title: Neurofeedback for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials.
abstract: We performed meta-analyses of randomized controlled trials to examine the effects of neurofeedback on attention-deficit/hyperactivity disorder (ADHD) symptoms and neuropsychological deficits in children and adolescents with ADHD.
  
  
  
  We searched PubMed, Ovid, Web of Science, ERIC, and CINAHAL through August 30, 2015. Random-effects models were employed. Studies were evaluated with the Cochrane Risk of Bias tool.
  
  
  
  We included 13 trials (520 participants with ADHD). Significant effects were found on ADHD symptoms rated by assessors most proximal to the treatment setting, that is, the least blinded outcome measure (standardized mean difference [SMD]: ADHD total symptoms = 0.35, 95% CI = 0.11-0.59; inattention = 0.36, 95% CI = 0.09-0.63; hyperactivity/impulsivity = 0.26, 95% CI = 0.08-0.43). Effects were not significant when probably blinded ratings were the outcome or in trials with active/sham controls. Results were similar when only frequency band training trials, the most common neurofeedback approach, were analyzed separately. Effects on laboratory measures of inhibition (SMD = 0.30, 95% CI = -0.10 to 0.70) and attention (SMD = 0.13, 95% CI = -0.09 to 0.36) were not significant. Only 4 studies directly assessed whether learning occurred after neurofeedback training. The risk of bias was unclear for many Cochrane Risk of Bias domains in most studies.
  
  
  
  Evidence from well-controlled trials with probably blinded outcomes currently fails to support neurofeedback as an effective treatment for ADHD. Future efforts should focus on implementing standard neurofeedback protocols, ensuring learning, and optimizing clinically relevant transfer.
authors.affiliation: Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK; New York University Child Study Center, New York, and Solent NHS Trust, UK.
authors.forename: Samuele
authors.initials: S
authors.lastname: Cortese
authors.affiliation: Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK; Huntercombe Hospital Maidenhead, Maidenhead, UK.
authors.forename: Maite
authors.initials: M
authors.lastname: Ferrin
authors.affiliation: Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Psychiatric Hospital, University of Zurich, the Integrative Human Physiology and the Neuroscience Center Zurich, University of Zurich, Switzerland, and ETH Zurich.
authors.forename: Daniel
authors.initials: D
authors.lastname: Brandeis
authors.affiliation: LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr University Bochum, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Holtmann
authors.affiliation: Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
authors.forename: Pascal
authors.initials: P
authors.lastname: Aggensteiner
authors.affiliation: School of Medicine and MindTech Institute of Mental Health, University of Nottingham, UK.
authors.forename: David
authors.initials: D
authors.lastname: Daley
authors.affiliation: Institute of Psychiatry, Psychology and Neurosciences, King's College London, and the Maudsley Hospital, London, UK.
authors.forename: Paramala
authors.initials: P
authors.lastname: Santosh
authors.affiliation: Institute of Psychiatry, Psychology and Neurosciences, King's College London, and the Maudsley Hospital, London, UK.
authors.forename: Emily
authors.initials: E
authors.lastname: Simonoff
authors.affiliation: Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK.
authors.forename: Jim
authors.initials: J
authors.lastname: Stevenson
authors.affiliation: Institute of Psychiatry, Psychology and Neurosciences, King's College London, and the Maudsley Hospital, London, UK.
authors.forename: Argyris
authors.initials: A
authors.lastname: Stringaris
authors.affiliation: Academic Unit of Psychology, Developmental Brain-Behaviour Laboratory, University of Southampton, Southampton, UK; Ghent University, Ghent, Belgium and Aarhus University, Aarhus, Denmark. Electronic address: ejb3@soton.ac.uk.
authors.forename: Edmund J S
authors.initials: EJ
authors.lastname: Sonuga-Barke
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000628:therapy*; D006801:Humans; D058765:Neurofeedback / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*
keywords: ADHD; meta-analysis; neurofeedback; nonpharmacological treatment; risk of bias