Importance Neurofeedback has been proposed for the treatment of attention-deficit/hyperactivity disorder (ADHD) but the efficacy of this intervention remains unclear. Objective To conduct a meta-analysis of randomized clinical trials (RCTs) using probably blinded (ie, rated by individuals probably or certainly unaware of treatment allocation) or neuropsychological outcomes to test the efficacy of neurofeedback as a treatment for ADHD in terms of core symptom reduction and improved neuropsychological outcomes. Data Sources PubMed (MEDLINE), Ovid (PsycInfo, MEDLINE, Embase + Embase Classic), and Web of Science, as well as the reference lists of eligible records and relevant systematic reviews, were searched until July 25, 2023, with no language limits. Study Selection Parallel-arm RCTs investigating neurofeedback in participants of any age with a clinical ADHD or hyperkinetic syndrome diagnosis were included. Data Extraction and Synthesis Standardized mean differences (SMDs) with Hedges g correction were pooled in random effects meta-analyses for all eligible outcomes. Main Outcomes and Measures The primary outcome was ADHD total symptom severity assessed at the first postintervention time point, focusing on reports by individuals judged probably or certainly unaware of treatment allocation (probably blinded). Secondary outcomes were inattention and/or hyperactivity-impulsivity symptoms and neuropsychological outcomes postintervention and at a longer-term follow-up (ie, after the last follow-up time point). RCTs were assessed with the Cochrane risk of bias tool version 2.0. Results A total of 38 RCTs (2472 participants aged 5 to 40 years) were included. Probably blinded reports of ADHD total symptoms showed no significant improvement with neurofeedback (k = 20; n = 1214; SMD, 0.04; 95% CI, -0.10 to 0.18). A small significant improvement was seen when analyses were restricted to RCTs using established standard protocols (k = 9; n = 681; SMD, 0.21; 95% CI, 0.02 to 0.40). Results remained similar with adults excluded or when analyses were restricted to RCTs where cortical learning or self-regulation was established. Of the 5 neuropsychological outcomes analyzed, a significant but small improvement was observed only for processing speed (k = 15; n = 909; SMD, 0.35; 95% CI, 0.01 to 0.69). Heterogeneity was generally low to moderate. Conclusions and Relevance Overall, neurofeedback did not appear to meaningfully benefit individuals with ADHD, clinically or neuropsychologically, at the group level. Future studies seeking to identify individuals with ADHD who may benefit from neurofeedback could focus on using standard neurofeedback protocols, measuring processing speed, and leveraging advances in precision medicine, including neuroimaging technology.

中文翻译：

---

注意力缺陷/多动障碍的神经反馈：系统评价和荟萃分析。


重要性 神经反馈已被提议用于治疗注意力缺陷/多动障碍 （ADHD），但这种干预的效果仍不清楚。目的 对随机临床试验 （RCT） 进行荟萃分析，使用可能盲法 （即，由可能或肯定不知道治疗分配的个体评分） 或神经心理学结果，以测试神经反馈治疗 ADHD 在减轻核心症状和改善神经心理学结果方面的疗效。截至 2023 年 7 月 25 日，检索了数据源 PubMed （MEDLINE）、Ovid （PsycInfo、MEDLINE、Embase + Embase Classic） 和 Web of Science，以及合格记录和相关系统评价的参考文献列表，没有语言限制。研究选择纳入平行组随机对照试验，调查任何年龄的临床 ADHD 或多动综合征诊断参与者的神经反馈。数据提取和综合 所有符合条件的结局的随机效应荟萃分析中汇总了具有 Hedges g 校正的标准化均数差 （SMD）。主要结局和指标 主要结局是在干预后第一个时间点评估的 ADHD 总症状严重程度，重点是判断可能或肯定不知道治疗分配 （可能是盲法） 的个体的报告。次要结局是干预后和长期随访 （即，在最后一次随访时间点之后） 的注意力不集中和/或多动-冲动症状和神经心理学结局。使用 Cochrane 偏倚风险工具 2.0 版评估 RCT。结果 共纳入 38 项 RCT （2472 名 5 至 40 岁的参与者）。 可能对 ADHD 总症状的盲法报告显示神经反馈没有显着改善 （k = 20;n = 1214;SMD，0.04;95% CI，-0.10 至 0.18）。当分析仅限于使用既定标准方案的 RCT 时，观察到了小幅显着改善 （k = 9;n = 681;SMD，0.21;95% CI，0.02 至 0.40）。结果在排除成人或分析仅限于建立皮层学习或自我调节的 RCT 时保持相似。在分析的 5 个神经心理学结果中，仅观察到处理速度的显着但微小的改善 （k = 15;n = 909;SMD，0.35;95% CI，0.01 至 0.69）。异质性通常为低至中等。结论和相关性 总体而言，神经反馈在群体层面的临床或神经心理学上似乎没有对 ADHD 个体有意义地受益。未来寻求识别可能从神经反馈中受益的 ADHD 个体的研究可能侧重于使用标准神经反馈协议、测量处理速度以及利用精准医学的进步，包括神经影像学技术。