A Neurobehavioral Approach to Treating Attention Disorders (ADD/ADHD)
One of the most confounding conditions encountered by pediatricians, neurologists, mental health professionals, and educators is Attention Deficit Disorder, with or without Hyperactivity (ADD/ADHD). Once simply referred to as hyperactivity or minimal brain dysfunction, we now know that this condition is far more complex than those names imply. While there has been considerable speculation in the scientific literature as to the etiology of ADD/ADHD, only recently have we begun to understand that those suffering from attention disorders are neurologically different from the normal population. Two particularly compelling studies elucidate the neurobiological difference between those with attention disorders and normal populations.
Reduced Glucose Metabolism
The first was published in the New England Journal of Medicine in November 1990. It reported the results of a positron emission tomography (PET) scan study of adults who had been diagnosed with ADHD as children (Zametkin, et al.). The study showed that glucose metabolism in the brains of these adults was significantly reduced, particularly in areas of the brain associated with control of attention and motor activity.
Theta > Beta Wave Activity
A second study, published in Pediatric Neurology in February 1992, distinguished ADHD boys from a control group, using a topographic (EEG) brain-mapping protocol (Mann, et al.). The study indicated that ADHD subjects consistently produced more theta (4 – 7.75hz) slow EEG activity, and less beta I (12.75 – 21hz) fast-wave activity. Theta is associated with inattention, distractibility, disorganization, and poor task sequencing. Beta correlates with the ability to focus, organize, pay attention, sequence, and associate cause and effect.
ADHD clearly has a strong biologic substrate, and cortical activation is apparently decreased in ADHD. It is with this understanding, and the development of sophisticated computer hardware and software, that a neurobehavioral treatment for ADHD using EEG technology has been developed.
Requirements of Training
Neurobehavioral treatment of ADHD essentially requires patients to learn to normalize their EEGs. Patients train themselves to increase production of beta I while inhibiting theta and electromyographic activity (muscle activity or movement). This treatment protocol, developed by Dr. Joel Lubar, a psychophysiologist at the University of Tennessee, has been successful as an adjunct to traditional approaches to managing ADHD. In outcome studies that have been replicated in many clinical settings around the country, patients typically increase IQ scores by 10 to 15 points and improve significantly in measures of attentiveness, hyperactivity, and academic performance. Further, these positive EEG changes appear to be long-term.
This treatment of ADHD requires a significant commitment of time and resources by patients and their families. The treatment program generally requires 35 to 50 work sessions with the EEG instrument and, in the case of children, initial involvement by their parents. (Neurobehavioral treatment is effective with adult ADHD as well.) Some insurance companies may not cover costs, in which case a financial commitment is also necessary.
Some children are able to reduce and even eliminate the need for medication. The clinical results employing EEG biofeedback training have been replicated by more than 200 organizations internationally. Published clinical studies exist, and controlled studies are being planned or carried out to determine the effectiveness of EEG biofeedback training as compared to medication, behavior therapy, and other techniques. Additional research is needed to determine the extent of long-term benefits.
Many children with mild to moderate learning disabilities can respond very well to EEG biofeedback, provided material that is appropriate for their particular learning disability is integrated into the treatment program and directly used in conjunction with the biofeedback training itself. Learningdisabled persons without an accompanying diagnosis of ADD/ADHD are not particularly good candidates for biofeedback training.
The Power of EEG Training
Though EEG training can be very powerful, it has been shown to be even more effective when integrated into a multiple-component treatment program, which may include a certain amount of behavior management, medication if required, and parent training in management techniques.
When specific criteria are used to screen candidates, success is reported for 80% of clients. Success is measured and validated by testing, independent observation, and reports by teachers, parents, and other health care professionals.
Who is a Good Candidate for Neurofeedback Therapy?
Anyone with a primary diagnosis of ADD or ADHD, between the ages of 7 to 50, with at least average intelligence.
Who is Not a Good Candidate for This Therapy?
Treatment generally should not be offered if the person also has any of these conditions:
- Childhood psychosis
- Significant seizure disorder where medications interfere with learning (i.e., sedating medications)
- Severe depressive or bipolar illness
- Highly dysfunctional families who refuse to participate in indicated therapy
Zametkin AJ, Nordahl TE, Gross M, et al. “Cerebral Glucose Metabolism in Adults with Hyperactivity of Childhood Onset.” New England Journal of Medicine, 1990; 323:1361-6
Mann CA, Lubar, JF, Zimmerman, AW, et al. “Quantitative Analysis of EEG in Boys with Attention Deficit Hyperactivity Disorder; Controlled study with Clinical Implications.” Pediatric Neurology, 1992; 8, 1:30-6
