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Neurofeedback treatment of ADHD

Brendan Reid Luke Mueller Bryan Clark Adrian Scott. Neurofeedback treatment of ADHD. Outline. What is ADHD? Physiology and Neurofeedback Procedures 2 Efficacy Studies Criticism of Neurofeedback for ADHD treatment. What is ADHD.

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Neurofeedback treatment of ADHD

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  1. Brendan Reid Luke Mueller Bryan Clark Adrian Scott Neurofeedback treatment of ADHD

  2. Outline • What is ADHD? • Physiology and Neurofeedback Procedures • 2 Efficacy Studies • Criticism of Neurofeedback for ADHD treatment

  3. What is ADHD • A medical condition caused by genetic factors that result in certain neurological differences • Behavioral Characteristics • Problems with attention • Lack of Impulse Control • Motor Restlessness • Boredom • Classifications >Inattentive >Impulsive-Hyperactive

  4. TimelineNames Drugs

  5. Is ADHD on the Rise? • Market flooded with new drugs • Number of legitimate cases has remained steady • 5% in adults • 3% in children • Misdiagnosis • Drug exposure in-utero • Fetal Alcohol Syndrome(FAS) • Expectant Mothers: • ~5% report using illicit drugs* • >20% report using alcohol* *Source: National Institute of Drug Abuse (NIDA)

  6. “Dr. Quack’s Machine”Development of Neurofeedback Therapy for ADHD (I) • Dr. Barry Sternan • Commisioned by U.S. Navy • Training experiments on cats • D.A. Quirk • Showed interesting neurofeedback results with prisoners • First to test effectiveness at treating ADHD, as well as neurological disorders • Depression • Autism • Stroke

  7. Neurometric AnalysisDevelopment of Neurofeedback Therapy for ADHD (II) • Able to distinguish Learning Disabled from non-Learning Disabled children based on EEG differences • 97% successful diagnosis? • High Hopes • “Should be possible to use home computers…to carry out neurometric analysis right in the schools”

  8. Brain waves and their functions • Delta: 0.1-3 Hz • Deep sleep, lucid dreaming, increased immune functions, hypnosis • Theta: 3-8 Hz • Deep relaxation, meditation, increased memory, focus, creativity, lucid dreaming • Alpha: 8-12 Hz • Light relaxation, “super learning”, positive thinking • Low Beta: 12-15 Hz • Relaxed focus, improved attentive abilities • Midrange Beta: 15-18 Hz • Increased mental ability, focus, alertness, and IQ • High Beta: above 18Hz • Fully awake, normal state of alertness, stress and anxiety • Gamma: 40 Hz • Associated with information-rich task processing and high-level information processing

  9. Brainwaves in ADHD children • Lubar suggested that children with hyperactivity + an attention deficit have: • Less beta activity above 14 Hz • Excessive theta (4-8 Hz) activity • Suggests that these children are less able to shift from resting states (theta/alpha dominant) to excited states (beta dominant)

  10. Brainwaves in ADHD children • A case study of 6 such patients showed that SMR (12-15 Hz) training followed by beta training with theta inhibition produced significant and sustained improvements in school performance and psychometric measures • Letter grades improves, and SMR and beta production improved with decreases in theta

  11. What areas/systems are affected in ADHD patients? • Frontal lobe • Attention to tasks • Focus concentration • Make good decisions • Plan ahead • Learn and remember what we have learned • Behave appropriately in situations

  12. What areas/systems are affected in ADHD patients? • Limbic system • Base of our emotions • If over-activated, a person might have wide mood swings or quick temper outbursts • Might also be “over-aroused”: quick to startle, touching everything around, hyper vigilant

  13. What areas/systems are affected in ADHD patients? • The Reticular Activating System • Connected at its base to the spinal cord • Receives information projected directly from the ascending sensory tracts • Brainstem reticular formation runs all the way up to the mid-brain • Serves as a point of convergence for signals from the external world and from interior environment

  14. What areas/systems are affected in ADHD patients? • Functional imaging techniques have pointed to 3 areas related to the basal ganglia • Prefrontal cortex • Caudate nucleus • Globus palladus • Problems with the circuit between these three regions may be the underlying mechanism that causes ADHD symptoms

  15. EEG Biofeedback procedure • One or more sensors are put on the scalp and one on an earlobe • No pain • Non-invasive • Computer translates brainwaves into controls for a video game • Practice can allow the child to gain an increased control over their brainwaves • Number of sessions varies • Can take from 40-60 sessions to eliminate ADD, may need more than 60 for ADHD

  16. Two Efficacy Studies • Monastra et al. (2002) study • Fuchs et al. (2003) study

  17. Monastra et al (2002) • 100 subjects (mean age = 10) were diagnosed with ADHD using multiple tests • All subjects were given stimulant therapy, parental counseling, and school consultation • 51 of the subjects were administered neurofeedback • Subjects were tested after 1 year, then taken off Ritalin for 1week and retested

  18. Monastra: Detail of neurofeedback training • 30-40 minute weekly sessions • “point” given for each .5 seconds of improved arousal • 20 points could be exchanged for a $15 reward • Children were given training until their cortical slowing was within 1 SD of same-age peers

  19. Monastra Results • Tested after 1 year of medication with Ritalin, then 1 week later after no Ritalin • Non-neurofeedback group showed little improvement over their initial scores while on Ritalin, no improvement after the wash-out period; all still classified as ADHD • Neurofeedback group showed significant improvement; most were no longer classified as ADHD • Of the neurofeedback group, the only subgroup that still tested as ADHD were subjects who received non-systematic parenting

