Neurofeedback and ADHD: Training the Brain towards Self-Regulation
ADHD shows up in the brain in a number of brain wave patters. Commonly....
Children diagnosed with ADHD tend to have an excess of low frequency (theta) brain waves and fewer high frequency (beta) waves in certain regions of the cortex, as detected by EEG (Figure 1). Therefore, neurofeedback training for ADHD attempts to minimise the occurrence of lower frequency theta waves and enhance the occurrence of higher frequency beta waves. This is done by rewarding the children each time they demonstrate beta waves during neurofeedback training. Through the process of operant conditioning, the children intuitively learn to promote beta waves and suppress theta waves (Figure 1).
Figure 1. Neurofeedback as a treatment for attention-deficit hyperactivity disorder (ADHD). Children diagnosed with ADHD, who struggle to focus their attention, tend to display lower levels of high frequency beta waves and higher levels of low frequency theta waves, while children without this diagnosis show the opposite pattern (left). This observation suggests that beta waves are associated with an enhanced ability to focus. Neurofeedback training thus seeks to elevate the magnitude of beta waves and suppress the magnitude of theta waves using operant conditioning paradigms (right). During training, the patient receives feedback about their own brain activity, sometimes in the form of a game.
Interestingly, studies have shown that neurofeedback training as a therapy for ADHD may be even more effective than the standard medication (Methylphenidate/Ritalin) used to treat this disorder. This was shown in 2002 by Vincent Monastra and colleagues at the FPI Attention Disorders Clinic in New York, who studied 100 children diagnosed with ADHD (Figure 2). All of the kids were prescribed Ritalin, while approximately half of them also participated in NFB training. The children who participated in NFB training in addition to taking Ritalin showed greater improvements in focus and a significant decrease in hyperactive/impulsive behaviour. Furthermore, only those children who underwent neurofeedback training showed promising changes in patterns of brain activity associated with increased focus. Even more striking was that these behavioral and neurological improvements persisted even after medication was stopped. This was not true of those children who took Ritalin but did not participate in the NFB treatment, suggesting that brain training has the potential to induce long-term changes in the brain.
Figure 2. Clinical trial reveals that neurofeedback training outperforms medication in treatment of ADHD. This figure schematizes the experimental setup and outcome of the study conducted Monastra et al., in 2002. One hundred children diagnosed with ADHD were enrolled in the study. For one year, all of them were treated with medication (Ritalin), while half had their treatments supplemented by neurofeedback training. Immediately after the 1-year treatment period, the Ritalin-only group showed moderate improvement in the behavioral symptoms of ADHD while showing no improvement in patterns of brain activity associated with the ability to focus attention. By contrast, children treated with medication and neurofeedback training showed significant improvements in both behavior and brain activity patterns. Interestingly, one-week post-treatment, the beneficial effects of the neurofeedback-supplemented regimen persisted, while that of medication alone did not.
Recommended by Leading Doctors:
'With neurofeedback the child is exercising the nerve pathways that control attention and mental processing. As these neural pathways are exercised, children develop a sense of what concentration feels like, and they get excited about it. After practicing these exercises over a period of time, the pathways involved in attention and learning seem to work more efficiently. This enhanced brain activity becomes a natural part of the child's functioning.'
- William Sears, M.D., Associate Clinical Professor of Pediatrics at the University of California, Irvine, School of Medicine and practicing pediatrician for more than three decades.