Neurological Sciences

, Volume 39, Issue 12, pp 2071–2078 | Cite as

The efficacy of Ritalin in ADHD children under neurofeedback training

  • Fatemeh Pakdaman
  • Fatemeh IraniEmail author
  • Fakhri Tajikzadeh
  • Samaneh Amani Jabalkandi
Original Article


Current research has shown that neurofeedback (NF) is a viable treatment for attention deficit hyperactivity disorder (ADHD), however having pharmacological approach alongside such stimulants is still inevitable. Therefore, the purpose of this study is the comparison of neurofeedback with Ritalin and without Ritalin in treating children with ADHD. This study was causal-comparative in design. Participants were children aged 5–10 years with ADHD; seven participants were in neurofeedback group with Ritalin and seven in neurofeedback without Ritalin group according to random split and parent’s conformation. Clinical Q, Conner’s continuous performance test (CPT), and WISC-R were used before and after treatment. For analyzing data, we used descriptive statistical and Mann Whitney U tests. Results showed that even if the two groups were modified in all components, modifications of commission and reaction time of the CPT and F4 theta/alpha of the clinical Q were more accurate in NF with Ritalin treatment rather than the other group. These findings suggest that neurofeedback is efficient in improving some of the behavioral concomitants of ADHD in children whose parents favored non-pharmacological treatment, but Ritalin and neurofeedback combination is more efficient. So, multimodal approach is strongly recommended for ADHD treatment.


