Pediatric and Adult Neurofeedback now being offered. Please contact our office for more information.

ISNR Toolkit for neurofeedback as an evidence-based treatment for ADHD

Introduction to neurofeedback

Our brains have the remarkable ability to reorganize and form new connections. The latest research has shown that the brain can be reshaped, particularly during childhood. This phenomenon called “neuroplasticity” allows the brain to compensate or adjust to new experiences, injuries, and even overcome developmental problems.  By supplying the brain with new information and sensory stimulation (visual, auditory, tactile), neurofeedback can change behaviors and alter how the brain responds to different situations.  For years, neuroscientists believed that genetic and maladaptive traits were hard-wired and permanent. However, the concept of neuroplasticity has been accepted within the scientific community as an inherent brain construct, which facilitates environmental adaptation, injury recovery, and learning.

The goal of neurofeedback is to teach strategies that diminish unfavorable brain patterns, while promoting self-regulation. This can range from increasing attention and concentration to reducing states of anxiety.

Treatment for children with neurodevelopmental and psychological disorders has benefited from the knowledge that the brain’s complex blueprint can be redesigned. Neurofeedback, also known as electroencephalographic (EEG) biofeedback or neurotherapy, is one such treatment. It is based on the simple principle that brain processes which were once believed to be completely involuntary, can actually be consciously controlled and manipulated through practice.  When information is shared and communicated through different networks in the brain, it produces different types of waves which correspond to various mental states (i.e., attentive, distracted, anxious, depressed, excited).  For instance, studies have suggested that individuals with ADHD generate insufficient beta waves, which are associated with alertness and critical reasoning.  Moreover, excessive theta waves are also evidenced in ADHD, which can result in daydreaming and drowsiness. The goal of neurofeedback is to teach strategies that diminish unfavorable brain patterns, while promoting self-regulation. This can range from increasing attention and concentration to reducing states of anxiety.   

The concept of neuroplasticity allows the brain to adapt to environmental changes as a mechanism for survival. For several reasons, related to genetic predisposition, and environment, the brain begins to generate patterns of activity which are not conducive to everyday functioning, and prevent an individual from performing to their potential. Neurofeedback provides a way to train the brain to be more regulated by teaching participants how to control brain-wave frequencies, or electrical impulses. In the early 1960s, Joseph Kamiya, a psychologist at the University of Chicago, discovered that some people could control their brain-wave frequencies when provided with feedback. He found that these brain frequencies created an optimal environment for specific neuronal networks, and thus optimal brain functioning. For example, when brain waves function at a frequency that is ideal for relaxation, the ability to focus and pay attention increases.


During a neurofeedback session, sensors are placed on the scalp to detect electrical frequencies that the brain produces and translates these patterns onto a computer screen in the form of a graph. The data that are projected show the brain’s activity in the moment. Then, an audio or visual stimulus creates feedback to show if the brain is emitting frequencies at the desired range. This feedback can be as simple as an audible beep or as complex as maneuvering a character in a video game. Thus, participants are able to see the effects of their thoughts. So what exactly would that look like? As one example, a participant might have to fly a spacecraft in a video game, which is guided by frequencies produced by the brain. The closer the brain gets to the desired frequencies, the faster the spacecraft flies, and the more points are earned. There are several neurofeedback training modules or “games” that can be selected to fit an individual’s unique needs and interests. After consistent and repetitive practice, the brain trains itself and ultimately requires little effort to reach the desired frequencies of optimal regulation.   

While the concept of neurofeedback may seem unscientific, and the benefits a result of a placebo effect, there is a wealth of research supporting its efficacy as an evidence-based treatment modality. The majority of experimental investigations have recently targeted Attention Deficit/Hyperactivity Disorder (ADHD).  Although stimulant medication has shown consistent efficacy in decreasing ADHD symptoms, many parents are leery of turning to substance-based interventions as the first or sole treatment option. Neurofeedback is a promising noninvasive alternative or adjunctive treatment. In fact, the American Academy of Pediatrics has classified neurofeedback as a Level 1 Best Support for treating ADHD*.  This means that neurofeedback consistently shows superiority to placebo treatments and yields at least equivalent outcomes when compared to credible and well researched ADHD treatments.  There is less research support for other disorders; however, emerging evidence shows promise for anxiety and sports performance enhancement.   

* American Academy of Pediatrics Strength of Evidence Definitions:

I. At least 2 randomized trials demonstrating efficacy in one or more of the following ways:

A. Superior to pill placebo, psychological placebo, or another treatment;

B. Equivalent to all other groups representing at least one level 1 or level 2 treatment in a study with adequate statistical power (30 participants per group on average) that showed significant pre-study to post-study change in the index group as well as the group(s) being tied. Ties of treatments that have previously qualified only through ties are ineligible.

II. Experiments must be conducted with treatment manuals.

!!!. Effects must have been demonstrated by at least 2 different investigator teams.