Factors influencing therapeutic effectiveness of electroencephalogram-based neurofeedback against core symptoms of ADHD: a systematic review and meta-analysis
Bibliographic record
Abstract
Background: Factors affecting the effectiveness of electroencephalogram-based neurofeedback (EEG-NF) against the core symptoms of attention-deficit/hyperactivity disorder (ADHD) remain unclear. Methods: We searched the PubMed, Embase, Web of Science, ClinicalKey, Cochrane CENTRAL, ScienceDirect, and ClinicalTrials.gov databases from inception to August 2022 for randomized controlled trials (RCTs) on patients with ADHD involving outcome assessments of improvements on behavioural rating scales of inattention, hyperactivity/impulsivity, and global symptoms. Comparators included nonactive (e.g., wait list/treatment as usual) and active (e.g., cognitive training) controls. Results: Our analyses included 21 RCTs comprising 1261 participants. Our results demonstrated significantly better improvement in symptoms of inattention, hyperactivity/impulsivity and global symptoms of ADHD associated with EEG-NF than comparators from both proximal ( p = 0.01, p = 0.02 and p = 0.01, respectively; e.g., parents) and distal ( p = 0.01, p < 0.05 and p = 0.01; e.g., teachers) raters. Meta-regression revealed a positive association between therapeutic effects of EEG-NF and intelligence quotient (IQ) from observations of the most proximal raters. Subgroup analysis for studies combining 2 EEG-NF protocols showed better therapeutic effectiveness against symptoms of ADHD than those using a single NF protocol, whereas subgroup analysis adopting a double-blind design failed to demonstrate superiority of EEG-NF to sham control. Moreover, therapeutic effectiveness of EEG-NF was significantly better when wait list/treatment as usual comparators were used compared with sham/placebo EEG-NF controls on subgroup analysis. Limitations: Our findings are limited by the lack of a double-blind design in most of the studies included in our analyses. Conclusion: Our results support the effectiveness of EEG-NF for improving inattention, hyperactivity/impulsivity, and global symptoms in patients with ADHD. The high risk of detection and performance bias warrants further study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.015 | 0.037 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.031 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".