Method: Seven children diagnosed with attention-deficit hyperactivity disorder (ADHD) were trained using a standard EEG biofeedback treatment protocol designed to alter SMR/theta ratios and reduce behavioral symptomatology diagnostic of ADHD. During alternate periods they were also trained using a placebo protocol that was identical to the treatment protocol, save that the association between EEG patterns and feedback to the participants was random. Single-case design elements were used to control for the effects of internal validity threats such as maturation, history, and treatment order. Two participants failed to complete all training sessions, and the effects of training on behavior were analyzed both including and excluding these non-completers.
Results: When all participants were included in analyses that controlled for overall trend, EEG biofeedback was found to be no more effective than the placebo control condition involving non-contingent feedback, and neither procedure resulted in improvements relative to baseline levels. When overall behavioral trends unrelated to training were not controlled for and noncompleters were excluded from the analysis, it could be mistakenly concluded that EEG biofeedback is significantly more effective than placebo and that the effect sizes involved are moderate to large. These results indicate that many previous reports of the efficacy of EEG biofeedback for ADHD, particularly those presenting series of single cases, might well have been based on spurious findings.
Get full access to this article
View all access options for this article.
References
1.
Abarbanel, A. (1995). Gates, states, rhythms, and resonances: The scientific basis of neurofeedback training. Journal of Neurotherapy, 1, 15-38.
2.
Achenbach, T. M. (1991a). Manual for the child behavior checklist/4-18 and 1991 profile. Burlington, VT: University of Vermont Department of Psychiatry.
3.
Achenbach, T. M. (1991b). Manual for the teacher’s report form and 1991 profile. Burlington, VT: University of Vermont Department of Psychiatry.
4.
Achenbach, T. M., Conners, C. K., Quay, H. C., Verhulst, F. C., & Howell, C. T. (1989). Replication of empirically derived syndromes as a basis for taxonomy of child/adolescent psychopathology. Journal of Abnormal Child Psychology, 17(3), 299-323.
5.
Alberts, E., & van der Meere, J. (1992). Observations of hyperactive behavior during vigilance. Journal of Child Psychology & Psychiatry, 33(8), 1355-1364.
6.
Allison, D. B., & Gorman, B. S. (1993). Calculating effect sizes for meta-analysis: The case of the single case. Behavior Research & Therapy, 31(6), 621-631.
7.
Barkley, R. A. (1988). Attention. In M. Tramontana & S. Hooper (Eds.), Assessment Issues in Child Neuropsychology (pp. 145-176). New York: Plenum.
8.
Barkley, R. A. (1990). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: Guilford.
9.
Barkley, R. A. (1991). The ecological validity of laboratory and analogue assessment methods of ADHD symptoms. Journal of Abnormal Child Psychology, 19(2), 149-178.
10.
Barkley, R. A. (1992, April). Is EEG biofeedback treatment effective for ADHD children?CHADDerBox, 5-11.
11.
Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65-94.
12.
Barkley, R. A. (1998). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (2nd ed.). New York: Guilford.
13.
Barkley, R. A., & Grodzinsky, G. M. (1994). Are tests of frontal lobe functions useful in the diagnosis of attention deficit disorders?Clinical Neuropsychologist, 8(2), 121-139.
14.
Barlow, D. H., & Hersen, M. (Eds.). (1984). Single-case experimental design: Strategies for studying behavior change (2nd ed.). New York: Pergamon.
15.
Benton, A. L., & Hamsher, K. (1978). Multilingual aphasia examination. Iowa City: University of Iowa.
16.
Black, A. H. (1974). Operant conditioning of CNS electrical activity and the neural basis of learning. In M. H. Chase (Ed.), Operant control of brain activity: Perspectives in the brain sciences (Vol. 2, pp. 5-27). Los Angeles: University of California.
17.
Busk, P. L., & Serlin, R. C. (1992). Metaanalysis for single-case research. In T. R. Kratochwill & J. R. Levin (Eds.), Single-case research design and analysis (pp. 187-212). Hillsdale, NJ: Erlbaum.
18.
Center, B. A., Skiba, R. J., & Casey, A. (1985). A methodology for the quantitative synthesis of intra-subject design research. Journal of Special Education, 19, 387-400.
19.
Chabot, R. J., Orgill, A. A., Crawford, G., Harris, M. J., & Serfontein, G. (1999). Behavioral and electrophysiologic predictors of treatment response to stimulants in children with attention disorders. Journal of Child Neurology, 14(6), 343-351.
20.
Chabot, R. J., & Serfontein, G. (1996). Quantitative electroencephalographic profiles of children with attention deficit disorder. Biological Psychiatry, 40(10), 951-963.
