Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder in children, affecting nearly five percent of the population [Source: Holtmann]. While millions of children are treated with medication for ADHD, 25 percent might not respond to treatment or cannot tolerate the side effects of the medication [Source: Monastra]. Without treatment, children with ADHD are at a higher risk for academic problems, substance abuse, psychiatric disorders and lower job status [Source: Daley]. Although stimulant medication is the main form of treatment, the common side effects have made complementary and alternative medicine (CAM) a more popular option [Source: Daley]. One example of CAM is neurofeedback, also known as EEG biofeedback.
Neurofeedback is based on the relationship between brain wave frequencies and mental state [Source: Butnik]. Electroencephalography (EEG) measures the electric currents in the brain reflecting the function of certain brain activities [Source: Loo]. Theoretically, patients with ADHD have an under-aroused brain with insufficient communication among the neurons [Source: Butnik]. Neurofeedback protocols have been developed to inhibit cortical slowing and normalize the EEG activity in the area which is supposed to control attention and behavior. In the form of a rewards system, the patient learns to enhance the EEG desired frequencies and suppress the undesired ones [Source: Friel]. The goal of neurofeedback is to normalize the EEG [Source: Butnik].
There is substantial research on EEG and the underlying mechanisms in the thalamocortical area (related to the thalamus and cerebral cortex) [Source: Monastra]. EEG biofeedback for ADHD developed as a result of consistent findings in neuroimages of the frontal and central midline brain regions, and the EEG recording frequencies in alertness and behavior control [Source: Monastra]. Variations in alertness and behavior control are directly related to the frequency rhythms [Source: Monastra]. It is thought that through EEG feedback, we can train these rhythms, eventually normalizing and sustaining them [Source: Monastra]. During an unfocused state, slow EEG frequencies are dominant in the frontal cortex. As the shift to more attentive and increased awareness comes, there is an increase in amplitude [Source: Monastra].
After undergoing neurofeedback, there are several studies that report improvement in school notes, social adaptability and self esteem. In addition, these patients had significant improvements in their behavior and attention that persisted for at least six months following training. With neurofeedback training and medication together, there was improvement in ADHD-related behaviors. Even after the medication was stopped, there was sustained improvement.
Neurofeedback is generally safe to use. After treatment patients can experience headaches, tiredness, dizziness or increase irritability and moodiness [Source: Loo]. EEG biofeedback can also affect seizure threshold depending on the frequencies used [Source: Friel]. Other side effects to consider are the cost and the time it takes to get results.
Neurofeedback can be an effective treatment for ADHD with limited evidence comparable to stimulant medication. In light of standard medication failure, or lack of compliance, it is a great alternative worth considering.