Investigation of the Impact of QEEG-Based Biofeedback on Attention and Behavioral Features in Young Male Adolescents with ADHD

Document Type : Original Articles


1 Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

2 Paarand Specialized Center for Human Enhancement, Tehran, Iran

3 Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran


Introduction: Attention Deficit/Hyperactivity Disorder (ADHD) is a disorder of neurobiological behavioral system. This disorder includes features such as attention deficit, impulsivity, and chronic, disproportionate-with-growth hyperactivity which reduce the child's ability to regulate, control, organize his behavior and cause attention deficit in activity of daily living (ADL). ADHD is one of the most common childhood disorders. The aim of this study was to investigate the effect of QEEG-based biofeedback on behavioral and attention factors of 7 to 14 year-old boys diagnosed with ADHD.  Method: 40 boys diagnosed with ADHD were randomly assigned into the experimental and control groups. Integrated Visual and Auditory (IVA) test and Children's Behavioral Check List (CBCL) were used before the treatment and after 8 intervening weeks of treatment in both groups. Moreover, the brain mapping (QEEG) of the experimental group was used to design a treatment protocol. The experimental group received 24 sessions of neurofeedback therapy three times a week. The acquired data was analyzed using the Analysis of Covariance (ACNOVA). Results: Our findings demonstrated a significant difference in test results between the experimental and control groups upon IVA and CBCL tests following the neurofeedback intervention.  Moreover, there was a significant difference between pre- and post-tests in the neurofeedback group. Interaction effect was insignificant at the time. Conclusion: Results of the present study showed that neurofeedback can bring significant improvements in attention factors especially, sustained attention and children's externalizing behaviors. As such, neurofeedback may be considered as one of the therapeutic modalities used along with core therapies and medication, though, more research is needed to compare the clinical effects of different treatment protocols with one another.


