BACKGROUND: For children with attention deficit/hyperactivity disorder (ADHD), a reduction of inattention, impulsivity and hyperactivity by neurofeedback (NF) has been reported in several studies. But so far, unspecific training effects have not been adequately controlled for and/or studies do not provide sufficient statistical power. To overcome these methodological shortcomings we evaluated the clinical efficacy of neurofeedback in children with ADHD in a multisite randomised controlled study using a computerised attention skills training as a control condition. METHODS: 102 children with ADHD, aged 8 to 12 years, participated in the study. Children performed either 36 sessions of NF training or a computerised attention skills training within two blocks of about four weeks each (randomised group assignment). The combined NF treatment consisted of one block of theta/beta training and one block of slow cortical potential (SCP) training. Pre-training, intermediate and post-training assessment encompassed several behaviour rating scales (e.g., the German ADHD rating scale, FBB-HKS) completed by parents and teachers. Evaluation ('placebo') scales were applied to control for parental expectations and satisfaction with the treatment. RESULTS: For parent and teacher ratings, improvements in the NF group were superior to those of the control group. For the parent-rated FBB-HKS total score (primary outcome measure), the effect size was .60. Comparable effects were obtained for the two NF protocols (theta/beta training, SCP training). Parental attitude towards the treatment did not differ between NF and control group. CONCLUSIONS: Superiority of the combined NF training indicates clinical efficacy of NF in children with ADHD. Future studies should further address the specificity of effects and how to optimise the benefit of NF as treatment module for ADHD.

In a multicentre randomised controlled trial, we evaluated the clinical efficacy of neurofeedback (NF) training in children with ADHD and investigated the mechanisms underlying a successful training. We used an attention skills training, coupled with the training setting and demands made upon participants, as the control condition. At the behavioural level, NF was superior to the control group concerning core ADHD symptomatology as well as associated domains. For the primary outcome measure (improvement in the FBB-HKS total score), the effect size was .60. The same pattern of results was obtained at the 6-month follow-up. Thus, NF may be seen as a clinically effective module in the treatment of children with ADHD. At the neurophysiological level (EEG, ERPs), specific effects for the two NF protocols, theta/beta training, and training of slow cortical potentials were demonstrated. For example, for theta/beta training, a decrease of theta activity in the EEG was associated with a reduction of ADHD symptomatology. SCP training was accompanied inter alia by an increase in the contingent negative variation in the attention network test; thus, children were able to allocate more resources for preparation. EEG- and ERP-based predictors were also found. The present article reviewed the findings of the original papers related to the trial and outlines future research topics.