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Title: The Role of Neurofeedback in ADHD Treatment
Author: Anthony Kane, MD
Website: http://addadhdadvances.com
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The Role of Neurofeedback in ADHD Treatment
by Anthony Kane, MD
Neurofeedback is probably the most interesting and promising
treatment modality for ADHD in use today. The goal of the
treatment is to teach a person to change the way his brain works,
so that the person no longer functions like he has ADHD. That
means that with neurofeedback your child could teach his brain
not to have ADHD. Would such a thing interest you? We are now
going to go into how it works.
What is Biofeedback?
Biofeedback is the use of instrumentation to mirror
psychological and physiological processes of which the
individual is not normally aware. These processes are usually
considered involuntary. However, through biofeedback they may
be brought under voluntary control. The person receives
information about the status of his own biological state, and
using this information, learns to gain control over involuntary
biological functions.
Neurofeedback is a type of biofeedback that can be used to train
ADHD children to change their brain wave patterns to be more
like normal children. Using an electroencephalograph to monitor
the brain waves and a system of positive reinforcement, the
children learn how to make their brains become more attentive.
The result is that there is a significant reduction in ADHD
symptoms and improvements in behavior, relative to how well the
children learn to control their own brain function.
How Does Neurofeedback Work?
Every normal person has five major types of brain wave patterns.
Multiple patterns are present in the brain at any given time,
but each area of the brain has a predominate pattern that
reflects the person's current mental state. These patterns can
be measured and recorded by an electroencephalogram (EEG). The
EEG can be used to make a map of the person’s mental function.
The five types of brain wave patterns are:
Beta waves: These are fastest waves. When a person is
attentive, his brain has a lot of beta waves.
SMR waves: These are a subcategory of beta waves. These are
the waves that occur in the sensorimotor cortex when a person
is quietly focused to prepare for a physical challenge.
Alpha waves: These waves are slower. These are the brain
waves of relaxation.
Theta waves: These waves are even slower. This is the brain
wave pattern that a person has when he is daydreaming or almost
at the point of falling asleep.
Delta waves: These are the slowest brain waves. These are the
brain waves of deep sleep.
When a normal child tries to read or concentrate, he increases
the amount of beta waves in certain parts of his brain. ADHD
children don’t do this. Instead of increasing beta waves, they
increase theta waves, the daydreaming brain wave. That means
that where other children are concentrating harder to complete a
certain task, ADHD children are drifting off.
Does Neurofeedback Work?
The Claim
When an ADHD child is given a task requiring attention, instead
of increasing beta waves, sometimes he increases theta waves,
the daydreaming brain wave. These children have what is known
as a high theta/beta ratio. Using neurofeedback, a technique was
developed to train ADHD children to increase the beta/theta
ratio.
This is how it works: Over a series of 40 or more neurofeedback
sessions, children are gradually taught to inhibit the brains
production of theta waves and increase the brains use of beta
waves. A large number of children can learn to make these
changes. As the children learn to adjust their brain wave
patterns, they show an improvement in cognition, and a reduction
in ADHD symptoms and behavior. This symptomatic improvement is
similar to what we see when the children take stimulant
medication. There is one significant difference, however.
When children take stimulants, the effects last a few hours. As
the medicine wears off, the ADHD symptoms return. When children
learn to control their brain waves using neurofeedback, the
improvement in ADHD symptoms does not disappear. The child is
better.
I’ll say it again differently. When a child completes his
neurofeedback training and the treatment is successful, he now
has a normal beta/theta ratio, and many or all of his ADHD
symptoms disappear. This improvement is permanent. There have
been follow-up studies over a decade. Any gains the child makes
stays with him.
This means that when the treatment is successful, it probably
works for life. This makes neurofeedback a very significant
treatment. No other treatment makes a permanent change like this.
All of this is extremely exciting, provided that it is true.
The Counterclaim
However, many ADHD researchers, most notably Russell Barkley,
say it is not true. Barkley claims that there is little or no
evidence that neurofeedback works at all. He maintains that the
supporting research is sloppy and does not prove anything. In
an interview, Barkley expressed his skepticism.
“Case studies prove nothing because they’re totally
uncontrolled. There’s an aura of medical intervention
here. High technology in a medical environment has a
high placebo effect…. It’s not the equipment. It’s
the exercises, the mental exercises they are telling
these kids to do. (Some kids may be getting better)
with maturation alone…and some kids don’t have ADD.”
Another critic of neurofeedback is neurophysiologist, Sam
Goldstein. Goldstein is not quite as negative as Barkley, but
he echoes many of the same reservations.
“The older studies are not well done…There are a
number of possible explanations. One is, it works.
Two, its a placebo. Three is, there’s some mechanism
operating that we don’t understand…. I would like
these guys to do more research, and I support their
application for research grants.”
How valid are these complaints? How valid are the claims of the
supporters of neurofeedback?
