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A Symphony in the Brain: The Evolution of the New Brain Wave Biofeedback.
Jim Robbins
Getting Rid of Ritalin: How Neurofeedback Can Successfully Treat Attention
Deficit Disorder Without Drugs, Robert W. Hill, Eduardo Castro
ADD: The 20-Hour Solution. Mark Steinberg, Siegfried Othmer
Scientific Publications
Child Adolescent Psychiatry Clinics of North America. 2005 (1):83-104, vi.
Critical validation studies of neurofeedback.
Gruzelier J, Egner T. Division of Neuroscience and Psychological Medicine, Imperial
College London, St. Dunstan's Road, London W6 8RF, United Kingdom.
j.gruzelier@imperial.ac.uk
The field of neurofeedback training has proceeded largely without validation. In this
article the authors review studies directed at validating sensory motor rhythm, beta
and alpha-theta protocols for improving attention, memory, and music performance in
healthy participants. Importantly, benefits were demonstrable with cognitive and
neurophysiologic measures that were predicted on the basis of regression models of
learning to enhance sensory motor rhythm and beta activity. The first evidence of
operant control over the alpha-theta ratio is provided, together with remarkable
improvements in artistic aspects of music performance equivalent to two
class grades in conservatory students. These are initial steps in providing a much
needed scientific basis to neurofeedback.
Journal of Clinical Psychology. 2005 Feb 18
Neurofeedback in adolescents and adults with attention deficit
hyperactivity disorder.
Butnik SM. ADDVANTAGE, PLLC.
Neurofeedback is being utilized more commonly today in treating individuals who have
attention deficit hyperactivity disorder (ADHD). Neurofeedback, which is based on
theories that recognize the organic basis of ADHD, utilizes biofeedback to guide
individuals to regulate their brain activity. Neurofeedback relies on research that has
demonstrated that most individuals who have ADHD, as compared to matched peers,
have excess slow wave activity and reduced fast wave activity. It provides immediate
feedback to the individual about his or her brain wave activity in the form of a video
game, whose action is influenced by the individual's meeting predetermined thresholds
of brain activity. Over several sessions of using the video and auditory feedback,
individuals reduce their slow wave activity and/or increase their fast wave activity.
Individuals who complete a course of training sessions often show reduced primary
ADHD symptoms. Research has shown that neurofeedback outcomes compare
favorably to those of stimulant medication.
Applied Psychophysiology and Biofeedback. 2004 (4):233-43
The effectiveness of neurofeedback and stimulant drugs in treating
AD/HD: part II. Replication.
Rossiter T. t.rossiter@worldnet.att.net
This study replicated T. R. Rossiter and T. J. La Vaque (1995) with a larger sample,
expanded age range, and improved statistical analysis. Thirty-one ADIHD patients who
chose stimulant drug (MED) treatment were matched with 31 patients who chose a
neurofeedback (EEG) treatment program. EEG patients received either office (n = 14)
or home (n = 17) neurofeedback. Stimulants for MED patients were titrated using the
Test of Variables of Attention (TOVA). EEG (effect size [ES] = 1.01-1.71) and MED (ES
= 0.80-1.80) groups showed statistically and clinically significant improvement on
TOVA measures of attention, impulse control, processing speed, and variability in
attention. The EEG group demonstrated statistically and clinically significant
improvement on behavioral measures (Behavior Assessment System for Children, ES
= 1.16-1.78, and Brown Attention Deficit Disorder Scales, ES = 1.59). TOVA gain
scores for the EEG and MED groups were not significantly different. More importantly,
confidence interval and nonequivalence null hypothesis testing confirmed that the
neurofeedback program produced patient outcomes equivalent to those
obtained with stimulant drugs. An effectiveness research design places some
limitations on the conclusions that can be drawn.
Applied Psychophysiology and Biofeedback. 2003 (1):1-12.
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, Gartenstr. 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 non pharmacological treatment.
Applied Psychophysiology and Biofeedback. 2002, (4):231-49.
The effects of stimulant therapy, EEG biofeedback, and parenting style
on the primary symptoms of attention-deficit/hyperactivity disorder.
