January 18, 2024
Noting that “The efficacy of surface electroencephalographic neurofeedback (EEG‐NF) for improving attentional performance assessed by laboratory measures in patients with attention‐deficit/hyperactivity disorder (ADHD) remains unclear,” a Taiwanese study team systematically searched seven databases, including the U.S. clinical trials database, for randomized controlled trials (RCTs) through January of 2022.
They identified fourteen RCTs with a combined 718 participants that met criteria for inclusion in meta-analysis. The net outcome was a small-to-medium effect size improvement in attentional performance for participants receiving EEG neurofeedback by contrast with “comparators.”
The comparators varied widely: waitlist, treatment as usual, physical exercise, behavioral therapy, attention skills training, computer-aided attention training, medications, electromyographic biofeedback, sham EEG neurofeedback. This alone brings into question the meta-analysis outcome.
But there were additional methodological shortcomings. There was strong evidence of publication bias. And though the authors promised, “On encountering funnel plot asymmetry, potentially missing studies were imputed by using the Duval and Tweedie’s trim and fill method,” they never shared the outcome.
Another shortcoming was that only two of the fourteen RCTs blinded the participants, meaning that in twelve RCTs the participants were likely to be aware they were in the EEG neurofeedback group rather than the control group. And that made all the difference. The twelve unblinded RCTs were responsible for all the small-to-medium effect size improvement. There was no sign of improvement in the two blinded RCTs.
The authors tried to give a positive spin to these results, stating “our results supported the use of surface EEG-NF for improving attentional performance through the modulation of basic neurocognitive functioning in patients with ADHD,” while conceding, “However, given the small number of trials and the poor methodological qualities regarding blinding, our findings need to be judiciously interpreted and warrant further investigations for validation.”
A more candid assessment of this meta-analysis would be the one they began with: “The efficacy of surface electroencephalographic neurofeedback (EEG‐NF) for improving attentional performance assessed by laboratory measures in patients with attention‐deficit/hyperactivity disorder (ADHD) remains unclear.”
Hsien‐Jane Chiu, Cheuk‐Kwan Sun, Hsin‐Yi Fan, Ruu‐Fen Tzang, Ming‐Yu Wang, Ying‐Chih Cheng, Yu‐Shian Cheng, Pin‐Yang Yeh, and Weilun Chung, “Surface electroencephalographic neurofeedback improves sustained attention in ADHD: a meta-analysis of randomized controlled trials” Child and Adolescent Psychiatry and Mental Health (2022), 16:104, https://doi.org/10.1186/s13034-022-00543-1.
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A recent study from Istanbul sheds light on how psychiatric admissions and diagnoses changed during the first few months of the pandemic compared to previous periods, offering critical insights for parents, clinicians, and policymakers.
This study, conducted by a team of researchers led by Ozalp Ekinci, examined psychiatric admissions among children and adolescents during 2019 and 2020.
By looking at diagnosis rates for various psychiatric conditions, the researchers aimed to pinpoint shifts in the mental health landscape as a direct response to the pandemic.
The analysis revealed several notable trends in psychiatric diagnoses among children and adolescents:
This study’s findings highlight some key takeaways that can guide mental health support efforts for children and adolescents:
As we continue to see the effects of the COVID-19 pandemic on mental health, studies like this one serve as important reminders of the unique mental health needs of young people. Supporting children and adolescents through proactive and targeted mental health services—especially during times of crisis—will be crucial to fostering resilience and well-being in future generations.
Adult ADHD has long been a subject of debate in the field of mental health, with previous estimates of its prevalence varying widely. To achieve a more precise understanding, an international team of researchers conducted a new umbrella review and meta-analysis, offering an updated estimate of adult ADHD rates worldwide.
This large-scale analysis combined five systematic reviews and meta-analyses, incorporating data from 57 unique primary studies. Altogether, the research synthesized findings from a pooled total of over 21 million participants. This comprehensive approach provided a more accurate estimate of the global prevalence of ADHD in adults.
The study concluded that the worldwide prevalence of adult ADHD is 3.1%, with a 95% confidence interval ranging from 2.6% to 3.6%. This estimate falls within the range of earlier reports but provides a more targeted understanding of the rate at which ADHD affects adults globally.
The researchers described this prevalence rate as “relatively high.” They noted that it is only slightly lower than the estimated prevalence of major mental health conditions like schizophrenia (4%) and major depressive disorder (5%)—disorders that have historically received significant attention and resources worldwide.
Moreover, the prevalence of adult ADHD is higher than that of several other well-known mental health conditions, including bipolar disorder (1%), as well as anxiety disorders such as PTSD (Post-Traumatic Stress Disorder), OCD (Obsessive-Compulsive Disorder), GAD (Generalized Anxiety Disorder), and panic disorders.
This updated estimate emphasizes that ADHD is a significant global mental health concern in adults, comparable to or exceeding the prevalence of other disorders that are often more widely recognized. These findings underscore the need for greater awareness, research, and treatment options for adult ADHD, which is still frequently misunderstood or overlooked in the broader discourse of mental health.
By providing a clearer picture of how prevalent ADHD is in adult populations around the world, this study contributes valuable data that could shape future research, policy, and clinical approaches.
Attention-Deficit/Hyperactivity Disorder (ADHD) remains a prevalent condition among children and adolescents in the United States. A recent analysis based on the National Health Interview Survey (NHIS), conducted by the National Center for Health Statistics at the CDC, provides an updated look at ADHD prevalence from 2018 to 2021. Here’s a closer look at what the data reveals.
The NHIS is an annual survey primarily conducted through face-to-face interviews in respondents’ homes. Telephone interviews are used as a substitute in cases where travel is impractical. For each family interviewed, one child aged 3-17 is randomly selected for the survey through a computer program. Over the four years studied (2018-2021), a total of 26,422 households with children or adolescents participated.
The analysis found that 9.5% of children and adolescents in the United States had been diagnosed with ADHD, based on reports from family members. However, the prevalence varied significantly with age:
The increase in ADHD diagnosis with age underscores the importance of monitoring children’s developmental needs as they progress through school and adolescence.
The survey revealed a notable difference in ADHD prevalence between genders, with 12.4% of males diagnosed compared to 6.6% of females—nearly a two-to-one gap. This aligns with previous research indicating that ADHD is more frequently diagnosed in boys than girls, though awareness of how ADHD presents differently across genders is growing.
Family income played a significant role in ADHD prevalence, particularly among lower-income groups:
This pattern suggests that socioeconomic factors might influence the diagnosis and management of ADHD, with lower-income families possibly experiencing greater barriers to early diagnosis or consistent treatment.
Geographic location also impacted ADHD rates. Prevalence was highest in the South (11.3%), followed by the Midwest (10%), the Northeast (9.1%), and significantly lower in the West (6.9%). These variations could reflect regional differences in healthcare access, diagnostic practices, or cultural attitudes towards ADHD.
Despite these variations in demographics, the overall prevalence of ADHD remained relatively stable across the study period from 2018 to 2021, showing no significant changes by year.
The findings from this updated analysis provide a clearer picture of ADHD’s prevalence across different demographic groups in the United States. They highlight the need for tailored approaches to diagnosis and care, taking into account factors like age, gender, income, and geographic location. With ADHD being a common condition affecting nearly 1 in 10 children, ongoing research and support for families are crucial to ensure that those with ADHD receive the care and resources they need.
This study reinforces the importance of awareness and early intervention, especially for families in underserved regions or those facing economic challenges. As clinicians and educators continue to support children with ADHD, understanding these demographic trends can help in creating more equitable access to diagnosis and treatment.
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