The Evidence
Neurofeedback has been used successfully in the treatment of
epilepsy and drug rehabilitation. It has some very impressive
results in both of these areas. This already lends a great deal
of credibility to the field. It changes the question we ask. We
don’t have to ponder if this is a genuine treatment modality. We
see that it is. The question is whether its efficacy also extends
to the treatment of ADHD.
Neurofeedback for ADHD has been actively studied and used
clinically for over three decades, and there is much to say in
its favor. There are numerous studies showing its effectiveness.
There are many children who have been gone through neurofeedback
and are now functioning normally.
What about the criticism? In many cases it is valid. The
experiments were not well done and they do not prove conclusively
that neurofeedback works. However, all the studies point in the
same direction. There are no studies suggesting that
neurofeedback is ineffective. In addition, none of the critics
have produced evidence that neurofeedback doesn’t work. The most
they claim is that the modality is still unproven.
The Down Side
There are problems with neurofeedback.
The treatment takes a long time- at least 40 sessions. Each
session can cost up to $100. Naturally, insurance does not cover
it. So, this fairly expensive treatment comes directly out of
your pocket. However, there are ways around this expense.
Neurofeedback requires the child to be motivated to complete the
full treatment. If the child gets bored, the treatment won’t work
as well.
The child has to be at the right age for the treatment. If he is
too young, he will not be able to do what he needs to do. As he
gets older, it may become boring for him. Also, the older the
patient gets, the harder it is to make the EEG changes. Adults
have a more difficult time getting good results with this
treatment than children.
Finally, this treatment does not work for everybody. I have not
seen any hard data on what the percentages are. The leading
proponents claim that the success rate is greater than 90%.
Is this true? Probably not. One therapist told me that he feels
it might help only about 50% of the patients. The trouble is that
you don’t know whom it is going to help until you are very far
into the program. It make take over twenty sessions before you
know things are not going well. That is a lot of money and time
invested in a treatment that may not work.
There is one other concern that no one else is going to tell you.
This is my personal concern. It seems to me that a treatment that
is so powerful that it can permanently change the way the brain
functions may have some very significant adverse effects if
misapplied. It is not clear to me that we know so much about
brain function that we can monkey around with it and get it
perfectly right every time.
Now admittedly, there is no report of any harmful affects. Any
damage must be small enough that it is possible to overlook it.
It might be something as subtle as a decrease in creativity.
On the other hand, who is going to report it? The scientists who
feel neurofeedback works and have invested their lives and
businesses in it have a very good reason not to look too
rigorously for negative effects.
The major opponents of neurofeedback certainly will not claim
there is a potential for harm. They would have to admit that
neurofeedback does something first, which is contrary to their
platform that it is ineffective.
So the only one who will even suggest the possibility that
neurofeedback may be dangerous is someone like myself, who has
no personal stake in whether or not it works. If I have to start
selling pencils on the street next week, it is not going to be
because of what is happening in the world of neurofeedback.
What You Should Do
There is enough evidence that supports the efficacy of
neurofeedback that I feel it is worth the time and the risk.
As far as the cost, neurofeedback is less than half of what
you will spend for your child’s first semester at Yale or
Princeton. And if it works, you might be sending your child
there.
Also, as I describe in ***How to Help the Child You Love***,
there are ways you can greatly reduce the cost. You may be
able to save as much as $3000. I was able to have both of
my ADHD children treated for less than $800. So, the price
is not as big a factor as it sounds.
So the question is not whether or not you should investigate
neurofeedback, but how you should approach it. It is my
perception that there is a great deal of variability in the
field. That means that there are some neurofeedback providers
that are excellent and some fall somewhat short of excellent.
You must choose your provider carefully.
Conclusion
EEG biofeedback is not a “cure” for ADHD. Nevertheless, there is
an increasing body of evidence that it leads to “normalization”
of behavior and can enhance the long-term academic performance,
social functioning, and overall life adjustment of your ADHD
child.
It would be wonderful if we could have solid experimental
evidence whether or not neurofeedback works in ADHD. That is out
of our hands. However, if I had an AHDH child, which I do, and
knowing the evidence available, which I do, I would not wait
around for another decade or so, which I didn’t, until enough
evidence accumulated to confirm the efficacy of neurofeedback
before I would try it on my child, which I did.
The main thing to remember is, just don’t pick anyone. You must
have a way to determine who is good. You can use the approach I
outline in ***How to Help the Child You Love***. You can use a
different approach. You have to have a way of finding who in your
area is good and whom you should avoid.
Anthony Kane, MD
ADD ADHD Advances
http://addadhdadvances.com
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Anthony Kane, MD is a physician, an international lecturer, and
director of special education. He is the author of a book,
numerous articles, and a number of online programs dealing with
ADHD treatment (http://addadhdadvances.com/childyoulove.html),
parenting issues (http://addadhdadvances.com/betterbehavior.html),
ODD, and education.
You may visit his website at http://addadhdadvances.com.
To sign up for the free ADD ADHD Advances online journal send
an email to: subscribe@addadhdadvances.com?subject=subscribeart
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