  1. Sandra FR. The ADD/ADHD cheklist, A Practical Reference for Parents and Teachers. 2nd ed2008.
  2. Davids E, and M. Gastpar. Attention deficit hyperactivity disorder and borderline personality disorder. . Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2005;29(6):865-77.
  3. Gimpel GA, Holland ML. Emotional and Behavioral Problems of Young Children: Effective Interventions in the Preschool and Kindergarten Years,. New York: Guilford press.; 2002.
  4. Kerr DCR. Parental discipline and externalizing behavior problem in early child: The roles of moral regulation and child gender. Journal of Abnormal Child Psychology. 2004;32(4):369-83.
  5. Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Science/Clinical Psychiatry: Lippincott Williams & Wilkins; 2014.
  6. Nigg JT. What causes ADHD?Understanding What goes Wrong and Why? New York: Guilford press; 2006.
  7. Willcut EG, Pennington BF, & DeFries JC. Twin study of the etiology of comorbidity between reading disability and attention-deficit/hyperactivity disorder. , . American Journal of Medical Genetics. 2000:96, 293-301.
  8. Hollenstein T. Rigidity in parent – child interaction and the developmental of externalizing and internalizing early childhood. Journal of Abnormal child Psychology. 2004;32(4):595-607.
  9. Arnsten AF. Toward a new understanding of attention-deficit hyperactivity disorder pathophysiology. . CNS drugs. 2009;23(1):33-41.
  10. Barkley RA. Attention - deficit hyperactivity disorder: A handbook for diagnosis and treatment. 3 rd ed. New York: Guilford Press; 2005.
  11. Willcutt EG, Doyle AE, Nigg JT, Faraone SV, Pennington BF. Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biol Psychiatry. 2005;57(11):1336-46.
  12. Chu S, and F. Reynolds. Occupational therapy for children with attention deficit hyperactivity disorder (ADHD), part 1: a delineation model of practice. The British Journal of Occupational Therapy. 2007:70(9): p. 372-83.
  13. Mostofsky SH, Reiss AL, Lockhart P, Denckla MB. Evaluation of cerebellar size in attention-deficit hyperactivity disorder. Journal of child neurology. 1998;13:(9).
  14. Lubar JF, Swartwood MO, Swartwood JN, & Timmermann DL. Quantitative EEG and auditory event-related potentials in the evaluation of attention-deficit disorder: Effects of methylphenidate and implications for neurofeedback training. . Journal of Psychoeducational Assessment Monographs,. 1995((Special ADHD Issue)):143-60.
  15. Kaiser DA. Basic description of Quantitative Electroencephalography (QEEG) in the context of neurotherapeutic application. Rochester Institute of Technology. 2002.
  16. Logemann HN, Lansbergen MM, Van Os TW, Bocker KB, Kenemans JL. The effectiveness of EEG-feedback on attention, impulsivity and EEG: a sham feedback controlled study. Neuroscience letters. 2010;479(1):49-53.
  17. Clarke AR, Barry RJ, McCarthy R, Selikowitz M. Children with attention- deficit/hyperactivity disorder and comorbid oppositional defiant disorder and EEG analysis. . Psychiatry Resident. 2002:111,81–90.
  18. Coburn KL, Lauterbach EC, Boutros NN, Black KJ, Arciniegas DB, CE C. The value of quantitative electroencephalography in clinical psychiatry: a report by the Committee on Research of the American Neuropsychiatric Association. . Neuropsychiatry Clinical Neuroscience. 2006;18(4):460-500.
  19. Thornton KE, & Carmody DP. The relation between memory improvement and QEEG changes in three clinical groups as a result of EEG biofeedback treatment. journal of neurofeedback. 2013.
  20. Fox D, Tharp D, Fox L. Neurofeedback: An Alternative and Efficacious Treatment for Attention Deficit Hyperactivity Disorder. Appl Psychophysiol Biofeedback. 2005;30(4):365-73.
  21. Sterman MB. EEG Markers for Attention Deficit Disorder: Pharmacological and Neurofeedback Applications. Child Study Journal 2000;30(1):1-24.
  22. Gevensleben H, Holl B, Albrecht B, Schlamp D, Kratz O, Studer P, & , et al. Distinct EEG effects related to neurofeedback training in children with ADHD: a randomized controlled trial. . International Journal of Psychophysiology,. 2009;74(2):149-57.
  23. Achenbach TM, & Rescola L. A Manual for the ASEBA school age : Form & profiles. Burlington, VT: University of Vermont, Department of Psychiatry..2001.
  24. Shahrivar Z, Shirazi E, Bagheri Y, A., Alagheband-rad J. Validity of the Child Behavior Checklist- Persian Version in a Community Sample of Iraninan Youths. Behavioral Science. 2011;5(1):45.
  25. Minai A. School age forms guide of measurement system based on Achenbach experience. . Family and child specialized clinic2005.
  26. Pahlevanian A, Alirezaloo N, Naghel S, Alidadi F, Nejati V, Kianbakht M. Neurofeedback Associated with Neurocognitive-Rehabilitation Training on Children with Attention-Deficit/Hyperactivity Disorder (ADHD). International Journal of Mental Health and Addiction. 2015:1-10.
  27. Eamonn Arble, Jeffrey Kuentzel, Barnett. D. Convergent Validity of the Integrated Visual and Auditory Continuous Performance Test (IVA+Plus): Associations withWorking Memory,Processing Speed, and Behavioral Ratings. Archives of Clinical Neuropsychology. 2014;29:300-12.
  28. Linden M, Habib T, & Radojevic V. 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. 1996;21(1):35-49.
  29. Carmody DP, Radvanski DC, Wadhwani S, Sabo MJ, & , Vergara L. EEG biofeedback training and attention-deficit/hyperactivity disorder in an elementary school setting. Journal of Neurotherapy. 2000;4(3):5-27.
  30. Amer DA, Rakhawy MY, & , El Kholy SH. Quantitative EEG in children with attention deficit hyperactivity disorder. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery,. 2010;47:399-406.
  31. Hammond DC. Neurofeedback treatment of depression and anxiety. Journal of Adult Development. 2005;12(2-3):131-7.
  32. Cannon R, Congedo M, Lubar J, & , Hutchens T. Differentiating a network of executive attention: LORETA neurofeedback in anterior cingulate and dorsolateral prefrontal cortices. International Journal of Neuroscience. 2009;119(3):404-41.
  33. Egner T, Zech TF, &, Gruzelier JH. The effects of neurofeedback training on the spectral topography of the electroencephalogram. Clinical Neurophysiology. 2004;115(11):2452-60.
  34. Apter A, Van Praag HM, Plutchik R, Sevy S, Korn M, & , Brown SL. Interrelationships among anxiety, aggression, impulsivity, and mood: a serotonergically linked cluster? Psychiatry Research. 1990;32(2):191-9.
  35. Lubar J, Shouse M. EEG and behavioral changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR). Biofeedback and Self-regulation. 1976;1(3):293-306.
  36. Lubar JO, & Lubar JF. Electroencephalographic biofeedback of SMR and beta for treatment of attention deficit disorders in a clinical setting. ,. Biofeedback and Self Regulation. 1984;9(1-23. ).
  37. Pishyareh E. Effects of computer base of attention training on sustain attention in children with attention deficit hyperactivity disorder-. 3rd International Congress on ADHD From Childhood to Adult Disease; Berlin • Germany2011.
  38. Yaghoubi H, Jazayeri AR, Khoushabi K, Dolatshahi B, . NZ. Compare of effectiveness neourofeedback, Ritalin and mix treatment in reduction of ADHD symptoms. Raftar Daneshvar Journal. 2008;15(31):71-84.