The following is Chapter 8 from The A.D.D. Book by William Sears, M.D., and Lynda Thompson, Ph.D. (1998) Little, Brown and Company, Boston. This material is copyright 1998 William Sears. Reprinted by permission.Brown and Company, Boston. This material is copyright 1998 William Sears. Reprinted by permission.

8
Neurofeedback

AMONG THE NEWER approaches to managing A.D.D., the most exciting is a learning process called neurofeedback. It empowers a person to shift the way he pays attention. After more than twenty-five years of research in university labs, neurofeedback has become more widely available. This is a pleasing development, because neurofeedback has no negative side effects. Instead of using chemicals to alter brain activity; neurofeedback training uses the latest computer technology to teach people with A.D.D. to maintain focus and concentration in situations in which they used to drift off.

The overall goal of neurofeedback is to improve mental flexibility so that a person can produce a mental state appropriate to the situational requirements. This is just what people with A.D.D. do poorly; they lack the ability to get their mind in gear and make themselves do something that seems uninteresting.

H0W DOES NEUROFEEDBACK WORK?

The brain is full of millions of neurons, special cells that are like tiny batteries in that

they discharge electricity whenever activated. Sensors on the head can pick up this electrical activity. The electrical patterns produced by neurons are called brain waves. A fast computer translates this information into a video display on the computer monitor. So far, this is much like an electroencephalogram (EEG), the brain wave tracings used by neurologists and brain researchers. In neurofeedback training, however, one does not just look at the EEG signal. The EEG gets translated into information that the subject can learn from. He looks at the video display and hears auditory feedback as well. The feedback alerts him to what his brain is doing concentrating or drifting off and he can then use this information to change his brain activity as necessary. The computer display provides rewards for making these changes. Controlling the computer display teaches the subject how to produce the brain waves that are associated with being attentive and still. With enough practice, the subject can do this on his own, without the computer feedback.

The exact mechanisms by which brain activity becomes enhanced have not yet been established. Researchers like Dr. Barry Sterman at the University of California at Los Angeles and Dr. Joel Lubar at the University of Tennessee have written on the neurophysiology and neuroanatomy of the brain with respect to possible mechanisms by which brain waves are modified. It is generally known that exercising nerve pathways facilitates their growth and development. Neurofeedback for A.D.D. is just a method for repeatedly exercising the pathways related to attention and impulse control to facilitate their growth and development. Neurofeedback may also be affecting the neurotransmitters in the brain. Whatever the mechanism, the net result is that the subject becomes more focused and is able to learn more efficiently

WHAT IS NEUROFEEDBACK TRAINING?

Think of neurofeedback as weight training for the brain. If you want to build up your muscles, you go to a gym and start an exercise routine. With neurofeedback, you go to a training center and exercise the neural pathways to build up your brain so that you can concentrate better. For a child, it’s like going to gymnastics or piano lessons.


  The procedure is simple. Sensors are placed on the scalp, held in place with a special gel. Fine wires from these sensors conduct electricity from the child’s head to a recording instrument that registers the different frequencies and amplitudes of the electricity produced in the area of the brain being monitored. Changes in the brain wave patterns show whether the person is paying attention and whether he is sitting still (or, more accurately, suppressing the impulse to move). In an EEG, the brain wave tracing is shown as a wavy line. In neurofeedback training, the computer converts the brain waves into gamelike displays (e.g., a fish moving through a maze, puzzle pieces fitting together) or colorful images, like a rising sun. The colorful displays are paired with sounds to give auditory feedback as well. The child’s attentiveness controls what happens on the screen. Children can play the game only by controlling their level of concentration.

If the child’s mind wanders, as it does when he spaces out in class, the colors on the monitor change or the action stops. The better he sustains his attention, the faster the activity on the screen changes. With most neurofeedback systems, the child also wins points, which can be converted into rewards.

The games can be adjusted so that children can be successful, no matter what level of concentration they begin with. They have fun. They may be doing things such as playing basketball on the screen (the opponent scores if the child’s attention wanders) or moving a fish through a maze. The child feels successful, and, at the same time, he is altering his brain physiology. Just as an athlete uses weight training to build up the muscles needed for his sport, the child is exercising -and producing beneficial changes in his brain (settling down, attending, concentrating), which will help him pay attention in school and elsewhere.

A Workout for the Wandering Mind

With neurofeedback, the child is exercising the pathways in the brain that control attention and mental processing. As these neural pathways are exercised, children develop a sense of what concentration feels like, and they also realize what it feels like when they drift off. After they practice these exercises over a period of time, the pathways involved in attention and learning seem to work more efficiently. This enhanced brain activity becomes a natural part of the child’s functioning. It makes possible things that were very, very difficult before training.

One teenage girl did intensive training during the summer before going to Switzerland for her final year of high school. She e-mailed her mother in October, “I never knew I could sit in class and pay attention so well!” Another successful girl said after six months of neurofeedback training, “Now I know what it feels like to concentrate!” And a boy who had taken Ritalin for seven years and became able to attend high school without medication reported, “For the first time in my life I feel in control.”

Twelve-year-old Christopher had been diagnosed at an early age as having A.D.D. He had taken Ritalin since the third grade, but, after an initial good response, the effectiveness seemed to wane, and he really balked at taking it as he approached adolescence. He had been through behavior modification programs designed to reward him for completing his work in class and finishing

homework. His family had received counseling. His parents had put him in a private school with smaller classes and more individual attention. Despite all these efforts, this

bright boy was in danger of failing seventh grade. After the Christmas report card, his parents decided to try neurofeedback.

He had been going to Dr. Lynda’s ADD Centre twice a week for hour-long neurofeedback training sessions and, after five months, had completed almost forty sessions. He was well on his way to learning how to shift his brain wave pattern to regulate his own attention skills. He agreed to let a visitor to the center observe his session. Here is her description:

 

Christopher was sitting intently watching a computer screen, lie wasn’t using a mouse or a keyboard. He was just sitting calmly and watching the monitor Looking closely, I could see three tiny circular cups, smaller than my little fingernail, sitting on dots of gel.~ two on top of his head, and one just behind his ear From each of these sensors a thin wire led to a small box about the size of a cassette player that sat on the table beside him. A cable led from this small box, an EEG instrument that monitored Christopher’s brain waves, to the computer In the middle of the screen a fish moved forward through a maze. Each time it moved, it made a gurgling sound, like blowing bubbles underwater

“W7at are you doing?” I asked. “I’m concentrating,” he replied. ‘Row do you know this?” I asked. “The screen tells me about my brain waves. When I’m staying focused and concentrating, the fish will move through the maze, but the moment my mind wanders, it stops.”

Noticing the open workbook Christopher had on the table in front of him, I asked, “Has learning how to concentrate helped your schoolwork?”

