Neurofeedback - also known as EEG Biofeedback - is an approach for treating childhood and adult ADHD that has been studied and practiced for several decades. Through attached sensors, an individual’s brain wave responses to certain stimulus are measured in real time and the individual is taught to modify their cognitive responses, which translates into altered behavior. The way that EEG biofeedback training works is that the subject is given information about how his or her brain is working at the moment, and the subject uses that information to learn to change and control his own brain waves. NASA, the Navy and several major corporations use Neurofeedback to train pilots and executives to stay calm and focused during stressful situations. Neurofeedback may take at least 20 and up to 50 sessions to achieve the desired results.

Neurofeedback, unlike the commonly prescribed stimulants, has no negative physical side effects. It is a non-invasive form of therapy. Moreover, unlike medication, the training appears to produce permanent alterations in learning and behavior. Other studies show that neurofeedback may have many positive effects, such as increasing IQ and helping to relieve anxiety.

Neurofeedback’s use in treating ADHD is based on findings that measurements of brain activity in many individuals with ADHD indicate reduced activity in the prefrontal region and frontal lobes (cortical slowing). Neurofeedback treatment is designed to train individuals to increase the production of brainwave patterns that reduce or eliminate this cortical slowing, and thereby reducing or eliminating ADHD symptoms.

One significant study, The Effects of Stimulant Therapy, EEG Biofeedback & Parenting Style on the primary symptoms of ADHD (Monastra et. al.) found some strong evidence that Neurofeedback, combined with stimulant medication, parent and school counseling, and demonstrated far better results that the same combined modalities without Neurofeedback. The study was conducted over a 12-month period with 100 children, predominantly male, average age 10. Preliminary reports of this research were presented at the CHADD (Children and Adults with Attention Deficit-Hyperactivity Disorder) national conference in 1999 and the annual convention of the American Psychological Association (APA) in 2000. The findings indicate that Neurofeedback is a viable form of treatment for childhood ADHD and is critical for adult ADHD, where medication is less effective.

In a recent paper Update on attention-deficit/hyperactivity disorder published in Current Opinion in Pediatrics Katie Campbell Daley reviewed the research and practice standards on treatment of ADHD. Dr. Campbell serves on the staff of the Department of Medicine, Children’s Hospital Boston and in the Department of Pediatrics of the Harvard Medical School. She concluded:

“Overall, these findings support the use of multi-modal treatment, including medication, parent/school counseling, and EEG biofeedback, in the long term management of ADHD, with EEG biofeedback in particular providing a sustained effect even without stimulant treatment…parents interested in non-psychopharmacologic treatment can pursue the use of complementary and alternative therapy. The therapy most promising by recent clinical trials appears to be EEG biofeedback.”

Recently the National Institute of Mental Health (NIMH) issued a press release announcing that they are funding a research project on “novel and innovative approaches to treating children who have ADHD, focused on EEG Biofeedback training, Neurofeedback. L.Eugene Arnold, M.D., and Nicholas Lofthouse, Ph.D., of The Ohio State University, will lead the study. With the huge public backlash against increasingly expensive medications with side effects, uncertain outcomes and potential dangers, there is no doubt that interest in less invasive, more thoughtful and interactive therapies will continue. The move by the NIMH to test of efficacy of Neurofeedback techniques indicates that the medical community has acknowledged the potential of this approach and may move to benchmark and standardize its usage.

Adult and childhood ADHD (also known as ADD) are diseases that have not only touched many millions of people and their families but have also sparked unending controversies surrounding reactions to Ritalin and other pharmacological interventions, spurring the FDA to call for stronger warnings. To this end many medical professionals, with varying degrees of accredited expertise, have developed and provide multiple types of treatments. Some are combined modalities and some are stand-alone. This is an overview of these treatments; breakdowns of specific treatments can be found in the medication, alternative treatment and neurofeedback sections of this website.

