Megan Johnson

Neurofeedback therapy is costly and not yet proven, but evidence of success is building

If it weren't for the wires draped from his head, the boy might be just another kid playing a computer game. His eyes are locked on the screen, his forehead furrowed in concentration. But the wires, attached to electrodes on his skull and running to a nearby computer station, suggest activity of a more serious sort, which it is. The boy has attention deficit hyperactivity disorder, and this is a session of a controversial brain-training technique called neurofeedback. Its supporters say, and the evidence backing them up is increasing, that the treatment can improve such a child's ability to focus on homework, clean his room, and complete other tasks that challenge his attention span. While neurofeedback therapy takes many weeks and costs thousands of dollars, the prospect of an alternative to years of medication tantalizes parents and therapists alike.

The boy is concentrating on producing the right mix of brain waves, a pattern that will keep the action going on the screen. It could be almost anything--an airplane in flight or a Harry Potter movie brought from home. At the beginning of a typical 45-minute session, the therapist starts up the game or movie and observes the boy's brain waves on another monitor. The computer is programmed to reinforce brain-wave frequencies associated with focus and calm. If the child's attention wanders or he begins to fidget, the action slows or the movie screen darkens, and the therapist exhorts him to regain focus. He is registering the effect of his own thoughts. "It's like looking in a mirror," says psychologist Leslie Sternberg, a neurotherapist in Acton, Mass.

Better beta.

Neurofeedback, also called EEG (electroencephalogram) biofeedback, has been investigated as an ADHD treatment since the 1970s. Studies suggest that in this disorder, the brain generates insufficient beta waves, linked with focus and attention, and overabundant lower-frequency theta waves, produced during periods of drowsiness. Rewarding a child when he steps up production of beta waves should therefore teach him how to focus at will in other settings, such as when doing homework.

At least for some children, that seems to have happened. One of them is Cameron Rose, now 26, from Kingston, Canada. Before his neurofeedback treatments at age 11, says his mother, Joan, he could not be taught to read, although both she and her husband were teachers.

Diagnosed with ADHD just before starting sixth grade after two years in a class for the severely learning disabled, Rose had 60 sessions of neurofeedback therapy at the ADD Centre and Biofeedback Institute of Toronto. His reading level shot up from second to fifth grade, and his IQ scores jumped from low average to high average. He never took ADHD medication and has never had additional neurofeedback therapy. Recently, Rose graduated from Queen's University in Kingston with a degree in computer engineering. He recalls the treatments as "superfreaking boring." But they also gave him a sense of empowerment, and that, he says, was key.

Despite neurofeedback's anecdotal successes, it was largely dismissed by ADHD experts until recently. Most studies showing benefit have been run by investigators with a financial stake; under such conditions, says Peter Jensen, cochair of the division of child psychiatry and psychology at Mayo Clinic in Rochester, Minn., even a rigorously designed study "tends to find what it wants to find."

Nor have the studies been very rigorous--most have been small and sloppily done. Results have not been compared with results from medication or other forms of therapy, for example, nor has a control group received "sham treatment" that patients believed to be neurofeedback but in fact did nothing. A 2005 review coauthored by Russell Barkley, a leading expert on ADHD at the Medical University of South Carolina, raised some of these concerns.

But newer research has been promising. A German study published earlier this year was fairly large (94 children ages 8 to 12) and included a control group. Observations by the children's parents and teachers indicated that most kinds of ADHD-related behavior improved much more in the neurofeedback group than in the control group.

That study and 14 others were analyzed in the July issue of the Official Journal of the EEG and Clinical Neuroscience Society. Ten of the studies, involving nearly 500 children, used a control group. "The clinical effects of neurofeedback in the treatment of ADHD can be regarded as clinically meaningful," the authors concluded. "I look at this article, and I'm persuaded that there's something here," says Mayo's Jensen, who also is president and CEO of the REACH Institute, a nonprofit group that trains pediatric health practitioners in the latest mental-health therapies. "Previously, I was very skeptical that this treatment had much to offer," says Barkley. He says of the German study: "It looks like based on this study that there might be some promise to it." But he is not ready to embrace the technique. "Should [neurofeedback] be offered to the public? My answer would be no," he says.

Still, as evidence of benefit accumulates, increasing numbers of parents will ask themselves whether neurofeedback may be worth trying. The question, says Jensen, is whether the expense is justifiable. Forty to 60 sessions, typically costing $100 per session, are generally recommended; most health insurance plans consider neurofeedback an alternative treatment and will not cover the expense. Drug treatment can be more expensive over the long run--about $180 a month for some stimulants--but generic medications can cost as little as $10 a month.

Many practitioners view neurofeedback as complementing rather than replacing drugs.

Unlike neurofeedback, medication often produces immediate and dramatic results, says Eugene Arnold, professor emeritus of psychiatry at Ohio State University.

The catch with drugs is that many children stop taking them. In one large study, more than 60 percent of the children on stimulants discontinued them within eight years. Parental concern may be a factor--side effects are not uncommon. Neurofeedback, by contrast, "by and large doesn't appear to be a risky treatment," says Arnold. "Undoubtedly, it has less side effects than medicine."

That was why Kim Sanders of Aubrey, Texas, tried neurofeedback a few years ago with Macy, now 15, and Trent, 14. The drugs they were taking for their attention disorders inhibited their growth, she says. She has seen a "night and day" change in Trent's behavior and "remarkable" improvement in Macy's school performance. Drugs are no longer in the picture.


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