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ADHD and Attention Problems

Treat ADHD without medications

Do you or your child struggle with ADHD, behavioural problems, poor attention and/or concentration?

It is stressful when you or a loved one is struggling with attention, poor concentration and behavioural problems. It can cause problems in school, work and at home. If you or a loved one has any of the following symptoms, Neurofeedback may be able to help:

  • Poor attention and concentration
  • Difficulty focusing
  • Behavioural problems, such as poor compliance, acting out, etc
  • Hyperactivity
  • Impulsivity
  • Low motivation

Traditional treatment for ADHD has mainly focused on medications. However, in recent years strong research has demonstrated that Neurofeedback achieves equivalent effects as medication. In fact, Neurofeedback is now a Level 1-Best support intervention for ADHD, meaning that it is considered a best practice treatment for ADHD. Neurofeedback teaches adults and children how to improve their own concentration, focus, and attention. This training has been accepted into the front line treatment for attention problems across North America. Unlike drugs which have effectiveness while the person is taking them, Neurofeedback treatment retrains the brain so that it is able to regulate itself long-term. It helps an individual remain focused by decreasing unwanted slow wave activity and be able to spend longer periods of time focused on solving a problem by increasing appropriate fast rate activity. We can also decrease the frequency, length of time, and overall tendency ‘to tune out’ that is characteristic of ADHD. And finally it can target impulsive behavior and improve a child’s ability to follow directions. The training also empowers a child or adult to recognize that no one is causing the improvement and no medication is causing the change, but it is them that are in control and able to improve their own concentration.

BRAIN PATTERNS AND ADHD

Many people with ADHD have too much slow activity in brain regions, which helps us focus and maintain attention. One way people compensate for this underactivity is to try to wake up the brain by engaging in a lot of activity, like body movements, switching tasks, etc. The slow wave state is uncomfortable to people and they are constantly trying to activate their brain through these activities. Neurofeedback can train the brain to increase its own activation so that you do not have to engage in multiple tasks and behaviours to keep your brain awake.

Some people with ADHD also have too much fast activity, which can lead to impulsivity and other difficulties. When our brain is going too fast, it is difficult to sit still and follow directions by others. In these cases, Neurofeedback can help calm the brain so that you can feel better, more calm, and be able to follow directions and focus on one task.

WHAT CAN YOU EXPECT WITH NEUROFEEDBACK?

The most common form of treatment for ADHD is stimulant medication, such as Ritalin. These medications act to stimulate (increase arousal in) the frontal lobes of the brain, thereby waking up the brain so that the individual doesn’t feel constantly compelled to do so. Although the medication helps, the effects only last while a person is taking the stimulant medication. Neurofeedback, on the other hand, teaches the brain to regulate its own arousal, so that you don’t have to rely on medications. People who have tried Neurofeedback report feeling improved concentration and focus, decreased distractibility, improved memory, and decreased impulsivity.


RESEARCH ON NEUROFEEDBACK & ADD/ADHD

The American Academy of Pediatrics maintains a list of various treatments for ADHD. Neurofeedback treatment is now a Level 1-Best Support intervention for ADHD meaning that it has the strongest level of support, comparable to medications. There are multiple high quality studies that have examined the effectiveness of Neurofeedback for ADHD. These include studies examining functional MRI studies, randomized controlled trials comparing Neurofeedback to medication, and other studies of the benefits for children diagnosed with ADHD. Here are a few studies showing these positive results:

Functional magnetic resonance imaging investigation of the effects of neurofeedback training on neural bases of selective attention and response inhibition in children with attention-deficit/hyperactivity disorder
Bearegard, M., Lavesque, J. (2006) Functional magnetic resonance imaging investigation of the effects of neurofeed¬back training on neural bases of selective attention and response inhibition in children with attention-deficit/hyperactivity disorder Applied Psychology and Biofeed¬back, 31, 3–20.

