National Institute of Mental Health to Provide a Grant for Research into Neurofeedback Training for ADHD

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A recent press release from the National Institute of Mental Health (NIMH) that surprised me. NIMH is providing grants for two studies on what they call novel and innovative approaches to treating children who have Attention Deficit Hyperactivity Disorder (ADHD), and one of these studies will be focused on Neurofeedback training.

Attention Deficit Hyperactivity Disorder is a childhood disorder associated with attention problems, impulsivity, and hyperactivity. It affects around 5 percent of U.S. children, although some studies suggest as many as 8.7 percent of children are affected. Current diagnostic criteria include the presence of impairing symptoms by age 7, although children may not actually be diagnosed until later, most commonly in the third grade. While the symptoms of hyperactivity may decrease with age as the brain matures, other symptoms tend to persist, and it is not uncommon for ADHD-associated impairments to continue through the teenage years and into adulthood.

Two researchers from Ohio State University will lead a research project to study Neurofeedback, which is also known as EEG biofeedback. Neurofeedback training is an alternative therapy sometimes used to treat ADHD, and other conditions. We provided Neurofeedback training to our patients for a number of years at our office, and were impressed with how effective it could be with children as young as six or seven years old. The major drawback that we saw with it was that it took a number of training sessions to make a significant and lasting difference, and that these sessions could be expensive to the family.

The way that eeg biofeedback training works is that the subject is given information about how his or her brain is working at the moment, and the subject uses that information to learn to change and control his own brain waves. The information is often provided in the form of a video game, so that the training is more interesting. The player becomes successful at playing the game by changing his brainwave frequencies to be more optimal for his particular condition. A person with ADHD will be trained to produce more brain waves in the higher frequencies that are associated with focus, and to produce less of the slow brain waves associated with day-dreaming, or even sleep. We have seen the technology successfully used for ADHD, sleep disorders, alcoholism, and anxiety disorders. We have also used the technology with athletes for peak performance training and greater situational awareness.

Studies by Lubar and others have shown the potential value of this treatment, but the medical community, often backed by pharmaceutical dollars, never really bought into it. The medical community typically replied with the demand for double-blind studies, as one would do with pills. But there are many things that do not need to be studied with double-blind studies.

Take, for example, a study on the effectiveness of weight lifting to increase strength. Would such a study be done with a double-blind protocol? No, of course not. You cannot trick a person into thinking they are lifting weights hard when they are not. Another example would be the relationship between reading and learning. If one were to study the question of whether or not reading can increase learning, the researcher would not be able to look at the effectiveness of reading by use of a double-blind study design. There are no placebos for books, and the subject would know whether he was reading or not. And EEG biofeedback training is similar. Its effectiveness simply cannot be studied through a double-blind protocol, as the control group will quickly know that they are being tricked. The control group becomes unnecessary to the researcher, and unmotivated to participate, very quickly. The pharmaceutical companies know this, and the medical community knows this, but this is the argument that they have used to minimize the potential contribution that EEG Biofeedback training could make in the treatment of ADHD.

It is either fortunate, or unfortunate, but this will be the research design for the Ohio State study.

In their pilot study, Dr. Arnold and Dr. Lofthouse will randomly assign thirty-six children ages 6 to12 to receive either EEG neurofeedback in the context of computer games or a placebo EEG treatment. The researchers say that during the placebo treatments the participant will experience pre-programmed game effects that are not affected by his or her brain wave activity, but the reality of it is that it will take about three sessions before everyone in the placebo group knows that they are being tricked. People learn quickly when they are controlling what is taking place on the computer, and when they are not, so the control group part of the study will be a waste of time very soon into the project.

Further, if the study were to use a CPT test, such as the TOVA, to measure changes in performance, there would be no need for a placebo group as these tests have no placebo effect. These tests are not impacted at all by placebos. People either perform better on the tasks or they do not.

But the good news is that by using the double-blind study design, although unnecessary, the study will potentially be published in medical journals where the results will have to be considered by the medical community.

Subjects in the treatment group also will be randomly assigned to have either two or three sessions each week to see the effects of treatment frequency. Everyone in the study will complete forty treatments total. Parent and teacher rating scales will be used as the measure of improved performance, which is too bad as they are highly subjective.

We certainly wish L.Eugene Arnold, M.D., and Nicholas Lofthouse, Ph.D., of The Ohio State University all the best of success in this project, and believe that they will contribute a great deal of information to the medical community on the effectiveness of EEG Biofeedback training.

If the reader would like to learn more about the effectiveness of Neurofeedback in treating ADHD, consider the study entitled, A Comparison of EEG Biofeedback and Psychostimulants in Treating Attention Deficit/Hyperactivity Disorders, by Thomas P. Rossiter, and Theodore J. La Vaque. It is published in the Journal of Neurotherapy, Summer 1995. Also visit these two websites: the Brian Othmer Foundation at http://brianothmerfoundation.org/scientificarticlehome.html and the EEG Spectrum website at http://eegspectrum.com/Articles/ScientificArticles/ for a more research articles. Finally, Google the keywords: Joel Lubar (he is at the University of Tennessee), Neurofeedback ADHD, or EEG Biofeedback ADHD, for other articles.