Christopher took his eyes off the screen, and a broad smile spread across his face. “Does it help? I got into the groove last week at school, and I got A+ on a Geography test! It was the highest grade in the class. The teacher was so impressed. He was so happy. Then I had a Language exam today, and I had to write a short essay I did two pages, and the teacher was really really pleased with me. Most kids couldn’t think up more than a page. Before, I hated writing and never gave complete answers. So that’s a real change.”

 

Christopher’s parents described how Christopher had gone from the three “D’s” (discouraged, depressed, and feeling dumb) to believing in himself as a bright and capable boy Five months after starting training, he was off stimulant medication and doing better than ever in school, because, as they put it, he was finally maturing and starting to use his potential. When he was a preschooler, they had thought he was smart, but he had never before shown it in school. Now, both in class and at home, he was acting upbeat and confident.

A year later and with no additional training, Christopher was doing fine in eighth grade. His first-semester report card was excellent, with all grades as high as or higher than they had been in seventh grade. There were no longer any failing grades, and he was also doing better than ever in his sports and other extracurricular activities. His parents remarked, too, on how much he seemed to have grown up in terms of taking responsibility.

Practice Makes Perfect

Neurofeedback allows the person with A.D.D. to learn what concentration feels like, much like feedback from the brain’s balance systems allows the child learning to ride a bicycle to discover how to keep his balance. Learning to ride a bicycle usually takes several practice sessions spread over a few days. Learning to concentrate takes many training sessions, often spread over a period of months, depending on a number of factors, such as other neurological problems, severity of the A.D.D. problems, family support, and intelligence. One does not learn brain wave self-regulation as quickly as bicycle riding, perhaps because losing one’s concentration is not as traumatic as falling off a bicycle. Also, the computer feedback, though fast, is not as quick and accurate as the information one receives from the inner ear about balance. Yet it is much faster than any kind of verbal feedback. If you sit with a child as she does her homework, notice that faraway look in her eyes, and tell her she is daydreaming, the whole process takes a few seconds. The response time for neurofeedback from the computer is measured in thousandths of a second.

How exactly do neurofeedback clients learn to control their brain waves? What does it feel like? Most people cannot say what they do, but they seem eventually to be able to recognize the state of concentration and also to recognize when they drift off. Much of the learning in neurofeedback seems to happen at an unconscious level, which explains how young children can set their brain wave pattern without much conscious awareness of what they are supposed to do. Andy gave this answer to the question of how he learned to control his brain waves:

 

By watching the screen, I have learned sort of what it feels like to produce mostly fast waves. I can’t really tell you in words, but it’s different. I find that if I constantly challenge myself by asking myself questions, then I keep thinking and figuring things out. If I do that, I don’t get sleepy Once I get sleepy, it’s just too difficult to pull myself out of it. I can’t let that happen, and challenging myself seems to keep me in this active state.

 

Some teenagers are afraid at first that neurofeedback will take away their ability to choose for themselves. In fact, the opposite is true. In explaining to teenagers how neurofeedback works, we often choose as an illustration some activity or sport that they are interested in.

Jason was a particularly difficult teenager age eighteen, but a superb tennis player The trainer said to him, ‘Jason, before you learned how to hit a forehand tennis shot, you may often have missed the ball, sliced it over the fence, or hit the net. After you learned and practiced how to hit a powerful forehand, you had a choice! You could still choose to miss the ball or hit it over the fence. 0t you could choose to hit it perfectly and win the point! Because you have practiced, when you choose to play hard and win, the shots become almost automatic. Similarly, before neurofeedback training, you have little choice. Your mind wanders, you are not getting the grades you want to get. After you train here, you will have a choice. You can still choose not to listen or study but you can also choose to keep focused and learn efficiently and effectively You will be in control!”

 

Neurofeedback empowers people with A.D.D. to get into the concentration zone just as well as people without A.D.D. It may take more conscious effort, but they will be able to focus and sustain their focus once they have learned self-regulation through neurofeedback. One nineteen-year-old remarked,

I didn’t believe this could help. But gradually it came together I found I was able to concentrate without being distracted by things around me. It has made school so much easier

 

If learning to regulate brain waves to produce desired mental states sounds a little way out to you, remember that people have been doing this in lots of different ways for centuries. When you take a deep breath and count to ten before saying something, you are practicing mental control. When people learn prayer or meditation, they, too, are learning to control their mental state. Higher levels of martial arts training also call for learning mental control.

You cannot tell a person with A.D.D. how to concentrate. And trying too hard produces tension that actually interferes with concentration. Yet one can “get a feel for it.” Learning self-regulation can empower your child by improving certain skills and reducing bothersome symptoms. Neurofeedback is by -no means a cure-all. It is a technique that, in combination with other approaches (parenting and educational strategies and, possibly, medical intervention) can give the child with ADD. a way to manage his difficulties and make everyone’s life a little easier.

BRAIN WAVES AND THEIR CONNECTION TO BEHAVIOR

What Is a Brain Wave?

Everyone’s brain produces electricity. When we put a sensor on the scalp, we can record this electrical activity on an electroencephalogram (EEG). The electrical pattern is called a brain wave. Recorded on paper or displayed on a monitor, it looks something like waves on a lake. Just like on a lake, there will be some larger waves, and on top of these there may be smaller ripples or little waves. The large waves are referred to as slow waves, and the little, irregular ones are referred to as fast waves. The large waves pass by at the rate of only two or three per second a slow frequency. The small ripples have a higher frequency. The height of the wave is called amplitude. The greater the amplitude, the more power there is. The relationship between amplitude and power is obvious if you think of waves breaking on a beach: taller waves have more power.

 

The Discovery of Neurofeedback for Epilepsy and A.D.D.

The history of neurofeedback is a wonderful example of scientific serendipity discovering something special accidentally while looking for something else. It may have struck you that the SMR frequency band does not have a Greek letter name like the theta, alpha, and beta brain wave bands. That is because it used to be considered part of the beta range but was renamed after Dr. Barry Sterman identified some unique properties of brain waves at 12 to 15 cps. Back in the late 1 960s, as part of the research being done in Sterman’s labs, cats were taught to increase SMR. He labeled this wave form “sensorimotor rhythm,” or SMR, because it was most easily measured across the sensorimotor strip of the brain, which runs across the head from ear to ear, and because these waves seemed to reflect both sensory and motor activity.

Sterman was asked to investigate how hydrazine a fuel used in rockets, including rockets for the first manned space flights might produce seizures, and he was experimenting with hydrazine’s effects on cats. He observed that one group of cats seemed resistant to seizures. Those were the cats who had

been trained during earlier research to increase the SMR brain waves. Further investigation demonstrated that what was true for cats also applied to people. When humans who had seizure disorders were trained to increase this wave form, their seizures decreased. During these experiments in the early 1970s, the observation was made that many of the subjects who displayed hyperactivity and restlessness in addition to having seizure disorders showed a decrease in these symptoms when they were trained to increase SMR. So the next question was, If hyperactive people with seizure disorders decrease their hyperactivity when they increase SMR, what happens with hyperactive children who do not have seizures? Dr. Joel Lubar had also been researching brainwaves since the early 1970s and took a special interest in children with A.D.D. Sure enough, with training to increase SMR, their hyperactivity was reduced. Since the publication of those first results in 1976, researchers have continued to study ways in which neurofeedback can improve the lives of children with A.D.D.

