Study shows: ILF neurofeedback leads to significant improvement in impulse control and attention in children with ADHD
As part of the study—which was conducted in cooperation with the Neurofeedback Network and a group of child and adolescent psychiatric practices in Munich—251 patients with AD(H)D received neurofeedback treatment. Attention was assessed before the start and after completion of the therapy. A comparison of the test results showed significant improvements in attention and impulse control; patients also reported an improvement in AD(H)D symptoms.
A detailed article on the study was published in May 2020 in neue AKZENTE, issue no. 115 (ADHS Deutschland e.V.).
Citation:
Mackert, J. (2020). Neurofeedback in AD(H)D – Improving attention with ILF neurofeedback. neue AKZENTE, 115(1), 8–12.
PDF version available via ResearchGate.
The Diagnosis of AD(H)D
Approximately five percent of children of school age are affected by AD(H)D. They exhibit cross-situational symptoms of inattention, impulsivity, and, in some cases, hyperactivity, which can cause considerable distress. The disorder is generally associated with functional impairments, and problems frequently arise, particularly in the areas of school and education. Affected individuals and their parents are therefore seeking effective treatment methods—especially those that can achieve lasting therapeutic effects without the use of psychopharmaceuticals.
AD(H)D and Neurofeedback
As neurological and psychiatric disorders are associated with specific alterations in brain activity (Hammond, 2019), neurofeedback— a non-invasive, EEG-based, computer-assisted therapeutic method—can represent a meaningful treatment option. Neurofeedback allows certain components of a patient’s own brain activity to be visualized in real time. These visual stimuli serve as feedback signals that can be decoded by the visual processing centers of the brain. Based on this visualization of brain activity, different training modules can be applied depending on the therapeutic goal.
Infra-Low-Frequency Neurofeedback
In this study, Infra-Low-Frequency (ILF) neurofeedback was applied. This approach confronts the brain with components of its own activity that lie within an extremely low frequency range. By placing electrodes on the scalp above specific associative brain areas, up to 15 different activity parameters can be fed back to the brain in order to reflect changes in its internal states and to initiate adaptive processes at an unconscious level (Wiedemann, 2015).
Clinical studies involving patients with AD(H)D have demonstrated since the 1980s that neurofeedback can lead to significant improvements in various parameters of attention, impulse control, and academic performance (Lubar & Lubar, 1985; Kaiser & Othmer, 2000; Sasu & Othmer, 2015). Follow-up studies have further confirmed sustained improvements in attention and academic performance six and 24 months after completion of neurofeedback therapy (Gani, Birbaumer & Strehl, 2008; Van Doren et al., 2018). More recent studies have shown that neurofeedback treatment can produce lasting effects comparable to those achieved with stimulant medication such as methylphenidate (Ritalin) (Fuchs et al., 2003; Monastra et al., 2002; Rossiter, 2004).
The Study
The aim of this multicenter observational study was to investigate whether ILF neurofeedback represents a therapeutically relevant treatment option for children, adolescents, and young adults with AD(H)D. Between January 2015 and September 2017, 251 children, adolescents, and young adults (aged 7–21 years) diagnosed with AD(H)D were observed. Over a period of 15 weeks, participants received approximately 30 neurofeedback sessions, corresponding to the recommended frequency of two sessions per week.
Participants completed a specific assessment of various parameters of attention and impulse control both before and after the neurofeedback therapy and also rated the severity of their symptoms.
ILF neurofeedback was delivered using EEG NeuroAmp® systems manufactured by BEE Medic. The applied treatment protocol followed the evidence-based method developed by Othmer, in which electrode placement and training frequencies (<0.1 Hz) are individually determined (Othmer, 2017). Attention and impulse control were assessed using the Continuous Performance Test (QIKtest), which measures attention across four variables: reaction time, variability of reaction time, omission errors, and commission errors.
Pre- and post-treatment data from n = 196 participants were included in the analysis (21% female, 79% male; mean age = 12.06 years). Table 1 presents the measured pre–post values for the four attention variables as well as the (significant) differences observed.
Results
Analysis of the attention test revealed significant improvements across all four parameters following neurofeedback therapy. This suggests that neurofeedback contributes to improved self-regulation of brain activity. On average, participants responded more quickly, showed reduced variability in reaction times, and made significantly fewer errors.
This effect was particularly pronounced for commission errors, indicating that participants exhibited significantly less impulsive response behavior after completing neurofeedback therapy.
In addition, 97% of participants subjectively reported an improvement in symptoms following neurofeedback treatment. Only 3% indicated no perceived improvement when comparing pre- and post-treatment symptom ratings.
The strongest changes in symptom ratings were observed for hyperactivity and inattention, both of which were rated as markedly less severe by participants after neurofeedback therapy.
Study Results and Implications
The results suggest that after approximately 30 neurofeedback sessions, patients showed significant improvements in attention, sustained attention, and impulse control. Furthermore, the perceived severity of symptoms was substantially reduced. Based on these findings, the therapeutic benefit of ILF neurofeedback can be rated as very good.
These results support the conclusion that ILF neurofeedback may represent a valuable therapeutic component for children, adolescents, and young adults with AD(H)D. Feedback from patients and their parents was consistently positive, and treating therapists also rated both the treatment method and patient outcomes very positively.
These promising findings encourage further research into ILF neurofeedback for the treatment of AD(H)D—particularly studies that address the limitations of this observational design by employing interventional approaches, control groups, and additional validated assessment instruments for attention, impulse control, and related parameters, including validity criteria. Comparative studies examining neurofeedback relative to other treatment approaches and investigations into the long-term effects of neurofeedback therapy would also be of interest.
Although the results of this observational study are only partially generalizable, the relatively large sample size demonstrates that both subjective and behavioral improvements in symptoms are achievable through ILF neurofeedback therapy in children and adolescents with AD(H)D. ILF neurofeedback thus represents a non-pharmacological, non-invasive, and pain-free treatment option that can meaningfully expand therapeutic approaches for AD(H)D.
Sources
Fuchs, T., Birbaumer, N., Lutzenberger, W., Gruzelier, J. H. & Kaiser, J. (2003). Neurofeedback Treatment for AttentionDeficit/Hyperactivity Disorder in Children: A Comparison with Methylphenidate. Applied Psychophysiology and Biofeedback, 28 (1), 1-12.
Gani, C., Birbaumer, N. & Strehl, U. (2008). Long term effects after feedback of slow cortical potentials and of theta-betaamplitudes in chindren with attention-deficit/hyperactivy disorder (ADHD). International Journal of Bioelectromagnetism, 10 (4), 209-232.
Hammond, D. C. (2019). Integrating Clinical Hypnosis and Neurofeedback. American Journal of Clinical Hypnosis, 61(4), 302- 321.
Kaiser, D.A. & Othmer, S. (2000). Effect of Neurofeedback on Variables of Attention in a Large Multi-Center Trial. Journal of Neurotherapy, 4 (1), 5-15.
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