Ask This One Question Before You Try Neurofeedback for ADHD

What do CBT, DBT and ACT work on?

The letters are the first thing that trips people up. Michelle Frank, a clinical psychologist, sorts them out in about five minutes. CBT stands for cognitive behavioral therapy. It is talk therapy about thoughts, feelings and actions. Frank calls it probably the most studied talk therapy for ADHD.

She is also honest about what it does not do. It will not give you a better memory. What it changes is how you cope. That means your self-talk. It also means how you face a task that feels hard. We like that she says so. An honest limit is a good sign in any kind of help.

Two more sets of letters come from the same family:

• DBT is a form of CBT. Frank says it helps people “turn down the volume” on strong feelings. It teaches coping skills. It also helps people speak up for what they need.
• ACT is a type of CBT too. It does not argue with hard thoughts. It helps you notice them, step back, and act on what matters to you. Frank calls it getting out of the tug of war with your thoughts.

Our view: match the therapy to the struggle. Big, fast feelings point toward DBT. Getting stuck in the same worried loop points toward ACT. Ask a therapist which one they would pick, and why.

Why is good help a mix and not one thing?

Frank opens the video with a list, not a single answer. She names therapy, skills training or coaching, and medication. She says a combination of them works best. Later she adds sleep and exercise. For children, she names social skills groups, occupational therapy, and supports at school. Her word for the whole mix is multimodal. It sounds clinical, and it means a combination of things.

Medication is a choice for you and your prescriber. We take no side on it. The rest of the list has something in common. Each part asks you to practice. Coping skills get practiced in and out of the therapy room. Sleep and movement get built into the day, one small habit at a time.

An old belief says you are born with the brain you have. We see it another way. Our position is that focus and coping are skills built through practice. They are not fixed limits. Focus grows from practicing real tasks, not from games that promise to train it.

This part is good news for you. Sleep and movement are yours to shape at home, starting tonight. Nobody needs a clinic for a steady bedtime. Pick one small step this week. Try a fixed lights-out time, or a walk before homework.

How do you tell a real result from a hopeful one?

Near the end, Frank turns to neurofeedback. Sensors on the head feed a game or a show. The screen rewards the brain when it stays alert. She describes the goal as changing brainwave patterns over time. This is the part where we slow down.

Here is the one question to ask. Did it still work when people did not know if their session was real? Good trials give some people a fake session that looks the same. If the gain fades once nobody knows, the sessions were not the reason.

Three follow-up questions help you read the answer:

• Was there a group that got a fake session?
• Did the people scoring the results know who got which?
• Did the gains hold after the sessions stopped?

One study shows why the question matters. Foroughi and colleagues (2016) put up two flyers for the same one-hour training. One flyer promised brain training. The other did not. Only the group that answered the brain-training flyer improved on a reasoning test. It was one study, in college adults, and it did not test neurofeedback. It is still a good reason to be careful with any brain-training promise.

Our view: a brainwave program is a hope until it beats a fake session. Ask the clinic to name its best trial with one. The same question works in the supplement aisle, too. Then put your hours where the practice is.