FAQ - Neurofeedback Therapy for ADHD

Frequently asked questions

How long is a session?

NF sessions typically last for 45 to 50 minutes. We advise to allow a full hour.

What happens on a NF training session?

Active sensors (surface electrodes) are placed in predetermined location(s) on the scalp to record the brain’s electrical activity. Reference and ground electrodes are generally placed on the ears, or other locations such as the mastoid, to complete the required electrical circuit. It is important to mention that no electrical current is introduced into the brain using NF equipment. Decisions regarding placement of the active recording electrode(s) and which EEG frequencies to reinforce/suppress are determined by: 1) the quantitative electroencephalographic assessment (qEEG), 2) the association of symptoms to brain locations, and/or 3) protocols that have been shown effective in research studies with similarly diagnosed patients.

How many sessions are needed and how often?

Typically, 30 to 40 NF sessions are required to treat an ADHD case of average severity but sometimes it takes more than 40. Most clinicians report reaching maximum effect, including long-term maintenance, by 40 sessions. Treatment is usually completed in four to seven months when sessions are conducted a minimum of two times per week.

How much does it cost? Why do some say it's an expensive treatment?

NF is usually a one-time intervention of 40 or fewer sessions over the course of four months or more, whereas psychotherapy and/or stimulant medications often will go on for several years. Very few if any individuals with ADHD will respond in five sessions or less to any form of treatment, including medications which are often prescribed for years. However, when NF treatment is complete, there is a high probability of long-term maintenance of treatment gains, unlike what research has found with medication usage. The cost of NF for a 10 year-old child typically ranges from £3000 to £4500 over a relatively short period of time compared to parent training and psychotherapy, plus continued medication usage for years, possibly into adulthood. Although medication costs vary, there is also the issue of quality of life, which is difficult to put a price on, but also includes the negative side effects that are common with stimulant medications.

Why is NF better than other behavioral or medical treatments for ADHD?

A key advantage that NF has in comparison to other treatment whether psychosocial or medications, is the use of normative, standardized and quantifiable measures to track clinical progress and to help guide treatment decisions. For example, EEG data is constantly produced and is used along with symptom monitoring to plan and evaluate treatment progress and outcome, affording NF a level of precision, personalization and accountability not available to other therapies. This consistent individual measurement and accountability is strengthened when the data is paired with standardized and quantifiable psychological testing and assessments such as computerized continuous performance tests (CPT) and behavioral rating scales used in treating ADHD. Many practitioners use a CPT and behavior rating scale as a benchmark prior to initiating NF treatment and then retest several times over the course of treatment to help verify progress and change in targeted symptoms. Significant reductions in ADHD symptoms following NF treatment have been documented through numerous published articles in peer reviewed scientific journals.
This routine tracking of treatment progress with standardized instruments and metrics is in stark contrast to the typical total absence, or at best sporadic, use of standardized monitoring by almost all other behavioral health clinicians. This type of quantification and measurement available in NF treatment allows case management to be more precise than with other therapies, enabling treatment decisions to be based on an ongoing record of hard data.

Does the treatment effect last?

Since ADD/ADHD is a problem of brain disregulation, then the answer is yes, and that covers a lot of ground. Neurofeedback involves learning by the brain and if that brings order out of disorder, the brain will continue to use its new capabilities, and thus reinforce them.

What's the success rate?

Through our over-thirty years of experience with neurofeedback, we have reached the point of having very high expectations for success in training. When such success is not forthcoming, or if the gains cannot hold, then there is usually a reason for that which needs to be pursued. In the normal course of events, neurofeedback ought to work with everybody. That is to say, nearly everyone should make gains that they themselves would judge to be worthwhile. Our brains are made for learning and skill-acquisition. On the other hand, we are working with many families whose expectations have been lowered by their past experience. And they need to see progress before they will share our optimism. We understand that. It turns out that among the vast majority of clients (>95% in one clinician's experience) the actual outcome exceeds the prior expectations. Against such low expectations, the changes that can be produced with neurofeedback may even appear miraculous. One EEG Biofeedback office has a sign on its front desk: "We expect miracles. If none occur, something has gone wrong." What appears miraculous in all of this is really nothing more than the incredible capacity of our brains to recover function when given a chance.

What about medication?

With successful neurofeedback training, the medications targeting brain function may very well no longer be needed, or they may be needed at lower dosages, as the brain takes over more of the role of regulating itself. This decrease in medications is particularly striking when the medications play a supportive role in any event, as is often the case for the more severe disorders that we are targeting with our work. It is important for clients to communicate with their prescribing physician regarding neurofeedback and medications.

Is it available on the NHS?

Neurofeedback is not yet recognised by the NHS. Medication remains the intervention of choice. Councils can sometimes help with funding under their social care provision, for example - under adoption care programme. In the USA, Neurofeedback is covered by most US health insurance companies.

Why can't I do it myself at home?

Some people wish that they could simply buy their own neurofeedback equipment and train themselves or their children. This is fraught with potential for harm or ineffectiveness. To be done properly, neurofeedback needs to be conducted or supervised by someone with specialized expertise concerning brain function and who is knowledgeable about much more than simply how to operate equipment and software. For training to be successful and side effects avoided, it is vitally important for an assessment to be performed and the training to be individualized to the distinctive brainwave patterns and symptoms of each person. Everyone does not need the same training at the same locations, and research has shown that a person’s brainwave patterns simply cannot be distinguished by only observing the person’s behavioral symptoms. Therefore, prior to doing neurofeedback training, legitimate licensed clinicians will want to ask questions about the clinical history of the client or patient.