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Perspective: Neurofeedback treatment for ADHD is gaining strong support

neurofeedbackNeu­ro­feed­back — also known as EEG Biofeed­back — is an ADHD treat­ment in which indi­vid­u­als learn to alter their typ­i­cal EEG pat­tern to one that is con­sis­tent with a focused, atten­tive state. This is done by col­lect­ing EEG data from indi­vid­u­als as they focus on stim­uli pre­sent­ed on a com­put­er screen. Their abil­i­ty to Read the rest of this entry »

Comparing Working Memory Training & Medication Treatment for ADHD

Work­ing mem­o­ry (WM) is the cog­ni­tive sys­tem respon­si­ble for the tem­po­rary stor­age and manip­u­la­tion of infor­ma­tion and plays an impor­tant role in both learn­ing and focus­ing atten­tion. Con­sid­er­able research has doc­u­ment­ed that many chil­dren and adults with ADHD have WM deficits and that this con­tributes to dif­fi­cul­ties asso­ci­at­ed with the dis­or­der. For an excel­lent intro­duc­tion to the role of WM deficits in ADHD, click here.

A sim­ple exam­ple illus­trates the impor­tance of WM for par­tic­u­lar aca­d­e­m­ic tasks. Try adding 3 and 9 in your head. That was prob­a­bly easy for you. Now try­ing adding 33 and 99. That was prob­a­bly more dif­fi­cult. Final­ly, try adding 333 and 999. This is quite chal­leng­ing for most adults even though each cal­cu­la­tion required is triv­ial­ly easy. The chal­lenge occurred because you need to store infor­ma­tion — the sum of 3+9 in the one’s col­umn and then ten’s col­umn — as you process the remain­ing part of the prob­lem, i.e., 3+9 in the hundred’s col­umn, and this taxed your WM. If your WM capac­i­ty was exceed­ed, you could not com­plete the prob­lem suc­cess­ful­ly.

This sim­ple prob­lem also illus­trates the dif­fer­ence between short-term mem­o­ry (STM) and WM. Short-term mem­o­ry sim­ply involves retain­ing infor­ma­tion in mind for short peri­ods of time, e.g., remem­ber­ing that the prob­lem you need to solve is 333+999. Work­ing mem­o­ry, in con­trast, involves men­tal­ly manip­u­lat­ing — or ‘work­ing’ with — retained infor­ma­tion and comes into play in a wide range of learn­ing activ­i­ties. For exam­ple, to answer ques­tions about a sci­ence chap­ter, a child not only has to cor­rect­ly retain fac­tu­al infor­ma­tion but must men­tal­ly work with that infor­ma­tion to answer ques­tions about it. Thus, when a child’s WM capac­i­ty is low rel­a­tive to peers, aca­d­e­m­ic per­for­mance is like­ly to be com­pro­mised in mul­ti­ple areas.

Because WM deficits play an impor­tant role in the strug­gles expe­ri­enced by many indi­vid­u­als with ADHD, it is impor­tant to con­sid­er how dif­fer­ent inter­ven­tions address this aspect of the dis­or­der. In this study, the authors were inter­est­ed in com­par­ing the impact of Work­ing Mem­o­ry Train­ing and stim­u­lant med­ica­tion treat­ment on the WM per­for­mance of chil­dren diag­nosed with ADHD.

Par­tic­i­pants were 25 8–11 year-old chil­dren with ADHD (21 boy and 4 girls) who were Placebo effect, mind hacksbeing treat­ed with stim­u­lant med­ica­tion. Children’s mem­o­ry per­for­mance was assessed on 4 occa­sions using the Auto­mat­ed Work­ing Mem­o­ry Assess­ment (AWMA), a com­put­er­ized test that mea­sures ver­bal short-term mem­o­ry, ver­bal work­ing mem­o­ry, visuo-spa­tial short-term mem­o­ry, and visuo-spa­tial work­ing mem­o­ry.

