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Peer-reviewedCC BY 4.0Journal of Child Psychology and Psychiatry, and Allied Disciplines

Emotional problems and dysregulation in children/youth with ADHD: predictive and moderating effects in a randomized controlled trial of methylphenidate and neurofeedback

  • Amelie Bohner1,2
  • Hilario Blasco‐Fontecilla3
  • Tomas Ros4
  • Eric Acquaviva5
  • Yohan Attal6
  • Tobias Banaschewski1,2
  • Sarah Baumeister1,2
  • Elisa Bousquet7
  • Aurore Bussalb8
  • Marie Delhaye9
  • Richard Delorme5
  • Renate Drechsler10
13 more authors
  • Allison Goujon7
  • Alexander Häge1,2
  • Louis Mayaud8
  • Konstantin Mechler1,2
  • Caroline Menache11
  • Olivier Revol12
  • Friederike Tagwerker10
  • Susanne Walitza10,13,14
  • Anna Maria Werling10
  • Stéphanie Bioulac15,16
  • Daniel Brandeis1,2,10,13,14
  • Diane Purper‐Ouakil7,17,18
  • Anna Kaiser1,2,19
19 affiliations
  1. 1Department of Child and Adolescent Psychiatry and Psychotherapy Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University Mannheim Germany
  2. 2German Center for Mental Health (DZPG), Mannheim ‐ Heidelberg ‐ Ulm, partner site Mannheim Mannheim Germany
  3. 3Instituto de Investigación y Transferencia (ITEI), Universidad Internacional de La Rioja (UNIR), CIBERSAM Madrid Spain
  4. 4Department of Neuroscience Campus Biotech CISA‐Université de Genève Genève Switzerland
  5. 5Child and Adolescent Psychiatry Department and Child Brain Institute, Robert Debré Hospital Assistance Publique‐Hôpitaux de Paris and Universite Paris Cite Paris France
  6. 6Cyrebro Neurosignals Paris France
  7. 7Unit of Child and Adolescent Psychiatry (MPEA1), CHU Montpellier‐Saint Eloi Hospital University of Montpellier Montpellier France
  8. 8RDS SAS Strasbourg France
  9. 9Child and Adolescent Psychiatry, Erasme Academic Hospital Université Libre de Bruxelles Bruxelles Belgium
  10. 10Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich University of Zurich Zurich Switzerland
  11. 11Clinique des Grangettes Chêne‐Bougeries, Geneva Switzerland
  12. 12Unit of Child and Adolescent Psychiatry Hospices civils de Lyon, Hôpital Femme Mère Enfant Bron Cedex France
  13. 13Neuroscience Center Zurich University of Zurich and ETH Zurich Zurich Switzerland
  14. 14Zurich Center for Integrative Human Physiology University of Zurich Zurich Switzerland
  15. 15LPNC, UMR 5105 University Grenoble Alpes Grenoble France
  16. 16Unit of Child and Adolescent Psychiatry CHU Grenoble Alpes Grenoble France
  17. 17Development and Trajectories INSERM CESP U 1018 Psychiatry Montpellier France
  18. 18CESP, INSERM U 1018 Paul Brousse Hospital Villejuif France
  19. 19Department of Child and Adolescent Psychiatry/Psychotherapy University Hospital of Ulm, University of Ulm Ulm Germany
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Abstract

Background: Children and adolescents with Attention‐Deficit/Hyperactivity Disorder (ADHD) often show increased emotional dysregulation (ED) and internalizing emotional problems (iEP). However, the predictive and moderating role of these emotional difficulties in the treatment of ADHD—particularly regarding pharmacological (methylphenidate, MPH) and non‐pharmacological approaches (neurofeedback at home, NF@home)—remains understudied. This study aims to evaluate the effectiveness of MPH and NF@home in reducing iEP/ED in children with ADHD and to assess the predictive role of iEP/ED and neuropsychological executive function (EF) measures in treatment outcomes.

Methods: The per‐protocol sample included 146 children (7–13 years) diagnosed with ADHD (inattentive or combined type). iEP was measured with the Strengths and Difficulties Questionnaire (SDQ), ED via a dysregulation profile, and EF using the BRIEF and Continuous Performance Test (CPT). ADHD symptoms were assessed using the ADHD Rating Scale IV. Participants were randomized to either the MPH group (n = 59) or the NF group (n = 87), which included NFSMR (n = 72) and NFTBR (n = 15), based on individual Theta/Beta‐Ratio (TBR). Mixed‐model analyses considered symptom severity at baseline, age, gender, IQ, and study center as covariates.

Results: All intervention groups showed significant changes in iEP, but with different effects regarding parent (NFSMR: d = −0.396, 95% CI [−0.574, −0.217]; NFTBR: d = −0.367, 95% CI [−0.747, 0.013]; MPH: d = −0.409, 95% CI [−0.603, −0.215]) and teacher ratings (NFSMR: d = −0.211, 95% CI [−0.405, −0.017]; NFTBR: d = −0.639, 95% CI [−1.06, −0.222]; MPH: d = −0.142, 95% CI [−0.340, 0.056]). There was no between‐intervention effect, supported by non‐inferiority analyses. For ED, we also found significant effects for all interventions; however, significantly more pronounced effects were obtained for MPH. Moreover, both prediction models indicated a limited predictive value.

