Non-pharmacological and Lifestyle Approaches to Attention-Deficit/Hyperactivity Disorder: 6. Biofeedback

It seems odd that hyperkinetic children and adults with attentional problems should be able to stop long enough to try yoga, meditation of biofeedback. Yet there is good evidence that they can and they do, and that all three modalities can be helpful.

Today we are going to look at the use of a specific form of biofeedback.

Neurofeedback is a form of behavioral training that is aimed at developing skills to help people self-regulate the activity of their brains.

The first attempts to use biofeedback in children with behavioral problems took place in the early 1980s, following some interesting work on using it to control epilepsy, headaches and an array of other problems. Several good quality neurofeedback studies have been published over the last ten years.

In neurofeedback training, people are taught to control specific aspects of electrical brain activity. They are hooked up to machine that records electric impulses from the brain – a form of electroencephalograph (EEG) and they are given immediate feedback and positive reinforcement, usually using a visual display.

In frequency training, people are asked to increase or decrease the activity of different EEG frequency bands. To learn to regulate their level of cortical excitability they are trained to generate and regulate slow cortical potentials (SCPs). Slow cortical potentials are slow event-related direct-current shifts of the EEG.

With a little practice, almost anyone can learn the basic techniques, and as they do, they constantly improve their ability to regulate their attention, thoughts, moods and reactions. Many young people with attention-deficit hyperactivity disorder (ADHD) look at it like a game, and quickly become engaged with it.

Studies of neurofeedback have shown some specific effects on attention and memory processes. The key point is that the improvements in performance are maintained once the person is engaged in real-life activities. The techniques can be used to help healthy people perform better as well as helping people with problems.

Several studies have shown that children with ADHD had improvements in behavioral and cognitive variables after both frequency (e.g., theta/beta) training and SCP training. Some of the improvements have been sustained for six months. It has also been possible to show improvements in some neurophysiological measurements. Most studies have been done in children with ADHD, and in most other things were done as well. For instance the children were kept on medications, or children were given other types of exercises to reinforce what they were learning.

There has been some good brain imaging research that has shown that neurofeedback in children with ADHD normalizes the functioning of the anterior cingulate cortex, the key neural substrate of selective attention

There is also another type of feedback training. There is evidence that the level of activity in a classroom containing hyperactive boys can be reduced using feedback about the level of activity together with positive reinforcement. Some recent research has produced preliminary data in which investigators used a device that combines a beeper and actigraphy technology for measuring, monitoring, and modifying motor excess in children. The feedback reduced the activity level of seven out of nine hyperactive boys.

There remain a lot of unanswered questions about biofeedback in the treatment of ADHD. In an excellent review article, John Gruzelier and Tobias Egner from London pointed out that neurofeedback had grown and been widely adopted with little in the way of research to back it up. However their own work has shown that the technique can help improve cognition, and they provided the first evidence of conscious control over the ratio of alpha and theta waves in the brain. They also showed that the technique could lead to remarkable improvements in artistic aspects of music performance, which were equivalent to two class grades in conservatory students.

The evidence for biofeedback is growing, and since it is non-invasive ad may be associated with a number of other improvements in mood and cognition, it will likely bean important option for some people with ADHD.