Neural and behavioural measures from attention testing show no support for efficacy of neurofeedback treatment for adult ADHD

Attention-deficit/hyperactivity disorder (ADHD) is associated with impairments in sustained attention and inhibitory control. Neurofeedback (NFB) is a widely used non-pharmacological treatment for ADHD and is generally well tolerated, but evidence for its efficacy remains mixed. Here we report results from secondary analysis of a randomized controlled trial of NFB training for adult ADHD, analysing behaviour and neural data from attention testing in both test-retest and treatment-vs-waiting list control group contrasts. We used electroencephalography (EEG) to investigate event-related cortical dynamics during the Test of Variables of Attention (TOVA), administered before and after NFB treatment. 44 adults with ADHD (NFB treatment, ADHD-T: n = 23; waitlist control, ADHD-W: n = 21) completed the TOVA before and after the NFB training period, while 128-channel EEG was recorded. Treatment-related change was examined through analyses based on behavioural TOVA performance, power spectral density, and event-related potentials, analysed with Bayesian linear mixed models. We found no meaningful evidence for NFB-specific improvements in TOVA behavioural performance over time, and no evidence that NFB modulated ERP or spectral indices relative to the ADHD-W group. Overall, we found no evidence that NFB treatment meaningfully benefited sustained attention or inhibitory control in adults with ADHD.