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ORIGINAL RESEARCH article

Front. Hum. Neurosci.
Sec. Brain Health and Clinical Neuroscience
Volume 19 - 2025 | doi: 10.3389/fnhum.2025.1478501
This article is part of the Research Topic Transdiagnostic approach in studying mental health conditions: The contribution of fundamental and translational brain research for precise interventions View all articles

Effects of a Novel Non-Pharmacological Intervention Based on Respiratory Biofeedback, Neurofeedback and Median Nerve Stimulation to Treat Children with ADHD

Provisionally accepted
Eduardo Santamaría-Vázquez Eduardo Santamaría-Vázquez 1,2,3Maria Anayali Estudillo Guerra Maria Anayali Estudillo Guerra 3Lna Ali Lna Ali 3Diana Martinez Diana Martinez 4Roberto Hornero Roberto Hornero 1,2Leon Morales-Quezada Leon Morales-Quezada 3*
  • 1 Biomedical Engineering Group, University of Valladolid., Valladolid, Spain
  • 2 Centro de Investigacion Biomedica en Red en Bioingenierıa, Biomateriales y Nanomedicina, Spain, Zaragoza, Spain
  • 3 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States
  • 4 Boston Neurodynamics, Boston, United States

The final, formatted version of the article will be published soon.

    Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects cognitive, academic, behavioral, emotional, and social functioning, primarily in children. Despite its high prevalence, current pharmacological treatments are not effective in 30\% of cases and show poor long-term adherence. Non-pharmacological interventions can complement medication-based treatments to improve results. Among these therapies, neurofeedback (NFB) and respiratory biofeedback (R-BFB) have shown promise in treating ADHD symptoms. Moreover, median nerve stimulation (MNS) can help to enhance the efficacy of these treatments, but it has never been explored in this context. This study aimed to: (1) investigate the effectiveness of a combined R-BFB and NFB intervention to treat ADHD, and (2) explore the potential benefits of MNS in enhancing the proposed intervention. Sixty children with ADHD participated in the study, divided into two experimental groups. The active group received verum MNS, and the sham group received sham MNS. Both groups performed the NFB/R-BFB treatment. Clinical assessments (i.e., Conner’s parent rating scale) and electroencephalography (EEG) measurements were taken before the intervention, immediately after treatment, and one month later. The results showed that the combined therapy significantly improved behavioral problems, anxiety, hyperactivity, and impulsivity-hyperactivity. Moreover, MNS enhanced the positive effects of the intervention, as the active group achieved higher improvement compared to the sham group. EEG analysis revealed significant changes in spontaneous brain activity, with an increase in frontal theta power (p = 0.0125) associated with reduced anxiety, which might explain the clinical outcomes. These changes were maintained one month after the intervention (p = 0.0325). Correlations between EEG changes and clinical outcomes were observed, suggesting a potential relationship between neurophysiological markers and ADHD symptoms measured by standardized scales. The study findings suggest that the proposed R-BFB/NFB intervention may be an effective non-pharmacological therapy for ADHD, with the additional application of MNS potentially enhancing its effects.

    Keywords: Attention and hyperactivity deficit disorder (ADHD), median nerve stimulation (MNS), Neurofeedback (NFB), Respiratory biofeedback, Electroencephaloagraphy (EEG)

    Received: 09 Aug 2024; Accepted: 13 Jan 2025.

    Copyright: © 2025 Santamaría-Vázquez, Estudillo Guerra, Ali, Martinez, Hornero and Morales-Quezada. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Leon Morales-Quezada, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, 02129, Massachusetts, United States

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