What About The Science?
Frank Duffy, MD, Neurologist, Head of the Neuroimaging Department and of Neuroimaging Research at Boston Children’s Hospital, Harvard Medical School Professor and Associate Editor the EEG and Clinical Neuroscience Society Journal, conducted an independent review of the literature on neurofeedback for Clinical Electroencephalography (2000) writes:
"The [research] literature, which lacks any negative study of substance, suggests that EEG biofeedback therapy 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….It is a field to be taken seriously by all." (p. vii)
Efficacy of Neurofeedback Treatment in ADHD: the Effects on Inattention, Impulsivity and Hyperactivity: a Meta-Analysis by Arns M, de Ridder S, Strehl U, Breteler M and Coenen A, Journal of Clinical EEG & Neuroscience, July, 2009
Abstract
“Since the first reports of neurofeedback treatment in Attention Deficit Hyperactivity Disorder (ADHD) in 1976, many studies have investigated the effects of neurofeedback on different symptoms of ADHD such as inattention, impulsivity and hyperactivity. This technique is also used by many practitioners, but the question as to the evidence-based level of this treatment is still unclear. In this study selected research on neurofeedback treatment for ADHD was collected and a meta-analysis was performed.
Both prospective controlled studies and studies employing a pre- and post-design found large effect sizes (ES) for neurofeedback on impulsivity and inattention and a medium ES for hyperactivity. Randomized studies demonstrated a lower ES for hyperactivity suggesting that hyperactivity is probably most sensitive to nonspecific treatment factors.
Due to the inclusion of some very recent and sound methodological studies in this meta-analysis, potential confounding factors such as small studies, lack of randomization in previous studies and a lack of adequate control groups have been addressed, and the clinical effects of neurofeedback in the treatment of ADHD can be regarded as clinically meaningful. Three randomized studies have employed a semi-active control group which can be regarded as a credible sham control providing an equal level of cognitive training and client-therapist interaction. Therefore, in line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude that neurofeedback treatment for ADHD can be considered "Efficacious and Specific" (Level 5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.”
In a recent paper (April 2004 - Volume 16 - Issue 2 - pp 217-226) Update on attention-deficit/hyperactivity disorder published in Current Opinion in Pediatrics Katie Campbell Daley reviewed the research and practice standards on treatment of ADHD. Dr. Campbell serves on the staff of the Department of Medicine, Children's Hospital Boston and in the Department of Pediatrics of the Harvard Medical School. She concluded:
"Overall, these findings support the use of multi-modal treatment, including medication, parent/school counseling, and EEG biofeedback, in the long term management of ADHD, with EEG biofeedback in particular providing a sustained effect even without stimulant treatment...parents interested in non-psychopharmacologic treatment can pursue the use of complementary and alternative therapy. The therapy most promising by recent clinical trials appears to be EEG biofeedback."
A recent special issue of Child and Adolescent Psychiatric Clinics of North America was devoted to emerging interventions that affect brain function. Neurofeedback was featured in seven of the ten chapters in the volume. The volume editors provided an overview and clinical perspective on all the approaches presented. About neurofeedback they concluded:
"EEG biofeedback meets the American Academy of Child and Adolescent Psychiatry criteria for clinical guideline (CG) for treatment of ADHD, seizure disorders, anxiety (OCD, GAD, PTSD, phobias), depression, reading disabilities, and addictive disorders. This suggests that EEG biofeedback should always be considered as an intervention for these disorders by the clinician."
Vincent J. Monastra ADHD Study cited by WebMD
"WebMD says that, although prescribing drugs such as Ritalin and Adderall are the most common way of managing ADHD -- and bring improvement in about 80% of patients, says the American Psychiatric Association - they are not without problems. Many children taking them suffer side effects such as sleep problems, weight loss, jitters, and stomach upset, and nearly half of those with some types of ADHD don't respond to the drugs at all. Some experts are also concerned with their long-term use.
A study, published in the December, 2002, issue of Applied Psychophysiology and Biofeedback, indicates that ADHD kids who had weekly sessions of traditional biofeedback therapy for a year were able to reduce or eliminate their medication - and maintained the same level of improvement in focus and concentration as when they had been on drug therapy."
Vincent J. Monastra, PhD, of the FPI Attention Disorders Clinic in Endicott, N.Y., studied 100 children 6-19 years of age with ADHD for a year, all of whom were taking Ritalin and had school and family counseling. But half of the children also had weekly EEG biofeedback therapy, in which they were hooked to a device that measures the activity of their brain waves. "At the conclusion of treatment, all of those who underwent biofeedback were able to cut their medications by at least half - and still enjoy the improvements they got from the drugs. And about 40% were able to discontinue their medication," he tells WebMD. "The kids who didn't get biofeedback needed to continue medication to sustain improvements."
Why biofeedback, which has shown success in treating a host of conditions including migraine and other headaches, chronic pain, digestive problems, hypertension and substance abuse? "Studies show that about 90% of ADHD kids have an under-arousal in activity in the front lobe -- the region of the brain that is involved in sustained attention, focus, concentration, and problem-solving," Monastra says. With biofeedback, the theory goes, ADHD patients can be "taught" to bolster activity in these brain areas.
In these sessions, Monastra's study participants were placed in front of a video screen whose characters moved only when the children produced a short but sustained burst of activity in those areas of the brain thought to be under-aroused. In essence, the 51 patients who got biofeedback played a video game that continued only when they exercised the portion of their brain that is deficient in the ability to focus and stay attentive.
