Neurofeedback: The Alternative to ADHD Medication
– By Bob Gottfried, PhD
Children with Attention Deficit Hyperactivity Disorder (ADHD) exhibit impulsive behavior, pronounced hyperactivity and attention difficulties. 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 psychostimulant (like Ritalin). Originally, 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. 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 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. Finally, an individual in a drowsy or daydreaming state generates theta and delta waves . Since most ADHD subjects present abnormally high theta oscillations and low beta oscillations , the most common protocol is designed to stimulate the high-frequency beta activity, and suppress the low-frequency theta activity, simultaneously. Therefore, these sessions are designed to teach an ADHD subject how to maintain brain wave patterns consistent with the suppression of hypertension and inattention, essentially giving them back control over their emotions.
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 . Live monitoring of the electroencephalogram (EEG) allows the therapist to guide the subject toward a specific mental state typical for an individual experiencing focus and attention. The subject watches a video game in which the screen brightness and motion of a figure are preset to threshold values, while remaining as peaceful as possible. Each time the EEG indicates that the patient generates the desired wave pattern, a positive reinforcement is given by increasing the screen brightness or making the figure move faster. On the other hand, if the brain waves drift toward undesirable frequencies, the therapist hinders the video game experience. While neurofeedback training causes a significant reduction of all major ADHD symptoms in nearly 80% of the patients within 10 sessions, it is recommended to complete 40 sessions (4-6 months; 2/3 sessions of 45 minutes/week) for a long-term suppression of inattention and hyperactivity . 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 . 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 ADHD 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 still 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 Ritalin?
Over the past 30 years, numerous clinical trials demonstrated a significant and 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  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 . 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 the will to interact socially with a positive attitude.
Bob Gottfried PhD is the clinical director of ACEclinics located in Toronto, Canada. WWW.ACEclinics.com
He specializes in neuro-cognitive treatment to treat ADD, ADHD, LD and other neuro-cognitive disorders.
1. Linden, M., Habib, T. & Radojevic, V. (1996) A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities., Biofeedback Self Regul. 21, 35-49.
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.
4. van Dongen-Boomsma, M., Lansbergen, M. M., Bekker, E. M., Kooij, J. J., van der Molen, M., Kenemans, J. L. & Buitelaar, J. K. (2010) Relation between resting EEG to cognitive performance and clinical symptoms in adults with attention-deficit/hyperactivity disorder., Neurosci Lett. 469, 102-106.
5. Fleischman, M. J. & Othmer, S. (2005) Improvements in IQ score
Keywords: ADHD, ADD, brain waves, Biofeedback, EEG, Neurofeedback, Ritalin, neuro-cognitive training
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