Neurofeedback can help some kids with ADHD

NEW YORK (Reuters Health) - Training the brains of children with attention-deficit hyperactivity disorder (ADHD) using a technique called neurofeedback can improve their behavior and reduce hyperactivity and impulsivity, according to a team of Swiss and German researchers.

But the strategy doesn’t work for every child and shouldn’t be thought of as a replacement for drug treatment, Dr. Renate Drechsler of the University of Zurich, the study’s lead author, told Reuters Health.

She and her colleagues compared the results of neurofeedback training with those of group training in 30 children 9 to 13 years old with ADHD.

The neurofeedback training began with two weeks of daily sessions on a computer program resembling a game that instructed the children to activate or deactivate activity in a portion of their brain, rewarding them with points if they were successful. The exercises targeted slow patterns of brain electrical activation, known as slow cortical potentials.

After a five-week break, the children moved on to once- or twice-weekly transfer training in which they didn’t receive feedback for three weeks. During the break, children were instructed to use a set of red and blue cards to practice brain activation and deactivation in everyday life.

“Impaired control of attention is a core problem in ADHD,” Drechsler explained via e-mail. “Neurofeedback is aimed at learning how to regulate cortical activation in order to induce better attentional control, and thereby improve a main symptom directly.”

The other children were took part in 14 to 15 group therapy sessions lasting 90 minutes each, with four to five children in each group. The child psychologists used techniques based on cognitive behavioral therapy to train children in social skills, self-awareness, self-management, and other skills.

Parents were encouraged to collaborate in both the neurofeedback and group therapy sessions.

After the training programs were complete, parents of the 17 children in the neurofeedback group reported greater improvement in their child’s attention and cognitive performance compared with parents of the 13 children in the group therapy intervention.

Within the neurofeedback group, the researchers identified eight children who learned to regulate their brain activity successfully and nine who didn’t. The so-called “good performers” also showed greater improvements in controlling hyperactivity and impulsivity. “The better the children learned to regulate their cortical activity - during transfer conditions - the more they improved according to parents’ estimations,” Drechsler noted.

Parental involvement also played a role, she and her colleagues found, with children showing greater improvement if their parents had encouraged them to practice the techniques and rewarded their training efforts.

Teachers also rated children’s behavior, reporting some improvement in the kids who had done neurofeedback training (though less than the parents had) and no improvement in the children who participated in group training.

Drechsler said it isn’t clear why some children learned the technique but others didn’t.

Neurofeedback training should be considered as a companion treatment to ADHD medication, she added, although it may also be a valuable option for children who aren’t helped by ADHD medication or can’t tolerate the drugs.

“Maybe neurofeedback training could be a viable alternative for a subgroup of children with ADHD who respond particularly well to this type of treatment,” she said. “But further research is still needed to establish the potential of neurofeedback training for children and adults with ADHD.”

Neurofeedback training should be provided in a behavioral therapy setting, Drechsler concluded. “It is important to keep in mind that neurofeedback training is a learning process that demands the active participation of the child who needs to be motivated in order to keep on track.”

SOURCE: Behavioral and Brain Functions, July 26, 2007.