What is ADD/ADHD?
Attention deficit disorder, learning disabilities and autism are brain/neurological disorders that become increasingly disruptive during childhood, adolescence, and into adulthood. The structure of the brain is usually normal, but the manner in which the brain is functioning is abnormal in someone with ADD/ADHD or LD, and autism.
People with LD, ADD/ADHD or autism usually have brainwaves characterized by the presence of inefficient, excessive slow brainwave (delta, theta, or alpha) activity. The brain is simply not operating correctly. Below is part of a quantitative EEG brain map illustrating the typical profile of someone with a learning disability (LD). Black represents normal, red-yellow-white indicate an excess, and lighter shades of blue an increasing deficiency. The map below shows excessive theta activity toward the rear of the head, in auditory and visual processing areas of the brain, and very slow delta brainwave activity throughout much of the brain.
QEEG Profile of Learning Disability
Children or adults with ADD or ADHD usually have quite different brainwave patterns than we see in LD or autism. In ADD/ADHD there tends to be a slowing of brain activity in the frontal and central regions of the brain, most often in the theta or alpha frequency bands. Scientific research has identified several different subtypes of ADD/ADHD, the most common being the theta subtype, as seen on the next page. This map (which comes from a different normative database than the one above) is from a boy with ADHD. It shows very excessive theta activity, especially frontally, and a deficiency of healthy beta brainwaves. There is also an alpha subtype more often seen in adults or teenagers, and a beta subtype which is less common. There are also many individuals who display a combination of the different subtypes. Therefore, a careful and thorough assessment of brain function is important.
In people with the alpha or theta subtypes of ADD/ADHD, essentially the frontal lobes are lazy and underactive. The brain’s frontal lobes are the executive control centers that control attention, emotion, and behavior. When there is slowed brainwave activity frontally, the brain lacks the proper inhibitory capacity. The result is a problem controlling attention and poor intellectual efficiency, problems controlling emotions, and problems controlling behavior. Thus, the person tends to be impulsive, lacks good judgement, and acts on the emotion and impulse of the moment without adequately considering consequences. Because the brain is not functioning properly, the inhibitory processes of the frontal lobes are not adequately putting on the “brakes” to create self-control.
Traditional Treatment for ADD/ADHD
Medication treatment does produce short-term improvements in ADHD symptoms in about 70% of cases, as long as someone remains on the drugs. There is little medication research on ADD, Inattentive Type. Almost all of the studies of the effects of medication have a short (3 week average) follow-up period and, thus, long-term improvements from drugs on academic outcome, antisocial behavior, or social functioning are not well documented. However, treatments can be combined, and when side effects are not problematic, patients will often remain on medication during much of the time they are receiving neurofeedback training. Following neurofeedback training ,several studies have found improvements that are comparable to those obtained from medication treatment, without remaining on medication. Research by Monastra (2002) documented, one year after the study, that neurofeedback was more effective than ritalin in changing ADD/ADHD without being on medication. A placebo controlled study has also shown the effectiveness of neurofeedback in producing significant improvements in learning disabilities.
Neurofeedback: Another Alternative
Neurofeedback research began in the 1970’s, first proving successful in reducing seizures in uncontrolled epilepsy. Neurofeedback is a powerful form of biofeedback–EEG biofeedback. Ordinarily we cannot control our brainwave activity. However, when we can see our brainwaves on a computer screen almost instantaneously, it gives us the ability to influence our brain’s activity. Neurofeedback training is done with an electroencephalograph (EEG) that measures the brain’s electrical activity more than 1,000 times a second and sends the information to a computer. The person is given instantaneous feedback that gradually helps to suppress slow brainwave activity and recondition healthier patterns that become enduring. In addition to short-term studies, follow-up research at 1 year and 10 years after treatment have found that in almost 80% of cases it can eliminate or substantially reduce the ADD/ADHD symptoms, usually allowing the patient to go off medication. Improvements in IQ scores have been found in every study where it was measured, ranging from 6 to 23 IQ point increases!
Frank H. Duffy, M.D., a Professor and Pediatric Neurologist at Harvard Medical School, stated in an editorial clear back in the January 2000 issue of the journal Clinical Electroencephalography that scholarly literature suggests that neurofeedback “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.” He said, “It is a field to be taken seriously by all.” Neurofeedback is also used with chronic fatigue, fibromyalgia, OCD, depression, anxiety, insomnia, alcoholism and drug abuse, concussions and head injuries, strokes, cognitive dysfunction associated with aging, physical balance, seizures, and for cognitive improvement following neurosurgery. While not a cure for autism, significant changes in expressive and receptive language, behavior, sensory processing, and interaction usually occur.
Assessment: Mapping the Brain
Before neurofeedback, we first do a QEEG brain map. Twenty small electrodes in a snug cap are placed on the scalp so we can measure and record the electrical activity in different parts of the brain, just like a physician listens to your heart. This is painless and noninvasive. No electrical current is put into the brain. The brainwave activity is relayed to the computer and recorded. A normative database analyzes the brainwave patterns, interactions between different parts of the brain, and the efficiency of communication within the brain. All of this is done while the patient is resting quietly with his or her eyes closed, and sometimes during a cognitive task. The QEEG importantly allows us to individualize training. Once our goals have been established, we place an electrode on the scalp during neurofeedback training sessions. The trainee then receives feedback from the computer that facilitates a reconditioning of brainwave patterns. With recent advancements, the neurofeedback training usually requires only about 30 sessions, depending on the degree of brain abnormality. These sessions are usually held twice a week and, very importantly, are individually administered by Dr. Blume.
This Cutting Edge Technology is Available
Neurofeedback and brain mapping services are available at the offices of Dr. Barbara Paul-Blume, Ph.D., BCIA. She is board certified in EEG Neurofeedback, and a licensed Clinical Psychologist in California (PSY 10174). Dr. Blume has used neurofeedback to work with many problems including head injuries and concussions, ADD/ADHD, learning disabilities, depression, insomnia, restless legs, OCD, anxiety and panic disorder, post-traumatic stress disorder, stroke, alcoholism, drug abuse and damage resulting from substance abuse, autism, Asperger’s, following neurosurgery, for problems with physical balance, to counter effects of aging on the brain, with chronic fatigue, fibromyalgia, and uncontrolled epilepsy.