This alternative therapy uses real-time EEG data to help patients work to train their ADHD brains for intense focus, impulse control, and organized executive function. Studies are encouraging, but not conclusive. Here’s what you need to know.
The brain is malleable. With frequent, intense practice, we may transform our brainwave activity. Over time, we can work to increase our ratio of faster brain waves, leading to stronger focus and improved impulse control. This is, in essence, the concept of neuroplasticity — and the core principle behind neurofeedback training.
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The Central Benefits
Since the 1970s, patients with ADHD and other neurological disorders have used neurofeedback in hopes of training their brains. According to proponents, the reported benefits of this alternative therapy are twofold:
Brainwave alterations are measurable and appear to endure well beyond the therapy’s end.
Brainwave improvements may lead to behavior improvements — most notably, sustained focus, diminished impulsivity, and reduced distractibility out in the real world.
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Real-Time Biofeedback
Neurofeedback is a distinct type of biofeedback. Biofeedback is the process of learning how to change your own physiological activity using real-time monitoring of biological data like breathing rates, muscle activity, and heart function.
In neurofeedback training sessions, practitioners monitor a patient’s brain waves using scalp sensors. These sensors pick up the brain’s activity and relay it so that the therapist and patient can see exactly when and how brain waves reach an optimal level. The trick is then to repeat and practice the behaviors that lead to this ideal brain state until they become second nature.
Many ADHD brains generate an abundance of low-frequency delta or theta brain waves, and a shortage of high-frequency beta brain waves. Over 20 to 40 training sessions, neurofeedback works to reverse that ratio. The end goal is an activated, engaged brain, and an overall reduction in ADHD symptoms.
More specifically, neurofeedback therapy works to increase the brain’s capacity and predisposition for beta waves, which are associated with efficient information processing and problem solving. At the other end of the spectrum are delta and theta waves, which occur in the brain when it is relaxing or daydreaming. When a high proportion of theta waves are present, patients complain of incomplete work, disorganization, and distractibility. Neurofeedback aims to diminish the frequency of delta and theta waves.
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What Does Neurofeedback Therapy Look Like?
Each traditional neurofeedback therapy session lasts no more than 30 minutes, ideally. During that time, the patient wears scalp sensors that measure and broadcast brain-wave activity via an EEG display. The patient works with his or her therapist to recognize when the brain is operating in its optimal beta zone, and to consciously sustain and replicate that state. It’s like strength training for the brain.
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Step One: Assess
Not all ADHD brains look alike. To effectively tailor treatment to the individual — and his or her innate strengths and weaknesses — the neurofeedback practitioner should first conduct an assessment of the patient’s natural brain wave patterns. This assessment typically uses one or two EEG sensors to obtain a baseline snapshot of the brain. Many practitioners also use standard ADHD rating scales to gauge a patient’s everyday ability to focus, control impulses, and complete tasks.
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Step Two: Personalize
Some patients with ADHD may have an excess of low-frequency brainwave activity, while other have an excess of fast frequency brainwave activity. An effective neurofeedback practitioner customizes a training program based on the brain wave patterns established in the initial assessment in order to target the behaviors to change.
Frequent benchmarking is key to meaningful neurofeedback treatment. What this means: A therapist should regularly compare each patient’s new EEG readings to his or her baseline assessment. This comparison helps assess the type and scale of changes taking place in brain wave patterns, and helps the practitioner adjust treatment going forward.
Also important is gathering parent or patient feedback about behavior changes reflected at home. Parents should initially commit to no more than 6 to 10 neurofeedback sessions and insist on frequent evaluation. If brain-wave and behavior improvements take place in this time, most experts recommend completing 20 to 40 sessions total in order to achieve lasting changes. Sometimes, children will attend several sessions before seeing positive results. But if treatment is not working after 10 sessions, it’s time to stop.
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What Symptoms Does It Address?
Numerous studies, although none blind, show that neurofeedback therapy can result in improved attention, diminished hyperactivity, and enhanced executive functions, including working memory.
In 2012, researchers studied 14 randomized trials and calculated the following effect sizes: a 0.8 reduction in inattention and 0.7 reduction in hyperactivity for participants with ADHD. In the scientific community, these are considered fairly robust results, though not as high as the approximate effect size of 1.0 that is typical of stimulant medications.
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Who Does Neurofeedback Help the Most?
The brain remains plastic throughout life, but younger brains can more quickly change and adapt than can older brains. In other words, adults can use neurofeedback to treat ADHD. But children often require fewer sessions, are less skeptical of the treatment, and make improvements more quickly.
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What Makes a Good Neurofeedback Practitioner?
The results of neurofeedback therapy are positively correlated with the skill of the clinician, especially for children. Hyperactive, fidgety children may require four, five, or even six sessions before settling down, engaging, and truly training their brains. Seek out an experienced clinician who knows techniques for focusing a child with ADHD and who is certified by the Biofeedback Certification International Alliance. Qualified practitioners are designated by the letters “BCN” on BCIA.org.
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What Is the Cost?
Each neurofeedback session costs $40-$150, and this treatment is not typically covered by insurance. Since 20 to 40 sessions are recommended for achieving lasting change, the cost of treatment can reach as much as $6,000.
Computer-based, at-home alternatives do exist. These headset systems typically cost less than $100, however research linking these home-based alternatives to sustained brain-wave improvement does not yet exist.
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So, Does It Work?
Neurofeedback is a promising treatment for ADHD, but the current research suggests it's best considered as a complement to medication and/or behavior therapy rather than as a standalone treatment. Research support for both stimulant medication therapy and behavior therapy is stronger than for neurofeedback at the moment.
Many studies provide parents with reason to expect benefits from neurofeedback training. However, some of the most important researchers in the ADHD field would argue that the efficacy of neurofeedback for ADHD has not been conclusively established.
