Reviewed by Lauren Guilbeault
The concept of positive or negative reinforcement is not new to most; whether knowledge centers around mechanisms for teaching beloved pets how to use a litter box indoors, or focuses on ways to study for college courses more effectively, positive and negative reinforcement can be observed in virtually all walks of life. Although positive and negative reinforcement can be useful in helping yourself and helping others, there are limitations to the simplest aspects of reinforcement—limitations that therapies like neurofeedback aim to overcome.
ADHD: A Brief Overview
Attention Deficit Hyperactivity Disorder (ADHD) is broadly classified as a mental disorder but is also typically called a developmental disorder or learning disorder, as it is most commonly identified and diagnosed in school-aged children. As the name suggests, ADHD is characterized by difficulty paying attention, and a seeming inability to stay still. Although these are dramatic oversimplifications of the many nuances of the disorder, they identify a key concept of ADHD: impulse control. People with ADHD typically experience very little impulse control, which can manifest in the form of verbal or physical tics (also called “stims”), difficulty paying attention, constantly racing thoughts, and difficulty with executive function.
While ADHD is most commonly identified in school-aged children, it is not relegated to childhood; many people reach adulthood without having received an ADHD diagnosis, but feel as though they are uniquely unable to “adult,” or behave in a way that is appropriate in work, social, or academic settings. These feelings are often brought about by ADHD, and do not signal a unique flaw or character deficit, but are actually differences in brain function. For many adults, an ADHD diagnosis actually comes as something of a relief, because it explains a lifetime of struggle and confusion.
As is often the case with disorders such as ADHD, the exact symptoms and manifestations can vary widely from person to person. Some experience symptoms focusing largely on attention and focus, with struggles almost entirely relegated to academics, while others struggle more with impulse control, and may have more difficulty with authority figures or adhering to rules. Others experience a conglomeration of symptoms and find themselves constantly in trouble both academically and socially. Consequently, an ADHD diagnosis can open a lot of doors, and relieve a lot of confusion, fear, or shame about one’s own behavior, or the behavior of a child, friend, or loved one.
Neurofeedback: The Basics
Neurofeedback is an in-office therapy practice that uses a series of steps to either reinforce or discourage a series of behaviors. The practice operates on the assumption that the human brain is capable of being mapped and demonstrating which aspects of the brain are not functioning as they need to. These deficits or difficulties are identified, and the patient undergoes a series of treatments that improve brain wave activity through tasks and routines assigned in therapy. Over time, brain wave activity in those areas strengthens, and patients are more readily able to engage their ability to focus their attention and attend to tasks.
The first step in this process is patient history and mapping. Therapists take a detailed history of the individual with ADHD, including their greatest areas of struggle, and then they proceed to attaching a series of electrodes to the scalp in order to create a map of the brain, and how it responds to tasks such as reading, playing, or even just sitting still for a period of time. This allows the therapist to identify the exact regions of the brain in need of stimulating and attending to.
From there, therapists can create a detailed treatment plan, focusing on the exact areas of the brain that are being over or under-stimulated. Patients are then encouraged to play games or complete tasks requiring those areas of the brain to be utilized, often through a simple video game and rewards system. Over time, the brain is essentially retrained to utilize its attention and focus skills,
Standard ADHD Treatment
Although there are certain therapies available for ADHD treatment, the gold standard for ADHD treatment has long been pharmaceutical intervention. Whether people with ADHD are being given stimulants or suppressants, many practitioners rely primarily on pharmaceutical intervention to manage the symptoms associated with ADHD. For some, medication is started in early childhood, while others only begin to experience distress enough to warrant pharmaceuticals in their teen years or adulthood. Perhaps the most commonly prescribed medications for ADHD are Adderall and Ritalin. Both are stimulants and seek to relieve the effects of ADHD that inhibit attention and focus. They are often prescribed in response to children struggling in academic settings and are considered an effective and safe treatment method for ADHD.