 

How are brain waves described? Brain waves can be described by their frequency and amplitude. Frequencies are measured in cycles per second (cps) or hertz units. A hertz (Hz) is equal to one cycle per second. The height or amplitude of the brain wave is expressed in terms of power (picawatts) or electric potential (microvolts).

The brain waves that are of interest in neurofeedback are the ones with frequencies between 4 and 20 cps. The slow brain waves are called theta (4 to 7 cps) and alpha (8 to 11 cps) waves. The fast brain waves are called sensorimotor rhythm (SMR, 12 to 15 cps) and beta (16 to 20 cps) waves. The definitions for theta, alpha, SMR, and beta are not precise; different researchers separate frequency bands at slightly different places. There may also be subtle differences between high- and low-frequency waves within each group; for example, 8- and 9-Hz activity is perhaps associated with a slightly different state than 10- and 11-Hz activity, even though they are all alpha waves.

 

How are brain waves measured? The EEG machine measures brain waves at each frequency. To do this, a sensor that is smaller than a little fingernail sits on a little gel on the subject’s head. The gel acts as a conductor between the scalp and the sensor. The number of sensors that are used varies from three in most neurofeedback training programs to as many as 256 in some research labs. The sensor conducts some of the electricity produced by the subject’s brain along a wire to an EEG instrument that has filters to check how much of each frequency is being produced. The information then gets sent to a computer that produces a picture of the brain waves. The picture always shows a mixture of waves at all the different frequencies, just like the different kinds of waves on the lake. The computer is able to determine how much power there is at each frequency and if there is more slow wave activity than fast wave activity. Typically, in individuals of any age with A.D.D., you see more slow wave activity.

 

A moment-to-moment guide to the brain. Research shows that brain wave patterns are a reasonable reflection of what the area of the brain beneath the sensor is doing. If you were to watch the brain waves as your child falls asleep, for example, you would see the dominant brain wave frequency change to slower waves. Just before he falls asleep, you would see a lot of slow theta waves (4 to 7 cps). When he is asleep, you would see even slower activity~ at 2 or 3 cps (the delta range). When children daydream in school, they also show a lot of theta wave activity, between 4 and 7 cps. If the brain is just resting for a moment and the child is reflecting on what the teacher just said, the slow wave activity might be in the alpha range (8 to 11 cps). If the child is working on a problem or actively reading or listening, you would see quite a bit of faster wave activity, in the 12- to 20-cps range.

Here is a quote from psychologist Dr. Barry Sterman about how behavior is linked to brain waves:

 

As one who has studied EEG patterns in normal people, I can almost read them from facial expressions and body language. I am reminded of the difficult task of lecturing to students or others shortly after the lunch or dinner hour Some people are just unable to pay attention. This leads to glazed eyes or drooping eyelids. I can just see the alpha rhythm spreading across their cortex. Even more dramatic, however are the slumping heads, sudden twitches, or even occasional snot ~ expressed by those who are falling asleep. Theta has taken over In this context I have always appreciated the few wide-eyed listeners (usually at the front of the room) who are sitting up straight and clinging to every word. They are probably generating lots of SMR and faster frequencies.

 

Brain waves thus reflect what a persons brain is doing from moment to moment. With modern equipment, neurofeedback trainers can use this information to let children know the instant they stop listening, reading, or problem solving and begin to daydream. The sensor is placed over the area of the brain expected to be active when the child is sitting fairly still and reading, listening, or figuring out things. The feedback is very fast. It can be seen on the screen 39 to 150 milliseconds after it happens in the brain, depending on the equipment. Thus, with this tool, a neurofeedback trainer can see immediately when the child tunes out and when he tunes back in. Bursts of slow activity correspond to flickering attention and show clearly how a person can be really trying to pay attention but still miss part of

what is said (e.g., one number in a sequence or part of the instructions).

Slow waves predominate in very young children. As children grow older, this pattern changes until the balance between slow wave and fast wave activity evens out in adults over the age of eighteen. Regular adult EEG patterns are low voltage and fairly level.

Specific Brain Waves for Specific Tasks

The human brain likes to do one thing at a time. When one part is active and producing fast waves, other parts take a rest and produce slow waves. For example, if you are driving a car, you are being vigilant, processing all the information your eyes are taking in. But if you reach toward the dashboard and turn your radio dial, for an instant you turn off all those vigilant areas that are processing information about the highway and turn on the small area of your brain that controls your hand. Someone watching your car might notice that it strays slightly from the straight course you were driving. Similarly, your child isn’t in high gear, working on school problems all the time. She is turning on and off and on again working, then resting, then working again. Indeed, very bright people often turn on the thinker waves (16 to 20 cps) for very short periods of time and then revert to the resting waves (8 to 11 cps). You will see more fast wave activity when a person is learning a new task than when the task has been practiced and is easier. This is because once the task is familiar, it takes less mental effort.

A Simplified Description of Brain Waves

Mental State

Frequency

of Waves

We are Going to

Call These Waves

Sleep

delta: 0.5-3  cycles per second (cps)

The sleep waves

Inner reflection without much attention focused on the outside world (being tuned out); drowsy

theta: 4-7 cps

The tuned-out waves

Resting in a meditative and perhaps creative state (a second type of tuning out or daydreaming); inattentive

alpha: 8-11 cps

The resting,  daydream waves

Calm, not fidgeting, not impulsive not thinking about bodily sensations, often externally oriented and aware; quietly alert

SMR: 12-15 cps

The calm waves

Focused, analytic, often externally oriented, intense thinking

beta: 16-20 cps

The thinker waves

The slow waves are the tuned-out waves and the daydream waves.

The fast waves are the calm waves and the thinker waves

 

 

 

John, age twelve, was doing a math word problem as part of a neurofeedback training session. He skipped words as he read it, and a number of key facts did not register in his mind. His EEG showed the electrical energy concentrated in slow waves between 4 and 7 cps. Watching John’s brain waves on the screen, his trainer saw tuned-out waves with high amplitude, but then John would focus for a moment, and the slow wave amplitude would drop precipitously His reading would become more superficial, and the slow wave amplitude would instantly rise again. These bursts of tuned-out wave activity happened several times within just a few seconds/A minute or two later there was a shift in John’s concentration. The trainer noticed that the sound from the speakers was absolutely steady indicating that John’s attention was no longer flickering. He was sustaining the fast wave activity the thinker waves (16 to 20 cps), indicating extremely focused concentration.

When the trainer looked away from the screen, he found John staring out the window watching a little mourning dove that had hatched a few days earlier on the window ledge. The trainer told him to stay focused on the baby bird and notice if he felt different. John replied later “Yes, I could feel the difference. But It’s hard to concentrate like that when I’m reading.”

