Neurofeedback improves ADHD symptoms

Last Updated: 2006-11-23 12:20:17 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Children with attention deficit/hyperactivity disorder (ADHD) can be trained through biofeedback to regulate their brain waves, investigators in Germany report. This learned control is associated with durable improvements in behavior, attention and IQ scores.

Dr. Ute Strehl and her colleagues at University of Tubingen explain that neurofeedback is used to modify activity of the brain, specifically of slow cortical potentials for patients with ADHD.

Although previous studies have shown the improved self-regulatory capacities in this patient population, no reports included electroencephalogram (EEG) data during learning and follow-up. An EEG measures the brain's electrical activity.

Their study included 23 children with ADHD, ages 8 to 13 years, who were told the purpose of the training was to "speed up their brain to maintain concentration in situations that are normally difficult," such as conversations or homework.

The training was introduced as a computer game. The subjects faced a computer that provided visual feedback in the form of movement of a ball, in which the position of the ball reflected amplitude of brain waves. Auditory feedback was also given and the children received small gifts at the end of a session based on the number of accurate responses.

While viewing a ball on the screen, they were told "to be attentive to the feedback and to find the most successful mental strategy to move the ball into the required goal."

The subjects completed 30 one-hour sessions divided into three phases. Each phase lasted for 2 weeks and the training sessions were held 5 days per week. After each phase was completed, the subjects took a 6 to 8-week break. During the last phase, the children worked on their homework while they applied the self-regulation strategy they had learned.

At the end of the training and at a 6-month follow-up, EEG tests indicated that the children had learned to regulate negative slow cortical potentials. Two of the subjects at the end of training and three at follow-up no longer fulfilled the diagnostic criteria for ADHD.

Performance IQ scores on Wechsler Intelligence Scale for Children, and measures of attention improved significantly from screening to follow-up.

Pediatrics November, 2006.

I'm not totally convinced yet...

The problem I've noticed with a lot of these studies over the past few years that have been done into neurofeedback and ADHD is the way they've been conducted including the very small number of participants usually.

The one above has 23 children. I've not read the original article yet, but that's what it says there. There was one study out of New Zealand with seven children. The last one I've posted uses 18. The list goes on. If they're serious about this, they need to sort out their clinical trial criteria and at least start using larger sample sizes.

J Atten Disord. 2003 Sep;7(1):43-55.
EEG biofeedback vs. placebo treatment for attention-deficit/hyperactivity disorder: a pilot study.

Heywood C, Beale I.
Arohanui Special School, Te Atatu South, Auckland, New Zealand.

http://www.biof.com/linden.html
A CONTROLLED STUDY OF
THE EFFECTS OF EEG BIOFEEDBACK
ON COGNITION AND BEHAVIOR OF CHILDREN
WITH ATTENTION DEFICIT DISORDERS
AND LEARNING DISABILITIES

Michael Linden, Ph.D.; Thomas Habib, Ph.D. Vesna Radojevic, Ph.D.
Mission Psychological Consultants

Very interesting.

Hi, I don't read in this forum much, but I post in the TOS forum regularly. Sorry to crash but I saw this thread and have relevant experience, happy to share it...

I put my (then) 12yo daughter into neurofeedback. She was newly diagnosed at the time (hit major wall in 7th grade leading to evaluation and dx)

She has fairly severe add...and more of a hyperactive brain than one that has trouble turning on. (kind of like Dr Amen's ring of fire type) We did quantitavtive EEG testing at the neurofeedback clinic she went to which is where I got this interpretation of her brain activity. And yes people will argue that quantitative EEG is not accurate enough to be used as a measure so I only offer it up for what it is: a quantitative EEG that may or may not be meaningful.

That being said, we attended on the order of 60 neurofeedback sessions. THe dr in charge thought that my daughter would require about 40 more when we stopped. We quit because we were going 3-4 days a week and it was very time consuming due to the travel involved, my daughter hated it, and I eventually lost the fight to ge ther to go. She was having very good results with COncerta, so we tabled it.

In any case, I just wanted to offer up my thoughts and observations. We personally knew three other families trying this technique with kids of various ages. (SO we almost make up a small study? lol) Also, my daughter and I were working with the only known local psychiatrist who believed that neurofeedback was a viable treatment for ADD.

I personally found the following:

1. Neurofeedback did help my daughter. She currently takes 72mg/day of Concerta, on neurofeedback she only required 54. Perhaps we could have brought it down more if we had finished, but I don't know.

2. The effects of the Neurofeedback wore off slowly and I think they were basically gone after about 6 months.

The other families I know have had similar results, and the psychiatrist and pediatrician both echoed that they had seen the same thing happen with others.

