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

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

  • Yuliang Wang1,2
  • Ka Yi Hui1
  • Siu Fung Lu1
  • Qing Chuan Hannah Lui1
  • Lawrence Ma1
  • Suhail Theparambil Asharaf2
  • Davis Lak2
  • David Coghill3,4
  • Patrick Ip1,5,6
  • Tatia Mei Chun Lee2
  • Winnie Wan Yee Tso1,5,6
6 affiliations
  1. 1Department of Paediatrics and Adolescent Medicine University of Hong Kong Hong Kong China
  2. 2Department of Psychology University of Hong Kong Hong Kong China
  3. 3Murdoch Children's Research Institute Melbourne Victoria Australia
  4. 4The University of Melbourne Melbourne Victoria Australia
  5. 5The Duchess of Kent Children's Hospital Hong Kong China
  6. 6The Hong Kong Children's Hospital Hong Kong China
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Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusions: 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.

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Cite

BibTeXRIS
BibTeX
@article{wang2026doubleblind,
  title = {{A double‐blind randomized controlled trial of personalized upper‐alpha neurofeedback in children with ADHD}},
  author = {Yuliang Wang and Ka Yi Hui and Siu Fung Lu and Qing Chuan Hannah Lui and Lawrence Ma and Suhail Theparambil Asharaf and Davis Lak and David Coghill and Patrick Ip and Tatia Mei Chun Lee and Winnie Wan Yee Tso},
  journal = {Journal of Child Psychology and Psychiatry, and Allied Disciplines},
  year = {2026},
  month = jun,
  doi = {10.1111/jcpp.70188},
  url = {https://doi.org/10.1111/jcpp.70188},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - A double‐blind randomized controlled trial of personalized upper‐alpha neurofeedback in children with ADHD
AU  - Yuliang Wang
AU  - Ka Yi Hui
AU  - Siu Fung Lu
AU  - Qing Chuan Hannah Lui
AU  - Lawrence Ma
AU  - Suhail Theparambil Asharaf
AU  - Davis Lak
AU  - David Coghill
AU  - Patrick Ip
AU  - Tatia Mei Chun Lee
AU  - Winnie Wan Yee Tso
PY  - 2026
DA  - 2026/06/21
JO  - Journal of Child Psychology and Psychiatry, and Allied Disciplines
DO  - 10.1111/jcpp.70188
UR  - https://doi.org/10.1111/jcpp.70188
AB  - Background: 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.  Methods: 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.  Results: 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).  Conclusions: 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.
SN  - 0021-9630
SN  - 1469-7610
ER  -