The Pros and Cons of Neurofeedback for Kids

We Tested Neurofeedback: Here’s What We Found

Gemm Learning is an agnostic provider of evidence-based learning interventions. We were excited to investigate the pros and cons of neurofeedback for kids, hoping it could be a good addition to our portfolio of learning solutions for ADHD. Before we began, based on our research, our main questions were, “Is neurofeedback permanent or temporary?” and “Does neurofeedback last after stopping?”

We tried neurofeedback with several young students with inattentive symptoms as a precursor to offering it as a service.

The results were disappointing. In addition to the logistical difficulties – it was not possible to monitor participation remotely with anywhere near the precision we are accustomed to with our primary intervention, Fast ForWord – the impact on the children was not what we’d hope for:

• Improvements in focus during the program were subtle. Being fair, measuring gains is a challenge with all ADHD programs.
• Six months after the neurofeedback stopped, parents asked us about other program ideas. Their child’s learning didn’t change.

In hindsight, the results were not surprising. Neurofeedback attempts to retrain the brain despite the presence of the cognitive skill gaps causing the ADHD. Rewriting the brain’s response to underlying cognitive skill gaps is like training a person not to limp with a broken ankle. It’s possible, but not natural.

While neurofeedback reminds children how to focus while on the program, after the program, without those reminders, the underlying causes inevitably reassert themselves, just as they do when a child goes off ADHD drugs. The limp comes back.

Based on these outcomes, we decided not to offer home neurofeedback systems to our clients.

How Home Neurofeedback Systems Work

Neurofeedback, also known as EEG biofeedback, uses real-time displays of brain activity to teach self-regulation of brain function. It is based on the idea that we can train the brain to function more effectively, improving mental health and performance.

It’s a cool-looking technology where brain waves – thinking – can impact what happens on a computer screen. Using feedback to recognize errors or see more clearly what to do is a powerful tool used in many areas, from ABA therapy for children with autism to TrackMan setups for golfers.

Furthermore, the technology has improved substantially.

Early on, neurofeedback required going into a clinician’s office for 40-50 sessions and being hooked up to a neurofeedback machine; today’s most popular systems are much more compact and used at home. Instead of electrodes, students wear armbands (for Play Attention) or headbands (for MyndLift).

Home neurofeedback system features:

1. Brainwave Monitoring: Sensors measure brain activity (electroencephalogram or EEG).
2. Real-Time Feedback: The brain’s activity impacts what is displayed on a screen as visual or auditory cues. For example, a calm brain state might result in smoother video playback, or sustained focus will keep a plane flying.
3. Training: The individual learns to modify their brainwave patterns by doing things like focusing on an object and then observing how changes in that focus change the brainwave patterns – that’s the “feedback” part of the therapy.
4. Repetition: With practice, the brain learns healthier patterns.

Neurofeedback therapy for kids is mainly for ADHD. The technology is used for anxiety, depression, PTSD, and neurological conditions (such as epilepsy, migraines, and traumatic brain injuries), sleep disorders, and sports performance to help athletes understand focus and stress management.

While overall neurofeedback is a growing market for adults, the pros and cons of neurofeedback for kids are such that neurofeedback is waning as an ADHD treatment for kids.

Pros and Cons of Neurofeedback for ADHD

The concept behind neurofeedback is to help a child understand what concentration feels like. It uses brain waves to move things on a computer screen when the student concentrates. Seeing the screen change gives the child immediate feedback, letting him know he is focusing correctly.

A home-based version of neurofeedback, called Play Attention, encourages a student to raise a plane and keep flying it simply by concentrating. Another version of neurofeedback lets children run videos using their concentration.

The goal of neurofeedback is to train the brain to regulate itself and function better.

Pros of Neurofeedback

The feedback loop of neurofeedback systems that detect lapses in focus is extremely enlightening for most children. The immediate feedback from a drop in focus – the plane starts dropping, the video stops playing – is unique and helpful.

Home neurofeedback systems are convenient and straightforward to use. A parent can watch the screen and see whether their child is focusing.

Other positive changes from neurofeedback, such as better sleep or less anxiety, can start to occur after a few sessions.

Cons of Neurofeedback

The main con is that ADHD is a complex issue, and there is not much evidence to support the long-term effectiveness of neurofeedback for ADHD. There are two issues:

• Neurofeedback does not address the underlying cause of ADHD
• Brain patterns related to ADHD are complex

Lack of focus is a symptom of a cognitive skill gap (such as a language processing delay) that makes listening exhausting or hard to follow, which can lead to drifting off.

Neurofeedback attempts to overwrite the brain’s response to these underlying gaps rather than address them. While there is evidence of improvement while a child works on the program, the underlying causes of inattention tend to reemerge once neurofeedback stops.

In this way, neurofeedback is more comparable to ADHD meds. It reminds the brain how to focus. Without those reminders, the inattentiveness will gradually return. The gains from neurofeedback don’t last after stopping.

In NIH research studies, a common theme is that gains often detected while using neurofeedback start to fade after the program stops. In a fairly comprehensive study, the NIH concluded as follows:

[Neurofeedback] has been questioned in terms of conclusive scientific evidence of its effectiveness. Moreover, it is an expensive procedure which is not covered by many insurance companies. It is also time-consuming and its benefits are not long-lasting. Finally, it might take several months to see the desired improvements.

Neurofeedback Options

There are three forms of neurofeedback:

• In-clinic systems
• At-home systems with professional oversight
• At-home systems unsupervised

When forming a neurofeedback treatment plan, the home or in-center choice may come down to what is available in your area.  Bear in mind that neurofeedback creates feedback loops and so can target different skills — practitioners tend to have particular areas of interest that may or may not coincide with your child’s needs.

Some of the most commonly used neurofeedback systems are:

• Play Attention. Play Attention is a home-based neurofeedback program that consists of a BodyWave biofeedback armband and software you install on your Mac or PC. With Play Attention, you play simple games while the armband gives you feedback on how hard you’re concentrating. Buying the software also gives you access to an adviser who will review your data and offer guidance.
• BrainMaster. BrainMaster offers a variety of qEEG-based neurofeedback packages. The most cost- and time-efficient way to get started with BrainMaster neurofeedback is at a center. Here is a list of Brain Master’s affiliated clinicians.
• BrainTrain. Like BrainMaster, BrainTrain makes a range of hardware devices and software packages for professionals rather than home users.
• NeurOptimal. NeurOptimal sells systems for home users and for clinicians. The home use system is expensive. Alternatively, you can find a NeurOptimal Trainer in your area.
• Cereset. Cereset (formerly known as Brain State) aims to help the brain relax and rebalance itself, improving overall brain functioning, including learning, memory, sleep, and stress resilience. It creates an “acoustic brain mirror” by providing feedback through sound – in this sense, it differs from neurofeedback systems that often use primarily visual feedback. Brain State is only available through licensed clinicians.

Alternatives to Neurofeedback

It comes down to managing ADHD symptoms with neurofeedback or ADHD medication, or trying to remediate the source of ADHD once and for all with an intervention.

ADHD Interventions like Fast ForWord and Interactive Metronome have a different approach to neurofeedback. They aim to resolve ADHD once and for all by addressing the cognitive skill gaps (Fast ForWord) or neural synchronization (Interactive Metronome) that cause inattentiveness.

By remediating the deep-seated causes of ADHD, interventions aim to make a lasting change.

Gemm Learning provides Fast ForWord at home. It’s a brain-based program, but that’s about where the similarities with neurofeedback end. Fast ForWord uses cognitive training to improve reading and overall learning efficiency, with focus as a key target. It is the best choice for children with ADHD and language-based delays such as reading or listening accuracy issues.

Cogmed Attention Training exercises working memory to improve understanding, engagement, and attention. Gemm Learning provides Cogmed at home with oversight.

Because we have concerns about the long-term effectiveness of neurofeedback, we do not provide home neurofeedback systems.

Gemm Learning has been a trusted provider of Fast ForWord software in the U.S. and Canada since 2006. To see if Fast ForWord is right for your child, call us anytime at 1-877-914-4366.