Medication

Medication has long been considered the gold standard of ADHD treatments and there are consequently many options to choose from. ADHD medications come in two varieties: stimulants and antidepressants, with stimulants being prescribed as the first course of treatment. The side effects of stimulant-type ADHD medications can include increased heart rate and blood pressure, tremors, changes in mood, confusion, paranoia, hallucinations, delusions and irregular breathing.
The main drug prescribed for ADHD is Methylphenidate; it belongs to the group of medicines called central nervous system (CNS) stimulants. Methylphenidate drugs (like Concerta, Ritalin LA, Focalin XR, or Metadate CD) increase the level of neurotransmitters in the brain called dopamine and norepinephrine. Neurotransmitters are chemicals that assist in sending messages between nerve cells in the brain. In addition to pills, methylphenidate is also available in a patch, called Daytrana that can be placed directly on the skin allowing medicine to be absorbed. Amphetamines (such as Adderall, Adderall XR, Vyvanse, Dextrostat, and Dexedrine) treat ADHD in ways similar to methylphenidate medications.
Antidepressants are a second-line therapy to be used when the stimulants are not working. Tricyclic antidepressants work in the body to prevent the nerves from taking up the chemicals such as dopamine and norepinephrine believed to be low in the brain in ADHD. The medication allows these chemicals to stay around longer in the blood and be used by the body in a more productive manner. Two tricyclic antidepressants frequently prescribed are – Imipramine (The most commonly encountered side effects associated with Imipramine include fast heart rate, blurred vision, urinary difficulty urinating, dry mouth, constipation, weight gain or loss, and low blood pressure when standing.) and Desipramine (The most commonly encountered side effects associated with Desipramine include fast heart rate, blurred vision, urinary retention (difficulty urinating), dry mouth, constipation, weight gain or loss, and low blood pressure upon arising.). There are other medications that used but not approved by the FDA, including Bupropion (The most common side effects associated with Bupropion are agitation, dry mouth, insomnia, headache, nausea, constipation, and tremor.), Clonidine (The most common side effects noted with Clonidine are tiredness, lethargy, drowsiness, constipation, and dry mouth. Headache, dizziness, fatigue, and weakness also occur with Clonidine.), and Guanfacine (The most common side effects noted with Guanfacine are dizziness, drowsiness, headache, constipation, gas pains, diarrhea, loss of appetite, fatigue, and nasal congestion may occur.)

Multi-Modal treatment

The use of multi-modal treatment, including medication, parent/school counseling, and EEG biofeedback, in the long term management of ADHD, with EEG biofeedback in particular providing a sustained effect even without stimulant treatment…parents interested in non-psychopharmacologic treatment can pursue the use of complementary and alternative therapy. The therapy most promising by recent clinical trials appears to be EEG biofeedback.”

Alternative treatments

Humans are complex creatures and our bodies are tuned to respond whatever we put inside them. Each person’s balance may be affected by diet, exercise, sleep, family conditions, and genetics, on top of the role played by neurotransmitters. There are many approaches to alternative (non medical) therapies, some of which we’ll cover here.

Neurofeedback

Neurofeedback - also known as EEG Biofeedback - is an approach for treating childhood and adult ADHD that has been studied and practiced for several decades. Through attached sensors, an individual’s brain wave responses to certain stimulus are measured in real time and the individual is taught to modify their cognitive responses, which translates into altered behavior. NASA, the Navy and several major corporations use neurofeedback to train pilots and executives to stay calm and focused during stressful situations. Neurofeedback, unlike the commonly prescribed stimulants, has no negative physical side effects. It is a non-invasive form of therapy.

Moreover the training appears to produce permanent alterations in learning and behavior. Other studies show that neurofeedback may have many positive effects, such as increasing IQ

LENS Neurofeedback

The LENS, or Low Energy Neurofeedback System, uses a very low power electromagnetic field to carry feedback to the person receiving it, via wires connected to the scalp. The feedback travels down the wires carrying the brain waves to the amplifier and computer. The feedback produces a measurable change in the brainwaves without conscious effort from the individual. The LENS software allows the EEG signals that are recorded at the scalp to control the feedback. This approach is popular because it doesn’t rely on drugs, which have been the source of great concern.  It is important to note that the LENS does not require the patient’s attention, focus, orienting toward feedback, home practice of self-regulation techniques, or, indeed, any conscious participation in any self-regulatory activity.  In contrast to other brainwave biofeedback procedures, LENS does not maintain that faster brain waves are better for some problems, or that slower brain waves are better for other problems.  Rather, LENS supports the brainwaves, at rest, becoming quieter, and at work, more flexible in their functioning.

Nutrition

There has been much research into nutritional deficiencies - especially with essential fatty acids and amino acids - as a contributing factor of Attention Deficit Disorder and learning deficiencies. Diet modifications include everything from introducing elements like flax seed oil to limiting sugars, eating only organic foods, avoiding all processed foods, dairy products, corn, squash, chocolate, NutraSweet, processed meats, MSG, fried foods, and food colorings. Naturally it is advised to conduct these changes under the supervision of a physician and dietician to chart the efficacy of the changes.

Herbal Supplements

The use of herbal medicine in the treatment of ADHD is of interest to the many families looking for alternatives to drug therapy. Many of the herbs prescribed mimic the action of the drugs prescribed: they’re stimulants. Here is the most commonly suggested herbal alternatives: Ginkgo biloba, Brahmi (Bacopa monniera) Siberian Ginseng (Eleutherococcus senticosis) Gotu Kola (Centella asiatica, also Hydrocotyle asiatica) Green Oats (Avena sativa).

Sensory and behavioral therapies

There are a host of sensory related therapies based on the concept of an imbalance of sensory perceptions. Common behavioral treatments are best tried in the context of a psychotherapeutic course of treatment with a therapist or psychologist. The most common approaches to child ADHD include positive reinforcement, time out, response cost, token economy, and all various approaches of modifying behavior through punishment and reward systems.