Jessica Steele Western Michigan University A Literature Review of Neurofeedback on the Treatment of Attention Deficit-Hyperactivity Disorder

A TTENTION D EFICIT -H YPERACTIVITY D ISORDER Inattention, impulsivity and hyperactivity 3–5% of school-aged children in the United States Combined, Predominantly Inattentive, and Predominantly Hyperactive-Impulsive.

A TTENTION D EFICIT -H YPERACTIVITY D ISORDER Inattention Hyperactivity Impulsivity

C OMORBID DISORDERS Conduct, mood, anxiety, and tic disorders, Social skill deficits Increased risk for accidental injury Higher incidence of expulsion, substance abuse

T REATMENT Stimulant Medication Traditional Behavioral Treatment

T RADITIONAL B EHAVIORAL T REATMENT Consequence-focused Antecedent-focused

A NTECEDENT - FOCUSED B EHAVIORAL TXT Reducing work to complete Ensuring understanding before beginning task Providing extra time to the student Teaching study and note taking skills

C ONSEQUENCE - FOCUSED B EHAVIORAL TXT Reinforcement contingencies Response-cost Token Economy

F AILURES OF T RADITIONAL B EHAVIORAL TXT Many do not respond to behavioral treatments. Difficult to generalize to the different situations Little carryover Problem behaviors return to baseline in 50% of cases.

S TIMULANT M EDICATION Stimulant Medication to be superior treatment Methylphenidate (MPH) psychostimulant medication

F AILURES OF S TIMULANT M EDICATION High non-response Negative symptoms return upon termination Does not treat the co-occurring tribulations Side effects occur in 20-50% of individuals

B RAIN W AVES Delta (1-4 Hz)- relaxation Theta (4-7 Hz)- dreaming/creativity/sociability Alpha (8-11 Hz)- learning/anxiety/inspiration Beta (12-30 Hz)- attention/aggression

ELECTROPHYSIOLOGICAL ABNORMALITIES Abnormal brain wave characteristics 5 distinct brain wave profiles

F IVE EEG C LUSTERS Cluster 1 : ADHD combined type more aggressive, mood, and antisocial behaviors. Cluster 2 : age-appropriate, and are not very fearful or antisocial. Cluster 3 : impulsive, inattentive, poor language “Maturation lag” Cluster 4 : “typical” ADHD range of behaviors Cluster 5 : “confused or in a fog” arrange objects, prefer strict routine

I NTRODUCTION TO N EUROFEEDBACK Behavior highly correlates with subtypes. 1976, 1 st ADHD Neurofeedback sessions Neurofeedback Operant conditioning of brain wave frequencies

N EUROFEEDBACK Electrodes on the scalp Contingent auditory or visual feedback Theta, Sensorimotor Rhythm (SMR), and beta.

N EUROFEEDBACK ( CONTINUED ) Software plays movies or videogames Example: High theta/ low beta

N EUROFEEDBACK ( CONTINUED ) Brain adapts to the consequences Thresholds increase in difficulty Goal: Increase sensitivity to levels of arousal

N EUROFEEDBACK (C ONTINUED ) Improves attention/behavioral problems Improves scores on intelligence tests Increases academic achievement Closely comparable to medication

N EUROFEEDBACK C OMPARED TO A LTERNATIVES Long term affects Strehl (2006) No documented adverse side effects. (Hypothesized ideas of inducing seizures through Neurofeedback, but there has never been a documented instance) No adverse side effects

I N S UMMARY Equally significant results compared to stimulant medication No side effects Individualistic approach when compared to medication Future topics of research

References are available upon request