 

It is quite likely that John will remember the image of the nestling bird for years to come because he was so intently focused on it. But when John tuned out, he produced a lot of slow theta waves. With further neurofeedback training, he learned to remain for longer periods of time in the mental state of producing faster waves. The result was that he stopped missing things as he was reading or listening. He was able to advance in

school.

 

There is nothing wrong with any particular pattern of brain waves. We need all of them for different jobs. The goal of neurofeedback is to give someone the flexibility to be able to access the appropriate state to get a particular job done. Most people naturally stay alert and focused when a teacher or someone else is giving instructions. People with A.D.D. have to learn how to do this. Teaching them to recognize and use their calm waves (SMR) and thinker waves (beta) helps them pay attention when they must.

 

Alpha waves. Some people purposefully spend a great deal of time learning to produce an alpha wave state. Some practice alpha states to try to access their creativity. Others are learning how to relax and meditate. Meditation can be a very relaxing and useful skill. However, meditating in the classroom or, for an adult, in a boardroom meeting, is usually frowned upon. Small bursts of alpha are normal and indicate resting and reflecting for a moment. But too much alpha means the person is tuning out the external world. This isn’t what we want for classroom performance or even for good social interaction.

 

Theta waves. It is quite pleasant to drift slowly off to sleep. Theta waves usually predominate at these times. Production of theta waves is actually encouraged by some psychotherapists if they find that the client is able to recall memories from the past and access feelings more readily when in this state. In psychoanalysis, lying on the couch and being told to just let thoughts flow freely (free-associate) may actually encourage a patient to go into a theta state. However, once again, this is not the state of mind your child’s teacher hopes to see in the classroom.

Brain Wave Patterns and A.D.D.

The brain wave pattern of individuals with A.D.D. looks immature because there are more slow waves. This pattern is independent of the person’s intelligence level. It is important to note that the EEG is not abnormal in persons who have A.D.D.; there is just a different balance between slow and fast waves.

There is more than one pattern possible in individuals with A.D.D., but they all have in common excess slow wave activity. In the future, it may be possible to classify types of A.D.D. according to brain wave patterns. For example, one pattern is an immature pattern, with more slow waves (theta) throughout the brain. In another pattern, it is mainly the frontal portions of the brain, the seat of the executive functions (including directed attention, critical thinking, and impulse control), that show excessive slow waves.

The difference in brain wave patterns between a child who has ADD. and a child who does not have A.D.D. is more pronounced when they are doing school-like tasks, such as reading. Children who do not have A.D.D. produce more fast waves when they focus in on a reading task. Children wit -A.D.D. usually produce more slow waves. This means the brain is still in resting mode. Z

 

Bright daydreamers. Most individuals with7

A.D.D. tune out in theta waves. Some people show a different kind of slow wave activity ( to 11 cps) when they tune out. We call this the resting/daydream wave. Traditionally, it has been called alpha. Dr. Lynda has given these alpha producers the nickname “bright daydreamers.” They are often highly creative people. Brian was an example of this pattern:


  Brian, age eighteen, had dropped out of his final year of high school. He had tried working but did not last at the jobs he tried. He explained, “1 just can’t keep my mind on what I’m being told. ff1 try to read the instruction manual it takes ages. I have to keep going back over and over each paragraph. I guess I’m just not smart enough.”

Brian’s intelligence was assessed using the Wechsler Adult Intelligence Scale. It was in the superior range. On the EEG his problem was immediately apparent. After only a short time reading, he suddenly produced a very high-amplitude alpha rhythm. He just tuned out, as if meditating or in a daydream. This pattern also appears in people who have smoked marijuana recently, which Brian had not. He was just a natural alpha producer If he was reminded of the task, he would focus on it again for a short time, but then the resting/daydream state would reappear and he would tune out.

Using the computer monitor and watching his own brain waves, Brian rapidly trained himself to stay out of that alp ha pattern when listening and reading. When he managed this and was working on some academic subject, the predominant wave pattern became his faster “thinker waves” (beta; 16 to 20 cps). He returned to high school in September and also got a part-time job, which he held on to. Later that year he was awarded a prize for his excellent results in Physics. His was a remarkable turnaround.

 

Hyperactive children. Neurofeedback helps the hyperactive child by teaching him

to become calm and able to suppress the urge to move. Certain brain waves (calm waves, or sensorimotor rhythm) are seen when a person inhibits the urge to move around. Hyperactive, impulsive children can be taught to produce these waves. In our experience, the hyperactive child often takes longer to benefit from neurofeedback training than the child with the inattentive type of ADD.

 

Sometimes the child is not physically “bouncing off the walls” but is just verbally impulsive, as in blurting things out. This type of child may have never had a behavior problem at all. Cathy, age nine, was a good example of this. She was a very active and impulsive girl. She would constantly do things without reflecting first. When asked, “Why did you do that?”, her shrug and “I dunno” were completely honest. There was no thought-out reason behind her behavior. She just acted without thinking. Cathy’s mother gave this description of her daughter prior to neurofeedback training:

 

We’re so discouraged. Cathy has been put on Ritalin on the recommendation of her teacher It has helped slow her down and keep her at her desk, but she is still going to be placed in special education for the fourth grade. She thinks of this as being demoted. Even though we couldn’t really afford it, we put her into a good private school, but that didn’t solve the problem. She is at the bottom of her third-grade class. Cathy has been tested on the Wechsler Intelligence Scale for Children, and the psychologist said she was bright. She has also had special tutoring. We know she’s smart, but she just cannot sit without fidgeting. She is so impulsive! We are proud that she answers questions in class, but she does it before the teacher even finishes the question.

 

She never thinks about what she is going to say She seems to just blurt out whatever thought has come into her mind. Being bright, she sometimes will happen to give the right answer but more often than not she is wrong. This behavior irritates not only the teachers but her classmates as well. She can read beautifully if you make her sit and do it. But she keeps skipping things, and if you aren’t right beside her she will say she is finished but will have missed the main points and just have remembered all the funny little things that don’t matter We just don’t know what to do.

 

Cathy underwent the same kind of training as Christopher (see page 207), except she was trained to increase the production of brain waves referred to as SMR, or sensorimotor rhythm (12 to 15 cps). Research studies have shown that these brain waves are at work when the motor system is less active and the impulse to move is suppressed. Facilitating this state in children who do not naturally produce much SMR is helpful. Cathy learned how to voluntarily produce more sensorimotor rhythm waves. To do this she had to sit still and not even think about moving. The trainer said, “Cathy, pretend that your brain moves into your fingers every time you move those fingers. Where do you want your brain to be when you are thinking about a problem?” Cathy said, with a laugh, that it should be in her head and not in her hands.

Three months after beginning training, Cathy was off Ritalin, ranking in the top half of her class and no longer on the list for special education for fourth grade. When we followed up three years later, she was an A student in seventh grade who was well liked by both her teachers and her peers. The only modification to her school program at present is enrichment classes in math.

