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Attention Deficit/Hyperactivity Disorder and NeurofeedbackAttention Deficit/Hyperactivity Disorder (ADHD) is a condition that can profoundly affect a person's efficiency and quality of performance at school and work as well as the nature of their participation in social and family relationships. It is a condition that is diagnosed based on the presence of a degree of inattention and/or hyperactivity/impulsivity that is so significant that it interferes with a person's ability to succeed in important life areas and situations. ADHD is a neurobiological condition. Support for the conceptualization of ADHD as a biologically-based disorder continues to grow. The results of twin studies support that ADHD is a condition with a high degree of inheritability. Neuroimaging studies have noted significant differences in the regions of the brain that involved behavioral inhibition and attentional functions. SPECT and PET scans have implicated the involvement of the circuitry of the right frontal lobes, the basal ganglia, along with the moderating influence of the cerebellum in ADHD. Collectively, neuroimaging (MRI, fMRI, PET, SPECT) studies suggest that ADHD is a result of under arousal of neurons in those regions of the brain responsible for sustained attention as well as behavioral planning and motor control. Given the growing evidence of the neurobiological foundation of ADHD, when we think of addressing challenges with ADHD it is most prudent to begin by considering ways of addressing this neurobiological foundation. In the absence of a modality designed to address the neurobiological foundation of ADHD, the potential for efficiently managing symptoms in other ways is reduced. Psychosocial interventions such as parent training, behavioral modification in classroom settings, intensive social skills training, and other interventions hold less potential for effectiveness in modulating behaviors associated with the symptoms of ADHD. In the National Institute of Mental Health Multimodal Treatment Study of ADHD, none of these types of psychosocial treatments was considered to be effective in treating the core symptoms of ADHD in the absence of a pharmacological intervention. From a treatment perspective, among the neurobiological approaches commonly utilized with ADHD are medication and neurofeedback training. Medication treatment is designed to impact and modify the chemical-electrical functioning within the brain. Neurofeedback training is designed to impact and modify the neuroelectrical functioning within the brain through the training of brainwaves and the subsequent strengthening of neuronal pathways within the areas of the brain most commonly associated with ADHD. Each intervention is intended to address the core symptoms of ADHD utilizing neurobiological methods. Stimulant medications i.e., Ritalin, Adderall, Focalin, etc., have emerged as the primary type of treatment for the core symptoms of ADHD. Stimulant medication has been the "gold standard" of treatment and the foundation on which other treatment considerations are based or with which other treatment considerations, including neurofeedback, are compared. The effectiveness of the use of stimulant medication in addressing the core symptoms of ADHD has been established in numerous studies over the years and it deservedly remains the mainstay for addressing core symptoms of ADHD. There are however, individuals who have been diagnosed with ADHD and who have an interest in utilizing a non-pharmacological intervention to address the neurobiological foundation of ADHD. Neurofeedback training is often the non-pharmacological method of choice for addressing symptoms of ADHD for those individuals. The decision to use medication or to use neurofeedback training is not necessarily an either/or choice. There are individuals who are successfully utilizing low dose medication along with neurofeedback training as a means of addressing their neurobiological symptoms. In addition, there are individuals who use neurofeedback to help bridge periods in which medication use has been temporarily suspended by choice (medication holidays, weekends, and periods away from home [camp, sports or military training]) or at the recommendation of their physician. In addition, there are other individuals for whom the use of medication is not a viable option. Among this group of individuals are those for whom the symptoms of ADHD do not respond to stimulant medication (approximately 25% of those who have attempted medication). There is another group of people who cannot tolerate medication side effects (i.e., sleep onset insomnia, loss of appetite, stomachache, headache, and increased irritability). There is yet another group of individuals who because of their participation in a particular activity or because of their chosen profession are not allowed to use stimulant medication (some branches of the military, some professional and amateur sports governing bodies prohibit use of medication, the Federal Aviation Agency [FAA], and other professions with rules prohibiting stimulant use). Taken together, there are large numbers of individuals who have ADHD and who by circumstance or choice are interested in considering a non-pharmacological treatment for ADHD. Neurofeedback training offers a prudent choice for those individuals to consider as a primary or conjoint (with low dose medication) option in addressing the symptoms of ADHD. It was noted in the National Institute of Health Consensus Statement on the Diagnosis and Treatment of ADHD that, neurofeedback training (EEG biofeedback) is a non-pharmacological treatment that has been associated with clinical and functional improvements in patients with ADHD in both case and controlled studies. In the Brown University Child and Adolescent Psychopharmacology Update from February of 2005, neurofeedback was identified as an alternative brain-based treatment in which participants with ADHD benefited from its application in a number of studies. A growing body of research utilizing neurofeedback with individuals with ADHD has been encouraging for those for whom medication is not a viable option. Although additional research with greater control of variables is needed in order to more fully understand the impact of neurofeedback on functioning with ADHD, a significant body of research has been accumulated over the past 30 years suggestive of neurofeedback training holding potential benefit. The basic mechanism by which neurofeedback training works is by assisting the ADHD client to learn how to modify the chemical-electrical activity in those parts of the brain associated with attention and impulse control. The goal of neurofeedback training is mental flexibility, in other words, to develop the ability through training to learn to produce the type of brainwave activity that is associated with a focused and attentive state when necessary. Individuals learn how to efficiently produce brainwave patterns conducive to attention and/or self-control when such ability is necessary or desired. Over the course of training sessions it is expected that it will gradually become easier for the client to achieve this relaxed and attentive state and to maintain it for longer periods of time. Neurofeedback training is intended to address the neurobiological foundation of ADHD and therefore support psychosocial interventions utilized in a multi-modal approach.
Dr. Hanson | |