21.
Chassan, J. B. (1979). Research design in clinical psychology and psychiatry (2nd ed.). New York: Irvington.
22.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
23.
Cook, T. D., & Campbell, D. T. (Eds.). (1979). Quasiexperimentation: Design and analysis issues for field settings. Chicago: Rand McNally.
24.
Corkum, P. V., Schachar, R. J., & Siegel, L. S. (1996). Performance on the continuous performance task and the impact of reward. Journal of Attention Disorders, 1, 163-172.
25.
Dunn, T. G., Gillig, S. E., Ponsor, S. E., Weil, N., & Utz, S. W. (1986). The learning process in biofeedback: Is it feed-forward or feedback?Biofeedback and Self-Regulation, 11(2), 143-156.
26.
DuPaul, G. J. (1991). Parent and teacher ratings of ADHD symptoms: Psychometric properties in a comunity based sample. Journal of Clinical Child Psychology, 20(3), 245-253.
27.
Edgington, E. S. (1972a). An additive method for combining probability values from independent experiments. Journal of Psychology, 80(2), 351-363.
28.
Edgington, E. S. (1972b). A normal curve method for combining probability values from independent experiments. Journal of Psychology, 82(1), 85-89.
29.
Edgington, E. S. (1987). Randomization tests (2nd ed.). New York: Marcel Dekker.
30.
Edgington, E. S., & Haller, O. (1984). Combining probabilities from discrete probability distributions. Educational & Psychological Measurement, 44(2), 265-274.
31.
Faith, M. S., Allison, D. B., & Gorman, B. S. (1996). Metaanalysis of single-case research. In R. D. Franklin, D. B. Allison, & B. S. Gorman (Eds.), Design and analysis of single-case research (pp. 245-277). Mahwah, NJ: Erlbaum.
32.
Fetz, E. E. (1969). Operant conditioning of cortical unit activity. Science, 163, 955-958.
33.
Franklin, R. D., Gorman, B. S., Beasley, T. M., & Allison, D. B. (1996). Graphical display and visual analysis. In R. D. Franklin, D. B. Allison, & B. S. Gorman (Eds.), Design and analysis of single-case research (pp.119-158). Mahwah, NJ: Erlbaum.
34.
Fried, R. (1993). What is theta?Biofeedback and Self-Regulation, 18, 53-58.
35.
Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. San Diego, CA: Academic Press.
36.
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy. Journal of Consulting and Clinical Psychology, 59(1), 12-19.
37.
Kety, S. S., & Schmidt, C. F. (1948). The effects of altered arterial tensions of carbon dioxide and oxygen on cerebral blood flow and cerebral oxygen consumption in normal young men. Journal of Clinical Investigation, 27, 484-492.
38.
La Croix, J. M. (1981). The aquisition of autonomic control through biofeedback: The case against an afferent process and a two-process alternative. Psychophysiology, 18, 573-587.
39.
Lahey, B. B., & Loeber, R. (1994). Framework for a developmental model of oppositional defiant disorder and conduct disorder. In D. K. Routh (Ed.), Disruptive behavior disorders in childhood (pp. 139-180). New York: Plenum.
40.
Lam, C. M., & Beale, I. L. (1991). Relations among sustained attention, reading performance, and teachers’ ratings of behavior problems. Remedial and Special Education, 12(2), 40-47.
41.
Lick, J., & Bootzin, R. (1975). Expectancy factors in the treatment of fear: Methodological and theoretical issues. Psychological Bulletin, 82, 917-931.
42.
Linden, M., Habib, T., & Radojevic, V. (1996). A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback and Self-Regulation, 21, 35-49.
43.
Lou, H. C., Henriksen, L., & Bruhn, P. (1984). Focal cerebral hypoperfusion in children with dysphasia and/or attention deficit disorder. Archives of Neurology, 41, 825-829.
44.
Lubar, J. F. (1997). Neocortical dynamics: Implications for understanding the role of neurofeedback and related techniques for the enhancement of attention. Applied Psychophysiology and Biofeedback, 22(2), 111-126.
45.
Lubar, J. F., Swartwood, M. O., Swartwood, J. N., & O’Donnell, P. H. (1995). Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores, behavioral ratings, and WISC-R performance. Biofeedback and Self Regulation, 20(1), 83-99.
46.
Lubar, J. O., & Lubar, J. F. (1984). Electroencephalographic biofeedback of SMR and beta for treatment of attention deficit disorders in a clinical setting. Biofeedback and Self Regulation, 9(1), 1-23.
47.
