Neurofeedback treatment of ADHD

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Neurofeedback treatment of ADHD

• Brendan Reid
• Luke Mueller
• Bryan Clark
• Adrian Scott

2
Outline

• What is ADHD?
• Physiology and Neurofeedback Procedures
• 2 Efficacy Studies
• Criticism of Neurofeedback for ADHD treatment

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What is ADHD

• A medical condition caused by genetic factors
  that result in certain neurological differences
• Behavioral Characteristics
• Problems with attention
• Lack of Impulse Control
• Motor Restlessness
• Boredom
• Classifications
• gtInattentive
• gtImpulsive-Hyperactive

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TimelineNames Drugs
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Is ADHD on the Rise?

• Market flooded with new drugs
• Number of legitimate cases has remained steady
• 5 in adults
• 3 in children
• Misdiagnosis
• Drug exposure in-utero
• Fetal Alcohol Syndrome(FAS)
• Expectant Mothers
• 5 report using illicit drugs
• gt20 report using alcohol
• Source National Institute of Drug Abuse (NIDA)

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Dr. Quacks MachineDevelopment of
Neurofeedback Therapy for ADHD (I)

• Dr. Barry Sternan
• Commisioned by U.S. Navy
• Training experiments on cats
• D.A. Quirk
• Showed interesting neurofeedback results with
  prisoners
• First to test effectiveness at treating ADHD, as
  well as neurological disorders
• Depression
• Autism
• Stroke

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Neurometric AnalysisDevelopment of Neurofeedback
Therapy for ADHD (II)

• Able to distinguish Learning Disabled from
  non-Learning Disabled children based on EEG
  differences
• 97 successful diagnosis?
• High Hopes
• Should be possible to use home computersto
  carry out neurometric analysis right in the
  schools

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Brain waves and their functions

• Delta 0.1-3 Hz
• Deep sleep, lucid dreaming, increased immune
  functions, hypnosis
• Theta 3-8 Hz
• Deep relaxation, meditation, increased memory,
  focus, creativity, lucid dreaming
• Alpha 8-12 Hz
• Light relaxation, super learning, positive
  thinking
• Low Beta 12-15 Hz
• Relaxed focus, improved attentive abilities
• Midrange Beta 15-18 Hz
• Increased mental ability, focus, alertness, and
  IQ
• High Beta above 18Hz
• Fully awake, normal state of alertness, stress
  and anxiety
• Gamma 40 Hz
• Associated with information-rich task processing
  and high-level information processing

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Brainwaves in ADHD children

• Lubar suggested that children with hyperactivity
  an attention deficit have
• Less beta activity above 14 Hz
• Excessive theta (4-8 Hz) activity
• Suggests that these children are
• less able to shift from resting states
• (theta/alpha dominant) to excited
• states (beta dominant)

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Brainwaves in ADHD children

• A case study of 6 such patients showed that SMR
  (12-15 Hz) training followed by beta training
  with theta inhibition produced significant and
  sustained improvements in school performance and
  psychometric measures
• Letter grades improves, and SMR and beta
  production improved with decreases in theta

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What areas/systems are affected in ADHD patients?

• Frontal lobe
• Attention to tasks
• Focus concentration
• Make good decisions
• Plan ahead
• Learn and remember what we have learned
• Behave appropriately in situations

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What areas/systems are affected in ADHD patients?

• Limbic system
• Base of our emotions
• If over-activated, a person might have wide mood
  swings or quick temper outbursts
• Might also be over-aroused quick to startle,
  touching everything around, hyper vigilant

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What areas/systems are affected in ADHD patients?

• The Reticular Activating System
• Connected at its base to the spinal cord
• Receives information projected directly from the
  ascending sensory tracts
• Brainstem reticular formation runs all the way up
  to the mid-brain
• Serves as a point of convergence for signals from
  the external world and from interior environment

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What areas/systems are affected in ADHD patients?

• Functional imaging techniques have pointed to 3
  areas related to the basal ganglia
• Prefrontal cortex
• Caudate nucleus
• Globus palladus
• Problems with the circuit between these three
  regions may be the underlying mechanism that
  causes ADHD symptoms

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EEG Biofeedback procedure

• One or more sensors are put on the scalp and one
  on an earlobe
• No pain
• Non-invasive
• Computer translates brainwaves into controls for
  a video game
• Practice can allow the child to gain an increased
  control over their brainwaves
• Number of sessions varies
• Can take from 40-60 sessions to eliminate ADD,
  may need more than 60 for ADHD

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Two Efficacy Studies

• Monastra et al. (2002) study
• Fuchs et al. (2003) study

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Monastra et al (2002)

• 100 subjects (mean age 10) were diagnosed with
  ADHD using multiple tests
• All subjects were given stimulant therapy,
  parental counseling, and school consultation
• 51 of the subjects were administered
  neurofeedback
• Subjects were tested after 1 year, then taken off
  Ritalin for 1week and retested

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Monastra Detail of neurofeedback training

• 30-40 minute weekly sessions
• point given for each .5 seconds of improved
  arousal
• 20 points could be exchanged for a 15 reward
• Children were given training until their cortical
  slowing was within 1 SD of same-age peers

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Monastra Results

• Tested after 1 year of medication with Ritalin,
  then 1 week later after no Ritalin
• Non-neurofeedback group showed little improvement
  over their initial scores while on Ritalin, no
  improvement after the wash-out period all still
  classified as ADHD
• Neurofeedback group showed significant
  improvement most were no longer classified as
  ADHD
• Of the neurofeedback group, the only subgroup
  that still tested as ADHD were subjects who
  received non-systematic parenting

