Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 5% of children and adolescents . Core symptoms include poor attention, hyperactivity and impulsivity, typically reported by teachers and parents .
While concern has been raised about both the overdiagnosis and overmedication of ADHD, other data indicate that a significant amount of cases each year remain undiagnosed , with consequences on adult life that may include poor academic performance, addictive behavior, and problematic interpersonal relationships, resulting altogether in unbalanced overall functioning [4, 5].
Most commonly, children and adolescents diagnosed with ADHD starting from age 6 years onward are treated with methylphenidate  a psychostimulant medication, mainly with the goal of improving attention and decreasing impulsivity.
It has been pointed out, however, that psychostimulant treatment has, in many cases, only short-term effects and that, in some patients, is associated with little or no changes in core symptoms. Further, psychostimulant treatment can induce both short-term and long term adverse effects, including fatigue, nausea and loss of appetite (short term) [1, 7] as well as cardiovascular effects and suppression of growth (long term) [8, 9]. Fearing these adverse effects, many parents choose to leave their children unmedicated, even after a diagnosis has been made .
In the attempt of finding a solution to these shortcomings, Neurofeedback or electroencephalogram (EEG) biofeedback, has been subject of research for a number of years now.
In general, there is agreement that, in the anterior regions of the brain of ADHD subjects, EEG absolute theta power is increased and absolute beta power decreased [11, 12]. Neurofeedback protocols aimed at reducing brain activity in the theta frequency band while increasing activity in the beta frequency band (or to decrease the theta/beta ratio), have been shown to improve attention. Further, neurofeedback protocols targeting frequencies in the range of 12–15 Hz have been shown to address hyperkinetic behavior.
Several studies have investigated the efficacy of neurofeedback as compared to placebo in the treatment of ADHD. In general, these studies show large effect sizes for neurofeedback on impulsivity and inattention, and medium to low effect sizes on hyperactivity. These results have led to the conclusion that neurofeedback can be considered “Efficacious and Specific”.
While several randomized neurofeedback control trials have been published in ADHD, only a few studies have compared the effects of neurofeedback with those of stimulants .
A recent review by Razoki  examined eight randomized control trials with children or adolescents with ADHD where the efficacy of neurofeedback treatment, either alone or in combination with stimulant treatment, was compared with stimulant medication.
Interestingly, in two studies, medication dosage was reduced when neurofeedback training was combined with the administration of methylphenidate, suggesting that neurofeedback should be considered when treating low responders to single-drug administration or children who exhibit adverse effects associated with the administration of stimulants [14, 15].
Neurofeedback for the treatment of children and adolescents with ADHD should be considered:
1) complementary to treatment with stimulants, with protocols tailored to the needs of the subject;
2) a viable alternative to pharmacotherapy in patients exhibiting low responses and/or who display significant adverse effects to stimulant treatment.
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