Mann, C. A., Lubar, J. F., Zimmerman, A. W., Miller, C. A., & Muenchen, R. A. (1992). Quantitative analysis of EEG in boys with attention-deficit-hyperactivity disorder: Controlled study with clinical implications. Pediatric Neurology, 8(1), 30-36.
48.
Marascuilo, L. A., & Serlin, R. C. (1988). Statistical methods for the social and behavioral sciences. New York: Freeman.
49.
Margolis, J. S. (1972). Academic correlates of sustained attention. Unpublished Doctoral Dissertation, University of California, Los Angeles.
50.
Morley, S., & Adams, M. (1991). Graphical analysis of single-case time series data. British Journal of Clinical Psychology, 30, 97-115.
51.
Olds, J. (1965). Operant conditioning of single unit responses, 22nd International Congress of Physiological Sciences (Lectures and Symposia). New York: Excerpta Medica.
52.
Onghena, P. (1992). Randomization tests for extensions and variations of ABAB single-case experimental designs: A rejoinder. Behavioral Assessment, 14(2), 153-171.
53.
Othmer, S., & Othmer, S. F. (1991). EEG biofeedback training for hyperactivity, Attention Deficit Disorder, specific Learning Disabilities and other disorders. Unpublished manuscript, EEG Spectrum.
54.
Parasuraman, R. (1984). The psychobiology of sustained attention. In J. S. Warm (Ed.), Sustained attention in human performance (pp. 61-101). New York: Wiley.
55.
Peek, C. J. (1977). A critical look at the theory of placebo. Biofeedback and Self-Regulation, 2(4), 327-335.
56.
Pelham, W. E., & Hinshaw, S. P. (1992). Behavioral intervention for attention deficit-hyperactivity disorder. In S. M. Turner, K. S. Calhoun, & H. E. Adams (Eds.), Handbook of clinical behavior therapy (pp. 259-283). New York: Wiley.
57.
Pelham, W. E., Wheeler, T., & Chronis, A. (1998). Empirically supported psychosocial treatments for attention deficit hyperactivity disorder. Journal of Clinical Child Psychology, 27(2), 190-205.
58.
Poulton, E. C. (1978). Increased vigilance with vertical vibration at 5Hz: An alerting mechanism. Applied Ergonomics, 9, 73-76.
59.
Rosenthal, R. (1978). Combining results of independent studies. Psychological Bulletin, 85, 185-193.
60.
Roth, R., Sterman, M. B., & Clemente, C. D. (1967). Comparison of EEG correlates of reinforcement, internal inhibition and sleep. Electroencephalography & Clinical Neurophysiology, 23, 509-520.
61.
Sterman, M. B. (1996). Physiological origins and functional correlates of EEG rhythmic activities: Implications for self-regulation. Biofeedback & Self Regulation, 21(1), 3-33.
62.
Swanson, J. M. (1989). Paired-associate learning in the assessment of ADD-H children. In L. M. Bloomingdale & J. M. Swanson (Eds.), Attention deficit disorder: Current concepts and emerging trends in attentional and behavioral disorders of childhood (pp. 87-123). Elmsford, NY: Pergamon.
63.
Tannock, R. (1998). Attention deficit hyperactivity disorder: Advances in cognitive, neurobiological, and genetic research. Journal of Child Psychology and Psychiatry, 39(1), 65-99.
64.
Thompson, L., & Thompson, M. (1998). Neurofeedback combined with training in metacognitive strategies: Effectiveness in students with ADD. Applied Psychophysiology and Biofeedback, 23(4), 243-263.
65.
White, D. M., Rusch, F. R., Kazdin, A. E., & Hartmann, D. P. (1989). Applications of meta-analysis in individual-subject research. Behavioral Assessment, 11, 281-296.
66.
Wilkins, W. (1986). Placebo problems in psychotherapy research: Social-psychological alternatives to chemotherapy concepts. American Psychologist, 41(5), 551-556.
67.
Winer, B. J., Brown, D. R., & Michels, K. M. (1991). Statistical principles in experimental design (3rd ed.). New York: McGraw-Hill.
68.
Wyler, A. R. (1984). Operant conditioning of single neurons in monkeys and its theoretical applications to EEG operant conditioning in human epilepsy. In T. Elbert, W. Rockstroh, W. Lutzenberger, & N. Birbaumer (Eds.), Self-regulation of the brain and behavior. (pp. 85-94). Berlin, New York: Springer-Verlag.
69.
Zentall, S. S. (1975). Optimal stimulation as theoretical basis for hyperactivity. American Journal of Orthopsychiatry, 45, 549-563.
70.
Zentall, S. S., & Zentall, T. R. (1983). Optimal stimulation: A model of disordered activity and performance in normal and deviant children. Psychological Bulletin, 94(3), 446-471.
