Children play their way to improved concentration
Neurofeedback – biofeedback that changes brainwave patterns – has proven effective in treating children with ADD/ADHD.
Neurology Photo: BrainGames
Could it be that attention deficit/hyperactivity disorder (ADD/ADHD) – a
seemingly intractable condition that makes life miserable for children and
parents alike and is widely treated with drugs – can be alleviated and even
cured with a type of biofeedback?
It sounds like a lot of hype, but a growing
number of clinical studies have shown that the technique can be successful in
about 80 percent of cases, and its effects long-lasting, without the need for
Ritalin and similar drugs.
Neurofeedback (NFB), also called EEG
(electroencephalogram) biofeedback or neurotherapy, is a type of biofeedback
that uses displays of electroencephalography or functional magnetic resonance
imaging (fMRI) in real time to show brain activity. Sensors are placed on the
scalp to measure brainwave activity, with measurements displayed using video
displays or sound. The signal can then be used by a person to receive feedback
about their own brain activity.
Every year, more and more prescriptions
for stimulants like Ritalin are prescribed to schoolchildren who can’t sit still
(hyperactivity) or who have attention deficits (difficulty concentrating).
Numerous parent complain of upsetting physiological and behavioral side effects
that require their children to stop taking the prescription drug. In any case,
about a quarter of children with the disorder do not respond to the drugs. There
are also reports of Ritalin abuse by pupils and even students in institutes of
higher learning who want to concentrate better for exams.
from the stimulants are not rare. Some studies have shown that as many as two
out of three children taking the drugs for ADD/ADHD gave up because of physical
or other symptoms that disrupted their lives or made them uncomfortable, and
concluded that the benefits of the stimulants did not offset the side
AN ISRAELI company that offers training sessions in
neurofeedback for ADD/ADHD is BrainGames- Israel, which is using a technology
developed at the US National Aeronautics and Space Administration (NASA) for
measuring and promoting concentration among astronauts.
uses games on conventional consoles like the Sony Playstation, or watching a
film, instead of the flight simulator used at NASA. The child with suspected
ADD/ADHD sits in front of a computer screen while his brainwave activity is
monitored with wires connected to button-like sensors on his head. These wires
are connected to computer software that detects, amplifies and records
brainwaves, with the information immediately sent back to the patient who can
see through changes in the action whether his brain activity lies within the
For example, if the child’s attention begins to wander,
the hero, racing car or other object he is supposed to maneuver slows down, or
the movie screen shuts down or the image turns to “snow,” informing the
therapist of the change in brainwave activity. The therapist then encourages the
child to focus his attention to make the game continue.
the right kind of brainwaves is reinforced or rewarded by continued action of
the hero or object and “conditions” the brain.
There are four types of
brainwaves – alpha, beta, theta and delta. Alpha waves are produced by the brain
at about eight to 13 cycles per second. When this pattern appears on an EEG
while the person is awake, he is alert but relaxed. Beta, at 13 to 40
cycles per second, predominates during wakefulness most of the day. Theta waves
are produced in four to seven cycles per second and connected to dreams and
creativity. The evenslower delta waves are produced at a rate of half to four
cycles per second and occur during deep sleep.
It is believed that
children with attention deficits have an inadequate amount of beta waves and too
many theta waves because they daydream or are tired. Thus if the neurofeedback
promotes the use of beta waves, the child can become much more
Rivi Sela, the director of BrainGames’ two clinics – at Airport
City near Lod and in the Arnona quarter in Jerusalem – became interested in the
technique because of ADD problems in her son.
“I studied behavioral
sciences and worked in medical technology at Sheba Medical Center at Tel
Hashomer. But I decided to leave my career when my son, who received Ritalin at
the age of 10, reacted very badly to the drug. He couldn’t sit quietly in class,
even though he is very intelligent, with an IQ of 150. We were offered
Ritalin, and he took it for a year, but the side effects, including anxiety,
were terrible, and he couldn’t stand it.”
Sela’s son then was given a
higher dose, and the side effects were even worse.
“Nothing helped. So my
husband and I took him out of school in sixth grade, and I taught him at home.