Monastra VJ, Monastra DM, George S. FPI Attention Disorders Clinic, 2102 E. Main
Street, Endicott, New York 13760, USA. poppidoc@aol.com
One hundred children, ages 6-19, who were diagnosed with
attention-deficit/hyperactivity disorder (ADHD), either inattentive or combined types,
participated in a study examining the effects of Ritalin, EEG biofeedback, and
parenting style on the primary symptoms of ADHD. All of the patients participated in a
1-year, multimodal, outpatient program that included Ritalin, parent counseling, and
academic support at school (either a 504 Plan or an IEP). Fifty-one of the participants
also received EEG biofeedback therapy. Posttreatment assessments were conducted
both with and without stimulant therapy. Significant improvement was noted on
the Test of Variables of Attention (TOVA; L. M. Greenberg, 1996) and the
Attention Deficit Disorders Evaluation Scale (ADDES; S. B. McCarney, 1995)
when participants were tested while using Ritalin. However, only those who
had received EEG biofeedback sustained these gains when tested without
Ritalin. The results of a Quantitative Electroencephalographic Scanning Process
(QEEG-Scan; V. J. Monastra et al., 1999) revealed significant reduction in cortical
slowing only in patients who had received EEG biofeedback. Behavioral measures
indicated that parenting style exerted a significant moderating effect on the expression
of behavioral symptoms at home but not at school.
International Journal of Psychophysiology. 2003 (1):75-85.
The effect of training distinct neurofeedback protocols on aspects of
cognitive performance.
Vernon D, Egner T, Cooper N, Compton T, Neilands C, Sheri A, Gruzelier J.
Department of Cognitive Neuroscience and Behaviour, Imperial College London,
Charing Cross Hospital, St. Dunstans Road, London W6 8RF, UK. d.vernon@ic.ac.uk
The use of neurofeedback as an operant conditioning paradigm has disclosed that
participants are able to gain some control over particular aspects of their
electroencephalogram (EEG). Based on the association between theta activity (4-7 Hz)
and working memory performance, and sensorimotor rhythm (SMR) activity (12-15 Hz)
and attentional processing, we investigated the possibility that training healthy
individuals to enhance either of these frequencies would specifically influence a
particular aspect of cognitive performance, relative to a non-neurofeedback
control-group. The results revealed that after eight sessions of neurofeedback the
SMR-group were able to selectively enhance their SMR activity, as indexed by
increased SMR/theta and SMR/beta ratios. In contrast, those trained to selectively
enhance theta activity failed to exhibit any changes in their EEG. Furthermore, the
SMR-group exhibited a significant and clear improvement in cued recall performance,
using a semantic working memory task, and to a lesser extent showed improved
accuracy of focused attentional processing using a 2-sequence continuous
performance task. This suggests that normal healthy individuals can learn to
increase a specific component of their EEG activity, and that such enhanced
activity may facilitate semantic processing in a working memory task and to a
lesser extent focused attention. We discuss possible mechanisms that could
mediate such effects and indicate a number of directions for future research.
Clinical Electroencephalography. 2000 (1):30-7.
Treatment of attention deficit hyperactivity disorder with neurotherapy.
Nash JK. Behavioral Medicine Associates, Inc., MN 55434, USA.
Significant public health concerns exist regarding our current level of success in
treating ADHD. Medication management is very helpful in 60-70% of patients. Side
effects, lack of compliance and the fact that stimulant medications cannot be given late
in the day limit the benefits largely to school hours. While stimulants improve behavior
and attention, less of an effect has been noted on academic and social performance.
Continuing concerns exist about long-term safety, and studies on long-term
cardiovascular and neurophysiological effects have not been carried out.
Neurotherapy for ADHD offers an effective alternate for patients whose
treatment is limited by side effects, poor medication response and in cases in
which the patients and/or their parents refuse to consider medications.
Studies indicate clinical improvement is largely related to measurable improvements in
the EEG signature, evidenced by declining theta/beta ratios over frontal/central cortex
and/or reduced theta/alpha band amplitudes.
Biofeedback and Self Regulation. 1995 (1):83-99.
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.
Lubar JF, Swartwood MO, Swartwood JN, O'Donnell PH. University of Tennessee,
Knoxville TN.
A study with three component parts was performed to assess the effectiveness of
neurofeedback treatment for Attention Deficit/Hyperactivity Disorder (ADHD). The
subject pool consisted of 23 children and adolescents ranging in age from 8 to 19
years with a mean of 11.4 years who participated in a 2- to 3-month summer program
of intensive neurofeedback training. Feedback was contingent on the production of
16-20 hertz (beta) activity in the absence of 4-8 hertz (theta) activity. Posttraining
changes in EEG activity, T.O.V.A. performance, (ADDES) behavior ratings, and
WISC-R performance were assessed. Part I indicated that subjects who successfully
decreased theta activity showed significant improvement in T.O.V.A. performance; Part
II revealed significant improvement in parent ratings following neurofeedback training;
and Part III indicated significant increases in WISC-R scores following neurofeedback
training. This study is significant in that it examines the effects of neurofeedback
training on both objective and subjective measures under relatively controlled
conditions. Our findings corroborate and extend previous research, indicating
that neurofeedback training can be an appropriate and efficacious treatment
for children with ADHD.
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