Neurofeedback: A “Best Support” Intervention for ADHD

In November 2012, the American Academy of Pediatrics (AAP) elevated neurofeedback to a “Level 1- Best Support” intervention for Attention Deficit and Hyperactivity Disorders. Neurofeedback is the mechanism we use at NEURO+ to train the ADHD brain to function properly. In short, neurofeedback uses visual or auditory representations of brain activity to make the patient aware of what is healthy brain activity, and then provides a technique to help them achieve and maintain that healthy activity. For more information and evidence on neurofeedback and our product, please see our earlier post.

So what does this endorsement by the AAP mean? Previously, neurofeedback was classified as a “Level 2- Good Support” intervention for ADHD. Now, neurofeedback sits among medication and behavioral therapy as an equally viable and successful intervention. To achieve a Level 1 status, interventions need to have three things:

1. At least two randomized trials demonstrating efficacy by being either superior to placebo or equivalent to another Level 1 intervention in a pre- post change paradigm with significant statistical power.

2. Experiments conducted with treatment manuals.

3. Effects demonstrated by two or more investigator teams.

The studies that helped to promote neurofeedback demonstrated that the treatment condition showed improvements in both impulsivity and attention on a range of measures and tasks.   Moreover, neurofeedback has been shown to solve many of the fundamental problems in patients with ADHD like dysregulation of the arousal system, perceptual focus problems and stressed brain syndrome…all without taking medication!

The AAP is a consortium of over 60,000 American pediatricians who work to advise all pediatricians on best practices. They are the foremost trusted entity in pediatrics. Their validation of neurofeedback has sparked a surge of research in the field. Investigators and entrepreneurs alike have recognized biofeedback as a domain ripe for progress and success. We have taken an integrative approach to neurofeedback by combining the behavioral therapy with a captivating video game platform.

While the AAP’s recognition of neurofeedback has increased the incentives in research and business, it has also raised some important questions and controversies. Will the FDA approve neurofeedback as a treatment for ADHD? Neurofeedback is still a rather costly investment…will health insurance companies consider covering it now? Given the increase in diagnosis of ADHD in older people, will neurofeedback’s endorsement be extended to adults? How can we translate this new technology to make it the most accessible to the largest population?

 

 

Adderall Abuse: “Smart Drug” by Day, “Kiddie Coke” by Night

Adderall is quickly becoming one of the most popular drugs on college campuses. Nicknamed “Addy” by young adults, the stimulant prescribed to patients with ADHD is now considered the most abused prescription drug in America. Estimates say that approximately 25% of college students abuse Adderall or Ritalin.

There are two primary abuses of Adderall and a multitude of reasons why. First, and most frequently, Adderall is used as a “smart drug”. It is taken by students when they need to grind through homework on a Sunday night or pull an all-nighter before an exam. Not surprisingly, the stimulant helps to promote productivity and focus. Often, students feel tremendous pressure to succeed, especially at top-tier universities, and feel that “Addy” will give them the extra kick that they need. The Cornell student newspaper published an article with personal anecdotes from students, one of which I will share here:

“Leah, who took Vyvanse, a stimulant similar to Adderall that is also used to treat ADHD, said she took 150 milligrams over the course of two days. The standard dose for a first-time user is 30 milligrams, according to clinical studies. ‘I needed to pass my multivariable calculus final, and I hadn’t gone to any of the lectures. I stayed awake for 72 hours. I started convulsing, and I was shaking and nauseous at the end. Afterwards, I fell asleep for a solid 24 hours,’ Leah said. ‘I won’t be doing Vyvanse again. I passed my final though, so that’s all that counts,’ she added.”

Studies have shown that non-medical use of these drugs was highest in “college students who were male, white, members of fraternities and sororities and earned lower grade point averages,” and that “rates were higher at colleges located in the north-eastern region of the U.S. and colleges with more competitive admission standards.” Students may think that Adderall abuse is not that bad because they are taking the drug for the right reasons.

One of the biggest concerns with the rise in Adderall abuse is that students do not understand the risks involved. In a study of 1,800 college students, the authors found that 81% of students thought that the drug was “not dangerous at all” or only “slightly dangerous”. However, Adderall is an amphetamine. It hijack’s the brain’s reward system and can cause addiction and dependence just like its cousins: cocaine, meth and morphine. Adderall can also have dangerous side effects like anxiety, blood pressure elevations, seizures and cardiac arrest, in addition to more common side effects like appetite loss.

