Transcript Neurofeedback treatment of ADHD

Neurofeedback treatment of ADHD
Brendan Reid
Luke Mueller
Bryan Clark
Adrian Scott
Outline
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What is ADHD?
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Physiology and Neurofeedback Procedures
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2 Efficacy Studies
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Criticism of Neurofeedback for ADHD treatment
What is ADHD
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A medical condition caused by genetic factors
that result in certain neurological differences
Behavioral Characteristics
1. Problems
with attention
2. Lack of Impulse Control
3. Motor Restlessness
4. Boredom
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Classifications
>Inattentive
>Impulsive-Hyperactive
Timeline
Names
Drugs
Is ADHD on the Rise?
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Market flooded with new drugs
Number of legitimate cases has remained steady
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5% in adults
3% in children
Misdiagnosis
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Drug exposure in-utero
Fetal Alcohol Syndrome(FAS)
Expectant Mothers:
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~5% report using illicit drugs*
>20% report using alcohol*
*Source: National Institute of Drug Abuse (NIDA)
“Dr. Quack’s Machine”
Development of Neurofeedback Therapy for ADHD (I)
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Dr. Barry Sternan
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Commisioned by U.S. Navy
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Training experiments on cats
D.A. Quirk
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Showed interesting neurofeedback results with
prisoners
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First to test effectiveness at treating ADHD, as well as
neurological disorders
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Depression
Autism
Stroke
Neurometric Analysis
Development of Neurofeedback Therapy for ADHD
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(II)
Able to distinguish Learning Disabled from nonLearning Disabled children based on EEG
differences
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97% successful diagnosis?
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High Hopes
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“Should be possible to use home computers…to
carry out neurometric analysis right in the schools”
Brain waves and their functions
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Delta: 0.1-3 Hz
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Deep sleep, lucid dreaming, increased immune functions, hypnosis
Theta: 3-8 Hz
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Deep relaxation, meditation, increased memory, focus, creativity, lucid
dreaming
Alpha: 8-12 Hz
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Light relaxation, “super learning”, positive thinking
Low Beta: 12-15 Hz
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Relaxed focus, improved attentive abilities
Midrange Beta: 15-18 Hz
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High Beta: above 18Hz
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Increased mental ability, focus, alertness, and IQ
Fully awake, normal state of alertness, stress and anxiety
Gamma: 40 Hz
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Associated with information-rich task processing and high-level
information processing
Brainwaves in ADHD children
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Lubar suggested that children with hyperactivity
+ an attention deficit have:
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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)
Brainwaves in ADHD children
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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
What areas/systems are affected in
ADHD patients?
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Frontal lobe
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Attention to tasks
Focus concentration
Make good decisions
Plan ahead
Learn and remember what we have learned
Behave appropriately in situations
What areas/systems are affected in
ADHD patients?
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Limbic system
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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
What areas/systems are affected in
ADHD patients?
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The Reticular Activating System
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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
What areas/systems are affected in
ADHD patients?
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Functional imaging techniques have pointed to
3 areas related to the basal ganglia
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Prefrontal cortex
Caudate nucleus
Globus palladus
Problems with the circuit between these three
regions may be the underlying mechanism that
causes ADHD symptoms
EEG Biofeedback procedure
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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
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Practice can allow the child to gain an
increased control over their brainwaves
Number of sessions varies
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Can take from 40-60 sessions to eliminate
ADD, may need more than 60 for ADHD
Two Efficacy Studies
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Monastra et al. (2002) study
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Fuchs et al. (2003) study
Monastra et al (2002)
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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
Monastra: Detail of neurofeedback
training
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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
Monastra Results
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Tested after 1 year of medication with Ritalin,
then 1 week later after no Ritalin
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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
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Neurofeedback group showed significant
improvement; most were no longer classified as
ADHD
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Of the neurofeedback group, the only subgroup that
still tested as ADHD were subjects who received
non-systematic parenting
Monastra: Results
Fuchs et al. (2003)
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34 children (mean age=9.8) diagnosed with
ADHD but not previously treated
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Treatment based on parent's choice
22 given neurofeedback (no Ritalin)
12 given Ritalin
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Typically 3 10-mg doses, only on school days
Treatment lasted for 12 weeks
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One subject in the Ritalin group dropped out
because of excessive side effects (tics)
Fuchs: Detail of Neurofeedback
Training
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Neurofeedback training to increase 12-18 Hz
activity, decrease 4-7 Hz and 22-30 Hz
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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
Fuchs: Detail of Neurofeedback
Training
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SMR is associated with inhibition of the
thalamo-cortical loop
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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
Fuchs: Results
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No difference between groups pre-treatment
After treatment, both groups showed similar
improvements on all tests
Problems with Neurofeedback
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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
Criticism: “Hunters in a Farmer’s World”
(Genetic basis of ADHD)
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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
Hunters in a Farmer’s World (cont.)
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"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
Criticism: Incomplete Knowledge
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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?
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Placebo effect (up to 50%)
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Reproducible results: Umbrella Diagnosis
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Symptoms: cause or effect?
Criticism: Afterwards
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Potentially permanent changes (side effects
may be more intractable, like loss of creativity)
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Personality changes
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Standardization of behavior
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Long term effects relatively unstudied
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Technology advancement and future uses
Neuroscience conference on
Neurofeedback (UCLA, 2005)
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Widespread support from clinical practitioners
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Skepticism from researchers
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“Scale Chauvinism”
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Unconvinced vs Under-funded
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Neurofeedback as alternatives to Psychostimulants
Double blind studies and Placebo effect
Neurofeedback, ADHD, and Altered
States of Consciousness
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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
References
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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.
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http://www.drbiofeedback.com/sections/biofeedback/howisbioperformed.html
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http://www.newideas.net/attention_deficit/neurology.htm
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http://brain.web-us.com/brainwavesfunction.htm
References (cont.)
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Lubar Joel F. (1985) EEG Biofeedback and Learning Disabilities Theory Into Practice,
24(2) 106-111.
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(2003) "The History of ADHD and Attention Deficit Disorder" May 20, 2005.
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http://www.add-adhd-help-center.com/newsletters/newsletter_15july03.htm
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Bate P (2004) Brief History of EEG Biofeedback May 20, 2005
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http://www.adhd-biofeedback.com/eeghist.html
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http://www.add-adhd.org/ADHD_attention-deficit.html
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http://www.adhd.com.au/Neuro.html
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http://www.attention.com/start/New_Abstracts.pdf
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http://www.eegspectrum.com/Applications/ADHD-ADD/EfficacySMR-BetaIntro2/