Comparative Effectiveness of Neurofeedback and Cognitive Behavioral Therapy on Inattention, Anxiety, and Hyperactivity in Children With Attention-Deficit/Hyperactivity Disorder

Mojtaba Ansari; Maryam Kalhornia Golkar; Maryam  Kaviani; Robabe Ataifar

Authors

Mojtaba Ansari Department of Psychology, Ki.C., Islamic Azad University, Kish, Iran. Author https://orcid.org/0000-0003-3824-4863
Maryam Kalhornia Golkar Department of Psychology, Ka.C., Islamic Azad University, Karaj, Iran. Corresponding Author https://orcid.org/0000-0002-6193-5649
Maryam Kaviani Department of Psychology, Ka.C., Islamic Azad University, Karaj, Iran. Author https://orcid.org/0009-0006-2291-3443
Robabe Ataifar Department of Psychology, Ka.C., Islamic Azad University, Karaj, Iran. Author https://orcid.org/0000-0001-6865-4842

Keywords:

attention-deficit/hyperactivity disorder, neurofeedback, cognitive behavioral therapy, inattention, anxiety, hyperactivity, children

Abstract

This study aimed to compare the effectiveness of neurofeedback and cognitive behavioral therapy (CBT) in reducing inattention, anxiety, and hyperactivity among children with attention-deficit/hyperactivity disorder (ADHD). This quasi-experimental study employed a three-group pretest–posttest–follow-up design with a no-treatment control group. Sixty children aged 7–12 years with DSM-5-confirmed ADHD in Karaj, Iran, were purposively recruited and randomly assigned to neurofeedback, CBT, or control groups (n = 20 each). Neurofeedback consisted of 20 twice-weekly 40-minute sessions, whereas CBT consisted of nine weekly 45–60-minute sessions. Inattention, hyperactivity, and anxiety were assessed using the Integrated Visual and Auditory Continuous Performance Test, Conners Parent Rating Scale, and Spence Children’s Anxiety Scale, respectively. Data were analyzed using mixed repeated-measures analysis of variance and Bonferroni-adjusted pairwise comparisons in SPSS 26. Significant time-by-group interactions were observed for inattention, F(4, 114) = 357.89, p < .001, partial η² = .926; hyperactivity, F(4, 114) = 498.74, p < .001, partial η² = .946; and anxiety, F(3.56, 101.65) = 677.19, p < .001, partial η² = .960. Neurofeedback significantly outperformed CBT for inattention at posttest (mean difference = −1.40, p = .006) and follow-up (−1.50, p < .001), and for hyperactivity at posttest (−1.50, p = .006) and follow-up (−1.35, p ≈ .028). Both interventions significantly outperformed the control condition. Although CBT produced lower anxiety scores than neurofeedback, between-treatment differences were not significant at posttest (p = .080) or follow-up (p = .090). Both neurofeedback and CBT appear effective in producing sustained improvements in inattention, hyperactivity, and anxiety among children with ADHD. Neurofeedback demonstrated a comparative advantage for core attentional and hyperactivity symptoms, whereas the two interventions showed comparable effectiveness for anxiety reduction. These findings support symptom-oriented treatment selection while emphasizing the need for larger and methodologically rigorous comparative trials.

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