Advanced Biofeedback Center

Attention Deficit Disorder

Assessment of condition

Overview

Children and adults may be affected by ADD or ADHD. ADD (Attention Deficit Disorder) usually refers to difficulty in "attending" (paying attention) to important information in the environment. For children at school, it may be sustaining attention long enough to learn a new math concept. For children at play, it may be sustaining attention long enough to learn a new technique taught by the soccer coach or to "keep your eye on the ball" during a little league baseball game. ADHD (Attention Deficit Hyperactivity Disorder) children and adults not only demonstrate difficulty sustaining attention over time ("vigilance"), but they also display impulsive, frenetic, "nervous," and sometimes foolish behavior. The prefrontal lobe "circuits" of the brain that typically modulate behavior and inhibit impulsive acts seem to be not functioning. Oddly enough, one of the most unusual symptoms of ADD/ADHD is the ability to be hyperfocused. This is observed when a child plays a video game for hours while simultaneously being unaware of any other aspects of his or her environment!

One of the most interesting aspects of ADD/ADHD is that children and adults may appear that they are "awake" and interacting with their environment, however, their brain waves frequently are predominantly in the frequencies typically associated with rest (Alpha wave activity, 8 - 12 Hz) or deep meditation (Theta wave activity, 4 - 7 Hz). 

Although simple observation of such behaviors may seem to be sufficient, usually a combination of neuropsychological tests, parent and teacher objective reports, and review of school records provides the most comprehensive manner of verifying that a child or adult is displaying behaviors consistent with ADD or ADHD.  If previous testing has been recently conducted by a private psychologist or a school psychologist, then it may not be necessary to repeat that same testing. At the very least, staff at the Advanced Biofeedback Center typically administer the TOVA (Test of Variables of Attention, Visual and Auditory Subtests) as a baseline of attention level and then readminister this computerized attention test periodically to document progress.

Sensors

Like other forms of biofeedback, neurofeedback uses harmless gold-plated sensors.

Where sensors are placed

EEG sensors are attached to the ear, ear lobe, and scalp after the skin is cleaned with the wipe of an alcohol pad. The EEG (electroencephalographic) signals actually are brainwaves that may be analyzed via a computerized biofeedback system. Real time data is collected, stored, analyzed, and compared as a trend across multiple sessions.

Behavioral intervention

Learning and behavioral change

The principal of operant conditioning --- one of the most well-researched learning principles in the field of psychology --- appears to explain why neurofeedback is an effective intervention. EEG biofeedback ("neurofeedback") has been shown as a very promising approach to training people to be more attentive, without the use of psychostimulant medications. Typically, neurofeedback candidates learn to decrease Theta wave activity (4 - 7 Hz), the brain wave activity that is associated with "shutting down" the frontal lobes of the brain, the very areas of the brain that normally would allow us to have meaningful, appropriate, goal-directed behavior. By decreasing Theta wave activity, we are once again able to allow the frontal lobes of the brain to better modulate our behavior.

It is important to recognize that the entire training experience also contributes to desireable behavior change in children and adults. If you are a parent, imagine training your child to sit quietly for 5 - 10 minutes while the scalp and ears are prepared for the sensors. Then your child must wait for the software startup. This is followed by 30 seconds of "eyes open" baseline testing and another 30 seconds of "eyes closed" baseline testing. Then training follows with 5 minute segments comprised of therapeutic "games" that gently challenge your child to remain relaxed, yet attentive. Your child is told that he or she simply needs to "watch the screen and allow the sound to be present." Sounds very simple? In reality, when your child's brain waves are "in the zone" --- meaning rather stable, not unduly variable EEG pattern --- the video and audio feedback continue. If momentary "instability" or "variability" of the EEG occurs, the video and audio cease, only to resume when EEG stability resumes. The child knows that by "sitting still" and focusing on the visual and auditory stimuli, the visual and auditory "reinforcement" will persist. The interesting aspect of this is that the child does not fully need to know how he or she is accomplishing this feat; he or she needs to know if. By repetitively accomplishing these behaviors, the desireable behaviors persist. At the end of each session, 30-second "eyes open" and 30-second "eyes closed" post session measurements are taken. Because all of the data is stored on the computer, it is possible to look at trends in improvement of physiological functioning.

Neurofeedback is not a new approach; some of the earliest reports of scientists and clinicians using neurofeedback date back to the 1960s! About 50 years of laboratory experiments and clinical trials have yielded some promising results.

Number of sessions

Unlike other forms of biofeedback, EEG biofeedback ("neurofeedback") is a time consuming process that requires patience on the part of the person receiving training as well as his or her family! Some clinicians and researchers suggest that a minimum of 40 - 80 sessions over the course of a year or two are necessary to results in relatively permanent change in behavior. Other experts in the field of neurofeedback suggest that some productive change can occur as early as 10 sessions and that substantial change can occur in as few as 20 - 40 sessions. In reality, much is dependent upon the severity of the ADD / ADHD symptoms and other factors, including the presence of other medical or behavioral problems.

Change in behavior

Goals

There may be several different goals for individuals receiving neurofeedback. Increased attention, decreased worry and anxiety, improved academic or work performance, better quality of relationships, and other positive changes may be desired. Frequently, the goal is to decrease Theta wave activity (4 - 7 cycles per second [cps or Hertz]) while simultaneously stabilizing or increasing Beta wave activity (15 - 18 Hz) of the left hemisphere (side of the brain) and SMR wave activity (Sensorimotor rhythm activity, 12 - 15 Hz) of the right side of the brain.