"It's like physical therapy for the brain," explains Monastra, who has studied biofeedback's effect on ADHD for several years. "Every time they produced a half-second burst of activity over the frontal lobe, they were reinforced by the screen to continue."
After a year of study, the children in both groups showed improvement in attentiveness from medication and other treatments. But what happened when the researcher abruptly stopped their medication for a full week?
"If you didn't have the biofeedback and I took way your medicine," says Monastra, "you were back to square one -- your scores from a very thorough evaluation and medical exam indicated that you had significant problems. But if you had received biofeedback, scores on behavioral ratings of teachers and parents, scores on attention and EEG tests measuring brain activity remained in the normal range of what had been achieved with the drugs. In other words, the kids who got biofeedback maintained the gain they achieved with medication, even without the medication."
Professor John Gruzelier Head of the Cognitive Neuroscience and Behaviour Laboratory at Imperial College London states that neurotraining “can positively influence the cognitive performance of healthy individuals.” Financial Times 2003
Candice B. Pert, Ph.D., former chief of Brain Biochemistry at the National Institute of Mental Health and author of Molecules of Emotion and Your Body is Your Subconscious Mind states: "Neurofeedback is on the cutting edge of the mind-body revolution. I believe it is one of the treatments that will keep us moving toward an era of new approaches of naturally managing our health."
Jonathan Walker, M.D., Neurologist, Dallas, TX -
"It improves seizures, depression, low self esteem or congenital head injuries, and it helps the ‘craziness’ that often comes with these . . . Patients report they sleep better, feel better, they don’t have seizures, they are more in control, and that they get more work done. It helps with closed head injury patients. It helps with chronic neurologic disease, where there is no active injury but there are problems with normal functioning. We’ve had success with multiple sclerosis, with toxic encephalopathy (for example, chemical poisoning interfering with neurologic functioning), with chronic pain, migraines and fibromyalgia. And of course, we get very good results with ADD."
Daniel Amen, M.D. Change Your Brain Change Your Life -
"In my experience with EEG Biofeedback and ADD, many people are able to improve their reading skills and decrease their need for medication. Also, EEG biofeedback has helped to decrease impulsivity and aggressiveness. It is a powerful tool, in part because the patient becomes part of the treatment process by taking more control over his own physiological processes." (pp. 143-144)
William Sears, M.D. The A.D.D. Book -
"Among the newer approaches to managing ADD, the most exciting is a learning process called neurofeedback. It empowers a person to shift the way he pays attention. After more than twenty-five years of research in university labs, neurofeedback has become more widely available. This is a pleasing development, because neurofeedback has no negative side effects." (Page 205)
David F. Velkoff, M.D. Medical Director Drake Institute of Behavioral Medicine, Los Angeles Physician’s Weekly POINT/COUNTERPOINT July 13, 1998 Vol. XV, No. 26 -
"In my own practice, I’ve used neurofeedback in a comprehensive medical treatment program to help more than 1,000 patients with attention deficit hyperactivity disorder. When combined with supportive therapies such as family counseling and educational therapy, EEG neurofeedback is the most effective treatment available. Critics of EEG neurofeedback hold this treatment to more rigid standards than drug treatments. Yet unlike drugs, neurofeedback is benign."
Terry Cook, Psychiatrist, New South Wales, Australia
"Used selectively for patients, it is a very good tool. For psychiatry, this is an area to look into. Not everyone gets better with Prozac, or other drugs. This is a biological intervention that gets the brain firing. I’ve only used Neurofeedback on a limited basis so far, I’ve gotten good results in my private practice with depression. I’ve also gotten good results with some children we have used it for. I would like to do more with it."
Jack Woodward, M.D, Board Certified Psychiatrist, Clayton
"In my 38 years of practice, I have never seen any treatment that comes close to producing the results that Neurofeedback offers . . . I have seen results achieved in days and weeks that previously took months and years to achieve, using the best methods available to us."
Dr. Thomas Brod, Psychiatrist, Los Angeles, CA -
"This is one of the broad reach of tools available, and it’s a good tool. Like any tool, it doesn’t work for everyone, but it does benefit most people. It accelerates symptom removal and the development of healthy self-regulation — meaning it helps the patient’s own body make the proper adjustments. "
From the Desk of Barry Belt, Psychologist -
There have been over twenty years of published research studies and thousands of anecdotal case histories which document the effectiveness of biofeedback in the treatment of ADD. Perhaps more importantly, there have been no published studies which negate the effectiveness of EEG biofeedback. During the past several years, many medical professionals have written books about the benefits of biofeedback for a variety of disorders. In addition, many psychiatrists and neurologists have added EEG biofeedback to their practices. Despite this support, physicians and health care professionals will often discourage clients from pursuing EEG biofeedback. The skepticism from health care professionals appears to stem from their lack of education, experience and expertise in EEG biofeedback (neurofeedback), rather than issues regarding the effectiveness of the treatment. Consequently, it is strongly recommended that when another health care professional or physician disputes the therapeutic value of biofeedback for the treatment of ADD, you ask them to identify the origin of their disapproval and suggest an exploration of the relevant scientific papers on this site.
How does it help : more efficient brain function, better quality of life, more balanced emotional life
For ADHD and learning disabilities : reduced distractibility/impulsivity, improved cognitive and academic performance, improved behavior, normalsied motor function, improved social awareness and interaction, elimination of psychostimulants, stabilize moods, improve confidence and self esteem, improved sleep patterns.
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