The Centers for Disease Control and Prevention (CDC) estimate that in 2011, 11 percent of children in the United States were living with the condition.
Medication, psychotherapy, and lifestyle changes can all relieve symptoms for many children, but they are not effective for everyone and, in some people, the drugs have side effects that the person finds intolerable.
Some parents are reluctant to medicate their children, or they may not have time to attend regular therapy sessions.
For these families, neurofeedback, sometimes called biofeedback or neurotherapy, could be a viable drug-free option for managing symptoms of attention deficit hyperactivity disorder (ADHD).
Many people with ADHD display differences in brain behavior, particularly in the brain’s frontal lobe. The frontal lobe is a brain region linked with personality, behavior, and learning.
Brain function and behavior impact each other. Therefore, changes in behavior can change the brain, and changes in the brain can change behavior.
Neurofeedback aims to change behavior by changing the brain.
The brain produces measurable electrical signals. Neurofeedback measures these electrical waves, usually with a device called an electroencephalograph (EEG).
Like other electrical devices, brain waves cycle at specific frequencies. The five different brain waves are alpha, beta, gamma, delta, and theta. They each have different frequencies, and these are measurable by an EEG.
Some research suggests that people with ADHD have too many theta waves, and too few beta waves. Neurofeedback claims to correct this difference by training people with ADHD to use their brains differently.
Neurofeedback practitioners begin by attaching electrodes to the head in order to measure brain activity. This produces an ongoing screen printout of brain waves that can be watched during the session.
Based on brain wave feedback, the neurofeedback provider will instruct the person to perform a specific task.
The process may involve sounds and other stimuli to encourage the brain to process information differently. There might be music or a tone, or sounds that suddenly stop or start.
This approach can interrupt, alter, or amplify brain activity based on feedback from the EEG.
Supporters of neurofeedback claim that this steady feedback can slowly alter brain waves. As brain waves change, so too do the symptoms of ADHD.
The use of neurofeedback is not limited to ADHD. It has been used to treat a range of psychological conditions, and it may help to improve general performance. Studies have suggested that it may help with depression.
Research on the effectiveness of neurofeedback is mixed. In 2009, a meta-analysis involving 467 people with ADHD found medium to large improvements in the symptoms, and suggested that neurofeedback might be “efficacious and specific.” A 2013 study indicated that it might reduce symptoms of ADHD.
In 2014, parental assessments given in a further meta-analysis indicated that neurofeedback brought improvements in impulsiveness, inattention, and hyperactivity. In the same study, teachers felt that improvements occurred only in inattention.
Neurofeedback appears to improve some symptoms, but the improvement assessments vary according to who is observing.
A larger meta-analysis conducted in 2016 did not conclude that neurofeedback is an effective treatment, and called for further research.
In 2013, researchers compared the effects of neurofeedback with those of stimulants, a widely accepted treatment for ADHD. Sixteen children aged between 7 and 16 years took stimulant drugs, and 16 underwent neurofeedback. Participants who took the drugs experienced a reduction in ADHD symptoms, but those who underwent neurofeedback did not.
A 2011 study looked at how neurofeedback might have a placebo effect. Eight children aged 8 to15 years underwent neurofeedback, and six others received fake neurofeedback. Both groups showed significant improvements in ADHD symptoms, suggesting that the benefits of neurofeedback could be due to a placebo effect.
Critics of neurofeedback argue that many studies supporting its use have had significant design flaws, making it difficult to prove whether the technique is effective or not. Authors of several studies have called for more research.
In 1990, psychologist Barry L. Beyerstein called neurofeedback a “neuromythology.” He argued that the success of neurofeedback was linked to the extent of a recipient’s belief that it would work.
Some critics have criticized neurofeedback as a money-making scam. Others argue that there are no accepted neurofeedback protocols.
It is unclear for how long or how frequently a person must undergo neurofeedback to see results. A neurofeedback recipient could be throwing away money, endlessly chasing an improvement that never comes.
A person who is going to participate in a neurofeedback session will start by answering a number of questions about their symptoms, treatment history, and lifestyle.
They will continue to provide information about their symptoms before each treatment session, as this will allow the provider to track improvements over time.
During each session, a provider will attach the patient to an EEG machine by placing electrodes on their heads. The number of electrodes varies depending on the practitioner and the session. The electrodes do not hurt, and they will not deliver an electrical current into the brain.
When the session begins, a real-time scan of the person’s brain waves will be visible on a screen. Based on this feedback, the provider will give instructions for adjusting the brain waves.
Activities might involve a video game, music, or listening to a tone.
As the session progresses, this input should change the brain waves. Across sessions, there may be more significant changes in the brain’s output. This should translate into changes in thought and behavior.
Neurofeedback is painless, and there is no evidence of negative side effects. If other treatments for ADHD are not effective, neurofeedback may be worth trying.
The primary drawback is cost.
Questions to ask a provider include:
It is always a good idea for people to discuss any treatment plan, or change in treatment plan, with a psychiatrist or healthcare provider.
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