For Which Children with ADHD is TBR Neurofeedback Effective? Comorbidity as a Moderator

Abstract

Abstract Introduction: We examined psychiatric comorbidities moderation of a 2-site double-blind randomized clinical trial of theta/beta-ratio (TBR) neurofeedback (NF) for attention deficit hyperactivity disorder (ADHD). Methods:Seven-to-ten-year-olds with ADHD received either NF (n=84) or Control (n=58) for 38 treatments. Outcome was change in parent-/teacher-rated inattention from baseline to end-of-treatment (acute effect), and 13-month-follow-up. Seventy percent had at least one comorbidity: oppositional defiant disorder (ODD) (50%), specific phobias (27%), generalized anxiety (23%), separation anxiety (16%). Comorbidities were grouped into anxiety alone (20%), ODD alone (23%), neither (30%), or both (27%). Results: Comorbidity (p=0.043) moderated acute effect; those with anxiety-alone responded better to Control than to TBR NF (d=-0.79, CI -1.55- -0.04), and the other groups showed a slightly better response to TBR NF than to Control (d=0.22~0.31, CI -0.3-0.98). At 13-months, ODD-alone group responded better to NF than Control (d=0.74, CI 0.05-1.43). Discussion: TBR NF is not indicated for ADHD with comorbid anxiety but may benefit ADHD with ODD.