger results. Methylphenidate has not been shown to be more effective than neurofeedback in several studies. Low sample sizes may lead to further issues. It is difficult to eliminate all the other effects involved with Neurofeedback, but they can be controlled by using randomization in studies. Studies which randomized trials often fail to utilize proper Neurofeedback and make serious errors in the administration of Neurofeedback. For example utilizing thresholds that are too high. Many randomized studies do not consider the effects of generalization or apply any learning strategies to aid this process. There should be a focus on specific protocol investigation. A multidimensional approach should be taken to work with neurofeedback. Newer modalities of Neurofeedback, LORETA, and sLORETA show increased promise when dealing with complex disorders.

In this study, Health university students were randomly assigned to the experimental group, sham group or control group. Participants in the experimental group trained to enhance beta waves at F4 and P4. Attentional performance and MRI data were recorded one week before training and one week after training. Higher scores on auditory and visual sustained attention were present in experiment group. Gray matter volume increases were detected in cerebral structures involved in this type of attention. This study constitutes the first empirical demonstration that neurofeedback training leads to microstructural changes in white and gray matter.

Neurofeedback is a nonpharmacological treatment for attention-deficit hyperactivity disorder (ADHD). The researchers proposed that operant conditioning of electroencephalogram (EEG) in neurofeedback training aimed to mitigate inattention and low arousal in ADHD, will be accompanied by changes in EEG band’s relative power. The sample size consisted of 18 children diagnosed with ADHD. The neurofeedback protocol provides one for Focus and one for Alertness. A quantitative EEG analysis was completed on each twelve 25-minute-long sessions using a custom-made MatLab application to determine the relative power of each of the aforementioned EEG bands throughput each session, and from the first session to the last session. Additional statistical analysis determined significant changes in relative power within sessions (from minute 1 to minute 25) and between session (from session 1 to session 12).  Analysis was of relative power of that, alpha, low and high beta, theta/alpha, theta/beta, and theta/high beta ratios. Analysis of the data determined that theta/low beta and theta/alpha ratios decreased significantly from session 1 to session 12, and from minute 1 to minute 25 within sessions. The findings regarding EEG changes resulting from brain wave self-regulation training, along with behavioural evaluations, will help elucidate neural mechanisms of neurofeedback aimed to improve focused attention and alertness in ADHD.

The objective of this study was to determine the efficacy and safety of neurofeedback in children with ADHD. This was done through a double-blind, randomized, placebo-controlled study of 41 children with a DSM-IV-TR ADHD diagnosis. 22 children were assigned to experimental EEG neurofeedback, whereas 19 were given placebo neurofeedback for 30 sessions at 2 sessions/week. Everyone except the neurofeedback therapist and the principal investigator were blinded to the treatment assignment. It was found that ADHD symptoms improved in both groups over time and there was no significant effect of treatment or clinical improvement. Therefore, EEG neurofeedback was not found to be superior to placebo neurofeedback in improving ADHD symptomatology in children. 

The objective of this study was to determine the viability of neurofeedback and self-management training in patients with attention deficit hyperactivity disorder (ADHD). This was determined by measuring core ADHD symptoms from parent and teacher reports, objective tests (Qb-Test), self-concept interviews with the children and quality of life assessments (KINDL-R self report) pre- and post intervention. 111 children with ADHD were randomly assigned to either neurofeedback or self-management training. Similar levels of improvement in ADHD symptoms was found in both treatment groups, however, quality of life and self-concept only improved after self-management training. Therefore, both treatment methods may reduce core ADHD symptomatology however self-management training also improves patients’ self-concept and quality of life. 

The objective of this study was to compare the effectiveness of neurofeedback training, behaviour management including attention enhancement training and medication in children with ADHD. 90 children between the ages of 6 and 12 with ADHD were equally split into the three treatment groups. Follow-up assessments were conducted 3 months after intervention using Conners 3-P short scale to measure improvements in symptoms. All three interventions contributed to decreases in core ADHD symptoms, including inattention, hyperactivity, executive functioning, though the greatest reduction was observed in the medication group. Further, although learning problems improved in all treatment groups, neurofeedback was the most effective, followed by medication. 

