Study: Non-Medication Treatments for ADHD Not as Effective as Stimulants
Stimulants are the most effective treatment for ADHD, according to two recent meta-analyses that found medication outperformed neurofeedback and other therapies.
April 29, 2025
Stimulant medications (amphetamine or methylphenidate) reduce ADHD symptoms better than non-pharmacological interventions, according to a meta-analysis published in The Lancet Psychiatry, which included 113 randomized clinical trials (RCTs) and 14,887 participants aged 19 to 44. 1
The researchers analyzed self-reports and clinician-reported rating scales submitted at 12, 26, and 52 weeks regarding the efficacy of medication and non-medication treatment for ADHD.
“Stimulants were the only intervention supported by evidence of efficacy in the short term (i.e., at time points closest to 12 weeks) for core symptoms of ADHD in adults (both self-reported and clinician-reported) and were associated with good acceptability (all-cause discontinuation),” they said. (Amphetamines and methylphenidate showed no notable difference in effectiveness.)
Atomoxetine, a selective norepinephrine reuptake inhibitor (SNRI), benefited adults with ADHD during the measured time periods, but atomoxetine had worse overall acceptability compared to placebo.
A small body of evidence suggested that non-medication treatment [i.e., cognitive behavioral therapy (CBT), neurofeedback, and relaxation therapy] benefited people with ADHD over longer periods. However, those studies, the researchers noted, had inconsistent results with variations depending on whether the individual with ADHD or their clinician rated the core symptoms.
“Our findings highlight how both individuals with ADHD and clinicians should be considered as sources of evidence, with ratings of symptoms by both groups measured in RCTs,” the researchers said. “Participants in RCTs might report positive effects of the active intervention to please the interviewer (the Hawthorne effect), or might not correctly report the perceived effects of interventions (especially when they feel under pressure from the clinicians and have difficulties with executive function, as is often the case in people with ADHD).”
Neurofeedback Therapy for ADHD Not Effective
A separate meta-analysis published in JAMA Psychiatry examined the results of neurofeedback treatment in 2,472 people with ADHD aged 5 to 40 years from 38 RCTs. 2
The review, led by the University of Southampton, King’s College London, and the University of Zurich, found insufficient evidence to recommend neurofeedback as a front-line treatment for ADHD. According to the researchers, neurofeedback did not significantly reduce ADHD symptoms of inattention, hyperactivity, and impulsivity, and it did not improve cognitive performance in adults. Their findings did show that adults who used neurofeedback gained a slight improvement in their processing speed.
In addition, the researchers did not identify any differences between neurofeedback and other non-pharmacological treatments, such as physical exercise or cognitive training. Newer neurofeedback techniques, such as functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS), also lack the evidence to support their efficacy at treating ADHD symptoms.
Neurofeedback is a distinct form of biofeedback that uses electroencephalography (EEG) to help patients train their brains to improve focus, impulse control, and executive function.
“The effects of neurofeedback don’t really last in the long term,” Stephanie Sarkis, Ph.D., said during the ADDitude webinar “Dispelling Myths About Supplements for ADHD.” “I know people who have used it say they felt more focused after sessions, but then they returned to baseline quickly. Neurofeedback is expensive to get that kind of a result, and insurance doesn’t cover it.”
A 2023 ADDitude survey of more than 11,000 caregivers and adults with ADHD found that 9% of adults and 14% of children have tried neurofeedback for ADHD. Of those respondents, caregivers rated the efficacy of neurofeedback as 2.9, and adults rated it as 2.88, on a five-point scale. In contrast, medication was rated 3.57 by caregivers and 3.52 by adults who responded to the ADDitude survey.
Indeed, the formal effect sizes for ADHD medication are .8 to 1.0, which are among the strongest in all of psychiatry.3 Clinical practice guidelines recommend medication as the first-line treatment for ADHD due to its overwhelming efficacy; for children with ADHD ages 4 to 6, parent behavior training is recommended by the American Academy of Pediatrics (AAP). 4
“Despite continuing progress in our scientific understanding of ADHD, little has changed for decades in terms of treatment,” said Edmund Sonuga-Barke, a professor of developmental psychology, psychiatry and neuroscience at King’s College London and joint senior author on the JAMA Psychiatry report. “Effective alternatives to medication as the front-line treatment for core symptoms are still lacking. The development of new, science-driven, and more effective non-pharmacological approaches for the treatment of ADHD, therefore, remains a priority for our field.”
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1 Ostinelli, E.G., Schulze, M., Zangani, C., Farhat, L.C., Tomlinson, A., Del Giovane, C., et al. (2025). Comparative efficacy and acceptability of pharmacological, psychological, and neurostimulatory interventions for ADHD in adults: a systematic review and component network meta-analysis. Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(24)00360-2
2 Westwood, S.J., Aggensteiner, P., Kaiser, A., Nagy, P., Donno, F. et al. (2025). Neurofeedback for attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2024.3702
3Faraone, S. V., & Buitelaar, J. (2010). Comparing the efficacy of stimulants for ADHD in children and adolescents using meta-analysis. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-009-0054-3
4Centers for Disease Control and Prevention. (2022, March 8). Treatment recommendations for healthcare providers. https://www.cdc.gov/adhd/hcp/treatment-recommendations/index.html
