Treating Learning Disabilities Using Neurofeedback

NEUROFEEDBACK FOR ADD/ADHD AND LEARNING DISABILITIES
by
D. Corydon Hammond, Ph.D.
Professor, Physical Medicine & Rehabilitation
University of Utah School of Medicine

INTRODUCTION
EEG biofeedback, which is popularly called neurofeedback, began in the early 1970's. The firsts research concentrated on using neurofeedback to reduce uncontrollable epileptic seizures. Double-blind, placebo controlled scientific studies demonstrated that neurofeedback was both effective and also that it's success was not due to placebo effects. During the seventies and 1980's, researchers began discovering that neurofeedback could benefit other brain abnormalities as well, including ADD/HD, learning disabilities, and head injuries.

ADD/ADHD is found in about 5%-6% of adults and children. We now know that it involves brain abnormalities. The frontal areas of the brain are basically our executive control centers which regulate attention, emotion, and behavior. We find that in ADD/ADHD, the brainwave patterns are almost always slower than normal in the frontal parts of the brain. Most commonly, there is a deficiency of healthy beta brainwaves and an excess of either theta or alpha (slow) brainwaves.

This physiological deficit makes it difficult to control attention. Thus,
individuals with ADD/ADHD are usually easily distracted, have a short attention span, and may have difficulty following directions and listening. Similarly, they will tend to lack control over their emotions, which makes them more prone to temper tantrums, mood swings, and emotional outbursts. In many cases they will also have difficulty controlling their behavior and tend to be impulsive, restless, overly talkative, and hyperactive.

MEDICATION AND ADD/ADHD
Medication has been the primary treatment for ADD/ADHD. Often medications produce improvements in thinking and behavior. However, one study found that 69% of children on Ritalin or other stimulants suffered from one or more side effects. Recently there has also come to be widespread concern about the long term effects of taking stimulant medication, which can have similar effects on the brain to cocaine. Even though medication might play a role in managing ADD/ADHD, a massive recent review of literature found
that medication did nothing for 25-40% of children with these problems.

Still another thorough review of studies on prescribed stimulants recently found that they provided "temporary improvement," but "on the other hand, changes that point toward longer- term improvement (e.g., in academic outcome, antisocial behavior, or arrest rate) were not found, and only small effects were observed on learning and achievement." In this regard, a Council on Scientific Affairs report from the American Medical Association concluded in 1998 that drug therapy alone, while effective in short-term symptomatic improvement, "has not yet been shown to improve the long-term outcome for any domain of functioning (classroom behavior,
learning, impulsivity, etc.)." For these reasons, we believe it is
important for adults with this condition, and parents of children with
ADD/ADHD, to realize that another valuable treatment option exists which may be used in conjunction with, or as an alternative to medication.

TREATING ADD/ADHD WITH NEUROFEEDBACK
There are now multiple research studies which include long term follow-ups demonstrating that neurofeedback can eliminate or substantially reduce symptoms of ADD and ADHD. Lasting change seems to occur in about 80% of cases where the patient is age 7 or older, and it appears that medication is no longer required in about 75% of cases.

Frank H. Duffy, M.D., a Professor and Pediatric Neurologist at Harvard Medical School, wrote an editorial in the January 2000 issue of the journal Clinical Electroencephalography. He indicated that the scholarly literature suggests that neurofeedback "should play a major therapeutic role in many difficult areas. In my opinion, if any medication had demonstrated such a wide spectrum of efficacy it would be universally accepted and widely used" (p. v). "It is a field to be taken seriously by all" (p. vii).

WHAT IS NEUROFEEBACK TRAINING?
We do neurofeedback training through the use of a piece of electronic equipment called an electroencephalograph (EEG). The EEG measures the power and frequency of a person's brainwave activity. This information is relayed to a computer and the results are presented to the patient in the form of visual and auditory feedback. Using this sophisticated technology, the therapist can then assist the child or adult in learning how to use this "neurofeedback" to both recognize and better regulate his or her brainwave patterns. Studies have shown that brainwave activity is literally reconditioned.

In working with children, the computer programs will sometimes take the form of games, such as flying an F-16 jet, or making a superman (or superwoman) figure or clown in a helicopter, fly higher. When the brain waves improve, the patient is rewarded through positive visual and auditory feedback. With continuing practice and coaching, the majority of people can learn to suppress the inefficient brainwaves and to produce more of the brainwaves associated with concentration, intellectual efficiency, and self-control. They are assisted to literally recondition their own brainwave activity into a more healthy pattern.

RESULTS OF NEUROFEEDBACK TRAINING
Neurofeedback training for ADD/ADHD is typically associated with improved concentration and academic performance. In fact, several studies in professional journals have consistently found that IQ scores improved, usually from 10-23 points, due to the enhanced intellectual efficiency. We usually see decreased impulsiveness and hyperactivity, greater emotional control and stability of moods, and improved sleep patterns.

