Neurofeedback and ADD/ADHD: Why Now

When researchers learned that human beings (and animals as well) have the ability to recondition and retrain brainwave patterns, a form of therapeutic training emerged that was dubbed EEG biofeedback or neurofeedback or simply NFB. Research has revealed four primary types of brainwaves, delta, theta, alpha, and beta. Each is found throughout the brain, and their relative relationship, power, and capacity to work together profoundly affect all aspects of how we function. From sadness to happiness, from distracted to focused, from forgetfulness to a razor-sharp memory…these are all influenced by these brainwaves. Sleep, mood, motivation, and energy are also transformed when these brainwave patterns are re-trained for optimal performance.

How Neurofeedback Works

How is inefficient brainwave function detected and then trained to work properly? After all, we have no way of observing or influencing our circulatory or digestive systems and only pharmaceutical intervention will alter their function. Sensors are placed on the scalp and earlobes and the brain’s electrical patterns are measured and its activity is conveyed to a computer. With sophisticated amplifiers and software, we can then see exactly what is happening in the brain.

Neurofeedback uses operant conditioning, proven to work in thousands of studies, to re-train the brain (Cortese et al., 2016). Patients are given real-time visual and auditory feedback about their brains’ brainwave patterns. That neuro-feedback, over time, allows them to change those patterns. This process is similar to the way in which one exercises or is trained by a physical therapist but, instead of improving bodily function, there is a gain in cognitive control and mental flexibility.

Neurofeedback Training for ADD and ADHD

In terms of attention-deficit disorders, both ADD and ADHD, neurofeedback training will often focus on theta (and sometimes alpha) brainwaves which, in those cases, are both excessive and slow. That leads to difficulty in controlling one’s attention, behavior, and/or emotions, as well as problems with concentration, memory, impulsivity, and intellectual efficiency.

In recent years, however, the advent of neurofeedback mapping has added a greater diagnostic understanding of the other problems in brainwave activity and allows for a more focused and specialized treatment protocol.

Effectiveness for ADD and ADHD

Is neurofeedback training an effective form of treatment? Going beyond theta and alpha brainwave activity, Zhang et al. (2018) focused on resting brain activity and lower arousal of patients’ central nervous system. The researchers determined that patient activation of delta brainwaves led to improved executive function, which is the regulation of one’s thoughts and behaviors.

As early as 1976, Lubar and Shouse reported that the use of EEG training reduced children’s hyperkinetic activity. Slightly less than twenty years later, Lubar, Swartwood, Swartwood, and O’Donnell (1995) examined the long-term use and effects of neurofeedback training for children diagnosed with attention-deficit disorders.

Here are the quite remarkable results from this study: They found that, for 80% of clients, symptoms of ADD and ADHD were significantly improved and, perhaps even more importantly, those changes were maintained over a 10-year period. Their research was highlighted and underscored by Hammond (2011), who found that seventy-five to eighty percent of the time, those improvements, only from NFB, become permanent through ongoing feedback, coaching, and practice (p. 306).

In their analyses of previously conducted studies, Gevensleben et al. (2009) found numerous examples of research pointing to the effectiveness of NFB training in the treatment of attention-deficit disorders, including Drechsler et al. (2007); Fuchs, Birbaumer, Lutzenberger, Gruzelier, and Kaiser (2003); Heinrich, Gevensleben, Freisleder, Moll, and Rothenberger (2004); Monastra, Monastra, and George (2002); and Strehl et al. (2006). In another meta-analysis, Arns, de Ridder, Strehl, Breteler, and Coenen (2009) noted the impressive amount of research demonstrating the positive effect of this training in reducing impulsive behavior, lack of an ability to focus, and hyperactivity.

And, with improved brain function from neurofeedback comes behavioral changes. That link was substantiated when reported changes in attention and concentration were mirrored by enhancements of brain function, as documented with fMRI neuroimaging (Lévesque et al., 2006). In addition, hyperactivity and impulsivity are significantly and lastingly improved by NFB training (Van Doren, Arns, Heinrich, Vollebregt, & Strehl, 2018).

Prescribing methylphenidate, a psychostimulant better known as Ritalin, is of course a standard, relatively effective treatment for attention-deficit disorders, despite adverse side effects that can be long-term. Research has shown that long-term treatment with methylphenidate will likely impair children’s height and reduces appetite and weight gain (Storebø et al., 2018), which can affect their self-esteem and confidence as they make their way through middle and high school and beyond.