The objective of this study was to determine the effect of quantitative EEG neurofeedback and the SmartMind game on time perception, attention and working memory in children with ADHD. 32 males with ADHD were randomly assigned to either an experimental group, which received neurofeedback and SmartMind treatment for 30 weekly sessions, or a control group. Performance on time perception test, a continuous performance test (CPT), and a Wechsler working memory test were administered pre and post intervention. It was found that the mean score in the experimental group was significantly different when compared before and after the intervention. Particularly, neurofeedback was found to improve short and long-time perception, omission error and correct response components in the CPT test and the visual forward component of working memory. Therefore, the combination of neurofeedback and cognitive computer games can aid to improve time perception, attention and working memory in children with ADHD. 

This meta-analysis aimed to determine the self-reported efficacy of EEG based neurofeedback against core ADHD symptoms in adolescents and adults. Randomized clinical trials (RCTs) with self-reported ADHD symptoms ratings were included from PubMed, Embase, ClinicalKey, Cochrane CENTRAL, ScienceDirect, Web of Science, and ClinicalTrials.gov from anytime between the initial usage of clinical neurofeedback to August 2021. Across the 5 RCTs included, 183 participants received neurofeedback treatment. Though no difference in hyperactivity/impulsivity was found between neurofeedback and comparison groups, which includes participants on the waitlist/treatment as usual (TAU), neurofeedback participants showed better improvements in inattention. Follow-up assessments 6-12 months after indicated no difference in inattention or hyperactivity/impulsivity between the groups. Overall, this pilot meta-analysis supports neurofeedback for improving inattention in adolescents/adults, though its effectiveness in improving hyperactivity/impulsivity is inconclusive. 

The objective of this study was to evaluate  the efficacy of neurofeedback  training in children with ADHD against a control group undergoing computerized attention skills training (AST). 102 children between the ages of 8 and 12 diagnosed with ADHD participated in the study. Children completed either 36 sessions of neurofeedback or computerized AST. The neurofeedback training encompassed 1 block of theta/beta training and one block of slow cortical potential (SCP) training. Each block was completed over the course of 4 weeks. Behavioural rating scales (German ADHD scale, FBB-HKS) were completed pre-, intermediate and post-training by parents and teachers. It was found that improvements in the neurofeedback group were greater than that of the control group. Parent-rated FBB-HKS total score had an effect size of 0.60. Further, similar effects were found between the 2 different neurofeedback training blocks. Lastly, parental attitude towards the experimental and control treatment did not differ. Overall, this study demonstrates the clinical efficacy of neurofeedback in children with ADHD.

It has been found that neurofeedback can be an effective intervention to improve attention and self-management capabilities in children with ADHD. The objective of this study was to determine if treatment effects were sustained at a 6-month follow up. 94 children between the ages of 8-12 years with ADHD completed either 36 sessions of neurofeedback or computerized attention skills training (AST). Behavioural rating scales (German ADHD rating scale, FBB-HKS) were completed pre, post and 6 months following treatment. However, follow up data was only analyzed in 61 children. 17 of the 33 children who dropped out had started medication after the end of training or early into the follow-up period. It was found that improvements in the neurofeedback group were greater than the AST group, and were similar to the effects seen at the end of training. Further, at least a 25% decrease in the primary outcome measure in the FBB-HKS was observed in 50% of children in the neurofeedback group. Overall, neurofeedback induced improvements in behaviour in children with ADHD was sustained at a 6-month follow-up. 

The objective of the current study was to compare the efficacy of neurofeedback as an intervention for ADHD against stimulant medication and physical activity. Children between the ages of 7 and 13 with a DSM-IV-TR diagnosis of ADHD were randomly assigned to receive either neurofeedback, methylphenidate, or physical activity over a course of 10-12 weeks. Neurofeedback training consisted of theta/beta training at Cz (the vertex). Physical activity consisted of moderate to vigorous intensity exercises. The Strengths and Difficulties Questionnaire (SDQ) and Strengths and Weaknesses of ADHD Symptoms and Normal Behaviour (SWAN) were completed by parents and teachers to assess outcomes. It was found that parents reported an improvement in behaviour on the SDQ and SWAN Hyperactivity/Impulsivity scale, irrespective of the intervention that was given. However, the SWAN inattention scale showed the greatest improvement in children who received methylphenidate compared to neurofeedback or physical activity. Further, teachers reported a decrease in ADHD symptoms on all measures for children undergoing methylphenidate treatment, but not for neurofeedback or physical activity. Overall, this study found that optimally titrated methylphenidate is a superior intervention for children with ADHD compared to neurofeedback or physical activity.

