The Main Types of Neurofeedback (NFB) for ADHD and Typical Treatment Settings (Part 2)

Sep 1

In our last post, we introduced neurofeedback (NFB) and explained how your brain’s electrical rhythms—known as brainwaves—affect focus, mood, and mental clarity. We also highlighted how training the brain to regulate these patterns can be especially helpful for people with ADHD, improving attention, decision making, memory, and more.

In this installment, we’ll go deeper into the main types of NFB most often used for ADHD and describe the typical settings where treatment takes place.

The Main Types of NFB for ADHD

There are a dizzying number of options when it comes to NFB. In this blog, we’ll highlight a few of the best-known and most relevant for ADHD:

Traditional (Frequency-Based) NFB: This is the classic and most widely studied approach for ADHD. Sensors measure brainwave activity in real time, and the brain receives positive feedback—such as pleasant sounds or visuals—whenever it produces more optimal rhythms. In ADHD, there’s often too much slow-wave activity (theta) and not enough fast-wave activity (beta). NFB training can help correct this imbalance and “power up” the brain’s ability to sustain focus.
Z-Score NFB: Z-score training adds another objective, data-driven element. A person’s brain activity is compared against a large database of recordings from healthy individuals. The training then nudges activity closer to healthier averages. For ADHD, this can help target both overactive and underactive brain regions more systematically.
fNIRS (Functional Near-Infrared Spectroscopy) NFB: A newer option being studied for ADHD, fNIRS uses safe near-infrared light to track blood flow and oxygen in the brain. By training brain metabolism instead of electrical signals, it offers a different window into how attention can be supported.
LORETA / sLORETA NFB: This advanced form uses complex 3D brain imaging techniques to record and influence electrical activity in deeper regions of the brain, not just at the surface. While not always needed for straightforward ADHD treatment, it can be valuable in tougher cases when attention issues are complicated by mood, trauma, or other co-occurring conditions.

The 4 Main Types of NFB for ADHD at a glance

Traditional: Balances brainwaves (theta/beta)
Z-Score: Compares activity to healthy averages
fNIRS: Tracks blood flow/oxygen in the brain
LORETA: Targets deeper brain structures

What These Approaches Have in Common

Although these approaches differ in technology and sophistication, they all share a common foundation: operant conditioning. In simple terms, the brain is rewarded—through sounds, visuals, or other feedback—when it moves toward healthier patterns of activity. Over time, much like practicing a skill at the gym or on an instrument, the brain “learns” to self-regulate. Whether the feedback is based on electrical signals or blood flow, the goal remains the same: to support more balanced and efficient brain function.

Before starting NFB, many clinics also use an EEG brain map (sometimes called a “qEEG”). This provides a snapshot of how different parts of the brain are functioning and can highlight patterns linked to inattention or overactivity. A brain map can help guide which type of NFB may be most effective, and when repeated after a course of treatment, it can also measure progress and suggest adjustments. Brain mapping can complement any of the methods mentioned above.

Typical Treatment Settings

NFB can be delivered in several ways:

In-Clinic NFB: Provided in a professional office-based setting with personalized oversight. This is often a good place to begin, especially for ADHD. Brain mapping is usually available only in this setting.
At-Home NFB: Portable systems make it possible to train outside the clinic, often with remote support from an NFB professional. Stand-alone devices (with no direct clinician monitoring) exist as well, though these are often less personalized and may not provide objective benchmarks of progress. However, they do offer convenience and accessibility when used thoughtfully.
Hybrid Models: Many people benefit from starting in a clinic to establish a solid foundation, then adding home-based sessions for maintenance and flexibility (still with clinician monitoring). For some, adding a stand-alone home device may also be supportive.

Choosing the Right Setting

The best option isn’t the same for everyone. Children and adults with ADHD may start with clinic-based training for accuracy and support, while others may eventually transition to a hybrid or home-based plan. What matters most is consistency. Just like physical exercise, NFB works best when practiced regularly over time.

Ready to Explore NFB?

Navigating the complexity of this field—and the sheer number of options—can feel confusing or overwhelming. I know, because I’ve experienced many of them myself and even pursued professional training in NFB. At Clarity Integrative Psychiatry, we believe that every brain has its own unique story and its own unique path forward. While our office does not directly provide office-based NFB, we can serve as your pathfinder—helping you make sense of the options and guiding you toward the ones that make the most sense for you. Together, we can explore how to use this powerful tool to help create a healthier brain—and a fuller life.

If you’re curious about whether NFB might be right for you or a loved one, contact us to schedule a consultation.

concierge mental healthadhd

Naveen Thomas, MD

I have been a practicing psychiatrist for nearly 20 years. I graduated from Emory University in Atlanta, Georgia and completed my medical school training at Emory University School of Medicine. I then went on to complete my post graduate psychiatric residency training at the University of North Carolina in Chapel Hill, North Carolina.

I became interested in the field of holistic/integrative psychiatry after experiencing the ongoing frustrations of the primarily medication-centered approach that I was trained in. Many of my patients were experiencing consistently disappointing results in achieving a state of greater healing and peace, despite significant efforts from all concerned. I began to suspect that the conventional allopathic model of medical and psychiatric care that focuses primarily in symptom reduction had very significant limitations.

I was gradually drawn to the field of integrative psychiatry, which emphasizes a more comprehensive approach that takes into account the profound interconnectedness between mind, body, and spirit and looks to address the root causes of challenging mental health symptoms.

My journey into this field formally began with a Fellowship Program through the University of Arizona Center for Integrative Medicine founded by Dr. Andrew Weill. This program taught me to begin to focusing on optimal nutrition diet, gut health, exercise, and mind/body exercises, to name a just a few.

As I began to start practicing the integrative tools that I learned and helping my patients address the root causes of their symptoms, I was delighted to see that more of my patients were making more meaningful gains in their own healing.

I eventually became certified through the Ketamine Training Center in another very powerful tool called Ketamine Assisted Psychotherapy. I have been consistently amazed at the transformations in the lives of my patients that committed to this process.

I look forward to being your partner on your journey to optimal health.