  20. Monastra: Results

  21. Fuchs et al. (2003) • 34 children (mean age=9.8) diagnosed with ADHD but not previously treated • Treatment based on parent's choice • 22 given neurofeedback (no Ritalin) • 12 given Ritalin • Typically 3 10-mg doses, only on school days • Treatment lasted for 12 weeks • One subject in the Ritalin group dropped out because of excessive side effects (tics)

  22. Fuchs: Detail of Neurofeedback Training • Neurofeedback training to increase 12-18 Hz activity, decrease 4-7 Hz and 22-30 Hz • Children of the hyperactive subtype were trained in SMR (12-15 Hz) • Children of the inattentive subtype were trained in beta1 (15-18) Hz activity • Children of the combined subtype were trained for half the sessions in SMR, half the sessions in beta1

  23. Fuchs: Detail of Neurofeedback Training • SMR is associated with inhibition of the thalamo-cortical loop • Hyperactivity is thought to be caused by overresonsiveness in the right hemisphere, so suppressing activity would lead to an decrease in hyperactivity • Attentional deficits may be caused by a predominance of theta and lack of beta activity in the left hemisphere

  24. Fuchs: Results • No difference between groups pre-treatment • After treatment, both groups showed similar improvements on all tests

  25. Problems with Neurofeedback • time and money (at least 40 sessions, up to $100 each) • insurance doesn't cover neurofeedback • requires patient to be motivated, bored patients not as successful • age: too young vs too old (somewhat individual) *ability to make EEG changes* • Unreliable success rate (~50% --> ~90%), • uncertainty of effectiveness until late in treatment

  26. Criticism: “Hunters in a Farmer’s World” (Genetic basis of ADHD) • cultural evolution v.s. biological evolution • AD/HD may not have always been a disorder (University of California, Irvine) • Attention-Deficit/Hyperactivity Disorder (AD/HD) first appeared 10,000 to 40,000 years ago • speculation that early humans with AD/HD had traits such as novelty-seeking, increased aggression and perseverance • traits have been associated with the DRD4 7R gene

  27. Hunters in a Farmer’s World (cont.) • "survival of the fittest" scenario • ever-increasing number of people with AD/HD • more aggressive, inquisitive, and willing to take risks meant a higher probability for mate selection and perhaps multiple sex partners • spreading of the gene – and its associated AD/HD behaviors – through the population. • Primitive hunters with this gene would have been more successful and would have been better providers for their families and tribes

  28. Criticism: Incomplete Knowledge • Incomplete understanding of underlying mechanisms of brain wave production • Is it wise to alter these mechanism by using their byproduct? Self directed alteration and morality. • Are unknown or intractable side effects in action? • Placebo effect (up to 50%) • Reproducible results: Umbrella Diagnosis • Symptoms: cause or effect?

  29. Criticism: Afterwards • Potentially permanent changes (side effects may be more intractable, like loss of creativity) • Personality changes • Standardization of behavior • Long term effects relatively unstudied • Technology advancement and future uses

  30. Neuroscience conference on Neurofeedback (UCLA, 2005) • Widespread support from clinical practitioners • Skepticism from researchers • “Scale Chauvinism” • Unconvinced vs Under-funded • Neurofeedback as alternatives to Psycho-stimulants • Double blind studies and Placebo effect

  31. Neurofeedback, ADHD, and Altered States of Consciousness • If states of consciousness are dependent on brain activity, then the mental states of an untreated ADHD patient are different from their treated mental states (since there is a change in EEG readings) • ADHD has effects on dopamine, norepinepherine, acetylcholine

  32. References • Masterpasqua, Frank and Kathryn Healey. “Neurofeedback in Psychological Practice. Professional Psychology: Research and Practice”. 2003, Vol. 34, No. 6, 652-656. • Fuchs, Thomas et al. “Neurofeedback for Attention-Deficit/Hyperactivity Disorder in Children: A Comparison With Methylphenidate”. Applied Psychophysiology and Biofeedback, Vol. 28, No. 1, March 2003. • Monastra, Vincent, Donna Monastra, and Susan George. “The effects of Stimulant Therapy, EEG Biofeedback, and Parenting Style on the Primary Symptoms of Attention-Deficit/Hyperactivity Disorder.” Applied Psychophysiology and Biofeedback, Vol. 27, No. 4, Dec. 2002. • http://www.drbiofeedback.com/sections/biofeedback/howisbioperformed.html • http://www.newideas.net/attention_deficit/neurology.htm • http://brain.web-us.com/brainwavesfunction.htm

  33. References (cont.) • Lubar Joel F. (1985) EEG Biofeedback and Learning Disabilities Theory Into Practice, 24(2) 106-111. • (2003) "The History of ADHD and Attention Deficit Disorder" May 20, 2005. • http://www.add-adhd-help-center.com/newsletters/newsletter_15july03.htm • Bate P (2004) Brief History of EEG Biofeedback May 20, 2005 • http://www.adhd-biofeedback.com/eeghist.html • http://www.add-adhd.org/ADHD_attention-deficit.html • http://www.adhd.com.au/Neuro.html • http://www.attention.com/start/New_Abstracts.pdf • http://www.eegspectrum.com/Applications/ADHD-ADD/EfficacySMR-BetaIntro2/

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