ADDHelpline is your ADD Information Source
If you are interested in learning more about how you can receive EEG Neurotherapy right in your home, using your own computer, enter your email address below.
Regular Features
THE
PARENT COACH
Dr.
Steven Richfield provides articles on many different aspects of raising a child
with ADHD.
ASK
THE ADVOCATE
Each
month we our advocate will be answering questions from our visitors about yours
and your children's rights in the educational system.
PARENTS
TALK
A mother is trying to help her teenage son learn anger management.
MOTIVATION
TIPS
Five great ideas for motivation, including The Shoe Race, Trading Places
and more.
ORGANIZATION
TIPS
Organize your child at home, and maybe find some tips that will help you
as well.
ADHD
IN THE NEWS
Headlines about ADHD, Learning Disability and Mental Disorders
Study on ADD and TV
The recent study published on watching television between the ages of one and
three and the possible link to ADD/ADHD did not take many considerations into
account. The author of the study even admits that he cannot conclude that
television watching and ADD/ADHD are linked.
Read the
Article
Back To Treatment Options Articles
NEUROTHERAPY AND ADHD
Jacques Duff
Psychologist MAPS
Behavioural Neurotherapy Clinic
82 Blackburn Rd
East Doncaster 3109
Australia
Tel: (61)3 98420370
http://www.adhd.com.au
BRAINWAVES AND ADHD
The firing of neurons in the brain controls all thoughts and activities.
This continuous process produces electrical activity, which can be measured as
rhythms or brainwaves on the scalp with an EEG. low brainwaves are associated
with tuning off and lack of concentration, while fast brainwaves are associated
with focused attention and sustained mental effort.
Studies done over the last 15 years have shown that persons with ADHD generally
have more slow-brainwave activity, particular in the frontal parts of the brain,
than those without ADHD.
When a person without ADHD engages in a task requiring mental effort they have
an increase in fast-brainwave activity. In contrast, hen persons with ADHD
engage in similar tasks, they tend to have a decrease in fast brainwave
activity, and a marked increase in slow brainwave activity, particularly in the
frontal regions of the brain.
This observation is consistent with imaging studies showing that the brains
of persons with ADHD are generally underaroused in the frontal regions,
particularly under task. This underarousal explains why many respond to
stimulant medication.
Frontal lobe underarousal accounts for the fact that persons with ADHD find
it hard to concentrate, hard to retain information they have heard or read,
and have a reduced ability to suppress their restlessness and activity
levels.
The very high level of activity seen in very hyperactive children, and the
obsessive behaviours seen in others, are due to separate additional
dysfunctions in the brains of ADHD children.
NEUROTHERAPY AND ADHD
Neurotherapy is a technique that enables ADHD children
and adults to retrain their brain and directly alter their
brainwave patterns. It is the result of the pioneering research of Barry
Sterman Ph.D. professor of Neurobiology at the UCLA School of Medicine,
developments by Prof. J. Lubar of Tennessee University, and subsequent studies
by other researchers in universities and clinical settings.
Studies and extensive clinical use have shown that Neurotherapy is effective in
at least 85% of ADHD sufferers. It helps concentration, impulsivity and
hyperactivity. It works just as well in both children and adults.
During Neurotherapy, sensors on the head pick up the brain's
electrical activity which is continuously sampled and fed to a computer.
The computer program processes these brainwave signals and displays them on the
screen in a simplified easily understood form much like a game. By watching
the levels of their own slow and fast brainwaves, clients can teach
themselves to produce the right brainwave patterns.
This process is called "operant conditioning" and is in fact how we
learn most things. We learned to walk and ride a bike in a similar way.
Through successive approximations the brain made necessary neuronal
connections as it learned the task. When we first learned to throw a ball, by
watching where the ball goes our brains learned to make adjustments on the
next throws and we gradually improved our performance. We learn because we get
feedback on the results of our actions. We could not have learned to throw
the ball accurately with eyes closed, and without visual feedback.
In ADHD, largely on account of inherited functional differences, the brain
connections produce combinations of fast/slow brainwaves that are not conducive
to sustained mental effort, and impulse control. The harder the ADHD children
try, the more the wrong pattern is produced, leading them deeper into their
difficulties.