In this study, the authors examined the neural substrates of selective attention and response inhibition through fMRI of Twenty unmedicated AD/HD children. Fifteen children were randomly assigned to the Experimental (EXP) group whereas the other five children were randomly assigned to the Control (CON) group. Only subjects in the EXP group underwent Neurofeedback. EXP subjects were trained to enhance the amplitude of the SMR (12-15 Hz) and beta 1 activity (15-18 Hz), and decrease the amplitude of theta activity (4-7 Hz). The results suggest that NFT has the capacity to functionally normalize the brain systems mediating selective attention and response inhibition in ADD/ADHD children.

Is neurofeedback an efficacious treatment for ADHD?: A randomized controlled clinical trial.
Gevensleben, H., Holl, B., Albrecht, B., Vogel, C., Schlamp, D., et al. (2009). Is Neurofeedback an efficacious treatment for ADHD? Jour¬nal of Child Psy¬chol¬ogy and Psy¬chi¬a¬try, 50, 780–789.

The authors compared children who completed Neurofeedback training with those completing a computerised attention skills training. Improvements in the Neurofeedback group were superior to the control group, including ratings of attention, hyperactivity, and oppositional behaviour.

Efficacy of Neurofeedback Treatment in ADHD: the Effects on Inattention, Impulsivity and Hyperactivity: A Meta-analysis
Arns, M., de Ridder, S., Strehl, U, Breteler M., and Coenen, A (2009).Efficacy of Neurofeedback Treatment in ADHD, Journal of Clinical EEG and Neuroscience.

Both prospective controlled studies and studies employing a pre- and post-design found large effect sizes (ES) for Neurofeedback on impulsivity and inattention and a medium ES for hyperactivity. Randomized studies demonstrated a lower ES for hyperactivity suggesting that hyperactivity is probably most sensitive to nonspecific treatment factors. The clinical effects of Neurofeedback in the treatment of ADHD can be regarded as clinically meaningful. Three randomized studies have employed a semi-active control group which can be regarded as a credible sham control providing an equal level of cognitive training and client-therapist interaction. Therefore, in line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude that Neurofeedback treatment for ADHD can be considered “Efficacious and Specific” (Level 5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.

Neurofeedback Treatment for Attention Deficit/Hyperactivity Disorder in Children: A Comparison with methylphenidate.
Fuchs, T., Birbaumer, N., Lutzenberger, W., Gruzelier, J.H., & kaisier, J. (2003). Neurofeedback Treatment for Attention Deficit/Hyperactivity Disorder in Children. Applied Psychophysiological Biofeedback, 28, pg 1-12.

The authors compared the effects of a 3-month electroencephalographic feedback program providing reinforcement contingent on the production of cortical sensorimotor rhythm (12-15 Hz) and beta activity (15-18 Hz) with stimulant medication. Results showed Neurofeedback and methylphenidate to result in improvements in all scales of attention, speed and accuracy, and other ADHD behaviours.

Sustained effects of Neurofeedback in ADHD: a systematic review and meta-analysis.
Van Doren, J., et al. (2018). Sustained effects of Neurofeedback in ADHD. European Child & Adolescent Psychiatry. 1 – 13. In-school Neurofeedback training for ADHD: sustained improvements from a randomized control trial Steiner, N. J., et al. (2014).

In-School Neurofeedback Training for ADHD. Pediatrics.

EEG Neurofeedback treatments in children with ADHD: an updated meta-analysis of randomized controlled trials
Micoulaud-Franchi, Jean-Arthur, et al. (2014). EEG Neurofeedback treatments in children with ADHD. Frontiers in Human Neuroscience.

Neurofeedback is the Best Available First-Line Treatment for ADHD: What is the Evidence for this Claim?
Pigott, H. Edmond., Cannon, Rex. (2014). Neurofeedback is the Best Available First-Line Treatment for ADHD: What is the Evidence for this Claim? International Society for Neurofeedback and Research. 4-23.

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