The second abuse of Adderall is as a party drug. Students will sometimes crush up the pills and snort them, with the drug causing users to stay active and alert late into the night. Sometimes its referred to as “kiddie coke”, because by snorting a larger dose you can achieve a similar high for far less money: $5-$25 a pill. When mixed with alcohol, the situation becomes even more dangerous. From 2005 to 2012 the amount of emergency room visits for brain stimulant abuse skyrocketed from 5,605 to 22,949, according to the Drug Abuse Warning Network.

Why have non-medical uses of stimulants become so popular recently? Other than the fact that they’re relatively cheap and don’t seem as “bad” to students, Adderall is so pervasive because of its widespread availability. With the steep rise in prescriptions for stimulants, almost everyone in college knows someone who has access to extra pills. One study showed that although American children are not more hyperactive or inattentive than other children, the United States holds 83%-90% of the total market share of ADHD medications. Because the drugs are prescribed in such quantities, the surplus on campuses has inevitably led to abuse.

If stimulant abuse isn’t on your radar, it should be. It may be one of the most threatening drug epidemics to hit young adults yet.

Why Your Child with ADHD Should Be Exercising

Children with ADHD have trouble paying attention largely due to dopaminergic dysfunction in the prefrontal cortex. In the typically developing brain, dopamine, a common neurotransmitter, works to help the brain tune in to the environment. In other words, dopamine acts as an amplifier helping the brain to pay attention. In children with ADHD, dopamine does not work as effectively in the prefrontal cortex, the part of the brain responsible for executive control, and thus patients have difficulty paying attention. Dopamine is critical for attention…so how can we help our kids to produce more dopamine and therefore pay more attention? One answer is exercise.

Exercise has been shown to increase neurotransmitter release, improving cognitive function. People often describe this effect as an endorphin high, and it is this natural high that can be leveraged to help treat inattention in ADHD. Studies have shown that acute aerobic exercise for just 30 minutes can significantly improve patients’ ability to pay attention. Further studies have shown that this improvement in attention occurs regardless of whether the patient uses stimulants like methylphenidate.

What’s even more promising is that exercise’s effects on the brain are long lasting. In fact, consistent exercise leads to “positive morphological, chemical and cognitive effects on the brain across the lifespan”. Because early childhood is the time period where there is the greatest amount of plasticity in the brain, it is vital that young children, especially those with ADHD, are encouraged to exercise, and that playtime is incorporated into their daily activities. In essence, physical activity may be a way to teach the brain how to mitigate the harmful symptoms of ADHD by prompting efficient dopamine signaling.

Exercise is a game changer for kids with ADHD, and not just because of its effects on attention. ADHD has high comorbidity with obesity, and research has shown that the link may again be dopamine. Dopamine may be acting to cause overeating in children with ADHD, increasing their risk for obesity. So, while dopamine is malfunctioning to decrease attention and increase obesity, exercise is acting to increase attention and decrease obesity. It’s like hitting two birds with one stone! While exercising may not be the be-all-end-all treatment for children with ADHD, it is certainly proving itself to be worthwhile in helping fight both symptoms and other comorbid disorders like obesity.

Physical exercise is really just another type of behavioral intervention that effectively helps your brain to function properly. In the case of exercise, it is likely through increasing dopamine signaling, and with our product at NeuroPlus, it is through correcting brain wave patterns. Either way, exercises, be they physical or mental, are rapidly revealing themselves to be remarkable treatments for ADHD that leverage the brain’s plasticity and alter the underlying dysfunction. More and more people are taking note of these alternative therapies as they hit mainstream media. So, what are you waiting for? It’s summertime and the perfect time to play outside and get some sunshine!

Your Brain on Video Games


In the media, there’s no shortage of negative attention on video games. Headlines abound portraying video games as equivalent to drugs or gambling as an addiction. There are even treatment programs available for helping children combat their video game addictions. Not only is the act of gaming controversial, but also the content of the games. More recently, however, video games’ association with ADHD has come to light. Speculation began when parents of children with ADHD reported their children being obsessed with gaming more frequently than other parents. Researchers have taken this association seriously, conducting studies attempting to clarify the link between gaming and ADHD. No studies have been able to verify the connection, except for the obvious…ADHD is an attention disorder and video games stimulate your attention constantly.

Despite the association, there is no evidence that video games cause ADHD or worsen ADHD symptoms…in fact there is some evidence to support just the opposite: video games increase attention and even vision in active gamers. Three years ago this month, Daphne Bavelier gave a TED Talk discussing her research on how the brain reacts to video games and on why we should be training people of all ages to concentrate using video games.