At time 1, the assess­ment was con­duct­ed when chil­dren had been off med­ica­tion for at least 24 hours. The sec­ond assess­ment occurred an aver­age of 5 months lat­er and when chil­dren were on med­ica­tion. The third assess­ment occurred after chil­dren had com­plet­ed 5 weeks of Cogmed Work­ing Mem­o­ry Train­ing using the stan­dard train­ing pro­to­col (see below). The final assess­ment occurred approx­i­mate­ly 6 months after train­ing had end­ed. This design enabled the researchers to make the fol­low­ing com­par­isons:

- WM per­for­mance on med­ica­tion vs. off med­ica­tion (T1 vs T2)
— WM per­for­mance on med­ica­tion vs. after train­ing (T2 vs. T3)
— WM per­for­mance imme­di­ate­ly after train­ing end­ed vs. 6 months fol­low­ing train­ing (T3 vs. T4)

This final com­par­i­son pro­vid­ed infor­ma­tion on whether any ben­e­fits pro­vid­ed by the train­ing had endured.

In addi­tion to mea­sur­ing STM and WM at each time point, mea­sures of IQ were col­lect­ed at times 1, 2, and 3.

- Work­ing Mem­o­ry Train­ing -

WM train­ing was con­duct­ed using the stan­dard Cogmed train­ing pro­to­col with each child Cogmed working memory trainingcom­plet­ing 20–25 train­ing ses­sions with­in a 25 day peri­od. The train­ing requires the stor­age and manip­u­la­tion of sequences of ver­bal, e.g., repeat­ing back a sequence of dig­its in reverse order, and/or visuo-spa­tial infor­ma­tion, e.g., recall­ing the loca­tion of objects on dif­fer­ent por­tions of the com­put­er screen.

Dif­fi­cul­ty lev­el is cal­i­brat­ed on a tri­al by tri­al basis so the child is always work­ing at a lev­el that close­ly match­es their per­for­mance. For exam­ple, if a child suc­cess­ful­ly recalled three dig­its in reverse order, on the next tri­al he had to recall four. When a tri­al was failed, the next tri­al was made eas­i­er by reduc­ing the num­ber of items to be recalled. This method of ‘adap­tive train­ing’ is thought to be a key ele­ment because it requires the child to ‘stretch’ their WM capac­i­ty to move through the pro­gram.

- Results -

- Impact of Short-Term Mem­o­ry and Work­ing Mem­o­ry -

Med­ica­tion vs. no med­ica­tion — When test­ed on med­ica­tion, Read the rest of this entry »

New Study Supports Neurofeedback Treatment for ADHD

Neu­ro­feed­back — also known as EEG Biofeed­back — is an approach for treat­ing ADHD in which indi­vid­u­als are pro­vid­ed real-time feed­back on their brain­wave pat­terns and taught to alter their typ­i­cal EEG pat­tern to one that is con­sis­tent with a focused, atten­tive state. This is typ­i­cal­ly done by col­lect­ing EEG data from indi­vid­u­als as they focus on stim­uli pre­sent­ed on a com­put­er screen. Their abil­i­ty to con­trol the stim­uli, for exam­ple, keep­ing the smile on a smi­ley face, is con­tin­gent on main­tain­ing the par­tic­u­lar EEG state being trained. Accord­ing to neu­ro­feed­back pro­po­nents, learn­ing how to do this dur­ing train­ing gen­er­al­izes to real world sit­u­a­tions and this results in improved atten­tion and reduced hyperactive/impulsive behav­ior.

Neu­ro­feed­back treat­ment for ADHD has been con­tro­ver­sial in the field for many years and remains so today. Although a num­ber of pub­lished stud­ies have report­ed pos­i­tive results many promi­nent ADHD researchers believe that prob­lems with the design of these stud­ies pre­clude con­clud­ing that neu­ro­feed­back is an effec­tive treat­ment. These lim­i­ta­tions have includ­ed the absence of ran­dom assign­ment, the lack of appro­pri­ate con­trol groups, raters who are not ‘blind’ to children’s treat­ment sta­tus, and small sam­ples. For addi­tion­al back­ground, you can find a recent review I wrote on exist­ing research sup­port for neu­ro­feed­back treat­ment of ADHD — along with links to exten­sive reviews of sev­er­al recent­ly pub­lished stud­ies -: How Strong is the Research Sup­port for Neu­ro­feed­back in Atten­tion Deficits?

