1. NEUROFEEDBACK for ADHD
• Rationale for Assessment and Treatment
• Elizabeth McCrann
Senior Clinical Psychologist
Mater CAMHS, James Joyce St., Dublin 1
01-8034793 email: emccrann@mater.ie
2. ADHD in Ireland
• 3-5% children have ADHD
• 30-40% children ref to CAMHS ADHD
• Co-Morbid conditions :anxiety(34%), learning
difficulties(70%), oppositional defiant
disorder(40%); conduct
disorder(14%);Tics(11%);Mood Disorder(4%)
• Outcome poor if early intervention does not take
place e.g early school leaving, RTA, substance
abuse etc.
• 50%children with ADHD not receiving treatment
3. Assessment of ADHD
• Clinical Interview
• Behaviour Rating Scales –Conners Parent
and Teachers Forms
• High false positives
• Continuous performance tests –TOVA and
IVA+Plus
• QEEG- Quantitative EEG
(neurophysiological measure of attention)
4. QEEG Assessment
• QEEG helps assess “cortical slowing” seen in
children with ADHD during academic tasks
• Baseline
• Silent Reading Task
• Listening Task
• Drawing or Working Memory task
• Attention Index (AI) calculated based on norms
published by Monastra and Lubar
5. Case Studies using QEEG
• John aged 8 years attending Mater
CAMHS. Referred for QEEG to confirm
presence or absence of ADHD
• High IQ but difficulty paying attention
• Conners parent and Teachers in clinical
range suggestive of a diagnosis
• Results of QEEG did not confirm ADHD
6. QEEG assessment
Mark aged 15 years
Attending Mater CAMHS since 2000
Average IQ + Language difficulties +ADHD
Attended Special School for EBD
Mainstream + Resources +Medication
Results of QEEG confirm diagnosis of
ADHD-Inattentive Type
Neurofeedback treatment offered
7. EEG Bandpasses
• What does your EEG look like?
• Age Dependant
• EEG slowing in ADHD (Excess Slow
Wave
• Evidence Based Studies
• Can you help children change their
experience of alertness?
8. Brain Waves - Description of EEG band passes/frequencies
11. Clinical Neurofeedback session
• Electrodes placed on scalp
• Video type games linked to client’s EEG as
measured by the software
• Gain control of attention through control of EEG
and rewards through instant feedback of “fast”
waves “.
• “Slow” waves are inhibited and games pause.
Child learns quickly through real time feedback
of EEG how he is progressing and gains control
of attention.
12. How does Neurofeedback Work
• Strengthens Neural Connections-
• Helps child experience alertness “what it feels
like” to pay attention
• Real Time Feedback using latest technology
provides information to client – Self regulation
• Interactive nature of multimedia technology
• Based on positive psychology model-
• Building on child’s strengths not an “illness”
model. Empowering children and increasing
motivation to succeed
16. Multimodal Treatment of ADHD
• Medical and Psychological Treatments
• Medication
• Neurofeedback
• Parenting Techniques/Behaviour Modification
• Support Groups& Education about ADHD
• Individual Psychotherapy
• Family Therapy
• Exercise
• Nutrition
17. OUTCOME STUDIES
• Monastra et al 2002 . “The Effects of Stimulant Therapy, EEG
Biofeedback & Parenting Style on the Primary Symptoms of ADHD”
• Monastra and Lubar (2001) The Development of QEEG scanning
process for ADHD. Reliability and Validity Studies.
Neuropsychology.
• Arns, M., De Ritter, D., Strehl, U., Breteler, M., Coenen, A. (2009).
Efficacy of neurofeedback treatment in ADHD: The effects on
inattention, impulsivity and hyperactivity: A meta-analysis. Clinical
EEG and Neuroscience, 40(3), 180-189.
• Gevensleben et al (2009)
18. Outcome studies
• EEG biofeedback(Lubar et al, 1995);Rossiter
& La Vaque 1995; Linden, Habib &
Radojevic, 1996; Thompson & Thompson,
1999; Monastra et al, 2001) are reporting
positive outcomes :-
• * reduction in behavioural symptoms of ADHD
• * improvement in the T.O.V.A.
• * improvements on tests of intelligence
• * reduced cortical slowing on QEEG
• * maintenance of clinical improvement when
medication is withdrawn
19. Future Applications
• Further Training in Biofeedback and
Neurofeedback :
• www.bfe.org (Biofeedback Foundation of
Europe)
• www.aapb.org (Applied Psychophysiology
• www.isnr.org (International Society of
Neurofeedback Research)
• Email: emccrann@mater.ie