Denver psychologist says ADHD neurofeedback should start with evaluation

A Denver-area psychologist says parents of children with ADHD should ask about brain evaluation before trying neurofeedback, especially when stimulant medication does not help or causes side effects. The advice comes as research on neurofeedback shows mixed but promising results and families look for alternatives.

Why it matters: - Up to 30% of children treated with stimulant medication for ADHD do not improve or develop side effects such as decreased appetite, insomnia and irritability. - Families in that group often start looking for nonmedication options, including neurofeedback. - The choice of evaluation and provider can determine whether treatment targets the right brain patterns or wastes months.

What happened: - Dr. Steffanie Stecker, a licensed psychologist and founder of Mountain Vista Psychology in the Denver area, said parents should ask whether a child's brain has actually been evaluated before starting neurofeedback. - Stecker said families often move from an ADHD diagnosis to medication, then to neurofeedback, without a proper assessment of what is being trained. - Mountain Vista Psychology offers psychological testing, counseling and neurofeedback for children, teens and adults across the south Denver metro area. - The practice has offices in Englewood, Greenwood Village, Littleton and south Denver.

The details: - Neurofeedback uses real-time measurement of brain activity to help people learn to regulate their own patterns. - A 2024 network meta-analysis of 13 randomized controlled trials involving 1,370 children found most neurofeedback approaches outperformed placebo on ADHD symptoms. - Other reviews, especially those using blinded raters, found smaller effects that did not reach statistical significance. - Stecker said she does not describe the science as settled, but says neurofeedback is well tolerated and has been studied for decades. - Stecker is board certified in neurofeedback and is a QEEG diplomate, a credential based on quantitative EEG mapping of brain activity patterns. - Stecker compared the evaluation step to an eye exam before prescribing glasses. - A randomized trial comparing neurofeedback with methylphenidate in children ages 7 to 14 found similar symptom reductions reported by parents and teachers in both groups. - That same trial found academic performance improved only in the neurofeedback group. - Stecker said the trial was small, but argued it reflects a pattern clinicians see: medication can reduce symptoms without changing classroom functioning.

Between the lines: - The main argument is not that neurofeedback replaces medication, but that the first step should be a better assessment of the child's specific brain activity and needs. - Stecker's view points to a broader split in the field: neurofeedback may help some children, but outcomes likely depend on provider skill, individualized protocols and the condition being treated. - Her comments also reflect a practical concern for families, since the wrong training plan can delay effective treatment.

What's next: - Stecker said parents should ask prospective neurofeedback providers about their training and experience, who selects the individualized protocol, and their experience treating ADHD, anxiety or trauma. - Families considering neurofeedback are likely to keep weighing it as an option when stimulant medication falls short. - The debate over how much neurofeedback helps is likely to continue as more studies compare symptom relief, classroom function and blinded outcomes.

The bottom line: - For families frustrated by ADHD medication, the key question may not be whether neurofeedback exists, but whether the child gets the right evaluation before treatment begins.