A double-blind randomized controlled trial of personalized upper-alpha neurofeedback in children with ADHD.

Authors

Yuliang Wang, Ka Yi Hui, Siu Fung Lu, Qing Chuan Hannah Lui, Lawrence Ma, Suhail Theparambil Asharaf, Davis Lak, David Coghill, Patrick Ip, Tatia Mei Chun Lee, Winnie Wan Yee Tso

Published in

Journal of child psychology and psychiatry, and allied disciplines. Jun 21, 2026. Epub Jun 21, 2026.

Abstract

Neurofeedback (NF) is a nonpharmacological approach for ADHD, but standard protocols often overlook individual EEG variability, potentially limiting efficacy. We report the first double-blind randomized controlled trial of a session-adaptive individualized upper-alpha NF protocol in children with ADHD, based on individualized 1/f + alpha model.
Forty-eight children (6-12 years) diagnosed with ADHD were randomized to individualized upper-alpha NF (n = 26) or sham feedback (n = 22). Participants completed eight 1-h sessions over four weeks. The primary outcome was parent-rated ADHD symptoms on the SWAN scale, measured at baseline, post-treatment, and follow-up. Secondary outcomes included PedsQL, CBCL, SDQ, and neuropsychological tests. Intention-to-treat linear mixed-effects models assessed Time × Condition interactions; within-group changes were evaluated via paired t-tests. EEG learning was defined as the change in each session's upper-alpha/theta-to-lower-alpha ratio.
Blinding was preserved (Bang's Index: caregivers = 0.13; staff = 0.21). In the NF group, 21/26 children (80.7%) achieved 'learner' status versus 36.4% in sham. Both groups showed significant reductions in ADHD symptoms post-treatment (SWAN Total: NF, d = -0.879, p < .001; sham, d = -1.261, p < .001), with no between-group difference (d = -0.062, p = .881). At six months, NF maintained improvements in ADHD symptoms (SWAN Total: d = -0.713, p = .006), without superiority over sham (d = 0.221, p = .633). Neuropsychological testing revealed NF-specific gains in Purdue Pegboard non-preferred hand (d = 1.093, FDR q = .042) and faster CPT-3 reaction time (d = -1.210, FDR q = .025).
Personalized upper-alpha NF produced higher EEG learning and selective motor-speed improvements but did not outperform sham in reducing parent-rated ADHD symptoms. Eight sessions sufficed for robust EEG modulation, yet non-specific training effects likely drove clinical gains, indicating NF alone may not be an adequate ADHD treatment.

PMID:
42324882
Bibliographic data and abstract were imported from PubMed on 22 Jun 2026.

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