Quantitative Electroencephalogram (QEEG) informed neurofeedback adapts standard neurofeedback protocol to individual EEG characteristics, to improve treatment efficacy. The objective of the current study is to determine the effectiveness of QEEG-informed neurofeedback in a large sample of patients and to investigate potential neurofeedback response predictors. 114 patients were treated with standard neurofeedback protocols (Sensori-Motor-Rhythm (SMR), Theta-Beta (TBR), or Slow Cortical Potential (SCP) neurofeedback), with additional coaching and sleep hygiene advice. At baseline, every 10th session and post-treatment, the ADHD Rating Scale (ADHD-RS) and Pittsburgh Sleep Quality Index (PSQI) were assessed. The Holland Sleep Disorder Questionnaire was only completed at baseline and post-intervention. It was found that 85% reported a ≥25% reduction, 70% reported a ≥50% reduction, and 55% even reported remission. Non-remitters had significantly higher baseline hyperactivity ratings. Further, women who remitted had significantly shorter P300 latencies and boys who remitted had significantly lower individual alpha peak frequency. 

The objective of this study was to determine if theta/beta ratio (TBR) electroencephalographic neurofeedback has a specific effect on ADHD. 144 children between the ages of 7 and 10 diagnosed with moderate/severe ADHD and a TBR ≥4.5 were randomized 3:2 to a TBR downstraining treatment group versus a control condition. The control was of equal duration, intensity and appearance and consisted of pre-recorded electroencephalograms with the participant’s artifacts superimposed. The primary outcome was parent- and teacher-rated inattention obtained at baseline, post-intervention, and at a 13-month follow up. It was found that both groups had significant improvements in parent/teacher-rated inattention from baseline to treatment and at follow-up, however participants in the neurofeedback group did not have a greater improvement compared to the controls at either time point. At the 13-month follow up there was no particular improvement in the neurofeedback group and mild deterioration in the controls. However, the neurofeedback group required significantly less medication at follow-up.

The objective of this study was to determine the long-term clinical effects of neurofeedback in individuals with ADHD. Participants were between the ages of 7 to 9, and were diagnosed with DSM-IV-TR criteria ADHD. Participants were randomly assigned to either 25 sessions of slow cortical potential (SCP) neurofeedback or electromyogram biofeedback (EMG-BF). Parent ratings of ADHD were the primary outcomes. It was found that both groups had improvements in ADHD symptoms at a 6-month follow up compared to baseline, though there was no significant difference between the two groups. However, when considering all assessment time points (baseline, immediately after treatment, 1 month and 6 months after treatment), it was found that SCP neurofeedback participants had a stable improvement following treatment. Whereas EMG-BF participants had a relapse between post-intervention and the 1 month follow-up, and a subsequent remission at the 6 month follow up.

The objective of this study was to determine the efficacy of neurofeedback compared to electromyographic (EMG) feedback and assess self-regulation of slow cortical potentials (SCPs) in individuals with ADHD. 150 children between the ages of 7 and 9 diagnosed with ADHD were randomly assigned to either 25 sessions of feedback of SCPs (neurofeedback) or feedback coordination of the supraspinatus muscles (EMG). Primary outcomes were baseline and four-week follow up parent ratings of core ADHD symptoms. It was found that though both groups had a reduction in core ADHD symptoms, neurofeedback had a significantly superior effect over EMG treatment. Further, successful self-regulation of brain activity was only found in neurofeedback participants. In addition, though teachers did not report a superior improvement in neurofeedback participants compared to EMG, however, within-group analyses showed that neurofeedback improved the global ADHD score, inattention and impulsivity. Whereas, EMG feedback did not result in changes. Overall, this study provides support for neurofeedback being superior to EMG treatment in children with ADHD. 

The objective of this study was to determine the effects of neurofeedback and working memory training on cognitive functions in children and adolescents with ADHD. Individuals between the ages of 9 and 17 diagnosed with ADHD were split into either the slow cortical potential neurofeedback, live z-score neurofeedback, working-memory training (WMT) or treatment as usual. Various cognitive function tests were completed pre- post- and 6 months after treatment. It was found that the effects of working memory training on spatial and verbal working-memory were superior to neurofeedback and treatment as usual post-treatment, however these effects were only partially sustained at follow-up. There was no clear indication that the observed effects were moderated ADHD presentation, ongoing medication, age or sex. No other effects were observed. Overall, this study found that the sustained effects of neurocognitive training on cognitive functioning in children and adolescents with ADHD may be limited. 