ADHD Ritalin Neurofeedback Clinical Q 


  1. 1.
    Ho Y, Gwan L, Song G (2014) Genome-wide pathway analysis in attention-deficit/hyperactivity disorderGoogle Scholar
  2. 2.
    Cortese S, Kelly C, Chabernaud C, Proal E, Di Martino A, Milham MP et al (2012) Toward systems neuroscience of ADHD: a meta-analysis of 55 fMRI studies. Am J Psychiatry [Internet] 169(10):1038–1055 Available from: CrossRefGoogle Scholar
  3. 3.
    Koziol LF, Budding DE, Chidekel D (2013) ADHD as a model of brain-behavior relationships [internet]. Available from: doi:
  4. 4.
    Merwood A, Chen W, Rijsdijk F, Skirrow C, Larsson H, Thapar A, et al. (2014) Genetic associations between the symptoms of attention-deficit/hyperactivity disorder and emotional lability in child and adolescent twins. J Am Acad Child Adolesc Psychiatry 53(2)Google Scholar
  5. 5.
    McLoughlin G, Palmer JA, Rijsdijk F, Makeig S (2014) Genetic overlap between evoked frontocentral theta-band phase variability, reaction time variability, and attention-deficit/hyperactivity disorder symptoms in a twin study. Biol Psychiatry 75(3):238–247CrossRefPubMedGoogle Scholar
  6. 6.
    Baumeister S, Wolf I, Holz N, Boecker-Schlier R, Adamo N, Holtmann M, et al. (2016) Neurofeedback training effects on inhibitory brain activation in ADHD: a matter of learning? Neuroscience [internet].
  7. 7.
    Siqueira CM, Gurge-Giannetti J (2011) Poor school performance: an updated review. Rev da Assoc Médica Bras (English Ed) [Internet] 57(1):78–86 Available from: Google Scholar
  8. 8.
    Nevels RM, Dehon EE, Alexander K, Gontkovsky ST (2010) Psychopharmacology of aggression in children and adolescents with primary neuropsychiatric disorders: a review of current and potentially promising treatment options. Exp Clin Psychopharmacol 18(2):184–201CrossRefPubMedGoogle Scholar
  9. 9.
    Catalá-López F, Hutton B, Núñez-Beltrán A, Page MJ, Ridao M, Saint-Gerons DM et al (2017) The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: a systematic review with network meta-analyses of randomised trials. PLoS One 12:1–31Google Scholar
  10. 10.
    Felthous AR, Stanford MS (2015) A proposed algorithm for the pharmacotherapy of impulsive aggression. J Am Acad Psychiatry Law 43(4):456–467PubMedGoogle Scholar
  11. 11.
    Prado-Lima PA (2009) Pharmacological treatment of impulsivity and aggressive behavior. Rev Bras Psiquiatr [Internet] 31(Suppl 2):S58–S65 Available from: CrossRefGoogle Scholar
  12. 12.
    Dalsgaard S, Nielsen HS, Simonsen M (2012) Long-term consequences of ADHD medication for children’s human capital developmentGoogle Scholar
  13. 13.
    Lee EJ, Jung CH (2017) Additive effects of neurofeedback on the treatment of ADHD: a randomized controlled study. Asian J Psychiatr [Internet] 25:16–21. CrossRefGoogle Scholar
  14. 14.
    Meijer WM, Faber A, den Ban E, Tobi H (2009) Current issues around the pharmacotherapy of ADHD in children and adults. Pharm World Sci [Internet] 31(5):509–516. Available from. CrossRefGoogle Scholar
  15. 15.
    Graham J, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Dittmann RW et al (2011) European guidelines on managing adverse effects of medication for ADHD. Eur Child Adolesc Psychiatry 20(1):17–37CrossRefPubMedGoogle Scholar
  16. 16.
    Holtmann M, Sonuga-Barke E, Cortese S, Brandeis D (2014) Neurofeedback for ADHD: a review of current evidence. Child Adolesc Psychiatr Clin N Am 23:789–806CrossRefPubMedGoogle Scholar
  17. 17.
    Hofmann SG, Asnaani A, Vonk IJJ, Sawyer AT, Fang A (2012) The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cogn Ther Res 36:427–440CrossRefGoogle Scholar
  18. 18.
    Delgado-Rodríguez M (2006) Systematic reviews of meta-analyses: applications and limitations. J Epidemiol Community Health 60:90–92CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Arns M, Heinrich H, Strehl U (2014) Evaluation of neurofeedback in ADHD: the long and winding road. Biol Psychol [Internet] 95(1):108–115. Available from. CrossRefGoogle Scholar
  20. 20.
    Zuberer A, Brandeis D, Drechsler R (2015) Are treatment effects of neurofeedback training in children with ADHD related to the successful regulation of brain activity? A review on the learning of regulation of brain activity and a contribution to the discussion on specificity. Front Hum Neurosci [Internet] 9(March):1–15. Available from. CrossRefGoogle Scholar
  21. 21.
    Searight HR, Robertson K, Smith T, Perkins S, Searight BK (2012) Complementary and alternative therapies for pediatric attention deficit hyperactivity disorder: a descriptive review. ISRN Psychiatry [Internet] 2012:1–8 Available from: CrossRefGoogle Scholar
  22. 22.
    Wechsler D (2004) The Wechsler intelligence scale for children—fourth edition. The Wechsler intelligence scale for children—fourth edition. 153–190Google Scholar
  23. 23.
    Achenbach TM, Dumenci L, Rescorla LA (2001) Ratings of relations between DSM-IV diagnostic categories and items of the CBCL/6-18, TRF, and YSR. Vermont Res [Internet] 1–9. Available from:
  24. 24.
    Lubar JF, Swartwood MO, Swartwood JN, O’Donnell PH (1995) Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores, behavioral ratings, and WISC-R performance. Biofeedback Self Regul 20(1):83–99CrossRefPubMedGoogle Scholar
  25. 25.
    Jasper HH (1958) Report of the committee on methods of clinical examination in electroencephalography. Electroencephalogr Clin Neurophysiol Suppl [Internet] 10(2):370–375 Available from: CrossRefGoogle Scholar
  26. 26.
    Sterman MB, Wyrwicka W, Howe R (1969) Behavioral and neurophysiological studies of the sensorimotor rhythm in the cat. Electroencephalogr Clin Neurophysiol [Internet] 27(7):678–679 Available from: Google Scholar
  27. 27.
    Epstein JN, Erkanli A, Conners CK, Klaric J, Costello JE, Angold A (2003) Relations between continuous performance test performance measures and ADHD behaviors. J Abnorm Child Psychol 31(5):543–554CrossRefPubMedGoogle Scholar
  28. 28.
    Frazier PA, Tix AP, Barron KE (2004) Testing moderator and mediator effects in counseling psychology research. J Couns Psychol 51:115–134CrossRefGoogle Scholar
  29. 29.
    Riccio CA, Reynolds CR, Lowe P, Moore JJ (2002) The continuous performance test: a window on the neural substrates for attention? Arch Clin Neuropsychol 17:235–272CrossRefPubMedGoogle Scholar
  30. 30.
    Losier BJ, McGrath PJ, Klein RM (1996) Error patterns on the continuous performance test in non-medicated and medicated samples of children with and without ADHD: a meta-analytic review. J Child Psychol Psychiatry 37(8):971–987CrossRefPubMedGoogle Scholar
  31. 31.
    Swingle PG (2015) Adding neurotherapy to your practice: clinician’s guide to the ClinicalQ, neurofeedback, and braindriving. [Internet]. Adding neurotherapy to your practice: Clinician’s guide to the ClinicalQ, neurofeedback, and braindriving. Available from:
  32. 32.
    Leard Statistics (2016) Mann Whitney U test using SPSS statistics. Leard StatisticsGoogle Scholar
  33. 33.
    Rosner B, Grove D (1999) Use of the Mann-Whitney U-test for clustered data. Stat Med 18(11):1387–1400CrossRefPubMedGoogle Scholar
  34. 34.
    Nachar N (2008) The Mann-Whitney U: a test for assessing whether two independent samples come from the same distribution. Tutor Quant Methods Psychol [Internet] 4(1):13–20 Available from: CrossRefGoogle Scholar
  35. 35.
    McKnight PE, Najab J (2010) Mann-Whitney U test. In: The Corsini encyclopedia of psychology [Internet]. Available from: doi:
  36. 36.
    van Doren J, Arns M, Heinrich H, Vollebregt MA, Strehl UK, Loo S (2018) Sustained effects of neurofeedback in ADHD: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry [Internet] (123456789):1–13. Available from.
  37. 37.
    Arns M, De Ridder S, Strehl U, Breteler M, Coenen A (2009) Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis. Clin EEG Neurosci 40(3):180–189CrossRefPubMedGoogle Scholar
  38. 38.
    Steiner NJ, Frenette EC, Rene KM, Brennan RT (2015) Neurofeedback and cognitive attention training for children with ADHD in schools [Internet]. ADHD Attention Deficit and Hyperactivity Disorders 7:S16 Available from: Google Scholar
  39. 39.
    Janssen TWP, Bink M, Geladé K, van Mourik R, Maras A, Oosterlaan J (2016) A randomized controlled trial investigating the effects of neurofeedback, methylphenidate, and physical activity on event-related potentials in children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol [Internet] 26(4):344–353. Available from. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia S.r.l., part of Springer Nature 2018

Authors and Affiliations

  • Fatemeh Pakdaman
    • 1
  • Fatemeh Irani
    • 2
    Email author
  • Fakhri Tajikzadeh
    • 3
  • Samaneh Amani Jabalkandi
    • 4
  1. 1.Mehr Brain ClinicTehranIran
  2. 2.Psychology and Center for Interdisciplinary Brain ResearchJyvaskyla UniversityJyvaskylaFinland
  3. 3.Clinical PsychologyShiraz UniversityShirazIran
  4. 4.Department of Clinical PsychologyTehran University of Medical SciencesTehranIran

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