The Effectiveness of Neurofeedback on Child with Attention Deficit Hyperactivity Disorder (ADHD): A Case Study Cheah Hui Ming Prof Dato Dr. See Ching Mey Loh Guan Lye Specialists Centre
Attention Deficit Hyperactivity Disorder (ADHD) Fox, Tharp, & Fox (2005): Attention Deficit Hyperactivity Disorder (ADHD) is a psychological disorder that presents a persistent pattern of inattention and/ or hyperactivity-impulsivity in an individual s behavior.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V; American Psychiatric Association, 2013): ADHD include two criteria: (i) inattention, and (ii) hyperactivity and impulsivity.
United Nations Children s Fund (UNICEF, 2014): In year 2012, the total registered cases of children with special needs were 2,766 cases in Malaysia. 96 cases out of 2,766 cases were children registered under ADHD. Male to female ratio was 4:1.
Introduction Bio- Medical Instruments, Inc., (2008): Neurofeedback is a training method used to help child with ADHD to learn how to modify his/ her brain wave to improve attention, reduce impulsivity, and to control hyperactive behaviors.
Neurofeedback applies the concept of operant conditioning. If actions applied had pleasant effect, the child will be more likely to repeat them. If actions applied have unpleasant effect, and he/ she will be less likely to repeat them.
Neurofeedback and ADHD Sears & Thompson (1998): Neurofeedback has approximately an 85% success rate in reducing ADHD symptoms.
Lubar, Swartwood, Swartwood, & O Donnell, 1995 : Carried out a study to test the effectiveness of neurofeedback on 19 children with ADHD from the age 8 to 19 years old. After 40 sessions, feedback from the parents was that children showed behavior with improved attention, and reduced impulsivity and hyperactivity behaviors.
Gevensleben et al. (2009): Conducted a study by comparing two groups of children. One group is neurofeedback training group while the other is group therapy group. Children from the neurofeedback training group improved more than children who had participated in a group therapy program, particularly in attention and cognition.
Linden, Habib, & Radojevic (2002): Carried out an experiment using two different groups of children with ADHD. One group received neurofeedback trainings and another group received no trainings. The results showed that children who received neurofeedback trainings significantly reduced their inattentive behaviors.
Method 7 year old male who is diagnosed with ADHD. The child has global development level appropriate to his chronological age. The child underwent a total of 28 sessions of neurofeedback.
Procedure and Protocols The presenting behaviors are confirmed by both psychologist and his parent (mother). The presenting behaviors of the child were: difficulty in sustaining attention. difficulty in listening and following instructions. Impatient. like to interrupt other people s conversation and activity.
Protocols used on the child and its objectives. Protocols C3-CZ (Beta) C3 (Beta) C4-P4 (Delta) Objectives Improve attention and concentration Improve attention concentration Reduce impulsivity and hyperactivity
The child underwent 28 sessions of neurofeedback trainings over 6 months. Each session consisted of: four periods of beta trainings four periods of delta trainings
He started being training C3-CZ (Beta) for 16 sessions. Due to no improvement in his attention and concentration, a decision was made to shift to monopole training on C3 (Beta) only. C3 (Beta) is trained for 12 sessions. C4-P4 (Delta) is trained for 28 sessions to reduce his impulsivity and hyperactivity.
Number of sessions per month and protocols used. Month Number of sessions per month Protocols used 1 4 C3-CZ Beta, C4-P4 Delta 2 8 C3-CZ Beta, C4-P4 Delta 3 4 C3-CZ Beta, C4-P4 Delta 4 4 C3 Beta, C4-P4 Delta 5 4 C3 Beta, C4-P4 Delta 6 4 C3 Beta, C4-P4 Delta
Findings and discussion In the first three months (16 sessions), C3- CZ (Beta) protocol was used. Theta and hi-beta waves fluctuated.
