Neurotherapy and biofeedback for ADHD? Check out the facts first.

This week I was pleased to hear Brian Dunning at SKEPTOID (the podcast) address a student question about neurotherapy. Here's the question and Brian's answer (Brian has given me permission to post this here):

Student Question:
Hello, I'm Andrew from the Minneapolis College of Art and Design in Minnesota, and I would like to know if neurotherapy using EEG Biofeedback is an effective treatment?

Brian's Answer:
Usually marketed as neurofeedback, this is an alternative therapy that claims to treat a huge range of conditions through the use of EEG biofeedback. You've probably seen TV shows where people, often with some paralysis or other handicap, practice moving a cursor on a computer screen using only electrodes attached to their scalp. You can indeed train your brain to do this kind of thing, and based on this apparent legitimacy, a whole cottage industry has grown around the sales and marketing of such machines, and expensive training for alternative practitioners to learn how to use them.

What's lacking is evidence of efficacy, or plausible foundation for how or why this might treat medical conditions. Practitioners can be found who claim it treats just about anything: autism, ADHD, incontinence, migraines, chronic pain, depression, drug abuse, sleep disorders, you name it. These disorders all have different underlying causes, so it's implausible to expect a single treatment to target more than one of them, let alone all of them.

The theory, as it's offered, is based on the premise that there are healthy brainwaves and unhealthy brainwaves. What you do is put on the electrodes and practice with whatever's on the screen, usually some type of simple video game, until the practitioner declares your EEG to look "healthier". The idea is that you come back again and again, practicing to reach the "healthy" EEG sooner; and it's claimed that this trains your brain to normally reach an improved state on its own. All of this sounds perfectly reasonable, and impressively high-tech, which is why the treatment is so easy to sell to uninformed patients.

Dramatic conditions like epileptic seizures and brain injuries can indeed have obvious readings on an EEG, but healthy brains also have a wide range of possible EEG waveforms. The notion that some healthy EEG waves are "good" and some are "bad" is without any neurological foundation, and thus, so is neurofeedback. "Bad" EEGs are neither characteristic of, nor the cause of, the conditions neurofeedback pretends to treat, so save your money.

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I've often been impressed with what I have read about neurofeedback, and at one point was considering using it in my practice. As a matter of fact I am looking right now at my bookshelf and see "ADD: The 20-Hour Solution" by Steinberg and Othmer. When I first read that book I became convinced it was a quick and easy answer that many had overlooked. But then again, why was it so easily overlooked? There's the book. anyone could buy it. What's wrong. Well, it's a book, and honestly, people write lots of books, and a book is the least likely place your going to find solid scientific evidence. You need to look at peer reviewed research for that. And most of the neurofeedback research is published in their own professional journal, an arm of their professional association. There is some positive evidence and below I give a link to a nice, positive review from CHADD. Take a look there too.

CHADD has a more optimisitc reading on neurotherapy, and you can examine their overview of several recent research articles by clicking here.

Going back to the more critical, here on Quackwatch you will find a section discussing the problems with neurotherapy.

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So, what's a parent or individual to do? Or for that matter, what am I to do? I usually ask a couple basic questions when considering therapies that are not yet mainstream (although, some would argue even about this with neurotherapy). I consider first: "Is this a good choice as my FIRST line of attack on the condition I am concerned about? Are there already other well proven interventions and techniques? Will this prevent me from using those? Or distract me? And I ask myself: "Are the claims made reasonable?" Here is where, like many, I have a problem with neurotherapy. It seems to claim to cure everything, from headaches to autism to ADHD. How can it cure things which have such different causes?"

So, what are you to do? Read about therapies your considering and don't rely on the internet and web searches. You can find pages that support any and everything on the web. Check out reliable government sources. Check out respected professional groups. Check out other respected groups like CHADD. And finally, ask your family doctor if this would be the choice of intervention he or she would make. If not, where would they start? There are a number of "alternative" and "natural" treatments advertised for ADHD (Attention Deficit Hyperactivity Disorder) andI know it's difficult to tell which ones make sense and which do not. I can say that the internet, and blogs (even this blog) is no place to look for unbiased information. Go to your family doctor, and if you need to, go to a second one for a second opinion. Trust your doctor.

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My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.

Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com