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Updated: May 3, 2026
A Protocol for the Administration of Real-Time fMRI Neurofeedback Training
Published on: August 24, 2017
In-school neurofeedback training for ADHD: sustained improvements from a randomized control trial
Naomi J Steiner1, Elizabeth C Frenette, Kirsten M Rene
1The Floating Hospital for Children at Tufts Medical Center, Department of Pediatrics, Boston, Massachusetts; and.
Insights
Neurofeedback provided sustained ADHD symptom improvement in children aged 7-11, outperforming cognitive training and control groups at 6-month follow-up. This attention training shows promise for treating attention-deficit/hyperactivity disorder.
Area of Science:
- Neuroscience
- Child Psychology
- Clinical Psychology
Background:
- Attention-deficit/hyperactivity disorder (ADHD) affects children's attention and executive functions.
- In-school interventions aim to improve attention and related symptoms in children with ADHD.
- Sustained efficacy of attention training interventions requires long-term evaluation.
Purpose of the Study:
- To assess sustained improvements 6 months post-intervention in children with ADHD.
- To compare the long-term effects of neurofeedback versus cognitive training (CT).
- To evaluate the impact on ADHD symptoms, executive functioning, and stimulant medication use.
Main Methods:
- 104 children (7-11 years) with ADHD were randomized to neurofeedback, CT, or a control group.
- A 40-session in-school intervention was administered.
- Sustained effects were measured at 6 months post-intervention using parent reports (Conners 3-P, BRIEF) and classroom observations.
Main Results:
- Neurofeedback participants showed sustained significant gains in ADHD symptoms and executive functioning at 6 months.
- Cognitive training participants demonstrated delayed improvements in some areas.
- Neurofeedback group maintained stimulant medication dosage, unlike CT and control groups who increased it.
Conclusions:
- Neurofeedback offers prompt and sustained improvements in ADHD symptoms compared to CT and control conditions.
- Neurofeedback is a promising attention training intervention for children with ADHD.
- Sustained benefits suggest neurofeedback's potential as a long-term treatment option.
Objective:
To evaluate sustained improvements 6 months after a 40-session, in-school computer attention training intervention using neurofeedback or cognitive training (CT) administered to 7- to 11-year-olds with attention-deficit/hyperactivity disorder (ADHD).
Methods:
One hundred four children were randomly assigned to receive neurofeedback, CT, or a control condition and were evaluated 6 months postintervention. A 3-point growth model assessed change over time across the conditions on the Conners 3-Parent Assessment Report (Conners 3-P), the Behavior Rating Inventory of Executive Function Parent Form (BRIEF), and a systematic double-blinded classroom observation (Behavioral Observation of Students in Schools). Analysis of variance assessed community-initiated changes in stimulant medication.
Results:
Parent response rates were 90% at the 6-month follow-up. Six months postintervention, neurofeedback participants maintained significant gains on Conners 3-P (Inattention effect size [ES] = 0.34, Executive Functioning ES = 0.25, Hyperactivity/Impulsivity ES = 0.23) and BRIEF subscales including the Global Executive Composite (ES = 0.31), which remained significantly greater than gains found among children in CT and control conditions. Children in the CT condition showed delayed improvement over immediate postintervention ratings only on Conners 3-P Executive Functioning (ES = 0.18) and 2 BRIEF subscales. At the 6-month follow-up, neurofeedback participants maintained the same stimulant medication dosage, whereas participants in both CT and control conditions showed statistically and clinically significant increases (9 mg [P = .002] and 13 mg [P < .001], respectively).
Conclusions:
Neurofeedback participants made more prompt and greater improvements in ADHD symptoms, which were sustained at the 6-month follow-up, than did CT participants or those in the control group. This finding suggests that neurofeedback is a promising attention training treatment for children with ADHD.
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