About one-third of children with attention-deficit/hyperactivity disorder (ADHD) do not fully benefit from drug treatment with stimulants. One large study even showed that the success rate was only 56%. Moreover, some families refuse stimulant medication, sometimes for fear of possible side effects. Other treatments for ADHD are therefore needed. Neurofeedback (NF), or EEG biofeedback is, by many, considered the most promising alternative to medication. By using NF, children with ADHD can be taught to regulate, or normalize, their brain waves. This may sound like something out of a sci-fi movie but it certainly is not. Here is why.
Why would children with ADHD benefit from NF?
Studies indicate that children with ADHD are under-aroused. They have more slow-wave activity (theta waves) in their EEG than healthy children. Slow waves are associated with sleep and decreased vigilance. Conversely these children have less of the faster brain waves (beta waves) that are associated with concentration and immobility. One NF method that has been studied is designed to change this pattern.
So how is it done?
Electrodes, which detect the brain´s electrical activity, are placed on the scalp. The brain waves thus measured can be displayed on a computer as jiggly lines or wavy patterns. They can also be translated into something more exciting for the children to watch, such as a travelling space ship or a beautiful pattern. When the brain waves are of a certain type the spaceship moves continuously. When other, less desirable, brain waves are present, the spacehip stops or the beautiful pattern disintegrates. With continuous feedback like this, the child´s brain becomes conditioned to associate certain brain waves (i.e, the faster ones) with the desired outcome (e.g., a beautiful pattern or a moving space ship). The number of training sessions needed is often around 40 so this is quite a long process. But there is a lot to gain. When the treatment is successful the higher frequency brain waves associated with better concentration increase.
How strong is the evidence?
When searching a medical database (pubmed.com) using the keywords ADHD and neurofeedback I only came up with 81 articles. This shows that the study of NF and ADHD is still in its infancy. So it should not come as a surprise that the effectiveness of NF in the treatment of ADHD has not been proven. There certainly have been positive studies but there have also been studies showing no beneficial effects of NF on ADHD. And many of the studies suffer from methodological shortcomings. In a recent review Moriyama and colleagues concluded: “In summary, the available studies point to a possible efficacy and specificity of NF for the treatment of ADHD” (p. 592). They go on to say that large, methodologically sound studies are still needed. Lofthouse and colleagues reach a similar conclusion in saying that NF for pediatric ADHD is “probably efficacious” (p. 351).
Fortunately, well controlled studies are being prepared, in Europe as well as in the US, in order to study the efficacy of NF in the treatment of ADHD. This is a very exciting field and hopefully future studies will lead to more certainty about the effectiveness of NF in treating ADHD. If NF turns out to be an effective therapy for ADHD it should, in the long run, be cheaper than drug treatment. Additionally it does not have any known side effects. Therefore, there is much to be gained by studying the effectiveness of NF in the treatment of ADHD. It has also been used and investigated in other disorders (e.g., pain, insomnia). Hopefully NF will not just be a passing fad.
If you want to read more, Jim Robbins´s book, A Symphony in the Brain, that is written for the general public can be recommended.
Here is a personal account from someone whose child benefitted from neurofeedback
Lofthouse, N., Arnold, L. E. & Hurt, E. (2012). Current status of neurofeedback for attention-deficit/hyperactivity disorder. Current Psychiatry Report, 14, 536-542.
Lofthouse, N., Arnold, L. E., Hersch, S., Hurt, E. & DeBeus, R. (2012). A review of neurofeedback treatment for pediatric ADHD. Journal of Attention Disorders, 16(5), 351-372
Moriyama, T. S., Polanczyk, G., Caye, A., Banaschewski, T., Brandeis, D. & Rohde, L. A. (2012). Evidence-based information on the clinical use of neurofeedback. Neurotherapies, 9, 588-598.
Rabipour, S. & Raz, A. (2012). Training the brain: Fact and fad in cognitive and behavioral remediation. Brain and Cognition, 79, 159-179.
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