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Can neurofeedback treat attention deficit disorder?
David F. Velkoff, M.D.
Medical Director, Drake Institute of Behavioral Medicine, Los AngelesYES
In my own practice, I’ve used neurofeedback in a comprehensive medical treatment program to help more than 1,000 patients with attention deficit hyperactivity disorder. When combined with supportive therapies such as family counseling and educational therapy, EEG neurofeedback is the most effective treatment available.
ADHD is usually caused by underarousal. EEG studies of patients show excessive slow waves at rest or during cognitive challenge, or both. Some of these patients may have decreased dopamine receptors in the brain. Faster brainwaves are associated with dopamine and increased cerebral blood flow, which is associated with improved concentration.
Methylphenidate (Ritalin, Novartis), a stimulant, has the paradoxical effect of reducing hyperactivity. It probably does so by increasing arousal, which also turns up impulse control and improves concentration. Training patients to suppress slow waves and increase the fast brain waves associated with concentration teaches them to do the same thing.
In one of the earliest studies of neurofeedback for ADHD, Dr. Joel Lubar of the University of Tennessee showed that training children to suppress slow waves and increase fast brain waves improved concentration and behavior, and that subsequently training them to produce slow waves caused problems to return. Larger studies have confirmed the neurofeedback’s efficacy.
Critics of EEG neurofeedback hold this treatment to more rigid standards than drug treatments. Yet unlike drugs, neurofeedback is benign. I’ve seen adolescents who took stimulant drugs for years become physically stunted, or they develop hypertension or disturbing personality changes probably not part of ADHD.
Russell Barkley, Ph.D.
Professor of Psychiatry and Neurology, University of Massachusetts Medical CenterNO
Data supporting this treatment are thin. All the studies with positive results suffer from small size, poor methodology, or both. Overall, the results have been mixed.
There has been little since Dr. Lubar’s 20-year-old study to back up his findings of improvements in behavior and attention after biofeedback for four children.
In a small study in the early 1990s, Dr. Michael Linden of San Juan Capistrano, Calif., randomly assigned some children to biofeedback and left others out. Dr. Linden, a biofeedback advocate, found no effect on hyperactivity or impulsiveness, and a very mild effect on attentiveness.
Yet Dr. Linden’s study had major flaws. It was unblinded and included no placebo controls, and the children’s parents were paying for the treatment. Another study showed no benefit from biofeedback for ADD.
Dr. Aubrey Fine, a psychologist in San Francisco, found virtually no difference in outcomes between two groups of children, one getting biofeedback and the other playing computer games designed to improve attention in patients with head injuries. Several other small studies have had the same dismal results.
Though he’s presented no data to back it up, Dr. Lubar says that the effects of biofeedback last into adulthood. Yet the medical literature shows no follow-up studies of biofeedback for ADD.
Proponents want credibility but they don’t want to do the intellectual heavy lifting required in real science. I debated one proponent on network television who said he was too busy saving children’s lives to do research. That, he said, was up to academics like me. Apostolic attitudes like that should raise one’s suspicions.
Treatment of Attention Deficit Disorder and Attention Deficit Hyperactivity Disorders for Children and Adults
Learn more about the Drake Institute's treatment for ADD / ADHD
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