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Neurofeedback for ADHD and Other Attentional Problems
Neurofeedback treatment - also known as EEG biofeedback - is an alternative approach for treating ADHD and other types of attentional problems that many regard as a promising - but still unproven - treatment. In this treatment approach, individuals are trained to produce the patterns of brain activity that are associated with better-sustained attention and lower impulsivity. Over the years, a number of published reports have suggested that this approach has positive results for many children with ADHD, and that these benefits are sustained over time. Critics contend that these studies have suffered from a variety of methodological problems, however, making it impossible to make any definitive statement about the utility of this treatment approach for ADHD. This treatment approach has also been criticized because it is typically time consuming and expensive.
A study recently summarized in Clinical Psychiatry News (April, 1999) reports on a large-scale study of neurofeedback treatment that appears to address at least some of these concerns. (Note: Clinical Psychiatry News is a trade publication for the psychiatric profession and not a peer reviewed journal. In this publication, studies that have been published or presented at professional meetings are reviewed. The study reviewed in this article was conducted by Dr. Siegfried Othmer and presented at the recent annual meeting of the American Association for the Advancement of Science.)
In this study 1089 children and adults (726 children and 363 adults) with either formally diagnosed ADHD and/or other "attentional and behavioral disorders" received at least 20 sessions of neurofeedback therapy across 32 different psychology clinics and private practices. Approximately two-thirds of the participants were male and just under 20% had received a formal diagnosis of ADHD. Diagnostic information on the remaining participants was not specified, although it was noted that most had previously been treated for attentional disorders without success. None of the participants were receiving stimulant medication or anti- depressant medication during the study. (Note: The lack of diagnostic specificity is one methodological problem with this study.)
Specific details of the neurofeedback training were not provided. Typically, however, this involves training individuals so that they become able to produce patterns of brain activity that are associated with better sustained attention and reduced impulsivity. The idea is that by teaching an individual with ADHD to be able to produce these patterns, they will become better able to regulate their own attention level and to be less impulsive.
Results
After receiving the 20 sessions of neurofeedback training, 85% of the subjects were reported to show improvement in their ADHD symptoms. Improvement was measured by subjective reports (i.e. what the participants themselves felt), clinical evaluations, and computer-based tests of sustained attention. In addition, a subset of 157 participants who continued their neurofeedback treatment over an additional 20 sessions were reported to demonstrate continued improvement. Information on how long the reported improvements were sustained was not provided in the study summary.
These results are impressive - especially considering that all the participants were reported to have previously tried - and failed to be helped - by more conventional treatments such as stimulant medication. Given the extremely large and diverse nature of the sample, these results would appear to indicate that neurofeedback treatment has the potential to be a useful treatment approach - either alone or in conjunction with other treatments - for many individuals with ADHD or other types of attentional difficulties.
On the other hand, critics will rightly point out that absence of specific diagnostic information on participants, and the reliance on ONLY subjective reports and lab-based measures (i.e. computerized tests of sustained attention) to assess improvement is problematic. Although documenting improvement on such outcome measures is important, it is no substitute for clearly demonstrating meaningful improvement in important real-world settings. For example, it would be much more impressive to have shown that teachers - especially teachers who did not know the child was receiving treatment - reported significant improvement in the academic and behavioral functioning of children receiving the neurofeedback treatment. It is this type of data collected in carefully designed studies that is need to conclusively establish the efficacy of neuro- feedback treatment. The author of this study appears to be well aware of this need, however, and will hopefully be providing such data down the road.
Summary
What can be concluded from a report such as this? I think a balanced view is that the study contributes to a body of literature in which neurofeedback treatment emerges as a promising treatment approach for many individuals with ADHD. This study is impressive because of its large and diverse sample, and the fact that an apparently positive response was obtained by individuals who had reportedly not responded well to prior treatment approaches. It is unfortunate that some of the limitations noted above prevent more definitive conclusions from being reached, but one hopes that we will soon be seeing other studies of neurofeedback treatment in which such problems are addressed.
In the meantime, it is important to emphasize that should you consider neurofeedback treatment for your child, the key is to carefully monitor how your child is doing in school. The fact that he or she may show improvement on computerized tests of attention doesn't really matter much if behavior and academic performance at school are not also changing for the better. The need for this careful monitoring, with adjustments made to a child's treatment as needed, of course, is the key to promoting a child's long-term success regardless of what treatments a child is receiving.
Note: This article originally appeared in Attention Research Update, an online newsletter written by Dr. David Rabiner, a Duke University psychologist and former member of CHADD's Professional Advisory Board. You can learn more about Attention Research Update and sign up for a free subscription at www.helpforadd.com.