 

Impulsive children. For some children with ADD., impulsivity is the most critical problem. Impulsivity is a difficulty that is seen in children with ADD. with or without -hyperactivity. “Impulsivity” does not mean that the person demonstrates a behavior problem. It refers to acting without thinking (reflecting) first.

Children with this problem appear to have too little of the faster SMR calm waves. These:

brain wave frequencies are associated with inhibitory functions in the brain. Donald is another example of this kind of problem:

 

Donald was thirteen years old. His mother a school teacher noted, “Donald is a good boy He has never been a behavior problem. But I get so, so frustrated with him. fend up screaming at him. He is so bright (IQ above 130), but he just doesn’t read the problem. It doesn’t matter what subject it is, he just doesn’t do what the question is asking him to do. He jumps to conclusions! If he is given a math problem, he blurts out an answer He is very bright, so often it is the correct answer However if it is a word problem and he has to listen or read for a minute, then he will miss something and the answer will be the wrong one. if I force him to slow down and read carefully, he will get it right. It’s very frustrating. He is so bright, but he constantly makes careless little errors.”

 

Donald also had difficulty concentrating. His EEG pattern, as expected from mother’s description of his style, showed a lot of slow wave activity. In addition, he demonstrated a dip in brain wave activity in the calm wave (SMR) range. Neurofeedback training for Donald emphasized decreasing the tuned-out slow wave activity and increasing the faster calm wave (SMR) activity. When he learned to do this, he also demonstrated a marked increase in his ability to read questions carefully, note the facts, and then answer the question that was being asked. He became calmer and didn’t rush into things or blurt things out.

 

Children with social problems. Donald was also a rather difficult child socially Other children shunned him. He did not appear able to maintain friendships.

 

Donald’s constant questions were quite assertive and inappropriate. He said whatever came into his mind. He found it difficult to maintain friendships, and adults found him irritating, even rude. He never meant to say anything wrong. He behaved with the best of intentions. Donald really wanted to do the right thing and be liked and appreciated. But his behavior was, in a word, obnoxious. His parents tried medications. They tried behavior modification. They spoke with him about how he seemed to turn people off Nothing seemed to have any significant effect on their young motor mouth.

When Donald increased his calm waves, it changed not only his approach to schoolwork but also his social Interactions. He became considerate and polite and started making friends and maintaining friendships. This was a happy carryover effect of the training. Perhaps paying more attention to the external world caused him to notice people’s reactions more, so that he modified his own behavior accordingly

 

Anxious and inattentive children. Matt’s story provides an example of how a child with ADD. and anxiety was helped with neurofeedback. Regular biofeedback to teach him how to regulate his finger temperature

(an indicator of relaxation) was also part of his program:

 

Matt, a bright fifteen-year-old, was in neurofeedback training primarily to learn how to control his impulsive style of doing problems in school and to learn to remain focused when studying. At the same time, he was also attempting to pass a difficult figure skating exam that would put him at the national level for competition. He had failed twice. His third and final try for some time was coming up in just a few weeks. In practice, the double jumps and other required maneuvers were easily accomplished. In competition, he missed. In the initial evaluation, Matt’s mother had mentioned, ‘Apart from not being able to focus in class, my son does figure skating, and he doesn’t seem to do what the coach has just explained to him. Also, he gets very anxious before competitions.”

Matt learned quite rapidly to increase his focus by watching the computer monitor and listening to the audio feedback while doing academic tasks. However Matt was a very tense and anxious boy A sensor on his little finger registered a skin temperature of only 73 degrees Instead of a normal 94 to 96 degrees. This was a physiologic sign of inner tension. Some days when he came into training, his finger temperature would be as high as 89 degrees, but the moment anyone mentioned skating or a school problem, it would drop precipitously to the 70s. As he relaxed, his finger temperature would rise, and this feedback was displayed on the computer monitor Gradually he began to be able to keep his finger temperature in the 90s even when presented with an academic task. When the time for the skating competition came, he passed. His mother reported back, “He finally remembered what he was supposed to be doing for example, holding his hands correctly He seemed to be totally into his skating and not attending to the audience and the judges. It was really different. He actually looked relaxed!”

 

Matt produced another interesting result after neurofeedback training. At the end of the training sessions, he was retested on the Wechsler Intelligence Scale for Children. He scored 22 points higher than he had before training. Intelligence as measured on standardized tests is not expected to shift like that. Wechsler results are supposed to be largely independent of teaching and learning. Research on IQ changes with neurofeedback indicate average gains of around 10 points, so Matt’s gains were unusually good. Perhaps his initial scores were lower due to the combination of A.D.D. and anxiety and they shot up when both these conditions improved. We do not think that neurofeedback training makes people smarter, but they do seem better able to utilize their potential. This shows up in the classroom and also on standardized tests, including intelligence tests. Matt was certainly a much more confident student when he completed training than he had been when he started. Additionally, his mother reported that he talked to her more, shared his feelings more, and generally seemed more cheerful. “I actually like having him around now,” she reported with a laugh.

 

One could argue in each of the above cases that it was not the neurofeedback training that made the difference but other things the trainer was also working on, such as coaching in learning strategies. This is a possibility However, these children had previously had extensive tutoring. Two of the mothers were teachers. All of the parents worked with their

children and modeled logical approaches to schoolwork. The children had been taught similar strategies again and again, but nothing had sunk in. With neurofeedback they were in a different state of mind while thinking about using the strategies, and finally things clicked. The most pleasing thing about the neurofeedback approach is that the changes seen in training sessions do translate to the real world. Parents tell us that for the first time, their children settle down to do homework without being nagged. The students tell us they can listen and learn more easily in class.

 

Adolescents who fall asleep in class. The brain waves produced just before a person falls asleep are slow waves. These are exactly the wave patterns that are often seen when the student who has A.D.D. tries to listen to a teacher or when the student tries to study Students with A.D.D., if they get to college, may find it difficult to remain awake during lectures. In the classroom, the production of slower waves means they are becoming less and less attentive to the external auditory and visual stimuli of teacher, chalkboard, and textbook. The student who is actively engaged in listening to the teacher, by contrast, is inhibiting slow wave activity and may be increasing fast, thinker-wave activity.

There is another observation that is important here. Children and adults with ADD. demonstrate a very low, a very high, or a labile electrodermal response (EDR). EDR can be measured with two tiny sensors placed on the palm or on two fingers of one hand. EDR is a measure of skin conduction, which changes when the hand perspires. If a student is drifting off and becoming sleepy, the EDR will be low. It will shift in a dramatic fashion if the student is suddenly startled by a noise or someone entering the room. Sitting up straight also produces an increase in EDR. Students quickly understand how well this simple measurement can reflect their alertness level. With biofeedback training using the EDR feedback, they become more aware of when their alertness drops and learn how to increase it. This EDR training can be done at the same time as neurofeedback.

