Among NF practitioners there seems to be nearly universal agreement that this can be a highly effective treatment for many cases of attention deficit hyper-activity disorder (ADHD) in both children and adults. This may be especially true for cases of ADHD that involve cortical underarousal, and a growing body of research using brain imaging techniques such as functional magnetic resonance imaging (fMRI) and QEEG suggests that these may constitute the majority of cases. Relatedly, among the first and still most commonly used NF protocols for attention disorders is one designed to increase cortical activation (b or SMR amplitude) at frontal and/or central (e.g., Cz) scalp sites (often with simultaneous training of decreases in 0 or a and 0 amplitude). Joel and Judith Lubar pioneered this protocol, which in its original or slightly modified form continues to be considered highly effective. Some practitioners believe that NF can be effective as the sole treatment procedure, but most appear to advocate its use as a supplement to stimulant medication and/or psychological techniques such as family therapy, education about ADHD, and cognitive behavioral modification procedures. Indeed, some report past experiences in which a chaotic family situation seemed to prevent NF progress and refuse to treat children from highly dysfunctional families until that situation is addressed either before or during NF.
Whereas concurrent use of stimulant medication is often recommended and sometimes considered essential to enable the patient to attend sufficiently to the feedback stimuli during early sessions, there are frequent reports that less medication is needed as treatment progresses. In fact, some practitioners have reported that failure to adjust medications during treatment interferes with NF progress. In some cases the client reportedly has been able to cease the use of medication while remaining symptom-free.
The author's survey of highly experienced NF practitioners mentioned earlier found 42 NF treatment sessions (range = 25-60) to be the average number reported to be necessary for optimal results with attention deficit disorder without hyperactivity (slightly more when hyperactivity also was present). Many practitioners recommend having the client engaged in "challenge tasks" such as reading, writing, and listening during NF training, especially during later sessions. This is believed to facilitate the generalization of desired EEG changes to relevant real life situations. Ten-year (and more) follow-up of successfully treated clients has indicated that they remain symptom-free, suggesting a permanent "cure." However, it also commonly is recommended that some clients return a few times annually for "tune-up" sessions to help reinforce the ability to appropriately self-regulate the EEG. All practitioners have encountered situations, in which the usual protocols for ADHD were ineffective. When this occurs, common recourses are to reevaluate the QEEG findings to determine whether other protocols might be more appropriate (e.g., training coherence between certain scalp sites, decreasing rather than increasing activation at specific sites) and checking further into the client's background to determine whether factors such as lack of motivation, use of illegal drugs, or family, psychiatric, or other medical problems are precluding progress (or are the true cause of the ADHD symptoms).
Although there are some vocal critics whose views range from considering NF with ADHD a promising but experimental procedure in need of more research to considering it a passing fad capitalizing on placebo effects, many case reports and a few small-scale studies involving control groups have supported the efficacy of NF for treatment of ADHD. A large multisite research study on NF and ADHD currently is in progress, and results should lend greater credibility to NF as a useful treatment. However, the definitive large-scale study incorporating double-blind procedures demanded by some NF critics remains to be done. Although ADHD is the disorder for which NF currently most often is used, several others will be discussed briefly in the following paragraphs.
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