Neurology, Neuromuscular Disorders,
Sleep Medicine, and Psychology

Neurofeedback and Attention Deficit Disorder

Attention Deficit Disorder

Attention Deficit Disorder is a common condition affecting children and adults. Symptoms include easy distractibility, difficulty with sustained attention, difficulty staying on task, and difficulty completing tasks. Individuals suffering with ADD often cannot handle several tasks given at the same time. Often hyperactivitiy will accompany the attention problems. Hyperactive symptoms include being fidgety, unable to sit still, or overt inappropriate physical overactivity.

Symptoms

The symptoms of ADD/ADHD may occur with a variety of physical and emotional conditions. For this ireason, it is very important that the diagnosis is very carefully made by professionals who are experienced in the evaluation of these disorders. Often a detailed neurologic workup, coupled with a formal psychologic/academic workup is needed to make the diagnosis and exclude other conditions.

Treatment

The treatment of ADD/ADHD is multimodal. This means that a variety of different approaches are used together to help the individual to overcome his difficulties. Research studies have shown that the use of a combination of therapies is superior to any one modality alone. For school aged children, modification of the academic structure can include seating arrangment changes, allowing more time to complete tasks, closer supervision, and indivudal tutoring. Even for adults, certain allowances can be made in the workplace under the Americans with Disabilities Act. Behavioral and psychological therapy is often used to help the individual captialize on his strengths and minimize his weaknesses. A variety of medications, often stimulants, are also effective in improving attention and suppressing the hyperactivity of sufferers of these disorders. In recent years, a technique known as neurofeedback has emerged as an effective modality in the treatment of ADD/ADHD.

Neurofeedback

Neurofeedback can be thought of as a type of "brain-training." In neurofeedback training, the electrical activity of the brain is conditioned to operate more efficiently, usually in specific areas of the brain. This more efficient brain activity results in improvement of a variety of conditions that arise from dysfunctional brain activity such as seizures, attention deficit disorder, and traumatic brain injury. For more than thirty years, it has been known that the electrical activity of the brain can be shaped and modified by simply rewarding the individual whenever his brainwaves are in the desired range. First experiments in this field were done in cats and subsequently in monkeys using food as a reward. Later is was discovered that simple sounds, tones, and visual stimuli were equally effective as rewards in humans.

The first clinical application of the technique was in the treatment of epilepsy, when the therapy was found to have a profound protective effect against seizure activity. Since these early studies, other clinical studies have shown a positive effect in the treatment of ADD/ADHD. Although not considered a cure, neurofeedback can substantially improve the symptoms of ADD/ADHD and reduce or sometimes eliminate the need for medications in many individuals.

Neurofeedback involves the placement of wire sensors on the individual's head to measure the electrical activity of the brain (EEG). A computer then analyzes the EEG and displays the relevant information on the screen. The display can vary from an actual graph of the EEG, to animations driven by these EEG features. In addition, the computer can generate sounds related to the targeted EEG activity. These stimuli reward the individual when the brainwaves are in the desired zone. After repeated rewards the EEG activity shifts naturally to the desired profile. Often, certain dysfunctional areas of the brain are targeted by the individual's symptoms or by analysis and the overall EEG activity.

Benefits of neurofeedback can often begin in as little as five sessions. Depending on the severity of the disorder, the number of sessions required may be as little as five and as many as 50, averaging around 25-30. The effects of the training are long lasting, and typically do not require repeated training. In some cases, occasional "booster" sessions are necessary to maintain the effect. The length of fa session is about 30 to 45 minutes and they are usually scheduled weekly.

For more information on neurofeedback, read the book Symphony in the Brain, by Jim Robbins.