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Monday, May 16, 2011

Can Neurofeedback treat ADHD?

Neurofeedback is also called Biofeedback or Neurotherapy. Neurofeedback (NF) has been around since the 1960's, but not much research has been done to determine if it works.

Having children and teens read and write on a daily
basis may work much better than neurofeedback.
Activities of sustained attention should be match
hour for hour activities of distraction, like
video gaming.

As of 2010, there were only 6 "controlled trials" on the effectiveness of NF. A controlled trial is a scientific study where certain scientific methods are used, so that the results of the study can be considered valid. The researchers can then make conclusions about the results using statistical and logical inferences.

Studies of NF have had methodological 
limitations which have kept NF from 
being considered a valid form of treatment 
for ADHD. To date, there is little evidence that NF 
works better than a placebo for ADHD. 

A placebo is typically a sugar pill, but the participants in the study are not told what is in the pill. When people expect a treatment to work, it will often work. There is absolutely no evidence that NF works better than medications or contingency management (a form of behavior therapy).

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NF is being used to treat many disorders or problems. I suspect that most people who are referred for NF are not informed that it is "experimental" or unproven. NF may help alleviate symptoms of Generalized Anxiety Disorder, however, there is only one study that indicates that it may help GAD. 

NF should not be considered equal to or  better 
than Cognitive Behavioral Therapy or Medications 
for GAD or any other mental health or substance abuse problem.

Apparently NF does not cause harm to people. So, the worst side effects seem to be the potential for lost time and money. I never recommend therapies for which there is no evidence of effectiveness. So, as far as NF goes, I would not recommend it for anyone for any reason at this time. 

NF should probably be considered experimental therapy
until there is more research to back it up.

If NF is found to work better than a placebo, it is important to understand that its potential effectiveness might not have anything to with the neurofeedback portion of the therapy. It may be that the patient undergoing the treatment is improving because of another aspect of the therapy. For example, clients of NF receive incentives for cognitive changes. This is a form of Operant Conditioning. People often improve over time regardless of interventions, especially children because they are developing

This issue arose with EMDR. Initial research on EMDR seemed favorable, however, after more studies were conducted, it was determined that the eye-movement portion of the therapy did not improve the patient's condition - it was other factors not unique to EMDR that helped.

It is possible that the results of NF could be achieved through alternative, similar forms of Operant Conditioning without having to use NF. CogMed is another example of a program that purports to reduce ADD symptoms. There's not enough research on that either.

Aside from NF or CogMed, it may be possible that you can increase your child's attention span by giving them frequent rewards for performing behaviors where they sustain their attention, such as reading. You could measure the effectiveness of this intervention by testing their reading-comprehension. To my knowledge, this has not been tried or studied, perhaps because it is not fancy and there is no profit in it.

In America, more kids than ever are being diagnosed with ADHD. A Michigan State University study recently concluded that nearly 1 million children have been misdiagnosed with ADHD. Other studies have found similar problems with over-diagnosing and over-medicating children.

Why is ADHD so commonly diagnosed in America? One problem may be that our culture does not require our children to sustain their attention for long periods of time. They have to sit still in school most of the day, but sitting still is not the same as paying attention. Video games, television and music are exciting and rewarding for kids whereas homework is "boring" and requires effort at sustained attention. Parents find themselves fighting with their kids to "unplug" themselves from their electronics and to do their homework. Kids find themselves feeling bored with homework and obsessed with video games.

Attention span is fragile and relatively short. It's normal for a 10 year old to have about a 5-10 minute attention span. But when they get bored and have little incentive to learn how to push themselves to do "boring" activities, then they may never learn to expand and develop their ability to sustain their attention longer. Indeed, it may be that continued over-use of video games and television may diminish their attention span. 

We should not expect kids to be motivated to do homework. Kids can learn to enjoy homework when parents use incentives and try harder to make homework enjoyable, starting from age three. All to often, when it comes to homework, parents have little or no patience and start yelling at their kids; this leads to a parent-child pattern of relating to each other with anticipation of feelings of fear, frustration and anger; kids start to associate homework and school with negative emotions. When kids feel bad, they behave bad, and thus are labeled with ADHD.

Another issue is parents, pediatricians, and many mental health providers have no idea on how to effectively implement incentive programs for kids when it comes to doing homework. I have known many parents who say that they have "tried" incentives and they didn't work. But when I hear the details of their plan, I can see why.

Mental Health Advice Disclaimer

The information included in this post and blog are for educational purposes only. It is not intended nor implied to be a substitute for professional mental health treatment or medical advice. The reader should always consult his or her mental health provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a mental health or medical condition or treatment plan. Reading the information on this website does not create a therapist-patient relationship.

1 comment:

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