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Home > Evidence
Summary of Evidence for ADHD

Abstracts, links conclusions.

Summary of some evidence supporting the efficacy of biofeedback for ADHD

by Gary Ames, AlertFocus.com
610-668-3223
 

There is the comprehensive bibliography on neurofeedback with hundreds of references over many indications.  The ADHD literature is about 25% of this list.

http://www.isnr.org/uploads/compbiblio.pdf

See the 2005 white paper for a robust look at the literature and evidence.

http://www.aapb.org/files/public/Monastra_White_Paper.pdf

These 2 sites have a large bibliography with many abstracts available

http://www.eeginfo.com/research/research_papers.htm

http://www.eegspectrum.com/Applications/ADHD-ADD/

Kaiser and Othmer (2000) did a study, with 1,089 patients, which showed that neurofeedback training of sensorimotor and beta waves led to significant improvement in attentiveness and impulse control, and positive changes as measured on the Test Of Variables of Attention (TOVA). The patients had moderate pre-training deficits.
http://www.haworthpress.com/store/ArticleAbstract.asp?sid=G21WVLM481WT8GTCHJRHH95VBG6D07FA&ID=12758 or see below. 

Monastra, et al (2002) worked with 100 children taking Ritalin as well as having concurrent parent counseling and academic support. Half also received EEG biofeedback. There were similar improvements on the TOVA and an ADD evaluation scale. Only those children who had EEG biofeedback were able to sustain their improvements without Ritalin.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12557451

Another study found that 16 of 24 patients taking medication were able to lower their doses or discontinue medication totally after successful training (Alhambra et al 1995).

Two small studies have shown EEG biofeedback to be as effective as Ritalin on numerous measures (Rossiter & LaVaque 1995, Fuchs, Birbaumer, et al, 2003).

Other studies using similar techniques showed increases in intelligence scores and academic performance if theta training was added and was successful. (Lubar et al 1995).

One small study of 16 children compared children trained with neurofeedback to those on a waiting list. They found increased intelligence scores and reduced inattentive behaviors as rated by parents (Linden et al 1996).

Another type of evidence are the improvements in brain functioning after neurofeedback.   A recent fMRI study:  
http://www.mapageweb.umontreal.ca/beauregm/L%C3%A9vesque2006_NFT.pdf

Below is the abstract of 1 summary article and 3 larger studies.

Electroencephalographic Biofeedback in the Treatment of Attention-Deficit/Hyperactivity Disorder

Vincent J. Monastra, Steven Lynn, Michael Linden, Joel F. Lubar, John Gruzelier, and Theodore J. LaVaque
J. Appl Psychophysiol Biofeedback. 2005 Jun;30(2):95-114.

Historically, pharmacological treatments for attention-deficit/hyperactivity disorder (ADHD) have been considered to be the only type of interventions effective for reducing the core symptoms of this condition. However, during the past three decades, a series of case and controlled group studies examining the effects of EEG biofeedback have reported improved attention and behavioral control, increased cortical activation on quantitative electroencephalographic examination, and gains on tests of intelligence and academic achievement in response to this type of treatment. This review paper critically examines the empirical evidence, applying the efficacy guidelines jointly established by the Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neuronal Regulation (ISNR). On the basis of these scientific principles, EEG biofeedback was determined to be "probably efficacious" for the treatment of ADHD. Although significant clinical improvement was reported in approximately 75% of the patients in each of the published research studies, additional randomized, controlled group studies are needed in order to provide a better estimate of the percentage of patients with ADHD who will demonstrate such gains in clinical practice.

The Efficacy of Attention Training For Children with ADHD: A Double-Blind Placebo-Controlled Study

Roger debus, PhD, and J.D. Ball, PhD
Eastern Virginia Medical School, Norfolk, Virginia
roger.debeus@att.net

Introduction
This studys main objectives were to recruit children with a primary diagnosis of ADHD to participate in an attention training (EEG biofeedback) paradigm to determine the effect of this treatment on the cardinal symptoms of ADHD. This was the first study to utilize a placebo condition and double-blind interface with this type of treatment.

