Slow Cortical Potential Versus Live Z-score Neurofeedback in Children and Adolescents with ADHD: A Multi-arm Pragmatic Randomized Controlled Trial with Active and Passive Comparators.

Some ratings favored Live Z-Score over usual care, but neither neurofeedback approach outperformed working-memory training. Results varied by rater and assessment time.

Hasslinger J, Bölte S, Jonsson U.
Research on child and adolescent psychopathology · Publication date: 2021-09-03
Added to site: 2026-09-09
DOI: 10.1007/s10802-021-00858-1

First published online September 3, 2021; journal issue April 2022.

Modalities

Neurofeedback, Live Z-Score, Z-score, 2-channel

Clinical focus

ADHD, Attention

Population

Children and adolescents with ADHD, ages 9–17

Sample

217 randomized; 202 participated; 180 completed some final assessment

Intervention / method

25 sessions of two-channel Live Z-Score or slow cortical potential training

Comparator

Working-memory training and treatment as usual

Clinician summary

This four-arm trial included six-month follow-up. Selective teacher-rated advantages did not establish broad clinical superiority.

How to interpret the findings

Imperfect blinding and unadjusted multiple comparisons. Transient stress-related symptoms were frequent; no serious or lasting adverse events were reported.

Equipment and disclosures

Live Z-Score used BrainMaster Atlantis II with the Applied Neuroscience database. This was two-channel, not 19-channel training.

Funded by Region Stockholm and ALF PPG; open-access support from Karolinska. Bölte disclosed Medice/Roche work and textbook/test royalties.

Related evidence

Compare findings from the same clinical area, including mixed results.

• Error Related Negativity and Error Positivity: Neural Indices of Double-Faults in Elite Athletes. · Positive with limitations
• Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. · Positive with limitations
• Neurofeedback for Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. · Mixed
• Attention, Executive Function, Behavior, and Electrocortical Function, Significantly Improved With 19-Channel Z-Score Neurofeedback in a Clinical Setting: A Pilot Study. · Positive with limitations
• Infra-low frequency neurofeedback impact on post-concussive symptoms of headache, insomnia and attention disorder: Results of a randomized control trial. · Positive with limitations
• The potential of infra-low frequency neurofeedback training in peak performance: The first double-blinded placebo-controlled longitudinal study in healthy adults. · Neutral / negative
• Efficacy and safety of noninvasive brain stimulation for ADHD: a systematic review and meta-analysis of double-blind randomized controlled trials across international English and Chinese databases. · Positive with limitations
• ADHD classification using spherical phase space partitioning and symbolic time series analysis of multi-channel EEG signals · Positive with limitations