 

Andy was a pleasant and polite seventeen-year-old boy He was getting failing grades in his final year of high school. His parents said, "He just doesn’t care.” Andy had been diagnosed with A.D.D. when he was younger He complained that he was constantly falling asleep during classes and when doing homework. Beneath his unmotivated, lazy exterior Andy really did want to do well, but he was discouraged. In training when he was given a textbook to read, he kept drifting off If he was left alone for even a short time, the alpha and then theta wave activity would increase markedly His EDR was very low. Occasionally Andy would actually fall asleep in the chair

Andy trained himself to increase his EDR in order to stay awake and alert. Being able to do that encouraged him to believe that he could also improve the balance between his slow and fast brain waves. Gradually over the course of forty sessions, he began to remain alert, focused, and actively learning for longer and longer periods of time. As he did this, his calm waves and thinker waves increased. When he was being creative, he produced more of the slower more synchronous alpha (creative daydreaming) waves. When he was actively listening or organizing, writing, reading or expressing his ideas, he demonstrated more of the faster less synchronous (thinker wave) beta activity

As he proceeded with training, Andy raised his grade in English from a D to a B.

He said, “I’m just turning on my concentration when I’m in class and studying.” Andy had been hanging out with a dificult group of kids who were on drugs. He decided to stop meeting with them. It wasn’t easy to stay at home rather than going out with the group, and his parents worried for a few weeks that Andy was depressed. Eventually he found a new group of friends. He said, “The A.D.D. training gave me hope.”

QUESTIONS YOU MAY HAVE ABOUT NEUROFEEDBACK

Is my child a candidate for neurofeedback?

Not everyone with A.D.D. is automatically a candidate for neurofeedback training. The first visit to a neurofeedback provider will determine whether neurofeedback training is appropriate for your child. While nearly all people with neurologically based attention problems could benefit from this technique, the training must be customized according to the individual’s profile. This means that the person who provides neurofeedback training will first want to assess your child’s brain wave pattern as well as his history. For example, experience has shown that children whose primary problem is paying attention (the bright daydreamers) respond most quickly to neurofeedback. The neurofeedback training is directed specifically at suppressing those brain waves that reflect inattention and encouraging the type that reflect paying attention. When both learning disabilities and attention problems exist in a child, that child is a good candidate for neurofeedback. As the attention span increases, it becomes easier to remediate the learning

 

problems. If a child’s A.D.D. symptoms are accompanied by hyperactivity, learning disabilities, or behavior problems, the training takes longer. As with other kinds of learning, brighter children learn self-regulation faster.

Who is not a candidate for neurofeedback?

Some children show signs of inattention and learning difficulties plus other kinds of learning problems that cause their schoolwork to go right over their heads. Their pattern of EEG activity will not be like one associated with A.D.D. These children need tutoring or special education, not neurofeedback.

One problem that can mimic inattention is anxiety. The child may indeed have trouble concentrating, but it is worry causing the difficulty, not A.D.D. Again, neurofeedback is not the answer. Instead, treatment must investigate the source of the worries, and then appropriate interventions should be applied. This may involve a change of schools, family or individual therapy or medication or treatment for a medical disorder. Some children with A.D.D. also have symptoms of anxiety. When the two problems coexist, then neurofeedback may be appropriate and might be combined with other interventions. If there are significant problems in the family these should be sorted out before trying neurofeedback, or the family may be wasting time and money. The beneficial effects could be negated by the continuing family stress and conflict.

Certain medical conditions can also mimic A.D.D. For example, if the child has a sleep disorder, he will be sleepy during the day and inattentive. Absence seizures, involving brief lapses in attention, will also interfere with learning. These disorders should be treated by other professionals who specialize in

these conditions. If the child has A.D.D. in addition to such medical conditions, he can benefit from training, but the medical conditions must, of course, be treated by a physician.

Another limitation is age. Little research has been done with children who are younger than seven. Also, a lot of neurological maturation takes place naturally during kindergarten and first grade, so if a child’s A.D.D. symptoms are not interfering too much with learning in school, it may be wise to wait and see if the situation improves after that developmental spurt has taken place. For neurofeedback to work, the child must at least be old enough to follow instructions and watch the screen. This is usually around age five or six. Dr. Lynda’s youngest client for neurofeedback training was four, and her oldest sixty-three. Some centers doing neurofeedback research require a minimum age of seven and intellectual functioning that is at least low-average (i.e., IQ above 80).

When should we try neurofeedback?

We believe that it’s a good idea to have an evaluation for the appropriateness of neurofeedback training as soon as you recognize that your child may have A.D.D. You can make better decisions if you know what you are dealing with right from the start and know what your options are. Investing in the training right away makes sense if the A.D.D. symptoms are interfering to a significant degree with your child’s school progress and general happiness. In other situations, where the child is bright and the symptoms are not too severe, excellent parenting practices and a positive school environment may be the only interventions needed. Neurofeedback might become necessary later on as the child’s academic environment becomes more demanding.

 

The best argument for trying neurofeedback first is that it has no negative side effects. And because you are training the brain pathways involved in concentration and learning, you can expect the positive effects to last. Stimulant medication, in contrast, is effective only for the short-term management of behavior.

Many people try neurofeedback as a last resort. Often parents do not understand what neurofeedback is, or they may confuse neurofeedback with biofeedback for relaxation. Some may have been told that this approach is expensive yet unproven, a caution that was common a few years ago when there was less research. Often, they have simply not heard about neurofeedback. Most parents take their child to a physician when they suspect A.D.D., and while most physicians are knowledgeable about drugs for A.D.D., few are aware of neurofeedback as an alternative.

Considerations of time and money will also play a role in decisions about neurofeedback training (see page 224). Neurofeedback has a relatively high short-term cost, as do most individual therapies. Medications cost less in the short term, but the costs add up if your child is taking them for many years, and years of medication is a real possibility.

Should we try neurofeedback instead of or in combination with drugs for our child?

Neurofeedback can be used as an alternative to medication or in addition to medication. Your ADD. specialist can help you decide what is most likely to work well for your child. In general, stimulant medications help most other management techniques work better, especially in children with significant hyperactivity. Stimulant drugs do not appear to have much effect on the EEG, but they may help the child sit still, so that he can do the neurofeedback training more easily. In reality, since most training is done in the evenings and/or on weekends so as not to interfere with the child’s school routine and the parents’ work schedule, medication taken in the morning on school days has worn off. In our experience, many children can be weaned off their medication entirely or the dosage can be lowered partway into neurofeedback training. The neurofeedback approach is particularly attractive when medications do not seem to be helping a child or when they have undesirable side effects.

 

Physician or NeurofeedbackSpecialist? Whom Should You See First?