Though neurofeedback has been found to be a beneficial tool for ADHD therapy, approximately 20 plus training sessions are needed before behavioural improvements are observed. The objective of this study was to test the effectiveness of short-term theta/beta neurofeedback training in children with ADHD. Children with ADHD completed two theta/beta training sessions. In the first half of the sessions, three NF trials (puzzles as feedback animations) were run with pre- and post-reading and picture search tasks. During the second session, it was found that theta/beta ratio significantly decreased, due to a decrease in theta activity, providing evidence of rapid and successful neuroregulation by children with ADHD. For pre-post comparisons, children were split into good vs. poor regulator groups based on the slope of their TBR over the NF trials. For the reading task, significant EEG changes were seen for the theta band from pre- to post neurofeedback depending on individual neuroregulation ability. Further, these effects were not contained to Cz, but formed a general pattern, with maximal effects over the midline and right-hemisphere electrodes. Overall, this study provides evidence that short-term targeted neurofeedback can be a valuable tool to study neuroplastic mechanisms in children with ADHD. 

Individuals with ADHD have large EEG heterogeneity, therefore it is hypothesized that individualized neurofeedback approaches should improve the clinical outcome. Therefore the objective of the current study is to evaluate the effectiveness of a neurofeedback protocol of relative upper alpha power enhancement in fronto-central sites. Twenty children with ADHD underwent 18 training sessions. It was found that working memory, concentration, and impulsivity improved based on neurophysiological tests. Relative and absolute upper alpha power demonstrated long-term enhancement in task-related activity, and a positive learning curve was observed over sessions. Further, a within-session effects analysis revealed a power decrease in task-related activity, with no significant effects during training trails. Overall, enhancement of the individual upper alpha power was effective in improving various clinical measures and cognitive performance in children with ADHD. 

The objective of this study was to determine the effectiveness of neurofeedback and game-based cognitive training on children with ADHD. In a randomized double-blind trial, thirty-two male students were assigned to either 30 three times-weekly sessions of neurofeedback or waiting list control. The children were evaluated both pretest and post-test with EEG, Integrated Visual and Auditory Continuous Performance (IVA), and Conners Parent, and Teacher Rating Scales-Revised scales. As a result, the researchers found that treatment significantly improved all symptom variables except for attention deficit (AD) and auditory response control (ARC). As such, they concluded that combined neurofeedback and game-based cognitive training can produce positive therapeutic effects on brainwaves and ADHD symptomatology. 

This study examined the effects of self-regulation of slow cortical potentials (SCP) in nine children with ADHD. To assess behavioural changes, the Japanese ADHD rating scale (SNAP-J) was completed by parents. In SCP training, changes in EEG shifts were analyzed during 16 training sessions by calculating the peak amplitudes of positive and negative shifts. To measure the efficiency of SCP training, the authors conducted an attention task and measured contingent negative variation, which relates to the attention maintenance ability. It was found that peak amplitudes increased in sessions 11 and 12 for negative shifts, and in sessions 9 and 13 for positive shifts. Further, an enhancement of contingent negative variation amplitude in the attention task before and after training was found, indicating that the ability of these children to maintain attention could be modified by SCP training. However, no significant behavioural improvements were observed on the SNAP-J. Overall, these results suggest that even low numbers of training sessions, such as 16 can lead to physiological improvement, though a greater number of sessions may be needed to observe a behavioural change. 

This article reviewed and summarized literature researching the use of neurofeedback in treatment in attention-deficit/hyperactivity disorder (ADHD) in children. In particular, the authors present two studies with the first reporting the findings of a tomographic analysis over the course of a slow cortical potential (SCP) training and a correlational analysis of regulation skills and ADHD clinical outcomes in children. Similarly, the second study investigated changes in ADHD-related behaviors in children with tic disorder who either conducted SCP training or theta/low beta training. Both studies found that neurofeedback training had positive impacts on improving ADHD symptoms and provide further evidence for neurofeedback effects in ADHD. In all, the authors conclude that, despite a number of open questions, neurofeedback training seems to be a valuable option in the treatment of children ith ADHD.