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Neurofeedback and Cognitive Attention Training for Children with Attention-Deficit Hyperactivity Disorder in Schools

Steiner, Naomi J. MD*; Frenette, Elizabeth C. MPH*; Rene, Kirsten M. MA*; Brennan, Robert T. EdD; Perrin, Ellen C. MD*

Journal of Developmental & Behavioral Pediatrics: January 2014 - Volume 35 - Issue 1 - p 18–27
doi: 10.1097/DBP.0000000000000009
Original Article

Objective: To evaluate the efficacy of 2 computer attention training systems administered in school for children with attention-deficit hyperactivity disorder (ADHD).

Method: Children in second and fourth grade with a diagnosis of ADHD (n = 104) were randomly assigned to neurofeedback (NF) (n = 34), cognitive training (CT) (n = 34), or control (n = 36) conditions. A 2-point growth model assessed change from pre-post intervention on parent reports (Conners 3-Parent [Conners 3-P]; Behavior Rating Inventory of Executive Function [BRIEF] rating scale), teacher reports (Swanson, Kotkin, Agler, M-Flynn and Pelham scale [SKAMP]; Conners 3-Teacher [Conners 3-T]), and systematic classroom observations (Behavioral Observation of Students in Schools [BOSS]). Paired t tests and an analysis of covariance assessed change in medication.

Results: Children who received NF showed significant improvement compared with those in the control condition on the Conners 3-P Attention, Executive Functioning and Global Index, on all BRIEF summary indices, and on BOSS motor/verbal off-task behavior. Children who received CT showed no improvement compared to the control condition. Children in the NF condition showed significant improvements compared to those in the CT condition on Conners 3-P Executive Functioning, all BRIEF summary indices, SKAMP Attention, and Conners 3-T Inattention subscales. Stimulant medication dosage in methylphenidate equivalencies significantly increased for children in the CT (8.54 mg) and control (7.05 mg) conditions but not for those in the NF condition (0.29 mg).

Conclusion: Neurofeedback made greater improvements in ADHD symptoms compared to both the control and CT conditions. Thus, NF is a promising attention training treatment intervention for children with ADHD.

This article has supplementary material on the web site: www.jdbp.org.

*The Floating Hospital for Children at Tufts Medical Center, Department of Pediatrics, Boston, MA;

Harvard School of Public Health, Boston, MA.

Address for reprints: Naomi J. Steiner, MD, Floating Hospital for Children at Tufts Medical Center, 800 Washington Street, Box #854, Boston, MA 02111; e-mail: nsteiner@tuftsmedicalcenter.org.

Disclosure: Supported by the Institute of Education Sciences (R305A090100). The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jdbp.org).

Received July , 2013

Accepted September , 2013

© 2014 by Lippincott Williams & Wilkins