Check out Bavelier’s talk here:

(Pay close attention to the parts surrounding attention, ~5:00)

As you can see from Bavelier’s work, the negative discussion surrounding video games’ effects on attention is primarily a knee-jerk reaction, unfounded in science. The mental exercises promoted by action game use in fact help two elements of attention: resolving conflict and the ability to track objects, both of which are compromised in people with ADHD. The stimulated brain areas that Bavelier discusses are those of executive control, a dysfunctional area in patients with ADHD. Thus, not only can video game training be leveraged in the proposed contexts of senior citizens or people with compromised vision, it can be applied to treat symptoms of ADHD.

Bavelier’s results support exactly our goals here at NEURO+. By harnessing the stimulation and engagement that video games provide, we are able to extract and leverage their valuable training potential to help individuals with ADHD. In some cases, video game addiction may not be so bad after all…

 

Neurofeedback: forging a better brain

What is neurofeedback?

Neurofeedback is a form of cognitive training that uses real-time displays of brain activity to help subjects observe and adjust brain function. Most commonly, neurofeedback is used as a form of training to help people suffering from neurological disorders, like ADHD, manage their symptoms. Electroencephalography (EEG) is often used, projecting brain waves via visual or auditory feedback while the subject performs a task. The subject can then attempt to alter the signature brain activity of his or her disorder, essentially training the brain to function correctly. The sessions are non-invasive: users wear an EEG headset while they perform a videogame-like task that provides the feedback. Neurofeedback can be used as both a complement to and a replacement for other treatments.

neurofeedback

Neurofeedback and ADHD

ADHD has two main signatures in terms of brain function: increased slow theta waves and decreased fast beta waves. Thus, ADHD is often discussed in terms of a high theta/beta frequency ratio. With regard to neurofeedback paradigms, negative feedback, like an alarming sound or losing points in the video game, occurs in the presence of “unfocused” brain activity and positive feedback, like a reward in the game, occurs in the presence of “focused” activity. The goal here is to teach the patient’s brain to achieve a lower theta/beta ratio naturally, in a fashion similar to physical therapy. While it may be difficult at first, patients learn to control their brain waves in a way similar to yogis controlling their breathing. Once the subject becomes conscious of the forces causing their behavioral deficits, they can learn to control the source, effectively treating the symptoms. Neurofeeedback has also been proven to help treat syndromes like epilepsy, insomnia and anxiety by targeting different brain regions and patterns of activity.

Where’s the proof?

Neurofeedback has the highest possible ranking for evidence-based ADHD treatment by the American Society of Pediatrics. Often this type of behavioral intervention is appealing as a form of treatment because it is non-invasive and does not require the use of drugs. Parents around the world are turning to this type of therapy in the presence of rising prescription rates and drug use. Studies have shown that neurofeedback training both improves the theta/beta ratio and decreases ADHD symptoms inneurofeedback2 even the most severe cases (Luber et al. 1995). In comparison to
pharmacological treatment, neurofeedback has been shown to be just as, if not more effective in treating ADHD symptoms (Fuchs et al. 2003). Not only have the improvements in symptoms been significant, but they have also been shown to persist months after sessions end (For more info, check out this article and review by Dr. David Rabiner, a professor and psychologist at nearby Duke University: http://sharpbrains.com/blog/2010/08/05/long-term-effects-of-neurofeedback-treatment-for-adhd/). Thus, neurofeedback is not just a temporary fix. Patients maintain the strategies learned in the long term.

So why are you just hearing about this now? In the past, neurofeedback training has been quite costly and time-intensive. However, with the increase in clinical evidence and available technology, neurofeedback training is becoming a much more universal option for treatment. Because neurofeedback is so appealing as a behavioral intervention, the field is ripe for researchers and entrepreneurs, just like us here at NEURO+. Neurofeedback is opening the doors wide open for patients to autonomously improve their symptoms without negative side effects. In fact, our fun and interactive video game design insures that users won’t even know they’re training!

References

Fuchs, T., Birbaumer, N., Lutzenberger, W., Gruzelier, J. H., & Kaiser, J. (2003). Neurofeedback treatment for attention-deficit/ hyperactivity disorder in children: A comparison with methylphenidate. Applied Psychophysiological and Biofeedback, 28(1).

Hamilton, J. (2010, November 1). Train the brain: Using neurofeedback to treat ADHD. Retrieved May 11, 2015, from http://www.npr.org

Lubar, J. F., Swartwood, M. O., Swartwood, J. N., & O’Donnell, P. H. (1995). Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores, behavioral ratings, and WISC-R performance. Biofeedback and Self-Regulation, 20(1), 83-99.

Rabiner, D. (2010, August 5). Long-term effects of neurofeedback treatment for ADHD. Retrieved May 11, 2015, from http://sharpbrains.com/blog/2010/08/05/long-term-effects-of-neurofeedback-treatment-for-adhd/