Taking your child to a medical specialist first is a good idea, since the physician can rule out other medical conditions, like thyroid dysfunction, which can produce symptoms similar to A.D.D. The psychologist or other professional who does neurofeedback and the physician have different but complementary roles. Disorders that should be treated medically include:

 

• petit mal seizures (absence seizures, causing lapses in attention)

• clinical depression

• severe anxiety

• sleep disorders (e.g., sleep apnea)

• thyroid dysfunction

 

In other disorders, medical treatment may be required first, but neurofeedback might be considered as an adjunct to medical treatment to target specific symptoms such as poor attention span and acting before thinking. These conditions include Tourette Syndrome and Asperger Syndrome.

 

What about side effects? How safe is neurofeedback?

Neurofeedback is not a drug. It is as safe as playing a computer game. There are no negative physical side effects. A research team headed by Dr. George Fitzsimmons at the University of Alberta noted that, as the child improves, the family has to make some adjustments because they no longer have a problem child. Brothers and sisters who are used to being the “good” children in the family may feel displaced. All changes, including positive ones, require readjustments in the family dynamics, so this could be considered a side effect.

Dr. Lynda has observed that neurofeedback may have beneficial side effects, which she calls carryover effects. In some children social skills improve. This has been particularly noted in children who, prior to training, were not able to initiate or maintain friendships. Handwriting has been documented to improve. The small number of children who have bed-wetting problems “grow out of” that difficulty. The few children who have associated speech difficulties, particularly with respect to articulation, improved rather dramatically. All academic areas, especially reading, show remarkable improvements. Children who previously seemed completely egocentric (centered on themselves) begin to consider other people’s points of view. Perhaps each of these carryover effects has a neurological basis that further research will be able to explain. For now we’ll just call them a happy carryover and propose a simple hypothesis as an explanation. Keeping in

mind that the slow brain wave activity characteristic of older children who have A.D.D. is also seen in all young children, it may be that what we are observing is an acceleration of maturation as a result of neurofeedback training. All these happy carryover effects seem related to increased maturity and thus may be a natural result of practicing more mature brain wave patterns. Practicing to produce more mature brain waves may help a person mature out of difficulties in paying attention. It will be fascinating to see if this “giving maturation a nudge” hypothesis is borne out by research in the next few years.

Do results obtained through neurofeedback- --back last?

Unlike drugs, which are short acting, neurofeedback appears to produce permanent shifts in learning and behavior. More research will establish if the benefits always last, or if some clients may need refresher sessions.

Why haven’t I heard of neurofeedback before?

Neurofeedback training is based on more than twenty-five years of research. Dr. Barry Sterman, a professor at the University of California, Los Angeles, first published articles on using neurofeedback with human subjects in 1972. After collaborating with Dr. Sterman, Dr. Joel Lubar, a professor at the University of Tennessee, focused his research on using neurofeedback for children with A.D.D. This A.D.D. work was first published in 1976.

 

Since then, considerable research has been done in this field, but because the research was concentrated at a small number of universities and published in highly specialized journals, health care professionals, and even educational or behavioral specialists, were not aware of the possibilities. Now, however, advances in computer technology have taken neurofeedback out of the lab and transformed it into a useful clinical tool that can be used in psychologists’ offices and schools. As EEG equipment has become smaller and personal computers more powerful, there has been rapid growth in the field of neurofeedback, especially as it applies to attention problems.

I’ve beard that neurofeedback is controversial Why is that?

Any technique that is new becomes the subject of some controversy Professionals, like most people, tend to discount what they don’t understand or have no experience with. Most pediatricians know nothing about neurofeedback because it was not mentioned in medical school. Professionals in the field of A.D.D. have traditionally relied on drugs and behavior modification. They are comfortable with these approaches, even as they realize their limitations. As research and experience accumulates, however, neurofeedback is becoming more widely accepted.

Some people take the position that the benefits of neurofeedback training have not been scientifically demonstrated. What they usually mean is that double-blind controlled studies (such as exist for medication) have not been done. In double-blind studies, both the research subject and the experimenter are “blind” as to whether the subject is getting the real treatment or a placebo. One group gets a real pill and the other group (the control group) a look-alike pill with no active ingredient. The researcher then evaluates the subject’s behavior. After the behavior ratings have been collected, the researcher breaks the code to see which subjects had the real drug and to determine if there was significant improvement in this group compared to the group that got the phony pill. (There may have been improvement in the control group as well due to the placebo effect improvement that occurs because of the expectation that it will occur; see page 240 in Chapter 9 of our book.) Double-blind controlled studies can determine quite readily if a drug is effective. Using this medical model to do research, it has been established that stimulants such as Ritalin and Dexedrine produce some improvement in about 70 percent of children with A.D.H.D. symptoms. The positive response rate is higher in younger children (ages six to eleven) and lower in adolescents and adults. About 35 percent of children improve on a placebo alone.

It is not, however, an easy matter to come up with a control group for neurofeedback studies, and this makes it difficult and costly to do double-blind controlled studies of this technique. Whereas research on medications may be funded by the drug companies, who reap profits from the findings, funding for neurofeedback studies is harder to come by

There are, however, valid methods of research that do not use placebo-control designs. Neurofeedback research often uses series of clinical cases or comparison groups. For example, a study by Rossiter and La Vaque published in the Journal of Neurotherapy in 1995 compared a group of children receiving medication with a group doing neurofeedback training. It showed that twenty sessions of neurofeedback (usually forty to sixty sessions are recommended) got results equal to treatment with Ritalin. Improvement was measured using behavior rating scales similar to our A.D.D.-Q on pages 42 to 43 and a computerized test called the TOVA (Test of Variables of Attention), described on page 61.

Practical, clinical experience with neurofeedback is currently running ahead of the research. Anecdotal results (i.e., reports of individual cases) are impressive, and it will take some time for research, which is slow and expensive, to catch up. There are large studies now planned in both the United States and Canada. The time line for these studies, from start to finish, is estimated at a minimum of three years. In the meantime, success stories spread by word of mouth and via the Internet. The days of neurofeedback’s being controversial are quickly passing. There is enough positive evidence to recommend neurofeedback as a valuable tool in tackling the difficulties associated with A.D.D.

How does neurofeedback differ from biofeedback?

Neurofeedback can also be described as EEG biofeedback. It is a special kind of biofeedback. “Feedback” simply refers to feeding information about a person’s behavior back to him or her. Biofeedback involves measuring some biological function in the body and feeding that information back to the person. With this information, the person can become more conscious of body functions, such as temperature, respiration, blood pressure, or heart rate and also learn, to some extent, to control them. For instance, biofeedback can help someone learn to stay relaxed. Neurofeedback can show if the person is staying focused and concentrating. For certain clients neurofeedback sometimes is combined with regular biofeedback, because relaxed concentration is an optimal state for learning. (For an example of this technique, see the story of Matt, page 217.)

What does neurofeedback cost?