Methods
The design of the study consisted of a diagnostic workup, 40 sessions (with a crossover after 20 sessions), and pre-, mid-, and post-assessments. Testing measurements were parent, teacher, and self-report rating scales, and a continuous performance test. During the sessions each child played Sony PlayStation games with an active sensor placed at FZ. The children were randomized into two groups. Group 1 received 20 sessions of brainwave-modulated videogames and then received 20 sessions with the videogames while brainwave activity was monitored. Group 2 received treatment in the opposite order.

Results
Results are based on 53 seven- to 11-year-old children. The primary analysis used in this study was Hierarchical Multivariate Linear Modeling (HMLM). The outcome measures used to determine the efficacy of this intervention (experimental vs. placebo-control) were divided into five domains: (a) ADHD Symptoms (b) Aggression & Conduct Problems, (c) Internalizing Symptoms, (d) Adaptive Skills, and (e) Academic Performance. There were ten significant findings (p < .000) across all the domains for the experimental group compared to the control group.

Conclusions
In summary, the attention training via EEG biofeedback showed many significant improvements in the experimental versus the placebo-control condition. Some of the measured improvements included: (a) reduced hyperactivity and improved attention, (b) less aggressive behaviors, (c) better adaptability to change, interacting more successfully with others, and improved organizational skills; and (d) children showed improved responding and attention on a computerized attention task.

Efficacy of EEG Biofeedback for Attentional Processes 

David A. Kaiser, Siegfried Othmer
Los Angeles, CA
Presented at American Psychiatric Electrophysiological Association, San Diego, 1997.

Attention Deficit Disorder is often assessed with tools which include a continuous performance test (CPT of vigilance and focused attention. CPTs are particularly useful in titrating medication due to the absence of practice effects. In the present work, a CPT test was employed to assess progress with EEG biofeedback training for 408 children and 122 adults referred for attentional deficits and affective complaints.
The training protocol consisted of rewarding enhanced EEG amplitudes at the sensorimotor strip (site C3 or C4) in the 12-18 Hz frequency range, while simultaneously inhibiting excessive low frequency (4-7 Hz) and high-frequency (22-30 Hz) activity.
Significant improvement was found for measures of inattention, impulsivity and response variability after 20 training sessions, p < .001. Inattention and response variability in particular were restored to the normal range of functioning from pre-training deficit levels (Greenberg,1987). No effect of age or gender was found.
Of the 530 subjects, 62 opted to continue training after 20 sessions. Impulse control and response variability was found to improve with additional sessions, p < .01.
The extraordinary success rate of EEG biofeedback in remediating attentional problems, in the present and previous studies, suggests that profound effects on neurobiological mechanisms may be responsible for these results.

Kaiser and Othmer (2000)

Abstract:
Background: Neurofeedback studies have been criticized for including small numbers of subjects. The effect of SMR-beta neurofeedback training on the Test of Variables of Attention was evaluated in more than 1,000 subjects from thirty-two clinics. Methods: 1089 subjects (726 children, 324 females, 186 with ADHD or ADD diagnoses) underwent twenty or more sessions of SMR-beta neurofeedback training for attentional and behavioral complaints at thirty-two clinical settings affiliated with EEG Spectrum, Inc. Subjects were evaluated prior to training and at training completion. One hundred and fifty-seven subjects who elected extensive training (forty sessions or more) were tested after both twenty and forty training sessions. Results: Neurofeedback training produced significant improvement in attentiveness, impulse control, and response variability. Significant clinical improvement in one or more measures was seen in eighty-five percent of those subjects with moderate pre-training deficits.
Conclusions: Neurofeedback training is effective in remediating attentional dysfunction. Nevertheless, large-scale studies with greater control (e.g., wait-list designs) are sorely needed.

 

Gary Ames conclusion.  We have a remedy for ADHD with numerous advantages.

        Biofeedback in general, is accepted by academia as scientifically sound. 

        Neurofeedback works on the site of the disorder to reverse the mechanism of action.  Diverse imaging studies show that the ADHD is no longer detectable. 

        Effectiveness literature for ADHD consistently shows a 75-80% success rate.

        Broad benefits.  Neurofeedback remediates all the symptoms of ADHD.  Medications can be withdrawn, improved attention, academic success, etc. 

        Enduring results.  Follow ups have been tracked for months, years and decades.

        Adverse reactions are rare, minor and self-limiting.  It is relaxing and pleasant. 

 

 


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