Conclusions: The findings suggest non‐inferiority of NF versus MPH treating iEP within an ADHD sample. However, due to limited predictive value, no clear clinical guidance can yet be drawn regarding personalized treatment recommendations. Further studies are needed to confirm and extend these findings.

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Cite

BibTeXRIS
BibTeX
@article{bohner2026emotional,
  title = {{Emotional problems and dysregulation in children/youth with ADHD: predictive and moderating effects in a randomized controlled trial of methylphenidate and neurofeedback}},
  author = {Amelie Bohner and Hilario Blasco‐Fontecilla and Tomas Ros and Eric Acquaviva and Yohan Attal and Tobias Banaschewski and Sarah Baumeister and Elisa Bousquet and Aurore Bussalb and Marie Delhaye and Richard Delorme and Renate Drechsler and Allison Goujon and Alexander Häge and Louis Mayaud and Konstantin Mechler and Caroline Menache and Olivier Revol and Friederike Tagwerker and Susanne Walitza and Anna Maria Werling and Stéphanie Bioulac and Daniel Brandeis and Diane Purper‐Ouakil and Anna Kaiser},
  journal = {Journal of Child Psychology and Psychiatry, and Allied Disciplines},
  year = {2026},
  month = jul,
  doi = {10.1111/jcpp.70205},
  url = {https://doi.org/10.1111/jcpp.70205},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Emotional problems and dysregulation in children/youth with ADHD: predictive and moderating effects in a randomized controlled trial of methylphenidate and neurofeedback
AU  - Amelie Bohner
AU  - Hilario Blasco‐Fontecilla
AU  - Tomas Ros
AU  - Eric Acquaviva
AU  - Yohan Attal
AU  - Tobias Banaschewski
AU  - Sarah Baumeister
AU  - Elisa Bousquet
AU  - Aurore Bussalb
AU  - Marie Delhaye
AU  - Richard Delorme
AU  - Renate Drechsler
AU  - Allison Goujon
AU  - Alexander Häge
AU  - Louis Mayaud
AU  - Konstantin Mechler
AU  - Caroline Menache
AU  - Olivier Revol
AU  - Friederike Tagwerker
AU  - Susanne Walitza
AU  - Anna Maria Werling
AU  - Stéphanie Bioulac
AU  - Daniel Brandeis
AU  - Diane Purper‐Ouakil
AU  - Anna Kaiser
PY  - 2026
DA  - 2026/07/28
JO  - Journal of Child Psychology and Psychiatry, and Allied Disciplines
DO  - 10.1111/jcpp.70205
UR  - https://doi.org/10.1111/jcpp.70205
AB  - Background: Children and adolescents with Attention‐Deficit/Hyperactivity Disorder (ADHD) often show increased emotional dysregulation (ED) and internalizing emotional problems (iEP). However, the predictive and moderating role of these emotional difficulties in the treatment of ADHD—particularly regarding pharmacological (methylphenidate, MPH) and non‐pharmacological approaches (neurofeedback at home, NF@home)—remains understudied. This study aims to evaluate the effectiveness of MPH and NF@home in reducing iEP/ED in children with ADHD and to assess the predictive role of iEP/ED and neuropsychological executive function (EF) measures in treatment outcomes.  Methods: The per‐protocol sample included 146 children (7–13 years) diagnosed with ADHD (inattentive or combined type). iEP was measured with the Strengths and Difficulties Questionnaire (SDQ), ED via a dysregulation profile, and EF using the BRIEF and Continuous Performance Test (CPT). ADHD symptoms were assessed using the ADHD Rating Scale IV. Participants were randomized to either the MPH group (n = 59) or the NF group (n = 87), which included NFSMR (n = 72) and NFTBR (n = 15), based on individual Theta/Beta‐Ratio (TBR). Mixed‐model analyses considered symptom severity at baseline, age, gender, IQ, and study center as covariates.  Results: All intervention groups showed significant changes in iEP, but with different effects regarding parent (NFSMR: d = −0.396, 95% CI [−0.574, −0.217]; NFTBR: d = −0.367, 95% CI [−0.747, 0.013]; MPH: d = −0.409, 95% CI [−0.603, −0.215]) and teacher ratings (NFSMR: d = −0.211, 95% CI [−0.405, −0.017]; NFTBR: d = −0.639, 95% CI [−1.06, −0.222]; MPH: d = −0.142, 95% CI [−0.340, 0.056]). There was no between‐intervention effect, supported by non‐inferiority analyses. For ED, we also found significant effects for all interventions; however, significantly more pronounced effects were obtained for MPH. Moreover, both prediction models indicated a limited predictive value.  Conclusions: The findings suggest non‐inferiority of NF versus MPH treating iEP within an ADHD sample. However, due to limited predictive value, no clear clinical guidance can yet be drawn regarding personalized treatment recommendations. Further studies are needed to confirm and extend these findings.
SN  - 0021-9630
SN  - 1469-7610
ER  -