Overview & Efficacy: Several small controlled and moderately large clinical studies show that neurofeedback (brainwave biofeedback) significantly helps children with ADHD who have math problems.

This therapy is rated as efficacious (level 4 on a scale of 1 - 5 with 5 being the best).

Why biofeedback would help this problem: Children with this disorder have very specific physiological problems, which can be seen in their brain wave patterns. For example, hyperkinetic kids with concentration problems produce too much Theta wave forms (4-8 Hz) and too little Beta wave forms in some parts of the brain. SMR (sensorimotor rhythm) EEG 12 - 15 Hz is increased with inhibited movement.

People who do neurofeedback generally feel that the parts of the brain generating the abnormal proportions of brainwaves can be taught to function normally by teaching the brain to produce the correct (normal) proportions of brainwaves. Theoretically, the more normal the brainwaves are, the more normally the child should behave. Thus, the treatment's success is proportional to how well the child learns to normalize his or her brainwaves.

Children who are successfully trained to increase SMR show decreased activity levels. Successful neurofeedback training to decrease Theta while increasing Beta results in increased attention span and increased ability to learn math.

The training almost always takes place in a therapist's office. Sensors are pasted onto the scalp over the parts of the child's brain, which are to be trained. The sensors are connected to a computer, which runs a special training program. The program usually appears in the guise of a videogame. The videogame's progress or simply continuation is dependent upon the child producing the desired proportion of brain waves. The treatment may take 30 to 50 or more sessions for effects to be apparent and lasting.

Brief summary of evidence supporting the efficacy of biofeedback for ADD

Kaiser and Othmer (2000) did a study, with 1,089 patients, which showed that neurofeedback training of sensorimotor and beta waves led to significant improvement in attentiveness and impulse control, and positive changes as measured on the test of variables of attention (TOVA). The patients had moderate pre-training deficits.

Monastra, et al (2002) worked with 100 children taking Ritalin as well as having concurrent parent counseling and academic support. Half also received EEG biofeedback. There were similar improvements on the TOVA and an ADD evaluation scale. Only those children who had EEG biofeedback were able to sustain their improvements without Ritalin.

Other studies using similar techniques showed increases in intelligence scores and academic performance if theta training was added and was successful. (Lubar et al 1995).

One small study of 16 children compared children trained with neurofeedback to those on a waiting list. They found increased intelligence scores and reduced inattentive behaviors as rated by parents (Linden et al 1996).

Two small studies have shown EEG biofeedback to be as effective as Ritalin on numerous measures (Rossiter & LaVaque 1995, Fuchs, Birbaumer, et al, 2003).

Another study found that 16 of 24 patients taking medication were able to lower their doses or discontinue medication totally after successful training (Alhambra et al 1995).

* Much of the information provided here is from Carolyn Yucha and Christopher Gilbert's 2004 book "Evidence Based Practice in Biofeedback & Neurofeedback" AAPB, Wheat Ridge, CO.

Detailed information on biofeedback augmented treatment of ADD/ADHD

A. Citations to the papers summarized in the "brief summary":

Alhambra, M.A., Fowler, T.P., & Alhambra, A.A. (1995). EEG biofeedback: A new treatment option for ADD/ADHD. Journal of Neurotherapy, 1(2), 39-43.

Fuchs, T., Birbaumer, N., Lutzenberger, W., Gruzelier, J.H., & Kaiser, J. (2003). Neurofeedback treatment for attention-deficit / hyperactivity disorder in children: A comparison with methyphenidate. Applied Psychophysiology and Biofeedback, 28(1), 1-12.

Kaiser, D.A., & Othmer, S. (2000). Effect of neurofeedback on variables of attention in a large multi-center trial. Journal of Neurotherapy, 4(1), 5-15.

Linden, M., Habib, T, & Radojevic, V. (1996). A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback and Self Regulation, 21(1), 35-49.

Lubar, J.F., Swartwood, M.O., Swartwood, J.N., & O'Donnell, P.H. (1995). Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores, behavioral ratings, and WISC-R performance. Biofeedback and Self Regulation, 20(1), 83-99.

Monastra, V.J., Monastra, D.M., & George, S. (2002). The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder. Applied Psychophysiology and Biofeedback, 27(4), 231-249.

Rossiter, T.R., & La Vaque, T.J. (1995). A comparison of EEG biofeedback and psychostimulants in treating attention deficit/hyperactivity disorders. Journal of Neurotherapy, 1(1), 48-59.

Applied Psychophysiology Biofeedback. 2003 Mar;28(1):1-12.

Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: a comparison with methylphenidate.

Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: a comparison with methylphenidate.

Fuchs T, Birbaumer N, Lutzenberger W, Gruzelier JH, Kaiser J.

Institute of Medical Psychology and Behavioral Neurobiology, Eberhard-Karls-University, Gartenstrasse 29 72074 Tubingen, Germany.

Clinical trials have suggested that neurofeedback may be efficient in treating attention-deficit/hyperactivity disorder (ADHD). We compared the effects of a 3-month electroencephalographic feedback program providing reinforcement contingent on the production of cortical sensorimotor rhythm (12-15 Hz) and betal activity (15-18 Hz) with stimulant medication. Participants were N = 34 children aged 8-12 years, 22 of which were assigned to the neurofeedback group and 12 to the methylphenidate group according to their parents' preference. Both neurofeedback and methylphenidate were associated with improvements on all subscales of the Test of Variables of Attention, and on the speed and accuracy measures of the d2 Attention Endurance Test. Furthermore, behaviors related to the disorder were rated as significantly reduced in both groups by both teachers and parents on the IOWA-Conners Behavior Rating Scale. These findings suggest that neurofeedback was efficient in improving some of the behavioral concomitants of ADHD in children whose parents favored a nonpharmacological treatment.