As in learning to throw a ball, if they could see what happened in their
brain when they tried to concentrate, their brain could make the necessary
adjustments and learn to correct the dysfunctional slow/fast pattern, and
improve performance. Neurotherapy provides them with this feedback of their
brain activity in the form of a brainwave driven computer game.
Training ADHD sufferers to produce less slow brainwaves and
more fast brainwaves under sustained mental effort has been
shown to enable them to concentrate better and be less hyperactive and
impulsive. There are no adverse effects and according to follow-up of previous
ADHD subjects the improvements have been shown to persist 10 years later, and
are expected to be permanent
PSYCHOLOGICAL COUNSELING
Neurotherapy does not replace suitable psychological counseling which may be
needed in many cases. In some families difficult relationships may exist between
family members or with teachers, and appropriate help from a psychologist may be
important to promote more useful interpersonal relationships.
When Neurotherapy is started, children should not be taken off their medication.
Medications must be maintained, and any decision to reduce them must be made in
consultation with the doctor involved and only when clear improvements have
started to occur.
Neurotherapy is not a panacea, it will not fix every difficulty, in every case.
It is important to remember that for ADHD there is a 15% chance of not obtaining
the improvements hoped for, within the usual plan of approximately 40 sessions.
In such cases reassessment and further treatment may be called for, and the cost
may increase significantly. If the person suffers from severe hyperactivity,
conduct disorder, an obsessive disorder or other symptoms such as autistic
traits 60 to 80 or more sessions may be necessary. A minority of cases does not
respond at all to Neurotherapy.
Neurotherapy however has proven extremely helpful in some individuals with
chronic problems such as head injury or obscure symptoms such as sleep
disturbances, and bladder and movement disorders for which other treatments have
failed to help.
HOW EFFECTIVE IS NEUROTHERAPY ?
The research literature and clinical practice reports success rates for
Neurotherapy training of around 85 percent, when given over approximately 40
sessions. Here's a quote from a recent Medical Journal: Clinical
Electroencephalography Vol 31,1 Jan. 2000, which devoted the whole issue to
Neurotherapy.
"The literature, which lacks any negative study of substance,
suggests that Neurotherapy should play a major therapeutic
role in many difficult areas. In my opinion, if any medication
had demonstrated such a wide spectrum of efficacy it would
be universally accepted and widely used." Frank Duffy,M.D. of Harvard's
Children's Hospital. Associate Editor for Neurology
Neurotherapy is usually more successful in candidates where
the motivation to succeed is high, and where complicated
medical or neurological disorders do not co-exist. The
success rate can be increased with persistence, and very
difficult cases of ADHD actually may not improve until
over 60-80 sessions. The really important point is that the
benefits, once achieved, have been shown to last.
Neurotherapy improves attention, reduces irritability and
impulsivity and improves self-esteem. All academic areas,
including reading, speech and articulation difficulties often
show remarkable improvements.
As the person improves overall, secondary problems like
poor handwriting, tics, bedwetting, and headaches may
all improve. In some children social skills improve. This
has been particularly noted in those children who were
not able to initiate or maintain friendships before. Self-centered children
begin to consider other people's points of view. In many cases the person
feels a lesser need of medication after 25 sessions.
Significant IQ increases (10-15 points) occur after Neurotherapy in
childhood ADHD. This is not a magical result of Neurotherapy. It is due to
the person performing better through improved focusing of attention, lower
anxiety and stronger persistence. Hence, it is not a surprise that they will do
better in IQ tests.
Quarrelling parents who could use the problems in their child
to divert attention away from their own disagreements may
become reluctant to believe that their child has actually
become better. In such cases appropriate counselling
should be sought, as this may mean that the improvement
achieved in the training will be prevented from expressing
itself at home.
Differential Diagnosis of ADHD Every parent of a child with ADHD knows that
their child has different symptoms and degrees of responsiveness to medication
to other ADHD children.
Its no surprise that Neuroimaging studies indicate that there are many different
patterns of overactivation (fast waves) and underactivation (slow waves) in the
QEEG of ADHD children. Therefore they manifest different symptoms and respond to
different treatment. Cutting edge research tells us that QEEG Brainmapping (Topometric
Analysis) techniques comparing brain activity at rest to brain activity under
concentration tasks can identify the particular patterns that may be responsible
for the difficulties of an individual child.
