Does Neurofeedback Work?
When an ADHD child is given a task requiring attention, instead of increasing beta waves, sometimes he increases theta waves, the daydreaming brain wave. These children have what is known as a high theta/beta ratio. Using neurofeedback, a technique was developed to train ADHD children to increase the beta/theta ratio.
This is how it works: Over a series of 40 or more neurofeedback sessions, children are gradually taught to inhibit the brains production of theta waves and increase the brains use of beta waves. A large number of children can learn to make these changes. As the children learn to adjust their brain wave patterns, they show an improvement in cognition, and a reduction in ADHD symptoms and behavior. This symptomatic improvement is similar to what we see when the children take stimulant medication. There is one significant difference, however.
When children take stimulants, the effects last a few hours. As the medicine wears off, the ADHD symptoms return. When children learn to control their brain waves using neurofeedback, the improvement in ADHD symptoms does not disappear. The child is better.
I'll say it again differently. When a child completes his neurofeedback training and the treatment is successful, he now has a normal beta/theta ratio, and many or all of his ADHD symptoms disappear. This improvement is permanent. There have been follow-up studies over a decade. Any gains the child makes stays with him.
This means that when the treatment is successful, it probably works for life. This makes neurofeedback a very significant treatment. No other treatment makes a permanent change like this. All of this is extremely exciting, provided that it is true.
However, many ADHD researchers, most notably Russell Barkley, say it is not true. Barkley claims that there is little or no evidence that neurofeedback works at all. He maintains that the supporting research is sloppy and does not prove anything. In an interview, Barkley expressed his skepticism.
"Case studies prove nothing because they're totally uncontrolled. There's an aura of medical intervention here. High technology in a medical environment has a high placebo effect... It's not the equipment. It's the exercises, the mental exercises they are telling these kids to do. (Some kids may be getting better) with maturation alone and some kids don't have ADD."
Another critic of neurofeedback is neurophysiologist, Sam Goldstein. Goldstein is not quite as negative as Barkley, but he echoes many of the same reservations.
"The older studies are not well done There are a number of possible explanations. One is, it works. Two, its a placebo. Three is, there's some mechanism operating that we don't understand . I would like these guys to do more research, and I support their application for research grants."
How valid are these complaints? How valid are the claims of the supporters of neurofeedback?
The Evidence About Neurofeedback
Neurofeedback has been used successfully in the treatment of epilepsy and drug rehabilitation. It has some very impressive results in both of these areas. This already lends a great deal of credibility to the field. It changes the question we ask. We don't have to ponder if this is a genuine treatment modality. We see that it is. The question is whether its efficacy also extends to the treatment of ADHD.