So, depends on what you want out of it- it is not a miracle cure, but is can be helpful. And if the Dr. that runs your neurofeedback clinic tells you that you do it once (well, that first batch of 60-100 visits, anyhow) and it lasts forever, don't believe him or her, expect to have follow visits to maintain the progress.

I think if I had a younger child or one that did not respond well to meds I would have stuck with it. As it was, my daughter (now 14) is doing very well- her ability to do schoolwork, make friends, deal with pressure, stay organized, etc, has really gotten so so so so much better that I am not inclined to change what we are doing which is basically behavior mod, regular counseling, and Concerta.

hope I have been helpful to someone out there.

please feel free to PM me if you have specific questions


Johanna

My son has been recently diagnosed with ADD (the Dr. says he's not hyperactive, but he's been fooling me). I believe I have a case of undiagnosed ADD. Anyway, my son, in the first grade, was having several problems at school, not listening to teachers, fidgety, not starting tasks on time, not following directions, not finishing tasks on time, excessive talker, etc. However, he was (and is) in the most advanced reading & math classes and is a very bright and a happy (almost too goofy) child.

Anyway, once diagnosed, my spouse (and I to an extent) opposed medicating him because of potential side effects. Our pediatrician gives speeches on behalf of one of the major pharmaceutical companies that produces one of primary drugs used in the treatment of ADHD. He said its simple to treat and wanted to start prescribing meds. We asked about neurofeedback and apart from trying to mask his suspicion that we were from another planet, he kindly informed us that it couldn't hurt to try. I think he is betting that we will return shortly for him to medicate our son's condition.

In extensively researching ADD on the web (reading everything I could), I came across the technology provided at www.smartbraingames.com and a number of articles on the subject. We decided to try it at home on our own withoot physician oversight. (All in, I would say the cost is about $750-$800, when buying a playstation 2, new video game, electrolyte water, and the braingame system).

My wife agrees that we have seen significant improvement in our son since trying it out, but we also agree there is more to go. He has undergone 22 sessions at home (about 20-30 minutes) over the course of 6 weeks. I've done about 26 sessions. Basically, the technology has three sensors, one placed on the middle-top of your head and one behind either ear with an admittedly funny looking velcro visor to hold the sensors in place. You have to make sure the sensors are thoroughly soaked in water (20-30 minutes of soaking) before conducting a session. It helps the sensor read/monitor your brain waves.

We bought Playstation 2 and the game, Grand Tourismo 4. We consistenstly race the same car (Ford Mustang) around an oval test track during sessions because apart from the brain game's technology that gives you feedback in the form of one or a pair of tones as well as loss of stearing, it also controls your speed (you go faster when you are concentrating in a calm and controlled state). With the same car and track each time, my son knows whether he is doing well or not (and so do I) based on mph at any time and time per lap and time per session (7-8 laps at 3 to 4min per lap). When I am racing at my peek, I can get the Mustang up to 135mph and generally hover between 120mph and 130mph. My son has hit 120mph, but generally is between 100 to 110mph. However, when he daydreams, he can fall to 60 to 70mph and I mention something and he gets back into the game and racing faster again. Without the braingame system turned on, the Mustang and max out at 150mph.

The other day I asked his teacher how he was doing and she said she's seen a "marked improvement" and "he had a great day yesterday"...a day he did the neurofeedback. The teacher does not know that he has been diagnosed with ADD or that he is undergoing home therapy. (I know...you should do this under the guidance of a trained therapist, but I'm not going to address that point considering the extensive cost and time). The teacher did complete an ADHD survey for our pediatrician (I think it was the Hawthorne test), which, based on those results and those of another teacher assisted in formulating the diagnosis. I am going to request that they complete the survey again after 40session.

As for me, I have noticed extraordinary gains in my ability to maintain attention at work. We typically conduct the sessions in the morning, particularly since the day I did one after dinner and couldn't go to sleep til 2:00 a.m. because my brain was racing. I was just too alert.

Anyway, I could go on and on about it, but I believe it really works. The home version is probably good enough if you don't have an extreme case of ADD and you are willing to take the time to be in charge of helping your child or yourself help themselves to the next level personal control and awareness.

I"d like to add my 2 cents.... My son has tourette syndrome and we tried neurofeedback. At first it seemed to help with his attention span, but as far as helping with the tics and vocalizations, i cant say that it did. Insurance would not pay for it, so we stopped the sessions as it became VERY expensive. He is now 16 and doing quite well. If i knew then what i know now, i probally would not have tried it....
vicky

Most of the drugs for ADD have been around for 50 yrs or more, and yet news stories make them sound frightening. Ain't necessarily so. They are time tested. Moreover, once you go on them, you learn how to behave and do not need them as much.