Neurofeedback: An ADHD Treatment That Retrains the Brain?

Neurofeedback hasn't yet proved out and isn't cheap, but it dangles the prospect of a permanent cure.

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A controversial treatment for overcoming attention deficit hyperactivity disorder is getting new respect. Called neurofeedback therapy, it supposedly retrains the brain to produce electrical patterns associated with calm and focus. While the technique is costly, time consuming, and far from proven, its promise is tantalizing. Advocates claim that neurofeedback brings permanent ADHD cures, a seemingly magical alternative to years of medication.

During a typical 45-minute session, the child is seated in front of a computer. Wires lead from different points on his head. A therapist starts up a videogame or movie on the child's screen—he can bring a favorite to the session if he wants—and monitors his brain waves on another screen. He locks his eyes on the action, concentrating on sending the kind of brain waves that will keep a virtual airplane flying or perhaps a Harry Potter movie rolling. If his attention wanders or he begins to fidget, the car slows or the movie screen darkens, and the therapist encourages him to regain focus using techniques such as slow, deep breathing. As he watches the effect of his own thoughts, "it's like looking in a mirror," says Leslie Sternberg, a neurotherapist and a psychologist in Acton, Mass.

Neurofeedback, also called EEG biofeedback, has been under investigation as a treatment for epilepsy and ADHD since the 1970s. Putting it to use on children with attention deficits has logical appeal. Studies suggest that in ADHD, the brain generates insufficient beta waves, which are associated with focus and attention, and an overabundance of lower-frequency theta waves, produced during periods of daydreaming or drowsiness. Praising and rewarding a child when he steps up production of beta waves by concentrating on the game or movie should therefore teach him how to focus at will in other settings, such as doing homework assignments or cleaning his room. And at least for some children, that seems to have happened.

One of them is Cameron Rose, 26, from Kingston, Ontario. Before receiving neurofeedback treatments when he was 11, says his mother, Joan, he could not be taught to read, although both she and her husband were teachers. She would try to coax her son at age 6 or 7 to read the simplest book she could find—like one about frogs. "Frog," she'd say, turning the page and pointing out where the word was repeated. It wouldn't register.

Diagnosed with ADHD just before he started sixth grade, after spending two years in a class for the severely learning disabled, Rose had 60 sessions of neurofeedback therapy at the ADD Centre and Biofeedback Institute of Toronto. His reading scores shot up from second- to fifth-grade level, and his IQ scores jumped from low average to high average. He never took ADHD medication and has never had additional neurofeedback therapy. Recently, Rose graduated from Queen's University in Canada with a degree in computer engineering. He recalls the treatments as "superfreaking boring" but they gave him a feeling of empowerment, and that, he says, was key. His dedication, says his mother, probably helped.

Lynda Thompson, psychologist and director of the Toronto center where Rose was treated 15 years ago, observes that many kids with ADHD are extremely good at "hyperfocusing" on something that interests them. Rose, for example, loved playing chess, a game known to test patience and concentration. The challenge, says Thompson, is to get them to concentrate on something they find boring—and the idea of neurofeedback is to teach kids how to do just that.

While neurofeedback works in theory and has had anecdotal successes, it was largely dismissed by ADHD experts until recently. They have noted that most studies showing benefits have been run by investigators with a financial stake; even a rigorously designed study "tends to find what it wants to find" under such conditions, says Peter Jensen, cochair of the division of child psychiatry and psychology at the Mayo Clinic in Rochester, Minn.

Nor have the studies met standards for rigorous design. Historically, most have been too small to be credible, with fewer than 50 patients, and have been sloppily done. Results have not been compared with results from medication or other forms of therapy, for example, nor has a control group received "sham treatment" that patients believed was neurofeedback but in fact did nothing, like a placebo sugar pill in a drug trial. A 2005 review coauthored by Russell Barkley, a leading expert on ADHD at the Medical University of South Carolina, raised some of these concerns. The first long-term results of neurofeedback, published in 2008, were similarly flawed. While positive, they reflected only 23 children who were followed for just two years.