Personalized at-home neurofeedback compared to long-acting methylphenidate in children with ADHD: NEWROFEED, a European randomized noninferiority trial
AUTHORS: Purper‐Ouakil D, Blasco‐Fontecilla H, Ros T, Acquaviva E, Banaschewski T, Baumeister S, Bousquet E, Bussalb A, Delhaye M, Delorme R, Drechsler A, Goujon R, Häge A, Kaiser A, Mayaud L, Mechler K, Menache C, Revol O, Tagwerker F, Walitza S, Werling AM, Bioulac S, Brandeis D
The Journal of Child Psychology and Psychiatry, 1(1960): 51, June 2021
Background: Neurofeedback is considered a promising intervention for the treatment of attention-deﬁcit hyperac-
tivity disorder (ADHD). NEWROFEED is a prospective, multicentre, randomized (3:2), reference drug-controlled trial
in children with ADHD aged between 7 and 13 years. The main objective of NEWROFEED was to demonstrate the
noninferiority of personalized at-home neurofeedback (NF) training versus methylphenidate in the treatment of
children with ADHD.
Methods: The NF group (n = 111) underwent eight visits and two treatment phases of 16 to 20
at-home sessions with down-training of the theta/beta ratio (TBR) for children with high TBR and enhancing the
sensorimotor rhythm (SMR) for the others. The control group (n = 67) received optimally titrated long-acting
methylphenidate. The primary endpoint was the change between baseline and endpoint in the Clinician ADHD-RS-IV
total score in the per-protocol population (90 NF/59 controls). Trial registration: US National Institute of Health,
Results: Our study failed to demonstrate noninferiority of NF versus methyl-
phenidate (mean between-group difference 8.09 90% CI [8.09; 10.56]). However, both treatment groups showed
signiﬁcant pre–post improvements in core ADHD symptoms and in a broader range of problems. Reduction in the
Clinician ADHD-RS-IV total score between baseline and ﬁnal visit (D90) was 26.7% (SMD = 0.89) in the NF and
46.9% (SMD = 2.03) in the control group. NF effects increased whereas those of methylphenidate were stable between
intermediate and ﬁnal visit.
Conclusions: Based on clinicians’ reports, the effects of at-home NF were inferior to
those of methylphenidate as a stand-alone treatment.