1 | Uncomfortable and Unpractical
When making use of Neurofeedback, you need to utilize tedious equipment that’s typically uncomfortable and perhaps even painful to put on for a user. It’s also unpractical for easy and daily use.
The setup process itself can prove to be quite long. Out of a full 1 hour session, it can take somewhere in between 15-30 minutes to setup. Therefore, a patient may only get ~30 min of real training. This is highly dependent on the amount of electrodes used. In regards to neurofeedback, if more electrodes are used then you’ll get a higher quality and more reliable signal to use. But a higher amount of electrodes takes up increasingly longer setup times.
Clinical neurofeedback systems for ADHD typically use between 19-24 channels$^2$
What makes electrode placement more tedious is the fact that most setups require the use of saline gels. While saline gels are a pre-requisite for a fully functioning neurofeedback system in order to get a clear signal with a high Signal-to-Noise ratio (SNR), they can get very messy and sticky at times making is a hassle to apply them properly and to clean them up properly after a session.
There have been some reports in which electrode placement can be slightly painful — electrodes need to be well set to get a proper signal — which can affect overall user experience$^1$.
Overall, Neurofeedback doesn’t seem to be optimized for seamless, practical, and daily use.
2 | Boredom & Motivation
In order to get a person with ADHD to improve their levels of selective attention, during neurofeedback, they’re typically presented with boring scenes and boring training ‘tasks’. These training tasks are specifically designed to be boring and unstimulating for the user as it serves as a means of having them adapt to focusing with environments of little stimuli$^6$ $^7$. Inadvertendly, the little emotional involvement can lead to a lack of motivation to continue the treatment which can lead to a plateau in their progress$^8$.
3 | Inaccessibility & Price
Neurofeedback is a form of treatment with not much development nor immense popularity over many other forms of treatment for ADHD. Therefore, being more of an unconventional treatment, there’s a lack of insurance coverage for it leading to disenchantment or lack of opportunity to try this method of treatment$^5$. On the occasion where insurance doesn’t cover Neurofeedback treatment, a patient is forced to pay full price which typically ranges from $80-$200 per session $^9$ $^{10}$ $^{11}$.
In order for Neurofeedback to be effective in reducing ADHD inattention or hyperactivity symptoms, a user would typically need to undergo somewhere in between 30-50 neurofeedback sessions$^{12}$ $^{13}$ $^{14}$. Therefore, the cost for effective treatment can range from $2,400-$10,000 all dependent on the equipment, methodology, and healthcare provider. This can be quite detrimental for a person who desperately needs a solution, yet doesn’t have the resources to get one.
4 | Effectiveness
While aspects of the current literature supports the effectiveness of neurofeedback, contrasting pieces of research say otherwise and actually argue against the effectiveness of certain neurofeedack methodologies.
A study, when comparing the effectiveness of cognitive training vs neurofeedback training to improve working memory found no improved benefits of neurofeedback when compared to traditional cognitive training. In fact using stimuli that directly trained cognitive functions improved working memory at a better rate than neurofeedback$^{15}$. Albeit, this study was unrelated to ADHD, another study, comparing the effectiveness of neurofeedback to bolster attention this time in people with ADHD, found that while there were subjective reports of improvements in symptoms, there were no objective improvements measured by tests of variable attention (TOVA). This shows that there may be a discrepancy in improvements brought upon by neurofeedback when compared to improvements in symptoms exhibited in real life scenarios.
This is known as a lack of transfer effect.
A primary goal of neurofeedback training for ADHD is a reduction in the theta-beta ratio (TBR) as an elevated Theta band is shown to be representative of ADHD-like symptoms$^{16}$. So while this may be a worthwhile goal to pursue, the lack of a transfer effect onto real life scenarios may be an inhibitor of improvement in the TBR ultimately leading to lack of improvement in ADHD-like symptoms despite prolonged training$^{17}$.