By

Bob Gottfried, PhD

Keywords: ADHD, ADD, brain waves, Biofeedback, EEG, Neurofeedback, Ritalin, learning disabilities, neuro-cognitive training, ace clinics, aceclinics

Background

Children with Attention Deficit Hyperactivity Disorder (ADHD) exhibit impulsive behavior, attention difficulties and at times pronounced hyperactivity. They may also present a wide range of emotional symptoms (depression, anxiety, defiance, obsessive-compulsive disorder). At times even recurrent physical complications (immune system deficiencies, bed wetting and headaches). The most common approach to treatment has so far been using a psycho stimulant (like Ritalin). Orginally, ADHD was considered a psychological based condition, but we now know that ADHD is a neurological disorder, or more precisely, a neuro-cognitive disorder. However, Ritalin is reported to cause significant side-effects, including abdominal pain and loss of appetite and sleeping problems which is problematic especially for teens at the peak of development. Other ADHD medication can produce similar or other side-effects. For this reason, alternative forms of treatment have been explored to avoid the use and abuse of pharmaceutical agents.

What is Neurofeedback Training?

This non-medicinal therapy was originally proposed for the treatment of ADHD because hyperactivity and inattention are associated with abnormal brainwaves. There are four major different types of brainwaves: alpha, beta, delta or theta. In a relaxed and unfocused state, we typically generate alpha waves. In contrast, an alert state reached during a problem solving activity is associated with beta waves. Delta waves are associated with sleep. Finally, an individual in a drowsy or daydreaming state generates theta (and or alpha) waves [1]. Since most ADHD subjects present abnormally high theta or alpha oscillations and low beta oscillations [2], the most common protocol is designed to stimulate the high-frequency beta activity (specifically low beta), and suppress the low-frequency theta and or alpha activity, simultaneously. Therefore, these sessions are designed to teach an individual with ADD or an ADHD subject how to maintain brain wave patterns consistent with the suppression of hyperactivity and inattention, essentially giving them back control over their emotions. This protocol also applies to individuals experiencing different learning disabilities (LD)

During the a traditional training session, sensors are fixed on the scalp and ears of the ADHD individual to record the electrical activity forming the brain waves [3]. New EEG technology (Infra Red) is easier to apply. Live monitoring of the electroencephalogram (EEG) allows the clinician to guide the subject toward a specific mental state typical for an individual experiencing focus and attention. The subject follows a certain activity on a screen, while remaining as peaceful and focused as possible. The EEG system rewards the user when doing well. . This positive reward method encourages the user to improve performance over time. While Neurofeedback training causes a reduction of all major ADHD symptoms in nearly 80% of the patients within 10 sessions, it is recommended to complete at least 40 sessions (4-6 months; 2/3 sessions of 45 minutes/week) for a long-term suppression of inattention and hyperactivity [4]. It appears that once the brain has learned to operate properly again, it does not relapse. Interestingly, a study conducted on ADHD teenagers reported an average increase in IQ of 23 points [5]. The authors argue that they did not make the children smarter, but simply allowed their inherent mental ability to be more available for the learning experience.

Lately, advanced technology allows individuals with ADD, ADHD and LD to get the Neurofeedback benefits without the need for hardware (instruments and electrodes). One such neuro-cognitive training program developed at the ACEclinics in Toronto, Canada, enables the person to train at home. This training, which is done under clinical supervision, has not only made the training more convenient by eliminating the need to visit a clinic 3-4 time a week, but has also made the program significantly more affordable.

Can Neurofeedback Training Replace Medication?

Over the past 20 years, numerous clinical trials demonstrated a significant suppression of hyperactivity and inattention in ADHD patients during and after Neurofeedback training. Studies showed that this approach can be more efficient than Ritalin [6-8], and in more severe cases a protocol combining Neurofeedback training and Ritalin resulted in behavioral improvements superior to those observed with the drug alone [9] at least until Neurofeedback can create enough changes.

What Does the Future Hold?

Most research groups and clinics adopted a standard Neurofeedback training protocol for the treatment of ADHD. However, there is considerable variability in theta and beta brainwave activities between ADHD individuals [4, 10], suggesting that better outcomes may be reached by designing Neurofeedback protocols customized for each subject [4]. An important benefit of Neurofeedback is that it gets the person involved in the treatment, putting him back in control. When it comes to students, when the academic performance improves, the child recovers self-esteem and is willing to interact socially with a positive attitude.

Neuro-cognitive Therapy and Training

ADHD is a neuro-cognitive disorder and therefore only a neuro-cognitive approach can correct some or all the problems related to the condition. Neuro cognitive therapy and training has shown excellent results treating attention deficit disorders and learning disabilities with marked improvement on all levels. Improving brain regulation combined with developing all core skills such as visual processing, auditory processing, divided attention, multitasking, working memory and more, as shown at the ACEclinics, can contribute to considerable and permanent gains in cognitive performance and significant reduction in ADHD related symptoms.
 

Bob Gottfried, PhD is the clinical director of ACEclinics located in Toronto, Canada. He specializes in neuro-cognitive assessment and treatment of attention deficit hyperactivity disorders (ADD, ADHD), learning disorders (LD), dyslexia, Asperger syndrome, auditory processing disorder (APD), non-specific neuro-cognitive and memory deficiencies, as well as anxiety and stress disorders.


References


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2. Barry, R. J., Clarke, A. R. & Johnstone, S. J. (2003) A review of electrophysiology in attention-deficit/hyperactivity disorder: I. Qualitative and quantitative electroencephalography., Clin Neurophysiol. 114, 171-183.
3. Monastra, V. J., Lynn, S., Linden, M., Lubar, J. F., Gruzelier, J. & LaVaque, T. J. (2005) Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder., Appl Psychophysiol Biofeedback. 30, 95-114.
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