To facilitate decision support in freshwater ecosystem protection and restoration management, habitat suitability models can be very valuable. Data driven methods such as artificial neural networks (ANNs) are particularly useful in this context, seen their time-efficient development and relatively high reliability. However, specialized and technical literature on neural network modelling offers a variety of model development criteria to select model architecture, training procedure, etc. This may lead to confusion among ecosystem modellers and managers regarding the optimal training and validation methodology. This paper focuses on the analysis of ANN development and application for predicting macroinvertebrate communities, a species group commonly used in freshwater assessment worldwide. This review reflects on the different aspects regarding model development and application based on a selection of 26 papers reporting the use of ANN models for the prediction of macroinvertebrates. This analysis revealed that the applied model training and validation methodologies can often be improved and moreover crucial steps in the modelling process are often poorly documented. Therefore, suggestions to improve model development, assessment and application in ecological river management are presented. In particular, data pre-processing determines to a high extent the reliability of the induced models and their predictive relevance. This also counts for the validation criteria, that need to be better tuned to the practical simulation requirements. Moreover, the use of sensitivity methods can help to extract knowledge on the habitat preference of species and allow peer-review by ecological experts. The selection of relevant input variables remains a critical challenge as well. Model coupling is a missing crucial step to link human activities, hydrology, physical habitat conditions, water quality and ecosystem status. This last aspect is probably the most valuable aspect to enable decision support in water management based on ANN models.