NEUROFEEDBACK for ADHD

• Rationale for Assessment and Treatment

• Elizabeth McCrann

Senior Clinical Psychologist

Mater CAMHS, James Joyce St., Dublin 1

01-8034793 email: emccrann@mater.ie

ADHD in Ireland

• 3-5% children have ADHD• 30-40% children ref to CAMHS ADHD• Co-Morbid conditions :anxiety(34%), learning

difficulties(70%), oppositional defiant disorder(40%); conduct disorder(14%);Tics(11%);Mood Disorder(4%)

• Outcome poor if early intervention does not take place e.g early school leaving, RTA, substance abuse etc.

• 50%children with ADHD not receiving treatment

Assessment of ADHD

• Clinical Interview• Behaviour Rating Scales –Conners Parent

and Teachers Forms• High false positives• Continuous performance tests –TOVA and

IVA+Plus • QEEG- Quantitative EEG

(neurophysiological measure of attention)

QEEG Assessment

• QEEG helps assess “cortical slowing” seen in children with ADHD during academic tasks

• Baseline • Silent Reading Task• Listening Task• Drawing or Working Memory task• Attention Index (AI) calculated based on norms

published by Monastra and Lubar

Case Studies using QEEG

• John aged 8 years attending Mater CAMHS. Referred for QEEG to confirm presence or absence of ADHD

• High IQ but difficulty paying attention• Conners parent and Teachers in clinical

range suggestive of a diagnosis• Results of QEEG did not confirm ADHD

QEEG assessment

Mark aged 15 yearsAttending Mater CAMHS since 2000Average IQ + Language difficulties +ADHDAttended Special School for EBDMainstream + Resources +MedicationResults of QEEG confirm diagnosis of

ADHD-Inattentive TypeNeurofeedback treatment offered

EEG Bandpasses

• What does your EEG look like?• Age Dependant• EEG slowing in ADHD (Excess Slow Wave• Evidence Based Studies • Can you help children change their

experience of alertness?

Brain Waves - Description of EEG band passes/frequencies

EEG Neurofeedback Session

Clinical Neurofeedback session

• Electrodes placed on scalp• Video type games linked to client’s EEG as

measured by the software• Gain control of attention through control of EEG

and rewards through instant feedback of “fast” waves “.

• “Slow” waves are inhibited and games pause. Child learns quickly through real time feedback of EEG how he is progressing and gains control of attention.

How does Neurofeedback Work

• Strengthens Neural Connections-• Helps child experience alertness “what it feels

like” to pay attention• Real Time Feedback using latest technology

provides information to client – Self regulation• Interactive nature of multimedia technology• Based on positive psychology model-• Building on child’s strengths not an “illness”

model. Empowering children and increasing motivation to succeed

Multimodal Treatment of ADHD

• Medical and Psychological Treatments• Medication• Neurofeedback• Parenting Techniques/Behaviour Modification• Support Groups& Education about ADHD• Individual Psychotherapy• Family Therapy• Exercise• Nutrition

OUTCOME STUDIES• Monastra et al 2002 . “The Effects of Stimulant Therapy, EEG

Biofeedback & Parenting Style on the Primary Symptoms of ADHD”

• Monastra and Lubar (2001) The Development of QEEG scanning process for ADHD. Reliability and Validity Studies. Neuropsychology.

• Arns, M., De Ritter, D., Strehl, U., Breteler, M., Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: A meta-analysis. Clinical EEG and Neuroscience, 40(3), 180-189.

• Gevensleben et al (2009)

Outcome studies• EEG biofeedback(Lubar et al, 1995);Rossiter

& La Vaque 1995; Linden, Habib & Radojevic, 1996; Thompson & Thompson, 1999; Monastra et al, 2001) are reporting positive outcomes :-

• * reduction in behavioural symptoms of ADHD• * improvement in the T.O.V.A.• * improvements on tests of intelligence• * reduced cortical slowing on QEEG• * maintenance of clinical improvement when

medication is withdrawn

Future Applications

• Further Training in Biofeedback and Neurofeedback :

• www.bfe.org (Biofeedback Foundation of Europe)

• www.aapb.org (Applied Psychophysiology• www.isnr.org (International Society of

Neurofeedback Research)• Email: emccrann@mater.ie