Attention deficit disorder, neurofeedback and cognitive therapy – Psychoneuroimmunoendocrinology Review and Commentary
Robert A. Anderson
One-hundred-eleven subjects, 98 children (age 5 to 17) and 13 adults (age 18 to 63) with attention deficit disorder attended forty 50-rain sessions, usually twice weekly, that combined neurofeedback with the teaching of metacognitive strategies. This uncontrolled study utilized feedback contingent on decreasing slow wave activity (usually 4-7 Hz) and increasing fast wave activity, 15-18 Hz for most subjects but initially 1315 Hz for subjects with impulsivity and hyperactivity. Metacognitive strategies related to academic tasks were taught while the feedback indicated the client was focused. 30 percent of the children were taking stimulant medications (Ritalin) at baseline, contrasted to only 6 percent after the 40 sessions. Significant improvements were found in symptoms of inattention, impulsivity, and variability of response times on the Test of Variables of Attention scale, in full-scale scores of the Wechsler Intelligence Scales, and in academic performance on the Wide Range Achievement Test (all p<0.001). The average gain for the full scale IQ equivalent scores was 12 points. A decrease in the EEG ratio of theta/beta was also observed (NS).
Thompson L, Thompson M. Neurofeedback combined with training in metacognitive strategies: effectiveness in students with ADD. Appl Psychophysiol Biofeedback 1998 Dec; 23(4):243-63.
COMMENT: These data are important because the positive outcomes of decreased ADD symptoms plus improved academic and intellectual functioning suggest that the use of neurofeedback plus training in metacognitive strategies is a useful combined intervention for students with ADD. Critics argue that forty sessions is a great deal more expensive that Ritalin for 20 weeks. Very true. The drug use is ongoing, however, and includes problems of side effects. The patients who successfully apply their biofeedback experience actually function at a different level and have changed themselves in ways which are usually permanent. Parents and practitioners must make the choice.
Robert Anderson is a retired family physician. In mid-career, his practice took on a more holistic nature as decades passed. He has authored five major books, Stress Power! (1978), Wellness Medicine (1987), The Complete Self-Care Guide to Holistic Medicine (1999) (co-author), The Scientific Basis for Holistic Medicine, (5th edition) available from American Health Press, firstname.lastname@example.org, and Clinician’s Guide to Holistic Medicine (McGraw Hill, 2001). Anderson served as the founding president of the American Board of Holistic Medicine, is a past president of the American Holistic Medical Association, former Assistant Clinical Professor of Family Medicine at the University of Washington, and currently Adjunct Instructor in Family Medicine at Bastyr University.
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