Like all pharmaceuticals, both of these ADHD medications (and others like them) come along with possible side effects. These can include difficulty sleeping, weight gain, weight loss, adverse social symptoms, and the development of tics in speech or movement. Although people are not guaranteed to experience any or all of these side effects, their presence alone can function as a deterrent for some people seeking relief from symptoms. Typically, this is what paves the way for increasing interest in holistic or alternative treatment methods, such as neurofeedback.
Neurofeedback and ADHD: What Does the Research Say?
The research on ADHD and neurofeedback is promising if it is not quite as robust as standard ADHD medication research. Given that it is a relatively novel modality—at least applied to ADHD—it does not boast a huge range of research studies that are peer-reviewed and double-blind. Nevertheless, the existing research does suggest that gains made from neurofeedback therapy (increased focus, improved attention, and academic improvement) stay steady even years after treatment, while many other improvements made while undertaking different therapy modalities (and even medication) are often quickly lost, necessitating additional therapy sessions or continued medication.
Most research studies rely on patient, parent, and teacher ratings, to identify whether or not a child has successfully improved in school or at home. In many studies, as many as half of all children demonstrated greatly improved behaviors and a decline in symptoms—though there is some difficulty in authenticating these studies, as survey results and personal testimony do not bear the same weight as brain scans demonstrating improved mental acuity. Happily, there is at least one study that completed a brain map of participants both before and after the intervention, and this test did find that there was an improvement in the areas of the brain that were over or under-stimulated prior to treatment.
Because neurofeedback is an alternative therapy method, it is often utilized in conjunction with other treatment modalities. These can include medication, but may also include other interventions apart from pharmaceuticals. Additional therapies might include speech therapy, occupational therapy, physical therapy, acupuncture or acupressure, diet changes, lifestyle changes, and vitamin or mineral supplements. Although there are some reviews on and research about these types of therapies and interventions, much of the information about the efficacy of these therapies relies on anecdotal evidence. Although anecdotal evidence certainly should not be ignored or scoffed at, it does not boast the same rigorous academic and scientific inquiry as peer-reviewed, double-blind studies.
Although the research for neurofeedback is promising and seems to be particularly exciting when therapies are combined, there are some drawbacks to the practice—the most significant of which is the cost. Because many insurance companies do not yet recognize the validity of the therapy, it can require up-front or out-of-pocket payment, which can reach into the thousands. Although this may not be a deterrent for everyone, it can be problematic for families who rely on their insurance companies to secure therapies and other services.
The other potential drawback to neurofeedback is its focus on a single area of ADHD. Because people with ADHD may also struggle with social interactions and impulse control, the benefits of neurofeedback may not encompass all of the symptoms caused by the disorder; instead, they may focus largely on attention and focus. Improving concentration is ideal for academic pursuits and similar areas of need such as workplace attention, but may not fully address social needs and impulsivity.
Neurofeedback for ADHD: Is It Worth It?
While neurofeedback therapy for ADHD may not yet be a widely accepted practice or a commonplace therapy, research on the subject has revealed that it is a promising treatment modality for ADHD, particularly with regard to focus and attention. Because ADHD is continually on the rise and shows no signs of stopping, finding effective therapies with few side effects is essential. Neurofeedback, happily, shows promise as filling that need. Although it can require a significant upfront investment, as it continues to grow in normalcy and acceptance, the likelihood of it being covered by insurance grows.
Neurofeedback therapy is not a magic button that will, overnight, erase all symptoms of ADHD, nor is it a unicorn treatment that will effortlessly bring the brain back into sync. Instead, neurofeedback involves the process of retraining your brain to think and function in ways that are considered healthy and optimal, through your own hard work and dedication, under the careful guidance and tutelage of a therapy team. If you are concerned that you or someone you love is exhibiting symptoms of ADHD, check out our simple ADHD test for more information.