ADHD/ADD is probably the most researched condition in the neurofeedback literature. As any parent of a child with ADHD, or any adolescent or adult with ADHD knows, the major difficulty is focusing and sustaining attention in certain situations in which attention is important. The individual with ADHD can be distracted by things outside him or herself or by his or her own thoughts, can have difficulty initiating tasks or can have problems completing what he or she started. It can be hard to maintain a conversation, or sit still, or control one’s impulses. These problems can cause major difficulties at work, at school, and with one’s spouse, parents, children and friends.
ADHD/ADD is a biological condition that affects the ways in which the brain transmits information. It affects the electrical and chemical signals within the brain. While it is important for the individual with ADHD/ADD to learn how to manage his or her attention better, and for parents and teachers to learn effective ways to help the individual attend and be productive, it is also important to work with the underlying neurobiology. The electrical signals in the brain get transmitted at different speeds or frequencies. These frequencies help determine our mental state at any moment and affect the chemical signals that the brain transmits. They range from very slow frequency activity in sleep states, known as delta waves, to somewhat faster, but still slow activity in semi-awake states, know as theta waves, to more relaxed but not outwardly attentive states, dominated by alpha waves, to more engaged and attentive states characterized by beta wave activity. In order to focus and sustain our attention, there needs to be sufficient beta activity in and around the frontal lobes, and the inhibition of slow wave activity, such as theta and alpha, in the same brain region. The frontal lobes are known as the executive parts of the brain, because they are involved with coordinating and integrating all the other parts of the brain through processes such as attending, planning, organizing, inhibiting, delaying, controlling our emotional responses, considering long-term consequences, and considering alternative meanings of information and alternative courses of action. There are other parts of the brain that also seem important in regulating attention, such as the right parietal lobe, toward the back of the brain, and these brain areas might be more important in attention problems in some people.
When a person is presented with a learning or academic task, the brain normally inhibits slow wave activity, such as theta or alpha, and produces more beta activity, because the slow activity makes the brain inefficient and the beta activity makes the brain come more “on line” in engaging with an external task. In ADHD/ADD, the brain may do the opposite and instead produce even more slow activity and inhibit beta activity. The brain, in other words, goes more “off line” when presented with an academic task or a challenge which does not provide the individual with immediate stimulation, as does a video game or something fun.
This is a common pattern seen in ADHD/ADD, but there are other patterns of brain wave activity that also occur. For example, there might be a problem with how different parts of the brain are connecting or communicating with each other. For these reasons, a quantitative electroencephalogram (qEEG) or brain map might be helpful in sorting out exactly what brain wave abnormalities are involved with each individual.
In neurofeedback treatment for ADHD/ADD, we monitor the individual’s brain wave state or EEG in a comfortable and painless way while the individual sits in a comfortable chair and “plays” a video game-like exercise which is controlled by his or her brain wave activity. For example, the exercise can be set up so when the individual’s brain wave activity shows that he or she is increasing beta activity and inhibiting theta, or another form of slow wave activity, the individual earns points in the “game” and the action on the screen advances. When the brain wave activity gets out of the desired pattern, the action in the game stops, and the brain then has to find a way to get back into the desired pattern to earn more points. The brain does this unconsciously through the individual attending to the visual and auditory feedback that is provided when succeeding at the game. This is like exercise for the brain, and the brain learns to produce this pattern on its own.
Research has shown that neurofeedback training produces benefits equivalent to those produced by stimulant medication. Follow up studies have found that, unlike with medication, these benefits tend to last. There have been studies that have indicated benefits lasting for years. Furthermore, there have not been significant side effect risks reported in the literature.
Of course, no treatment works for everyone and there is always a potential risk of unwanted effects in any form of treatment. That is why we encourage you to discuss this treatment with someone knowledgeable about the scientific studies and the clinical applications of neurofeedback so you can make an informed choice for yourself or your child.
Studies dealing with the underlying brain mechanisms of ADHD and the use of neurofeedback for ADHD/ADD are the following:
Lubar, J.F. (1995). Neurofeedback for the management of attention-deficit/hyperactivity disorder. In M.S. Schwartz (Ed.), Biofeedback: A practitioner's guide (2nd Ed.). New York: Guilford Press, 493-523.
Lubar, JO and Lubar, JF (1984). Electroencephalographic biofeedback of SMR and beta for treatment if attention deficit disorders in a clinical setting. Biofeedback and self-regulation, 9 (1), 1-23.
Milham, MP, Kelly, AMC, & Castellanos, FX (2008). The resting brain in ADHD: back to the future Advances in ADHD, 2 (4), 106-111.
Monastra, VJ (2005). Electroencephalographic biofeedback (neurotherapy) as a treatment for attention deficit hyperactivity disorder: rationale and empirical foundation. Child and Adolescent Psychiatric Clinics of North America, 14, 55-82.
Monastra, VJ, and Monastra DM (2004). EEG biofeedback treatment for ADHD: an analysis of behavioral, neuropsychological, and electrophysiological response over a three-year follow-up period. Presented at the Annual Conference of the Association for Applied Psychophysiology and Biofeedback. Colorado Springs: April 2, 2004.
Monastra, VJ, Monastra, DM, & George, S. (2002). The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficity/hyperactivity disorder. Applied Psychophysiology and Biofeedback, 27 (4), 231-249.
Vernon, D., Enger, T., Cooper, N., Compton, T., Neilands, C., Sheri, A., and Gruzelier, J. (2003). The effect of distinct training protocols on aspects of cognitive performance. International Journal of Psychophysiology, 47, 5-85.