Intake session session 2 session 3 session 4 session 5 session 6 session 7 session 8 session 9 session 10 session 11 session 12 session 13 session 14 session 15 session 16 Average readings of C3-CZ (Beta) protocol 70 60 Theta Beta 50 40 30 Hi-Beta Linear (Theta) 20 Linear (Beta) 10 Linear (Hi-Beta) 0
Hi-beta increased tremendously in session 2, 11 and 13. High theta in session 3, 7, 11, 13 and 14. A decline in beta wave is also observed.
There was no improvement without proper diet management and good sleep quality. It is noted that training beta using bipolar protocols on a young child is not effective. Therefore, C3-CZ (Beta) was removed after 16 sessions.
Intake session session 2 session 3 session 4 session 5 session 6 session 7 session 8 session 9 session 10 session 11 session 12 C3 (Beta) was introduced in the fourth month. Average readings of C3 (Beta) protocol 100 90 80 70 60 50 40 30 20 10 Theta Beta Hi-Beta Linear (Theta) Linear (Beta) Linear (Hi-Beta) Linear (Hi-Beta) 0
Theta wave declined at session 2 to 5. However, theta increased in session 6 and 8. The child managed to regulate his theta wave from session 9 to 12. An overall improvement was observed. C3 (Beta) was an effective protocol for concentration.
Intake session session 2 session 3 session 4 session 5 session 6 session 7 session 8 session 9 session 10 session 11 session 12 session 13 session 14 session 15 session 16 session 17 session 18 session 19 session 20 session 21 session 22 session 23 session 24 session 25 session 26 session 27 session 28 The child was put on training of C4-P4 (Delta) protocol for 28 sessions. Average readings of C4-P4 (Delta) protocol 100 90 Beta 80 70 Delta 60 50 40 30 20 Hi-Beta Linear (Beta) 10 0 Linear (Delta) Linear (Hi-Beta)
His brain waves fluctuated for the first seven sessions. After proper diet management was consistent, his hi-beta waves decreased and maintained from session 8. Delta wave became stronger as the gaps between the delta, beta and hi-beta waves widen.
Conclusion Overall, there is clear improvement in the ADHD child as observed by his mother and teachers. Before neurofeedback Difficulties in paying/ sustaining attention After neurofeedback Able to pay attention in class Difficulties in listening and following instructions Able to obey instructions Impatient/ impulsive Interrupt others in conversation Able to take turn during activities Able to ask for permission
Neurofeedback is an effective brain training exercise for children with ADHD. There must be also diet management and consistent/sufficient sleeping hours management. It is also proposed that neurofeedback training should compliment other multimodal treatments needed by the child.
References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5 th ed.). Washington, DC: Author. Bio- Medical Instruments, Inc. (2008). Neurofeedback for ADHD. Retrieved from the World Wide Web: http://bio-medical.com/products/ Fox, D., Tharp, D., & Fox, L. (2005). Neurofeedback: An alternative and efficacious treatment for ADHD. Applied Psychophysiology and Biofeedback, 4(20), doi: 10.1007/s10484-005-8422-3 Gevensleben, H., Holl, H., Albrecht, B., Schlamp, D., Kratz, O, Studer, P., Rothenberger, A., Moll, G. H., & Heinrich, H. (2009). Is neurofeedback an efficacious treatment for ADHD? A randomized controlled clinical trial. Journal of Child Psychology and Psychiatry, 50(7), 780-789. doi: 10.1111/j.1469-7610-2008.02033.x Linden, M., Habib, T., & Radojevic, V. A. (2002). A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback Self-Regal, 21, 35-49. 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 TOVA scores, behavioral ratings, and WISC-R performance. Biofeedback Self-Regal, 20, 83-99. United Nations Children s Fund, UNICEF (2014). Statistical data ministry of health. Children with disabilities in Malaysia. Malaysia: Author. Sears, W., & Thompson, L. (1998). The ADD book: new understandings, new approaches to parenting your child. Boston: Little, Brown and Company.