As a clinical neuropsychologist specializing in neurodevelopmental disorders and neuropsychological assessment, I am frequently asked to recommend treatment options for parents whose children have been diagnosed with Attention-Deficit Disorder. While most people know that psychostimulant medications are often a helpful component of the treatment for this troubling neurodevelopmental problem, few people realize that children need specific training in certain life skills (related to habit building, establishing and maintaining routines, organizing the environment) to reduce the negative impact of these disorders. This is true whether ot not medication is utilized.
A relatively new approach to treatment involves a sophisticated computer-assisted process to actually train the brain to increase the capacity for sustained attention and focus. This process, called neurofeedback, is a specialized form of biofeedback (which has been standard practice in behavioral healthcare since the mid-1970's). Neurofeedback training is a process of measuring brain electrical activity (EEG) and, making the information available to the patient via an assortment of computerized "games." While the patient plays "computer games," he wins by increasing the strength and consistency of brain frequencies that are associated with higher levels of attention, concentration, and focus.
Results of neurofeedback vary, but with adequate motivation, children and adults can significantly improve their attention, whether they take medicine or not. To determine whether or not neurofeedback is appropriate, objective diagnosis of the condition must be established. In addition to assessing cognitive development levels, specific information about the capacity for sustained attention and impulse control must be obtained.
One of the most useful sources of objective diagnostic information is obtained using "continuous performance" tests. We use the Integrated Visual-Auditory Continuous Performance Test (IVACPT). This test provides the clinical neuropsychologist with scores of impulsivity (Response Control) and distractibility (Attention). Scores are derived for both visual and auditory functions, since inattention often occurs in one modality rather than both. Each subject's performance is compared to others' of his or her age and sex. A score of 100 is average; a score of 85 or below indicates the possibility of an attention disorder.
Neurofeedback treatment occurs over a period of several months; treatment sessions are held a minimun of two or three times per week. "Justin," an eleven year old boy with a diagnosis of ADHD-Inattentive Type, is a fairly typical example of treatment progress with neurofeedback training. He started the training after undergoing our cognitive and neuropsychological test procedures, which established the diagnosis of Attention Deficit-Hyperactivity Disorder, Inattentive type. His scores on the IVACPT at the onset of treatment were as follows:
Full Scale Response Control Quotient = 80
Auditory RCQ = 77 Visual RCQ = 87
Full Scale Attention Quotient = 86
Auditory AQ = 83 Visual AQ = 94
Justin was seen three times per week. At eight weeks of training, Justin was given the IVACPT again. His scores at this point in treatment were as follows:
Full Scale Response Control Quotient = 86
Auditory RCQ = 83 Visual RCQ = 94
Full Scale Attention Quotient = 94
Auditory AQ = 103 Visual AQ = 87
In most cases of ADHD, 35-50 training sessions are necessary to achieve desired results. Justin received 58 total sessions. After his 51st session, he was given the IVACPT again. This time, his attention and impulse control had improved substantially. His test results at session 51 were:
Full Scale Response Control Quotient = 102
Auditory RCQ = 107 Visual RCQ = 97
Full Scale Attention Quotient = 111
Auditory AQ = 108 Visual AQ = 110
In addition to the obvious improvement in measured attention, Justin reported that he now finished his homework more quickly, and with less frustration. His parents likewise reported his improvement at school, but also noticed his improved mood.
Clearly, this approach to treatment has certain advantages. While not always a "drug free" approach, it does allow for reduced need for medication. The problem of medical compliance (i.e. youngsters resist the idea of taking medicine at school) is reduced. The down side of neurofeedback is that it is time consuming, challenges the therapist to keep a highly distracted youngster enthusiastic about a difficult task, and it requires a significant financial commitment. However, for the right person, neurofeedback may be the most appropriate and useful approach to this prevalent neurodevelopmental disorder.