And it isn’t necessary; Van Doren et al. (2019) found the improvement in hyperactivity seen in patients undergoing neurofeedback training to be comparable to those patients prescribed methylphenidate. More importantly, perhaps, this study revealed the power of neurofeedback to create sustained and continued improvements AFTER treatment is complete.

Researchers found that follow-up months after the study revealed treatment effects that GREW from medium to large as time went on. This is becoming more consistent with Neurofeedback and suggests that the brain is learning how to become more and more efficient with the re-programming from neurofeedback. No other treatment models offer such cause of optimism.

Conclusion: Neurofeedback Often Best Choice for ADD/ADHD.

As a host of researchers have so clearly shown, biofeedback training has a remarkably positive effect in reducing hyperactivity, inattentiveness, and impulsive behavior. As we look at the recent trends in the research, it is clear that no other treatments compete with neurofeedback for effectiveness, combined with the absence of side effects. In addition, the fact that the NFB seems to train a brain that continues to learn and grow is quite extraordinary and suggests that results only get better with time.

Neurofeedback may be a new concept for those familiar only with the medical model of medication, or more traditional coping models. Yet, there is more than medication and more than just coping with ADD.

NFB offers an innovative, cutting-edge change process that avoids the adverse side effects of medication…and now it is available to all. If you or someone in your family struggles with ADD/ADHD, please consider Neurofeedback as a life-changing solution!

References:

• Arns, M., de Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis. Clinical EEG Neuroscience, 40(3), 180-189. doi: 10.1177/155005940904000311
• Cortese, S., Ferrin, M., Brandeis, D., Holtmann, M., Aggensteiner, P., … Sonuga-Barke, E. J. (2016) Neurofeedback for attention-deficit/hyperactivity disorder: Meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. Journal of the American Academy of Child and Adolescent Psychiatry, 55(6), 444-455. doi: 10.1016/j.jaac.2016.03.007
• Gevensleben, H., Holl, B., Albrecht, B., Vogel, C., Schlamp, D., Kratz, O., . . . Heinrich, H. (2009). Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. Journal of Child Psychology and Psychiatry, 50(7), 780-789. doi: 10.1111/j.1469-7610.2008.02033.x
• Hammond, D. C. (2011). What is neurofeedback: An update. Journal of Neurotherapy, 15, 305-315. doi: 10.1080/10874208.2011.623090
• Lévesque, J., & Beauregard, M., & Mensour, B. (2006). Effect of neurofeedback training on the neural substrates of selective attention in children with attention-deficit/hyperactivity disorder: A functional magnetic resonance imaging study. Neuroscience Letters, 394, 216-221. doi: 10.1016/j.neulet.2005.10.100
• Lubar, J. F., & Shouse, M. N. (1976). EEG and behavioral changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR) – A preliminary report.
• Biofeedback and Self-Regulation, 1(3), 293-306. Retrieved from https://www.neurofeedbackclinic.ca/journals/ADHD_ADD/EEG%20&%20Behavioural%20Changes%20in%20Hyperkinetic%20Child%20Concurrent%20w%20Training%20SMR.pdf
• Lubar, J. F., Swartwood, M. O., Swartwood, J. N., & O’Donnell, P. H. (1995). Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. Scores, Behavioral Ratings, and WISC-R Performance. Applied Psychophysiology and Biofeedback 20(1), 83-99. doi: 10.1007/BF01712768
• Storebø, O. J., Pedersen, N., Ramstad, E., Kielsholm, M.L., Nielsen, S. S., Krogh, H.B., . . . Gluud, C. (2018). Methylphenidate for attention deficit hyperactivity disorder
• (ADHD) in children and adolescents – assessment of adverse events in non-randomised studies (Review). Cochrane Database of Systematic Reviews, 5, 1-472. doi: 10.1002/14651858.CD012069.pub2.
• Van Doren, J., Arns, M., Heinrich, H., Vollebregt, M. A., Streh, U., & Loo, S. K. (2019). Sustained effects of neurofeedback in ADHD: A systematic review and meta‑analysis.
• European Child & Adolescent Psychiatry, 28, 293-305. doi: 10.1007/s00787-018-1121-4
• Zhang, D., Johnstone, S. J., Roodenrys, S., Luo, X., Li, H., Wang, E., . . . Sun, L. (2018). The role of resting-state EEG localized activation and central nervous system arousal in executive function performance in children with Attention-Deficit/Hyperactivity Disorder. Clinical Neurophysiology, 129(6), 1192-1200. doi: 10.1016/j.clinph.2018.03.009