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Monastra Results
21
Fuchs et al. (2003)

• 34 children (mean age9.8) diagnosed with ADHD
  but not previously treated
• Treatment based on parent's choice
• 22 given neurofeedback (no Ritalin)
• 12 given Ritalin
• Typically 3 10-mg doses, only on school days
• Treatment lasted for 12 weeks
• One subject in the Ritalin group dropped out
  because of excessive side effects (tics)

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Fuchs Detail of Neurofeedback Training

• Neurofeedback training to increase 12-18 Hz
  activity, decrease 4-7 Hz and 22-30 Hz
• Children of the hyperactive subtype were trained
  in SMR (12-15 Hz)
• Children of the inattentive subtype were trained
  in beta1 (15-18) Hz activity
• Children of the combined subtype were trained for
  half the sessions in SMR, half the sessions in
  beta1

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Fuchs Detail of Neurofeedback Training

• SMR is associated with inhibition of the
  thalamo-cortical loop
• Hyperactivity is thought to be caused by
  overresonsiveness in the right hemisphere, so
  suppressing activity would lead to an decrease
  in hyperactivity
• Attentional deficits may be caused by a
  predominance of theta and lack of beta activity
  in the left hemisphere

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Fuchs Results

• No difference between groups pre-treatment
• After treatment, both groups showed similar
  improvements on all tests

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Problems with Neurofeedback

• time and money (at least 40 sessions, up to 100
  each)
• insurance doesn't cover neurofeedback
• requires patient to be motivated, bored patients
  not as successful
• age too young vs too old (somewhat individual)
  ability to make EEG changes
• Unreliable success rate (50 --gt 90),
• uncertainty of effectiveness until late in
  treatment

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Criticism Hunters in a Farmers World
(Genetic basis of ADHD)

• cultural evolution v.s. biological evolution
• AD/HD may not have always been a disorder
  (University of California, Irvine)
• Attention-Deficit/Hyperactivity Disorder (AD/HD)
  first appeared 10,000 to 40,000 years ago
• speculation that early humans with AD/HD had
  traits such as novelty-seeking, increased
  aggression and perseverance
• traits have been associated with the DRD4 7R gene

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Hunters in a Farmers World (cont.)

• "survival of the fittest" scenario
• ever-increasing number of people with AD/HD
• more aggressive, inquisitive, and willing to take
  risks meant a higher probability for mate
  selection and perhaps multiple sex partners
• spreading of the gene and its associated AD/HD
  behaviors through the population.
• Primitive hunters with this gene would have been
  more successful and would have been better
  providers for their families and tribes

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Criticism Incomplete Knowledge

• Incomplete understanding of underlying mechanisms
  of brain wave production
• Is it wise to alter these mechanism by using
  their byproduct? Self directed alteration and
  morality.
• Are unknown or intractable side effects in
  action?
• Placebo effect (up to 50)
• Reproducible results Umbrella Diagnosis
• Symptoms cause or effect?

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Criticism Afterwards

• Potentially permanent changes (side effects may
  be more intractable, like loss of creativity)
• Personality changes
• Standardization of behavior
• Long term effects relatively unstudied
• Technology advancement and future uses

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Neuroscience conference on Neurofeedback (UCLA,
2005)

• Widespread support from clinical practitioners
• Skepticism from researchers
• Scale Chauvinism
• Unconvinced vs Under-funded
• Neurofeedback as alternatives to
  Psycho-stimulants
• Double blind studies and Placebo effect

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Neurofeedback, ADHD, and Altered States of
Consciousness

• If states of consciousness are dependent on brain
  activity, then the mental states of an untreated
  ADHD patient are different from their treated
  mental states (since there is a change in EEG
  readings)
• ADHD has effects on dopamine, norepinepherine,
  acetylcholine

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References

• Masterpasqua, Frank and Kathryn Healey.
  Neurofeedback in Psychological Practice.
  Professional Psychology Research and Practice.
  2003, Vol. 34, No. 6, 652-656.
• Fuchs, Thomas et al. Neurofeedback for
  Attention-Deficit/Hyperactivity Disorder in
  Children A Comparison With Methylphenidate.
  Applied Psychophysiology and Biofeedback, Vol.
  28, No. 1, March 2003.
• Monastra, Vincent, Donna Monastra, and Susan
  George. The effects of Stimulant Therapy, EEG
  Biofeedback, and Parenting Style on the Primary
  Symptoms of Attention-Deficit/Hyperactivity
  Disorder. Applied Psychophysiology and
  Biofeedback, Vol. 27, No. 4, Dec. 2002.
• http//www.drbiofeedback.com/sections/biofeedback/
  howisbioperformed.html
• http//www.newideas.net/attention_deficit/neurolog
  y.htm
• http//brain.web-us.com/brainwavesfunction.htm

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References (cont.)

• Lubar Joel F. (1985) EEG Biofeedback and Learning
  Disabilities Theory Into Practice, 24(2)
  106-111.
• (2003) "The History of ADHD and Attention Deficit
  Disorder" May 20, 2005.
• http//www.add-adhd-help-center.com/newsletters/n
  ewsletter_15july03.htm
• Bate P (2004) Brief History of EEG Biofeedback
  May 20, 2005
• http//www.adhd-biofeedback.com/eeghist.html
• http//www.add-adhd.org/ADHD_attention-deficit.htm
  l
• http//www.adhd.com.au/Neuro.html
• http//www.attention.com/start/New_Abstracts.pdf
• http//www.eegspectrum.com/Applications/ADHD-ADD/E
  fficacySMR-BetaIntro2/