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Neurofeedback treatment of ADHD


EEG Biofeedback procedure Two Efficacy Studies Monastra et al (2002) Monastra: Detail of neurofeedback training Monastra Results Monastra: ... – PowerPoint PPT presentation

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Title: Neurofeedback treatment of ADHD

Neurofeedback treatment of ADHD
  • Brendan Reid
  • Luke Mueller
  • Bryan Clark
  • Adrian Scott

  • What is ADHD?
  • Physiology and Neurofeedback Procedures
  • 2 Efficacy Studies
  • Criticism of Neurofeedback for ADHD treatment

What is ADHD
  • A medical condition caused by genetic factors
    that result in certain neurological differences
  • Behavioral Characteristics
  • Problems with attention
  • Lack of Impulse Control
  • Motor Restlessness
  • Boredom
  • Classifications
  • gtInattentive
  • gtImpulsive-Hyperactive

TimelineNames Drugs
Is ADHD on the Rise?
  • Market flooded with new drugs
  • Number of legitimate cases has remained steady
  • 5 in adults
  • 3 in children
  • Misdiagnosis
  • Drug exposure in-utero
  • Fetal Alcohol Syndrome(FAS)
  • Expectant Mothers
  • 5 report using illicit drugs
  • gt20 report using alcohol
  • Source National Institute of Drug Abuse (NIDA)

Dr. Quacks MachineDevelopment of
Neurofeedback Therapy for ADHD (I)
  • Dr. Barry Sternan
  • Commisioned by U.S. Navy
  • Training experiments on cats
  • D.A. Quirk
  • Showed interesting neurofeedback results with
  • First to test effectiveness at treating ADHD, as
    well as neurological disorders
  • Depression
  • Autism
  • Stroke

Neurometric AnalysisDevelopment of Neurofeedback
Therapy for ADHD (II)
  • Able to distinguish Learning Disabled from
    non-Learning Disabled children based on EEG
  • 97 successful diagnosis?
  • High Hopes
  • Should be possible to use home computersto
    carry out neurometric analysis right in the

Brain waves and their functions
  • Delta 0.1-3 Hz
  • Deep sleep, lucid dreaming, increased immune
    functions, hypnosis
  • Theta 3-8 Hz
  • Deep relaxation, meditation, increased memory,
    focus, creativity, lucid dreaming
  • Alpha 8-12 Hz
  • Light relaxation, super learning, positive
  • Low Beta 12-15 Hz
  • Relaxed focus, improved attentive abilities
  • Midrange Beta 15-18 Hz
  • Increased mental ability, focus, alertness, and
  • High Beta above 18Hz
  • Fully awake, normal state of alertness, stress
    and anxiety
  • Gamma 40 Hz
  • Associated with information-rich task processing
    and high-level information processing

Brainwaves in ADHD children
  • Lubar suggested that children with hyperactivity
    an attention deficit have
  • Less beta activity above 14 Hz
  • Excessive theta (4-8 Hz) activity
  • Suggests that these children are
  • less able to shift from resting states
  • (theta/alpha dominant) to excited
  • states (beta dominant)

Brainwaves in ADHD children
  • A case study of 6 such patients showed that SMR
    (12-15 Hz) training followed by beta training
    with theta inhibition produced significant and
    sustained improvements in school performance and
    psychometric measures
  • Letter grades improves, and SMR and beta
    production improved with decreases in theta

What areas/systems are affected in ADHD patients?
  • Frontal lobe
  • Attention to tasks
  • Focus concentration
  • Make good decisions
  • Plan ahead
  • Learn and remember what we have learned
  • Behave appropriately in situations

What areas/systems are affected in ADHD patients?
  • Limbic system
  • Base of our emotions
  • If over-activated, a person might have wide mood
    swings or quick temper outbursts
  • Might also be over-aroused quick to startle,
    touching everything around, hyper vigilant

What areas/systems are affected in ADHD patients?
  • The Reticular Activating System
  • Connected at its base to the spinal cord
  • Receives information projected directly from the
    ascending sensory tracts
  • Brainstem reticular formation runs all the way up
    to the mid-brain
  • Serves as a point of convergence for signals from
    the external world and from interior environment

What areas/systems are affected in ADHD patients?
  • Functional imaging techniques have pointed to 3
    areas related to the basal ganglia
  • Prefrontal cortex
  • Caudate nucleus
  • Globus palladus
  • Problems with the circuit between these three
    regions may be the underlying mechanism that
    causes ADHD symptoms

EEG Biofeedback procedure
  • One or more sensors are put on the scalp and one
    on an earlobe
  • No pain
  • Non-invasive
  • Computer translates brainwaves into controls for
    a video game
  • Practice can allow the child to gain an increased
    control over their brainwaves
  • Number of sessions varies
  • Can take from 40-60 sessions to eliminate ADD,
    may need more than 60 for ADHD

Two Efficacy Studies
  • Monastra et al. (2002) study
  • Fuchs et al. (2003) study

Monastra et al (2002)
  • 100 subjects (mean age 10) were diagnosed with
    ADHD using multiple tests
  • All subjects were given stimulant therapy,
    parental counseling, and school consultation
  • 51 of the subjects were administered
  • Subjects were tested after 1 year, then taken off
    Ritalin for 1week and retested

Monastra Detail of neurofeedback training
  • 30-40 minute weekly sessions
  • point given for each .5 seconds of improved
  • 20 points could be exchanged for a 15 reward
  • Children were given training until their cortical
    slowing was within 1 SD of same-age peers