Developmental learning disabilities (LD) are estimated to be found in
4%-6% of school children. Learning disabilities have more diverse and different brainwave patterns than is found with ADD/ADHD. Quantitative EEG's (brain maps) have shown that instead of excessive theta and alpha brainwaves, LD children especially tend to have excess delta activity - an even slower brainwave. Learning disabilities generally also involve more slow brainwave activity toward the back of the brain in visual and auditory processing areas, instead of frontally. Neurofeedback seems equally capable of helping to remediate learning disabilities.

Neurofeedback has also been found to be valuable in assisting persons with post-concussion syndrome or head injuries. Following an accident where there is a whiplash or someone hits their head, the person often struggles with difficulty concentrating, problems with short-term memory, irritability or temper outbursts, and many other symptoms. We have found that even years after a head injury occurred, neurofeedback is still often able to add a whole new dimension to their rehabilitation and recovery.

Neurofeedback involves a learning process. Therefore, it works best when training occurs with consistence, two or more times weekly. Treatment commonly requires 40-50 sessions for the best outcomes.

How can you find a neurofeedback provider? In addition to listings on this web site, you may also contact the primary professional society in this specialty - the Society for Neuronal Regulation. Their web site is www.snr-jnt.org. It lists practitioners throughout the United States and in some foreign countries.

Relevant References

Alhambra, M. A., Fowler, T. P., & Alhambra, A. A. (1995). EEG biofeedback: A new treatment option for ADD/ADHD. Journal of Neurotherapy, 1(2), 39-43.

Boyd, W. D., & Campbell, S. E. (1998). EEG biofeedback in the schools: The use of EEG biofeedback to treat ADHD in a school setting. Journal of Neurotherapy, 2, 65-71.

Goldman, L.S., Genel, M., Bezman, R.J., & Slanetz, P.J. (1998). Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Journal of the American Medical Association, 279(14), 1100-1107.

Linden, M., Habib, T., & Radojevic, V. (1996). A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback & Self-Regulation, 21(1), 35-49.

Lubar, J. F. (1985). EEG biofeedback and learning disabilities. Theory
into Practice, 26, 106- 111

Lubar, J. F. (1995). Neurofeedback for the management of
attention-deficit/hyperativity disorders. Chapter in M. S. Schwartz (Ed.), Biofeedback: A Practitioner's Guide. New York, Guilford, 493-522.

Lubar, J. F., Swartwood, M. O., Swartwood, J. N., & O'Donnell, P. H.
(1995). Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A, scores, behavioral ratings, and WISC-R performance. Biofeedback & Self-Regulation, 20(1), 83-99.

Lubar, J. O., & Lubar, J. F. (1984). Electroencephalographic biofeedback of SMR and beta for treatment of attention deficit disorders in a clinical setting. Biofeedback & Self-Regulation, 9, 1- 23.

Lutzenberger, W., Elbert, T., Rockstroh, B., & Birbaumer, N. (1982).
Biofeedback of slow cortical potentials and its effects on the performance on mental arithmetic tasks. Biological Psychology, 14, 99-111.

Othmer, S., Othmer, S. F., & Kaiser, D. A. (1999). EEG biofeedback:
Training for AD/HD and related disruptive behavior disorders. Chapter in J. A. Incorvaia & B. F. Mark-Goldstein, & D. Tessmer (Eds.), Understanding, Diagnosing, & Treating AD/HD in Children and Adolescents. New York: Aronson, 235-297

Pulvermuller, F., Mohr, B., Schleichert, H., & Veit, R. (2000). Operant
conditioning of left- hemispheric slow cortical potentials and its effect
on word processing. Biological Psychology, 53, 177-215.

Rossiter, T. R., & La Vaque, T. J. (1995). A comparison of EEG biofeedback and psychostimulants in treating attention deficit/hyperactivity disorders. Journal of Neurotherapy, 1, 48-59.

Shouse, M. N., & Lubar, J. F. (1979). Sensorimotor rhythm (SMR) operant conditioning and methylphenidate in the treatment of hyperkinesis. Biofeedback & Self-Regulation, 4, 299-311.

Tansey, M. A. (1984). EEG sensorimotor rhythm biofeedback training: Some effects on the neurological precursors of learning disabilities.
International Journal of Psychophysiology, 3, 85- 99.

Tansey, M. A. (1990). Righting the rhythms of reason: EEG biofeedback training as a therapeutic modality in a clinical office setting. Medical Psychotherapy, 3, 57-68.

Tansey, M. A. (1991). Wechsler (WISC-R) changes following treatment of learning disabilities via EEG biofeedback in a private practice setting. Australian Journal of Psychology, 43, 147-153.

Tansey, M. A. (1993). Ten-year stability of EEG biofeedback results for a hyperactive boy who failed fourth grade perceptually impaired class. Biofeedback & Self-Regulation, 18, 33-44.

Tansey, M. A., & Bruner, R. L. (1983). EMG and EEG biofeedback training in the treatment of 10-year old hyperactive boy with a developmental reading disorder. Biofeedback & Self- Regulation, 8, 25-37.