We heard about neurofeedback. It was very successful. Now he is 17 and
studying at Kfar Hayarok. He has been off Ritalin and all other drugs for
four years. He doesn’t even need neurofeedback any more,” she said. “One
couldn’t imagine he’s the same child. He shows no signs at all of
Seeing the success on her son, Sela went to Canada, the US and
Switzerland to study the technique, where there are thousands of neurofeedback
therapists – psychiatrists, psychologists and social workers – who use it for
ADD/ADHD. Since heading up BrainGames, she and her clinic staff have treated
over 800 children, with an 80% success rate. As none of the public health
funds have offered the technique, even though it saves money that would
otherwise go to stimulants, and it is not included in the Health Ministry’s
basket of health services, treatments are offered privately a NIS 250 per
“On average,” she says, “a patient needs 40 treatments. Progress
is seen already after 15 to 20 sessions. We don’t claim it’s the answer
for every ADD/ADHD child; some children still require Ritalin. But the technique
has really made a difference for many. Adults, too, can benefit from
The clinics’ neurofeedback equipment is imported at a cost of $2,800
to $12,000. An Israeli neurofeedback association whose therapists treat a
variety of problems has been set up to ensure a high professional
Neurofeedback is used for other disorders, from headaches and
insomnia to anxiety, substance abuse and autistic spectrum. An Israeli company
named Happy Neuron has produced a Hebrew-language program used for “brain
exercise from home via the Internet. It is used for cognitive development and
memory improvement for all ages.
BIOFEEDBACK OF all kinds has a long
history. It goes back almost a century to 1924, when a German psychiatrist named
Hans Berger connected electrodes to a person’s scalp and, using a galvanometer,
noticed the passage of a weak electric current. He subsequently published
over a dozen studies on EEGs (electroencephalograms) of the brain. Decades
later, understanding of the existing types of brainwaves increased, along with
In the past decade or so, numerous randomized studies
and metaanalyses on neurofeedback have been published in peer-reviewed medical
journals. The prestigious journal Pediatrics, published by the American Academy
of Pediatrics, studied 23 children aged eight to 13 who suffered from ADHD and
focused on their “slow cortical potentials” (slow event-related,
director-current shifts of the electroencephalogram). The youngsters
received 30 sessions of neurofeedback.
According to the researchers at
the US National Institutes of Health in Bethesda, Maryland, and the University
of Tübingen in Germany, the encephalographic data during neurofeedback showed
that the children learned to regulate their slow cortical potentials. “After
training, significant improvement in behavior, attention and IQ score was
observed.” The behavior ratings also included social behavior at school as
judged by teachers and parents.
According to the researchers, who
published their findings in 2006, all positive changes in the children’s
behavior remained stable six months at least after initial treatment, but as the
study did not include a control group who did not undergo neurofeedback, the
researchers could not state for certain that there was a causal
relationship. They noted that “adverse effects of stimulant medications
include reduced growth, sleep disorders, decreased appetite, stomach pain,
headache, and, in some cases, tics. There is no evidence of long-term efficacy
of stimulants or ADHD.”
The psychologist researchers concluded that “with
voluntary regulation of [slow cortical potentials], children may learn to
flexibly adjust their [neurotransmitter] balance to task requirements. We assume
that the acquired skill becomes automatic and, as a motor skill, is preserved
without explicit practice [of neurofeedback]. The children use it flexibly, and
success rewards and improves the skill, the behavior and attention beyond the
end of training.”
A German team followed up the original study two years
later, choosing 10 of the original children who received neurofeedback and found
that “most of our patients” had a total remission of ADHD symptoms after two
years. This is very good news.
A study on neurofeedback and ADHD
that was published in 2009 in the Journal of Child Psychology and Psychiatry and
studied 102 children aged eight to 12 also found significant benefits from the
Considering the fact that, unlike prescription drugs,
neurofeedback for ADD/ADHD does not cause side effects and that it has long-term
beneficial effects in significant numbers of young patients, it should be
examined by relevant Israeli national medical councils to make recommendations
to the Health Ministry.
If the training is judged to have positive
cost/benefits, the ministry would be wise to consider the treatment for
inclusion in the basket of health services while at the same time setting strict
standards for those who seek to provide the therapy.