Attention Deficit Hyperactivity Disorder As A Neurodevelopment Disorder

 Attention deficit hyperactivity disorder (ADHD) is a neurodevelopment disorder which is most common in children, it causes patients to be hyperactive, inattentive and impulsive (Geladé K 2017). ADHD patients have been found to have an increased Theta wave and a decreased beta wave, an increased theta wave causes the patient to have poor vigilance and a decreased beta causes patients to have reduced attention (Bink M). Currently the most common medication being used for the treatment of ADHD is methylphenidate which is a stimulate medication. It has been found that methylphenidate causes an increase in alpha and beta brain waves but did not have any effects on theta brainwaves (Janssen TWP 2016). Neurofeedback is a computer based behavioral therapy used on ADHD patients, it uses auditory and/or visual signals whilst being connected to an electroencephalogram (EEG) which tracks and records brain activity. It works by training the brain to decrease theta waves and increase beta waves (Pahlevanian A 2015). Findings have found that whilst it can be a successful treatment for some symptoms of ADHD, it may be better used with other prescribed treatments. This annotated bibliography will discuss how neurofeedback can help with the treatment of ADHD.

KEYWORDS: Neurodevelopment, methylphenidate, theta, beta, electroencephalogram

This study was conducted on male adolescents from the ages of 12-24, separated into two groups with one group consisting of 45 patients being treated with neurofeedback in conjunction with treatment as usual (whatever they have already been prescribed) and the other group consisting of 26 patients treated only with the usual treatment.

The study was carried out over 25 weeks and was then measured through questionnaires which revealed both the treatment as usual and the treatment as usual in conjunction with neurofeedback revealed a decrease in inattention but without a difference between the groups for hyperactivity and impulsivity, however both neurofeedback and treatment as usual had the same effectiveness on behavioral outcomes.

This study was a randomized controlled trial (RCT) on the effects of neurofeedback on cognitive function. It was completed on 103 children from ages 7-13 with 38 patients being treated by neurofeedback, 31 patients on methylphenidate and 34 treated by physical activity. Neurocognitive functions were then tested using auditory oddball which is used to measure attention, stop-signal which is used to measure inhibition and visual spatial working memory task which is used to measure short term memories. This RCT did not support neurofeedback alone as a treatment for neurocognitive functions, it found that methylphenidate is a much better treatment for neurocognitive functions than both neurofeedback and physical activity and shows a much faster response speed.

This study used the same patients as the previous study- completed using 103 children from the ages of 7 to 13 with 38 patients being treated with neurofeedback, 31 patients treated by methylphenidate and 34 treated with physical activity however only 81 were analysed: 29 using neurofeedback, 27 using physical activity and 25 on methylphenidate. This article instead of comparing neurocognitive functions it instead compares the effects of neurofeedback on theta and beta brain waves with the effects of physical activity and methylphenidate on theta and beta waves. The electroencephalogram power spectra was used to examine brain functions while patients had their eyes closed, eyes open and during active task conditions. Behaviours where tested by using parent and teacher reports and by using an electroencephalogram recording. Parents have claimed that their have been slight changes in behavior with the use of neurofeedback, however teachers have not noticed any changes.

This study was conducted on 45 females between the ages 5 to 7 who have had no prior ADHD treatments, they were split into 3 groups of 15. The first group was treated with only neurofeedback, the second group treated with both neurofeedback and cognitive rehabilitation which focused on working memory along with executive processes and the third group was a control group which received no treatment. An integrated visual and auditory test showed that the group treated with only neurofeedback showed better results, however the group treated with both neurofeedback and cognitive rehabilitation showed not only better results in the integrated visual and auditory test but also showed improvements in working memory.

This review explored 15 studies which used neurofeedback as a treatment on children who have ADHD, it discusses neurofeedback training on both the frequency bands and the 6 studies on neurofeedback training of the slow cortical potentials. The review also discusses transfer trials which is a treatment were the patient regulates brain activity without the need of feedback, or receiving delayed feedback, the review explains that this reflects the patient’s ability to regulate their brain activity without treatment.

This review suggested patients should be analyzed not only before and after treatment, but also during treatment. It also mentions if experiments had used a placebo control using Electromyography biofeedback would have been better, however even a placebo control may not be strong enough proof that neurofeedback shows improvements.