Neurofeedback involves an initial evaluation and at least forty sessions of training. Cost depends on what your local neurofeedback practitioner charges per hour. This is often in line with the hourly rate charged by other mental health professionals in your area. Evaluation usually ranges from $300 to $700 and sessions cost between $60 and $120. Think of it as the cost of professional tutoring. Many parents compare their investment in neurofeedback with the cost of orthodontics. Like orthodontics, it takes time and it is expensive, but the results last. Neurofeedback is an investment in improving your child’s quality of life. Dr. Lynda recalls one grandparent who said this when paying for a grandchild’s training: “I had put money aside for college, but we all realized that if he didn’t learn how to pay attention in class and finish his work, he’d never get to college.”

Some people have extended health insurance benefits that cover neurofeedback. Because it is a relatively new intervention, some companies may not have a code for neurofeedback but might group it under biofeedback. Many plans cover psychological services and, in those cases, parents can get reimbursement up to the limit of their plan if the practitioner is a psychologist. In Canada, the provincial health plans do not cover neurofeedback because it is not considered a medical procedure.

What is the success rate with neurofeedback?

Nothing works 100 percent of the time, but neurofeedback is usually successful in appropriate candidates. The research literature reports success rates for neurofeedback training of around 85 percent. Dr. Lynda finds a somewhat higher success rate in her practice, probably because she is using more sessions when needed and is combining neurofeedback training with learning strategies. Further research is needed to identify which clients can be helped by which combinations of techniques.

Every approach to managing ADD, has its good points, and all of them should be considered carefully with your child’s particular situation in mind. The combination of neurofeedback, biofeedback, and training in cognitive strategies is extraordinarily powerful. For a few children with extreme hyperactivity, these can be combined very well with medication. In Dr. Lynda’s experience, the majority of children who are on stimulant medications when they begin training slowly come off medication as neurofeedback takes effect. A few children who were extremely hyperactive still benefit from some medication after training, particularly in group situations. Usually a lower dose of medication can be used when neurofeedback is added. Some children with A.D.D. may also benefit from short-term use of the positive reinforcement strategies outlined in earlier chapters along with neurofeedback training. Parents may also appreciate short-term support and ideas generated by a parent’s group. Always consider using a multimodal approach that is, combine all the interventions likely to benefit your child. Do not forget the basics: a healthy diet, exercise, and enough sleep. “A sound mind in a sound body” is a good motto for everyone in the family

Parents must always be realistic. There are no panaceas. There is no absolute guarantee of improvement with any method or combination of methods used with children who have A.D.D. Nevertheless, the results with neurofeedback are very promising.

There are some situations in which neurofeedback is less successful or takes many more sessions to produce the desired results. These include children who have very extreme hyperactivity, learning disabilities, or severe behavioral or family problems.

 

Extreme hyperactivity in young children. At Dr. Lynda’s center, out of several hundred clients with A.D.D., a few children did not make all the desired gains. Some improvements, especially in academic performance, were seen in all the children, but there was a small group of about six extremely hyperactive children who continued to need stimulant medication, though at lower doses than previously These were children who initially climbed on the furniture during the first few minutes of an interview, despite being on high doses of stimulant medication. Some talked at a speed that made it difficult even for their own mothers to understand. When these children began neurofeedback, Dr. Lynda had thought that it would take about forty sessions. We now recognize that young children who have extreme hyperactivity may take considerably longer to improve perhaps sixty to ninety sessions. Eventually, they do slow down and may get off medication, at least in some situations, while still requiring it in low doses for group events and for school. Other aspects of the A.D.D. problem, such as attention span and academic achievement, improve for extremely hyperactive children in a much shorter time than changes in their activity level do.

 

Learning disabilities. Children with a combination of impulsiveness, hyperactivity, and severe learning disabilities take longer both to begin demonstrating changes (forty to fifty-five neurofeedback sessions instead of about twenty) and to complete training (occasionally more than seventy-five sessions). This group, however, may eventually make the most dramatic changes. Emerson was one of Dr. Lynda’s favorite clients at the ADD Centre.

 

When Emerson began training, he was four years behind his sixth-grade peers in terms of academics. His parents were teachers and had exhausted all the traditional routes for helping him. He was described as the most severely learning-disabled child seen at the local children’s hospital. Emerson had been given special-education support since the primary grades as well as lots of help at home, but he still struggled with second-grade reading material at eleven years of age. With neurofeedback training combined with coaching in learning strategies, be eventually began working at the appropriate grade level. His reading, for example, went from a second-grade level to a fifth-grade level between August, when he started training, and November when his first progress testing was done. Within a year of beginning training, his essay “On the Effects of Budget Cuts in Education” was among those published in the local newspaper He began his essay, ‘As an average seventh-grade student, I believe.. .“His parents sent us a copy of the newspaper and shared their joy that their learning-disabled son now considered himself an average student. His writing was still messy, but he finished seventh grade with straight A’s!

 

Adolescents with severe family problems. In Dr. Lynda’s experience, it is quite difficult to predict which adolescents who have family problems are going to do well in a neurofeedback program and which ones are likely to leave after only a few sessions. Most of the adolescents with behavior problems get quite interested in learning self-regulation and in changing their brain waves. They appropriately feel that they are under-

taking this program for themselves and for their own benefit. The teenager who is used to being nagged likes the idea of getting his parents off his back. Most of them do well, and parents and schools report major positive behavioral changes. On the other hand, it sometimes happens that improvements in brain wave self-regulation and on standardized tests of academic and intellectual functioning do not immediately translate into improved school performance. Sometimes difficult teenagers from difficult family situations drop out before giving the program a chance to have a positive effect. Sometimes they are very passive-aggressive and assert control over the situation by refusing to do their work or by doing it at the very last minute. Dr. Lynda prepares parents at the outset that this might happen.

 

One eighteen-year-old told us that the training had worked. She could now get A’s if she wanted to and had proved it for herself at school. It was certainly easier to listen and learn in class. She still was not doing much homework. She said it was impossible to please her father a professional man who was a perfectionist. If she managed C’~, he would want B’s. Producing B’s would elicit demands for A’s. She felt she couldn’t win, so why even try? She stopped coming to the program. We met with the parents and reconmended family therapy The effects in terms of improved attention were being sabotaged by the difficult family dynamics.

 

Training to decrease slow brain wave activity and increase fast brain wave activity can produce a lasting change in learning efficiency in children with A.D.D. Ideally the graduates of a neurofeedback training program should be able, at will, to put themselves into a mental state that is relaxed, alert, and focused. In this state, they can demonstrate concentration,

 

engage m organized problem solving, and efficiently and effectively accomplish tasks. The addition of some training in learning strategies improves their ability to listen, learn, organize, and remember material. This clear thinking can be applied equally well in academic, social, athletic, and on-the-job situations.

 

Dr. Lynda notes: Without neurofeedback training It takes incredible energy and on-

going supervision from parents and teachers to keep children with A.D.D. on track. It is wonderful to see children learning to do this for themselves as they learn to regulate their brain waves using neurofeedback. This is the most exciting thing I have done in my career as a psychologist. Neurofeedback empowers people to make changes and achieve things that were Just not possible for them before.

 

Copyright © 1998 William Sears