Monastra Results
  • Tested after 1 year of medication with Ritalin,
    then 1 week later after no Ritalin
  • Non-neurofeedback group showed little improvement
    over their initial scores while on Ritalin, no
    improvement after the wash-out period all still
    classified as ADHD
  • Neurofeedback group showed significant
    improvement most were no longer classified as
  • Of the neurofeedback group, the only subgroup
    that still tested as ADHD were subjects who
    received non-systematic parenting

Monastra Results
Fuchs et al. (2003)
  • 34 children (mean age9.8) diagnosed with ADHD
    but not previously treated
  • Treatment based on parent's choice
  • 22 given neurofeedback (no Ritalin)
  • 12 given Ritalin
  • Typically 3 10-mg doses, only on school days
  • Treatment lasted for 12 weeks
  • One subject in the Ritalin group dropped out
    because of excessive side effects (tics)

Fuchs Detail of Neurofeedback Training
  • Neurofeedback training to increase 12-18 Hz
    activity, decrease 4-7 Hz and 22-30 Hz
  • Children of the hyperactive subtype were trained
    in SMR (12-15 Hz)
  • Children of the inattentive subtype were trained
    in beta1 (15-18) Hz activity
  • Children of the combined subtype were trained for
    half the sessions in SMR, half the sessions in

Fuchs Detail of Neurofeedback Training
  • SMR is associated with inhibition of the
    thalamo-cortical loop
  • Hyperactivity is thought to be caused by
    overresonsiveness in the right hemisphere, so
    suppressing activity would lead to an decrease
    in hyperactivity
  • Attentional deficits may be caused by a
    predominance of theta and lack of beta activity
    in the left hemisphere

Fuchs Results
  • No difference between groups pre-treatment
  • After treatment, both groups showed similar
    improvements on all tests

Problems with Neurofeedback
  • time and money (at least 40 sessions, up to 100
  • insurance doesn't cover neurofeedback
  • requires patient to be motivated, bored patients
    not as successful
  • age too young vs too old (somewhat individual)
    ability to make EEG changes
  • Unreliable success rate (50 --gt 90),
  • uncertainty of effectiveness until late in

Criticism Hunters in a Farmers World
(Genetic basis of ADHD)
  • cultural evolution v.s. biological evolution
  • AD/HD may not have always been a disorder
    (University of California, Irvine)
  • Attention-Deficit/Hyperactivity Disorder (AD/HD)
    first appeared 10,000 to 40,000 years ago
  • speculation that early humans with AD/HD had
    traits such as novelty-seeking, increased
    aggression and perseverance
  • traits have been associated with the DRD4 7R gene

Hunters in a Farmers World (cont.)
  • "survival of the fittest" scenario
  • ever-increasing number of people with AD/HD
  • more aggressive, inquisitive, and willing to take
    risks meant a higher probability for mate
    selection and perhaps multiple sex partners
  • spreading of the gene and its associated AD/HD
    behaviors through the population.
  • Primitive hunters with this gene would have been
    more successful and would have been better
    providers for their families and tribes

Criticism Incomplete Knowledge
  • Incomplete understanding of underlying mechanisms
    of brain wave production
  • Is it wise to alter these mechanism by using
    their byproduct? Self directed alteration and
  • Are unknown or intractable side effects in
  • Placebo effect (up to 50)
  • Reproducible results Umbrella Diagnosis
  • Symptoms cause or effect?

Criticism Afterwards
  • Potentially permanent changes (side effects may
    be more intractable, like loss of creativity)
  • Personality changes
  • Standardization of behavior
  • Long term effects relatively unstudied
  • Technology advancement and future uses

Neuroscience conference on Neurofeedback (UCLA,
  • Widespread support from clinical practitioners
  • Skepticism from researchers
  • Scale Chauvinism
  • Unconvinced vs Under-funded
  • Neurofeedback as alternatives to
  • Double blind studies and Placebo effect

Neurofeedback, ADHD, and Altered States of
  • If states of consciousness are dependent on brain
    activity, then the mental states of an untreated
    ADHD patient are different from their treated
    mental states (since there is a change in EEG
  • ADHD has effects on dopamine, norepinepherine,

  • Masterpasqua, Frank and Kathryn Healey.
    Neurofeedback in Psychological Practice.
    Professional Psychology Research and Practice.
    2003, Vol. 34, No. 6, 652-656.
  • Fuchs, Thomas et al. Neurofeedback for
    Attention-Deficit/Hyperactivity Disorder in
    Children A Comparison With Methylphenidate.
    Applied Psychophysiology and Biofeedback, Vol.
    28, No. 1, March 2003.
  • Monastra, Vincent, Donna Monastra, and Susan
    George. The effects of Stimulant Therapy, EEG
    Biofeedback, and Parenting Style on the Primary
    Symptoms of Attention-Deficit/Hyperactivity
    Disorder. Applied Psychophysiology and
    Biofeedback, Vol. 27, No. 4, Dec. 2002.
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References (cont.)
  • Lubar Joel F. (1985) EEG Biofeedback and Learning
    Disabilities Theory Into Practice, 24(2)
  • (2003) "The History of ADHD and Attention Deficit
    Disorder" May 20, 2005.
  • http//
  • Bate P (2004) Brief History of EEG Biofeedback
    May 20, 2005
  • http//
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