Surface electroencephalographic neurofeedback improves sustained attention in ADHD: a meta-analysis of randomized controlled trials

Hsien-Jane Chiu; Cheuk-Kwan Sun; Hsin-Yi Fan; Ruu-Fen Tzang; Ming-Yu Wang; Ying-Chih Cheng; Yu-Shian Cheng; Pin-Yang Yeh; Weilun Chung

doi:10.1186/s13034-022-00543-1

Surface electroencephalographic neurofeedback improves sustained attention in ADHD: a meta-analysis of randomized controlled trials

Child Adolesc Psychiatry Ment Health. 2022 Dec 19;16(1):104. doi: 10.1186/s13034-022-00543-1.

Authors

Hsien-Jane Chiu^#^{1

2}, Cheuk-Kwan Sun^#^{3

4}, Hsin-Yi Fan⁵, Ruu-Fen Tzang⁶, Ming-Yu Wang^{7

8}, Ying-Chih Cheng^{7

9

10}, Yu-Shian Cheng¹¹, Pin-Yang Yeh^#¹², Weilun Chung^#¹³

Affiliations

¹ Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan.
² Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan.
³ Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.
⁴ School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
⁵ Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, No. 509, Fengping 1St Rd., Daliao Dist, Kaohsiung, Taiwan.
⁶ Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan.
⁷ Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu, Taiwan.
⁸ Department of Health Services Administration, China Medical University, Taichung, Taiwan.
⁹ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
¹⁰ Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
¹¹ Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, No. 509, Fengping 1St Rd., Daliao Dist, Kaohsiung, Taiwan. n043283@gmail.com.
¹² Department of Psychology, College of Medical and Health Science, Asia University, 500, Lioufeng Rd., Wufeng, Taichung, 41354, Taiwan. PsyYPY@asia.edu.tw.
¹³ Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, No. 509, Fengping 1St Rd., Daliao Dist, Kaohsiung, Taiwan. johnwayroom@gmail.com.

^# Contributed equally.

Abstract

Background: The efficacy of surface electroencephalographic neurofeedback (EEG-NF) for improving attentional performance assessed by laboratory measures in patients with attention-deficit/hyperactivity disorder (ADHD) remains unclear.

Methods: Following the PRISMA guidelines, the PubMed, Embase, ClinicalKey, Cochrane CENTRAL, ScienceDirect, Web of Science, and ClinicalTrials.gov databases were systematically searched for randomized controlled trials on the efficacy of surface EEG-NF against ADHD focusing on attentional performance evaluated by laboratory measures from inception to January 2022.

Results: Fourteen eligible studies were analyzed. Of the 718 participants involved, 429 diagnosed with ADHD received EEG-NF treatment. Significant improvement in attentional performance in ADHD subjects receiving EEG-NF was noted compared to their comparators (p < 0.01). Besides, there was a significant EEG-NF-associated beneficial effect on sustained attention (Hedges' g = 0.32, p < 0.01), whereas the impact on selective attention (p = 0.57) and working memory (p = 0.59) was limited. Moreover, protocol including beta wave enhancement was superior to that only focusing on reducing theta/beta ratio or modulation of slow cortical potential. Subgroup analyses showed that three sessions per week of EEG-NF produced the best effect, while the efficacy of surface EEG-NF was much poorer (Hedges' g = 0.05) when only studies that blinded their participants from knowledge of treatment allocation were included. No significant difference was noted in the improvement of attentional performance 6-12 months after EEG-NF intervention (n = 3, p = 0.42).

Conclusions: Our results demonstrated the satisfactory effectiveness of surface EEG-NF for improving sustained attention, especially when beta wave enhancement was included, despite its failure to sustain a long-term effect. Further large-scale trials are warranted to support our findings.

Keywords: Attentional performance; Biofeedback; Informant bias; Neurocognitive tests.