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Effects of neurofeedback versus methylphenidate for the treatment of ADHD: systematic review and meta-analysis of head-to-head trials
  1. Lixia Yan1,2,
  2. Siyuan Wang3,
  3. Yang Yuan4,
  4. Junhua Zhang5,6
  1. 1 School of Education, Jiangsu Key Laboratory for Big Data of Psychology and Cognitive Science, Yancheng Teachers University, Yancheng, China
  2. 2 Soochow University, Suzhou, China
  3. 3 School of Chinese Language and Culture, Nanjing Normal University, Nanjing, China
  4. 4 Yancheng Traditional Chinese Medicine Hospital, Yancheng, China
  5. 5 Yancheng Teachers University, Yancheng, China
  6. 6 School of Psychology, Nanjing Normal University, Nanjing, China
  1. Correspondence to Dr Junhua Zhang, Yancheng Teachers University, Yancheng 224002, China; junhuazh2003{at}


Background The comparative efficacy and tolerability of methylphenidate (MPH) and neurofeedback (NF) in individuals with attention-deficit/hyperactivity disorder (ADHD) remains uncertain. This study aimed to fill this gap by means of a systematic review/meta-analysis.

Methods PubMed, OVID, ERIC, Web of Science, and a set of Chinese databases were searched until 22 August 2018. Standardised mean differences (SMD) were pooled using comprehensive meta-analysis software.

Results 18 randomised controlled trials (RCTs) were included (778 individuals with ADHD in the NF arm and 757 in the MPH group, respectively; 13 studies in Chinese, five in English). At the study first endpoint, MPH was significantly more efficacious than NF on ADHD core symptoms (ADHD symptoms combined: SMD=−0.578, 95% CI (−1.063 to –0.092)) and on two neuropsychological parameters (inattention:−0.959 (-1.711 to –0.208); inhibition:−0.469 (-0.872 to –0.066)). Dropouts were significantly lower in NF versus MPH (OR=0.412, 0.186 to 0.913). Results were robust to sensitivity analyses, with two important exceptions: removing Chinese studies and non-funded studies, no differences emerged between MPH and NF, although the number of studies was small. At the study follow-up, MPH was superior to NF in some outcomes, but results were inconsistent across raters.

Conclusions Due to the risk of bias of included studies, the results of the sensitivity analysis excluding Chinese and non-funded studies, and the mixed findings on at the follow-up endpoint, further high quality studies are needed to assess the comparative efficacy and acceptability of NF and MPH in individuals with ADHD.

Trial registration number CRD42018090256.

  • impulse control disorders

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  • LY and SW contributed equally.

  • Contributors JZ conceived the study and supervised screening, data extraction and analyses and wrote the first draft of the manuscript. LY, SW and YY did the screening, data extraction and analyses and revised the manuscript.

  • Funding This study was supported by the projects of Postdoctoral Fund of Jiangsu (1401038c) and Jiangsu Overseas Research & Training Programme for University Prominent Young & Middle-Aged Teachers and Presidents ((2017)3523).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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