- Results from a New Study of Neu­ro­feed­back -

Recent­ly, a study of neu­ro­feed­back treat­ment for ADHD was pub­lished that address­es sev­er­al lim­i­ta­tions that have under­mined pri­or research [Gevensleben, et al., (2009). Is neu­ro­feed­back an effi­ca­cious treat­ment for ADHD? A ran­dom­ized con­trolled clin­i­cal tri­al. Jour­nal of Child Psy­chol­o­gy and Psy­chi­a­try.]

The study was con­duct­ed in Ger­many and began with 102 chil­dren aged 8 to 12. All had been care­ful­ly diag­nosed with ADHD and approx­i­mate­ly over 90% had nev­er received med­ica­tion treat­ment. About 80% were boys. Chil­dren were ran­dom­ly assigned to Read the rest of this entry »

Neurofeedback/ Quantitative EEG for ADHD diagnosis

Like all psy­chi­atric dis­or­ders, ADHD is diag­nosed based on the pres­ence of par­tic­u­lar behav­ioral symp­toms that are judged to cause sig­nif­i­cant impair­ment in an individual’s func­tion­ing, and not on the results of a spe­cif­ic test. In fact, recent­ly pub­lished ADHD eval­u­a­tion guide­lines from the Amer­i­can Acad­e­my of Pedi­atrics (AAP) explic­it­ly state that no par­tic­u­lar diag­nos­tic test should be rou­tine­ly used when eval­u­at­ing a child for ADHD.

While most ADHD experts would agree that no sin­gle test could or should be used in iso­la­tion to diag­nose ADHD, there are sev­er­al impor­tant rea­sons why the avail­abil­i­ty of an accu­rate objec­tive test would be use­ful.

First, many chil­dren do not receive a care­ful and com­pre­hen­sive assess­ment for ADHD but are instead diag­nosed with based on eval­u­a­tion pro­ce­dures that are far from opti­mal.

Sec­ond, although AAP guide­lines indi­cate that spe­cif­ic diag­nos­tic tests should not be rou­tine­ly used, many par­ents are con­cerned about the lack of objec­tive pro­ce­dures in their child’s eval­u­a­tion. In fact, many fam­i­lies do not pur­sue treat­ment for ADHD because the the absence of objec­tive eval­u­a­tion pro­ce­dures leads them to ques­tion the diag­no­sis. You can read a review of an inter­est­ing study on this issue at www.helpforadd.com/2006/january.htm

For these rea­sons an accu­rate and objec­tive diag­nos­tic test for ADHD could be of val­ue in many clin­i­cal sit­u­a­tions. Two impor­tant con­di­tions would have to be met for such a test to be use­ful.

First, it would have to be high­ly sen­si­tive to Read the rest of this entry »

Mindfulness Meditation for Adults & Teens with ADHD

We have talked about the val­ue of med­i­ta­tion before (see Mind­ful­ness and Med­i­ta­tion in meditationSchools), as a form of well-direct­ed men­tal exer­cise than can help train atten­tion and emo­tion­al self-reg­u­la­tion.  Which oth­er stud­ies have shown how it strength­ens spe­cif­ic parts of the brain, main­ly in the frontal lobe.

Dr. Rabin­er shares with us, below, an excel­lent review of a new study that ana­lyzes the ben­e­fits of mind­ful­ness for ado­les­cents and adults with atten­tion deficits. He writes that “although this is clear­ly a pre­lim­i­nary study, the results are both inter­est­ing and encour­ag­ing.”

- Alvaro

Does Mind­ful­ness Med­i­ta­tion Help Adults & Teens with ADHD

– By Dr. David Rabin­er

Although med­ica­tion treat­ment is effec­tive for many indi­vid­u­als with ADHD, includ­ing ado­les­cents adults, there remains an under­stand­able need to explore and devel­op inter­ven­tions that can com­ple­ment or even sub­sti­tute for med­ica­tion. This is true for a vari­ety of rea­sons includ­ing:
1) Not all adults with ADHD ben­e­fit from med­ica­tion.
2) Among those who ben­e­fit, many have resid­ual dif­fi­cul­ties that need to be addressed via oth­er means.
3) Some adults with ADHD expe­ri­ence adverse effects that pre­vent them from remain­ing on med­ica­tion.

Read the rest of this entry »

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