In conjunction with behaviour scales and a Test of Variables of Attention (TOVA),
the QEEG patterns revealed by Topometric Analysis can then be used to predict
medication and Neurotherapy effectiveness far more accurately than just through
behaviours alone.
The technology is still evolving, but already, impressive results are now
achievable. After initial testing, in most cases a report can be forwarded
to the child's paediatrician with
recommendations for treatment. Treatment might include
Neurotherapy in conjunction with specific medications or on
its own, as the case may be.
Medication is generally viewed as a short-term measure to manage difficulties,
while Neurotherapy provides more long-term remediation of symptoms. Medication
and Neurotherapy are therefore complementary components in the management and
treatment of ADHD and Learning Difficulties.
WHY DO THE RESULTS LAST?
The long term benefit of Neurotherapy is thought to be the result of
long term memory formation. It is generally known that exercising nerve
pathways facilitates their connectivity and their ability to fire again in
the same patterns. This long-term potentiation is due to the brain
selectively causing the same neurons to fire, thereby strengthening these
connections and establishing brainwave patterns. Neurotherapy is just one method
that repeatedly exercises the neural pathways.
During Neurotherapy the subject learns a skill or task, no
different to walking or riding a bike. Once learned, everytime the person
concentrates, or inhibits unnecessary activity, they are rehearsing the new
brainwave patterns and strengthening them. Research has demonstrated continued
behavioural benefits and sustained normalisation of the EEG after follow up of
10 years or more.
The result of Neurotherapy is robust. Neurotherapy training not
only affects daytime EEG but the effect also lasts into sleep in both human
and animal subjects. Neurotherapy actually changes the nighttime EEG (brain
waves). This is strong evidence that the effect of Neurotherapy is not due
to a psychological ("placebo") effect but an ongoing
physiological effect. Specific protocols produce specific improvements
unbeknown to the child, precluding the placebo effect. In any case placebo
effects are not permanent.
We continue to learn throughout life. Untreated ADHD symptoms can cause
long term dysfunctional learning in the brain to occur and cause life-long
maladaptive patterns to be reinforced time after time. Learning to feel
bad, acting impulsively, losing one's temper etc. Such long term
"learning" is one of the reasons we become more "set" in
behaviour as we become older adults.
IS NEUROTHERAPY CONTROVERSIAL?
Neurotherapy is scientifically well established and its effects
robust in ADHD. However, it is so new that most clinicians
have not heard of it. Any technique that is new can be the subject of some
professional skepticism. Professionals will consider a technique as
"unproven" until they themselves can understand it. And so they
should, as unsubstantiated claims in the media are commonplace . It is
important for professionals to remain skeptical until they are satisfied
with the evidence. It's a professional's duty to ensure that they do not
endorse a treatment until they are certain of its effectiveness and
harmlessness.
In the last 25 years, work on EEG (brain wave) biofeedback and human
clinical trials have progressed steadily. However, like all other
scientific areas it is built on specialised concepts and procedures and
published in narrowly focused academic journals. Most pediatricians,
psychiatrists and psychologists know nothing about Neurotherapy because it has
not yet been a part of the training curriculum they attended.
In the field of ADHD, medical professionals have traditionally
used medications and psychologists have used behavior
modification. They are comfortable with these approaches,
even though they fully realize their limitations.
Historically, mental health professionals have generally
been slow to reverse their earlier opinions about most issues, even when
new evidence becomes available. As research and clinical experience accumulates,
Neurotherapy is slowly becoming better accepted. For example, a Neurotherapy workshop
for psychiatrists has been arranged by the American Psychiatric Association
at their 17 May 2000
meeting in Chicago. The speakers include pioneers in the field: Professor.
Joel Lubar, Dr. Siegfried Othmer PhD, Peter Rosenfeld, Daniel Hoffman M.D,
and Thomas Brod Phd.
It is likely that Neurotherapy will become a popular and well-accepted technique
over the next few years, mostly on account of its overall effectiveness in many
conditions and the lack of adverse effects.