PURPOSE

Attention-deficit/hyperactivity disorder (ADHD) is a complex and prevalent neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity, often persisting into adulthood. This review aims to examine the neurobiological basis of ADHD, the role of quantitative electroencephalography (qEEG) in identifying biomarkers, and the clinical utility and challenges of neurofeedback (NFB) as a non-pharmacological intervention.

METHOD

A narrative review approach was employed to synthesize findings from recent neuroimaging and electrophysiological studies. Particular emphasis was placed on brain regions implicated in ADHD (e.g., prefrontal cortex, caudate nucleus, thalamus), EEG-based biomarkers (notably the theta/beta ratio), and methodological factors influencing the efficacy of NFB protocols.

FINDINGS

Evidence suggests that NFB, grounded in operant conditioning, can modify dysfunctional brainwave patterns associated with ADHD. qEEG serves as a valuable tool for both identifying neurophysiological subtypes (e.g., cortical hypoarousal, hyperarousal, delayed maturation) and tailoring NFB protocols. However, heterogeneity in protocols, placebo effects (∼40% short-term improvement), and variability in ADHD neurophysiology present significant challenges to standardisation and generalisability.

CONCLUSION

While neurofeedback shows promise in reducing ADHD symptoms, its long-term efficacy and comparability to pharmacological treatments remain inconclusive. Future large-scale, well-controlled trials are needed to establish robust, standardized protocols. Integrating NFB within a personalized, multimodal treatment framework may enhance clinical outcomes, particularly when tailored to EEG-based ADHD subtypes.