Neurotherapeutic Approach to
"Neurofeedback treatment for many disorders such as ADHD, depression, anxiety, seizures, and others has been shown to be highly effective with long term lasting results. There are hundreds of published studies and several books demonstrating this."
Joel F. Lubar Ph.D., BCN
University of Tennessee
Even though treatment protocols vary depending on your personal needs and goals, it is helpful to understand some of the ways ADD/ADHD may show up in the brain scan. With that in mind, we’ll discuss some of the most common profiles and outline research into using neurotherapy as a tool to treat ADD/ADHD.
The DSM-5 currently considers ADD/ADHD a singular disorder characterized by ongoing inattention and/or hyperactivity. Most research into this condition has centered around how it manifests in children, even though ADD/ADHD frequently persists well into adulthood. Because of this, adults with ADD/ADHD, or individuals who are primarily inattentive, may have a harder time finding effective help. Additionally, not everyone with this condition responds well to medication. Neurotherapy is different than other treatment options because it works to normalize what is dysfunctional in the brain; when the brain adopts more healthful patterns on its own, this often leads to profound shifts in one’s quality of life.
Neurotherapy is effective when it is tailored to your unique brain and an understanding of what is going on for you. While ADD/ADHD is considered a singular disorder, from a QEEG perspective, ADD/ADHD has several profiles that show up throughout the brain. Sometimes, what was diagnosed as ADD/ADHD can actually be a separate condition. While the QEEG is not a diagnostic tool, what it can do is shed light on how ADD/ADHD manifests for you, in the context of your personal history and struggles.
Alpha Slowing and High Theta/Beta Ratio
From a neurotherapy perspective, the most common presentation in adults and children with primarily inattentive ADD/ADHD is what is known as “alpha slowing” or a high theta/beta ratio, where the brain is generating too many slow waves in proportion to fast waves.
If the brain is generating an excessive amount of slow waves, in the theta and delta ranges, depending on the location, this could manifest as anything from difficulty paying attention, staying focused, or understanding and following directions. For example, a common ADD/ADHD profile is frontal slowing; a high theta/beta ratio in the frontal lobes is associated with the classic ADD/ADHD symptoms of excessive daydreaming and difficulty following instructions. (doi.org:10.1142/S0219635208001897)
Another common profile frequently seen in ADD/ADHD and other conditions is the presence of Mu rhythm. The presence of this rhythm in the EEG suggests mirror neuron dysfunction/frontal lobe disengagement. DOI:10.1037/bul0000031
Central slowing is a common profile seen in those diagnosed with ADD/ADHD, as demonstrated in the head map above. The colors yellow and orange indicate 2 and 3 standard deviations outside of the norm in the 5-6 hertz range.
Brain map of individual diagnosed with ADD/ADHD showing central/dorso-lateral slowing. Red indicates 4 standard deviations outside of the norm.
Image (left) of an EEG demonstrating the presence of Mu Rhythm in an individual diagnosed with ADD/ADHD. Mu Rhythm can indicate frontal lobe disengagement.
Picture of a brain scan revealing the presence of excessive beta, fast-wave activity. This is a common profile for individuals diagnosed with ADD/ADHD who are also impulsive.
Neurotherapy and Primarily Hyperactive ADD/ADHD Subtype
Another common presentation of ADD/ADHD is found in individuals who are highly distractible, described as ‘bouncing-off-the-walls,’ and may be impulsive. The hyperactive and impulsive subtype of ADD/ADHD is more obvious in children, but in adults, this subtype frequently presents as excessive mind wandering and a fast-paced brain that is unable to slow down or shut itself off.
From a QEEG perspective a common profile of this subtype is the presence of excessive beta activity, most commonly seen in the frontal or central regions of the brain. Beta brainwaves are fast brainwaves; when the brain is generating too many of these types of waves, this can manifest as one easily feeling overwhelmed with racing thoughts, impulsive, and unable to focus on any one thing for a sustained period of time. (see picture).
Raw EEG of Excessive frontal beta-spindling activity in an individual diagnosed with primarily hyperactive ADD/ADHD.
Image of normal adult brainwaves. Beta is the brainwave correlated with mental activity. Excessive beta, such as that seen in certain profiles of ADD/ADHD, can manifest as being highly distractble, fidgety, and unable to sustain attention.
Complex ADD/ADHD Profiles
In other cases, what may appear to be ADHD/ADD may actually be a separation condition. For example, mild traumatic brain injuries, such as that seen in stressful births or early life trauma, may contribute to diffuse slowing and connectivity abnormalities throughout the brain. (doi:10.1016/j.jpedsurg.2015.03.060) Additionally, there is some research indicating that conditions such as chronic sinus infection can have a role in altering brain connectivity (doi:10.1001/jamaoto.2021.0204). Research of this sort points to the fact that the type of attentional and cognitive challenges that characterize ADD/ADHD may be more complex than originally thought.
Accomplishing even simple tasks requires complex coordination between various regions of the brain. If the QEEG brain scan reveals abnormalities in phase relationships and synchronization in the brain, this could give more context to a variety of cognitive challenges you may be experiencing, such as difficulty paying attention, forming coherent thoughts, or learning new tasks. This type of dysfunction responds particularly well to training that targets improving connectivity of the default mode network in the brain. (doi.org/10.1016/j.isci.2022.104285)
Image sourced here visually representing the brain's default mode network. A dysfunctional default mode network has been implicated in a variety of brain-based disorders and disorders of altered consciousness, such as that seen in cognitive dysfunction.
What research supports the use of neurotherapy as a treatment for ADD/ADHD?
Neurofeedback as a treatment modality has been around since the 1970s. Since that time, there have been numerous studies documenting the efficacy of neurofeedback and neurostimulation in the treatment of ADHD/ADD. The following are some recent meta-analyses that together discuss the findings of many studies in this field:
(1) A 2022 meta-analysis of 41 different studies found that neurofeedback has a large effect on reducing ADD/ADHD symptom severity. (doi.org/10.3991/ijes.v10i01.29079)
(2) A 2019 meta-analysis of 10 studies found that the positive effects of using neurofeedback to treat ADD/ADHD are durable and sustained long after treatment has concluded. This supports the longevity of neurofeedback training—the positive effects of neurofeedback are often permanent. (doi.org/10.1007/s00787-018-1121-4)
(3) A 2018 literature review supported the use of neurostimulation such as rTMS and tDCS in alleviating ADD/ADHD and improving cognitive performance. This review found that stimulation of this sort has greater durability and fewer side effects compared to other treatment options such as medication. In our Tucson Neurotherapy practice, we use neurostimulation (including rTMS and tDCS) alongside traditional neurofeedback for maximum benefit.(doi.org/10.1016/j.brs.2018.12.644)
These recent reviews are but a sample of research that supports the efficacy of neurofeedback in the abatement of ADD/ADHD. Many individuals who successfully complete neurotherapy programs find that they no longer need medication. If you are considering neurotherapy as a treatment option for you or a loved one, it is helpful to get as much information about it as you see fit. We recommend Getting Started with Neurofeedback as clear, easy-to-understand overview of the science backing neurofeedback.
A consistent finding of research is that, for neurostimulation to be effective, it needs to be tailored to your unique brain. There are many profiles of ADD/ADHD. For this reason, we consider the QEEG an invaluable tool in better understanding and treating you as a whole person. Feel free to reach out to us for more information or to schedule a QEEG brain scan.