title: Behavioral Effects of Neurofeedback Compared to Stimulants and Physical Activity in Attention-Deficit/Hyperactivity Disorder: A Randomized Controlled Trial.
abstract: OBJECTIVE
  The efficacy of neurofeedback as a treatment for attention-deficit/hyperactivity disorder (ADHD), and whether neurofeedback is a viable alternative for stimulant medication, is still an intensely debated subject. The current randomized controlled trial compared neurofeedback to (1) optimally titrated methylphenidate and (2) a semi-active control intervention, physical activity, to account for nonspecific effects.
  
  
  METHODS
  A multicenter 3-way parallel-group study with balanced randomization was conducted. Children with a DSM-IV-TR diagnosis of ADHD, aged 7-13 years, were randomly allocated to receive neurofeedback (n = 39), methylphenidate (n = 36), or physical activity (n = 37) over a period of 10-12 weeks. Neurofeedback comprised theta/beta training on the vertex (Cz). Physical activity consisted of moderate to vigorous intensity exercises. Neurofeedback and physical activity were balanced in terms of number (~30) and duration of sessions. A double-blind pseudorandomized placebo-controlled crossover titration procedure was used to determine an optimal dose in the methylphenidate intervention. Parent and teacher ratings on the Strengths and Difficulties Questionnaire (SDQ) and Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) were used to assess intervention outcomes. Data collection took place between September 2010 and March 2014.
  
  
  RESULTS
  Intention-to-treat analyses revealed an improvement in parent-reported behavior on the SDQ and the SWAN Hyperactivity/Impulsivity scale, irrespective of received intervention (ηp² = 0.21-0.22, P ≤ .001), whereas the SWAN Inattention scale revealed more improvement in children who received methylphenidate than neurofeedback and physical activity (ηp² = 0.13, P ≤ .001). Teachers reported a decrease of ADHD symptoms on all measures for methylphenidate, but not for neurofeedback or physical activity (range of ηp² = 0.14-0.29, P < .001).
  
  
  CONCLUSIONS
  The current study found that optimally titrated methylphenidate is superior to neurofeedback and physical activity in decreasing ADHD symptoms in children with ADHD.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01363544.
authors.affiliation: Dennenhout 1, 2994 GC Barendrecht, the Netherlands. k.gelade@yulius.nl.|Yulius Academy, Yulius Mental Health Organization, Barendrecht, the Netherlands.|Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, the Netherlands.
authors.forename: Katleen
authors.initials: K
authors.lastname: Geladé
authors.affiliation: Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, the Netherlands.
authors.forename: Tieme W P
authors.initials: TW
authors.lastname: Janssen
authors.affiliation: Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, the Netherlands.
authors.forename: Marleen
authors.initials: M
authors.lastname: Bink
authors.affiliation: Royal Dutch Kentalis, Utrecht, the Netherlands.
authors.forename: Rosa
authors.initials: R
authors.lastname: van Mourik
authors.affiliation: Yulius Academy, Yulius Mental Health Organization, Barendrecht, the Netherlands.
authors.forename: Athanasios
authors.initials: A
authors.lastname: Maras
authors.affiliation: Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, the Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Oosterlaan
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D001611:Beta Rhythm / Q000502:physiology; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002540:Cerebral Cortex / Q000503:physiopathology; D002648:Child; D015444:Exercise / Q000502:physiology / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D058765:Neurofeedback / Q000379:methods*; D013826:Theta Rhythm / Q000502:physiology
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate