I’ve been trying to keep up with developments in research on the use of neurofeedback (NF) for ADHD. It is not easy. Many of the available studies have small samples, methodological problems, and considerable variation in the formats and modalities employed. Below, I’m sharing my summary of what I’m finding in the research, followed by some thoughts on guiding families dealing with ADHD.
It’s a fair reading, I think, of the state of the research to say that the results regarding the effectiveness of these treatments are no better than mixed. For example, a published meta-analysis by Lin et al. (2022) showed that combining EEG-based neurofeedback with medication produced additive benefits beyond the effects of medication alone, but the effects on core ADHD symptoms were modest and inconsistent. Voight, Mosier, et al. (2024) report clinically meaningful NF effects and highlight reasons to prefer newer modalities, such as fMRI-guided NF. However, just prior to that publication, Lam et al. (2022) in a double-blind, sham-controlled study found no benefits from the fMRI neurofeedback protocol. Himmelmeier et al. (2024) found some evidence of benefits using customized NF approaches but acknowledged that the research base remains small. Meanwhile, Westwood et al. (2025), in what appears to be the most recent and comprehensive review published in JAMA Psychiatry, found no benefits of NF at the group level. They left open the possibility that some individuals may respond to the treatment but noted that no advances have been made in determining how to identify those individuals.
There is a clear trend in the research toward exploring whether these treatments work for some individuals but not for others. In fairness, that lack of consistency of response applies to many treatments for many disorders. But it may also support what I’ve argued for over 30 years: that these treatments—expensive and time-consuming as they are—have been marketed to the public before they were adequately supported by research. I think there is some consensus that NF is a potentially effective treatment for a subset of individuals—but a subset we do not know how to identify in advance.
However we are only about a decade into accumulating reasonably methodologically sound studies. (Claims by some practitioners that NF is supported by 40 years of research are misleading unless you’re counting poorly controlled, small-sample studies.)
Brain-Mapping (“QEEG”)
Commonly employed in many NF practices—usually run by licensed professional counselors and school counselors, and far less often by doctoral-level clinicians—is “brain-mapping.” This usually refers to quantitative EEG (QEEG) assessments performed before NF begins to guide treatment selection. Research on QEEG for a wide variety of neurological and neurodevelopmental disorders is ongoing. However, as of this writing, few rigorous studies directly evaluate whether QEEG-based personalization of NF improves outcomes for ADHD. The use of this procedure remains driven more by clinical practice and marketing than by a robust body of scientific research.
Medication for ADHD
It’s fair to ask whether the research on ADHD treatment is similarly flawed and limited. Unlike the research on NF, the evidence for ADHD medications is extensive. Overall, research demonstrates that medication is an effective first-line treatment for ADHD, particularly in reducing core symptoms such as inattention, hyperactivity, and impulsivity. Stimulant medications have consistently shown robust short-term efficacy for approximately 75% of children. Non-stimulant options are also effective, though typically with smaller effect sizes and a slower onset of action.
However, the extent to which medications remain effective over the longer term is less clear. Some studies suggest that symptom reduction may diminish over time, though medications remain an important tool for many individuals.
What I Suggest Parents Discuss with Their Pediatricians about Treating ADHD
1. Medication Trials: In my opinion, with the exception of children with medical conditions that might complicate ADHD medication use, children with ADHD deserve the opportunity to try medication. Multiple doses—and if necessary, multiple different ADHD medications—should be tried before concluding that medications are ineffective. I regret the all-too-common stories of treatment being discontinued after one or two unsuccessful medication attempts. While side effects can be troublesome, they are generally not dangerous.
Often overlooked in treatment decisions is a full understanding of the risks of undertreating or not treating ADHD. Research consistently shows that untreated ADHD places children (and adults) at risk for academic underachievement and dropout, strained family and peer relationships, and poor self-esteem. Long-term studies link untreated ADHD to higher rates of substance use disorders, motor vehicle accidents, occupational difficulties, and legal problems in adolescence and adulthood. Untreated ADHD is also associated with increased risk for co-occurring mental health conditions such as anxiety, depression, and conduct disorder, as well as a variety of physical health problems, particularly those connected to unhealthy lifestyle behaviors such as poor diet, lack of exercise, inadequate sleep, obesity, diabetes, and heart disease.
2. Education for Adults: Children with ADHD benefit enormously from having adults in their lives who have a deep and broad understanding of the disorder. Unfortunately, it is uncommon for parents—and to some extent, teachers—to receive adequate education about ADHD. This often results in accumulating adverse childhood experiences. Disciplinary practices applied to these children by poorly informed adults are often erratic, impulsive, unnecessary, and harmful. Judgments are made about the child’s character rather than recognizing that many behavioral issues stem from a significant neurodevelopmental disorder. These children tend to benefit from behavioral treatment, interventions focused on parent-child interactions, and appropriate, individualized, and supportive academic accommodations.
3. Back to Neurofeedback: I advise skepticism toward clinics that insist on brain-mapping as a prerequisite for NF treatment. As for the treatment itself, parents who have the time, resources, and money to pursue NF may find there is a chance their child will benefit. However, I strongly advise against using NF as a substitute for more established and better-researched treatment, including medication, behavioral interventions, and school accommodations.
4. Ongoing Care: I strongly recommend that individuals with ADHD maintain long-term professional relationships with clinicians who have expertise in ADHD, regardless of how well they may be functioning. Even when individuals appear to be “doing well,” I encourage regular—though not necessarily frequent—check-ins with knowledgeable professionals. This approach recognizes the ongoing risks associated with ADHD and the long-term nature of the disorder. For example, a 15-year-old with ADHD who develops a serious depression will be able to more quickly access treatment if they maintained a relationship with a therapist—and a therapist who knows them because of their “check-ins” over time.
Thanks to my long-time colleague and friend Dr. Joe Ackerson for reading this before publication and contributing a couple of resources.
As a grandparent, parent, and former spouse of individuals with ADHD (and a career in special education), I agree with everything in your article. ADDitude is a great magazine for family members, professionals, and ADHDers. I've referred to its resources for decades. Medication worked for my child and grandchild, now both adults no longer on meds and thriving in their careers, having learned great organizational skills. There wasn't a label for it when my ex was a kid, and he somehow survived the unawareness of teachers and his parents to become a super science teacher, hyperactive and engaging like Bill Nye, the Science Guy. Thanks for this helpful report on research.