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Treatment of ADHD
Neurotherapy for Attentional Deficit





EEG Neurofeedback for the Treatment of Attention Deficit/Hyperactivity Disorder in Children and Adults


At present, stimulant medications and behavior therapy are the most frequently applied and most medically-accepted treatments for attention-deficit hyperactivity disorder (ADHD). However, recent large-scale studies and meta-analyses of published research studies have demonstrated some very real limitations of these treatments and have more clearly revealed the risks associated with the long-term use of stimulant drugs (see Molina, et al., 2009; Riddle, et al., 2013; Wang, et al., 2013).

Electroencephalogram (EEG) biofeedback, also known as EEG neurofeedback, has proven to be a highly promising alternative treatment for children and adults with attention deficit/hyperactivity disorder (ADHD) or an acquired attentional deficit who have not benefitted from medications or who do not wish to take medications. EEG neurofeedback has also shown itself to be both compatible with, and an effective enhancement, to behavior therapy (see Arns, et al., 2009; Gevensleben, et al.,  2010; Lofthouse, 2012; Micoulaud-Franchci, et al., 2014; Monstra, et al., 2002; Sonuga-Barke, et al., 2013; Thompson & Thompson, 1998). 

There is now over 40 years of accumulated research comprising literally hundreds of published clinical case studies and research reports  --more than 100 of these published in peer-reviewed scientific journals-- documenting the efficacy of EEG neurofeedback in the treatment of many thousands of ADHD children and adults in the United States, Canada, Europe, and Australia. Collectively these reports strongly support the contention that EEG neurofeedback is effective in reducing the core symptoms of ADHD. Perhaps more importantly, there have been no published studies negating the effectiveness of EEG neurofeedback or showing it to be as potentially harmful as the stimulant and other medications most commonly used in the treatment of ADHD. While it is true that much of the earlier research on the use of EEG neurofeedback to treat ADHD suffered from various methodological weaknesses, more recent stronger randomized controlled trials (RCTs) have provided substantial support for the claim that EEG neurofeedback is efficacious and specific and can provide a good alternative to treatment with drugs. In many ways, EEG neurofeedback is an ideal therapy modality because it is effective, non-invasive and quite safe.

In a recently published Association for Applied Psychophysiology and Biofeedback (AAPB) “White Paper” based on a thorough review of  the published research on the use of EEG biofeedback in the treatment of ADHD, the following conclusion was reached…

Review of the scientific literature revealed both controlled case and group studies on the effects of EEG biofeedback in treat­ing the core symptoms of ADHD. These studies examined the efficacy of well-defined treatment protocols in the treatment of patients diagnosed with hyperkinesis, as well as, those diagnosed with each of the pri­mary subtypes of ADHD (Inattentive, Hyperactive-Impulsive, or Combined). The results of these studies indicated improvement on standardized tests of intelligence, attention, and behavioural control following EEG biofeedback.  Increased level of cortical arousal was also reported during QEEG examination of patients treated with EEG biofeedback. As well fMRI studies of ADHD children treated with EEG biofeedback demonstrate that bio­feedback has the capacity to functionally normalize the brain systems mediating selective attention and response inhibition in ADHD children. Comparisons with a bona fide treatment for ADHD (i.e., stimulant medication) indicated that EEG biofeed­back yielded equivalent or superior results. The results of ran­domized, controlled group studies using a waiting list control also indicated the superiority of EEG biofeedback. Such findings suggest the efficacy of EEG biofeedback in the treatment of ADHD.”

[Arns, Heinrich, Strehl (2016). Attention Deficit Hyperactivity Disorder (Chapter 6) in Tan, Shaffer, Lyle & Teo (Eds.), Evidence-Based Practice in Biofeedback & Neurofeedback, Third Edition. Wheat Ridge, CO: AAPB.]

In 2012, the American Academy of Pediatrics endorsed EEG neurofeedback as a treatment with the "highest level of evidence-based support" for the treatment of ADHD. 


The Rationale for Treating ADHD with EEG Neurofeedback

According to the most recent reports of the U.S. Centers for Disease Control and Prevention and the American Psyciatric Association, attention-deficit/hyperactivity disorder (ADHD) is now the most frequently diagnosed childhood mental health and behavior disorder with an estimated 11% of American school-aged children (and nearly 20% of all high school boys) currently having a medical diagnosis of ADHD. These CDC findings are especially shocking because they reveal a 21% increase in diagnosed ADHD in 4-17 year old children between 2003 and 2008 and a greater than 40% increase in older teens (Visser, Bitsko, Danielso, 2010).

Additionally, some 30-50% of children with ADHD have significant difficulties that persist into adulthood, and they have an 80% chance of having at least one child with ADHD.

In Canada and the United States, ADHD is generally diagnosed in the early primary school years in children who show attention difficulties, easy distractibility, impulsive behaviors, and extreme levels of hyperactivity. ADHD is classified as a neurodevelopmental and psychiatric disorder and, as with the majority of psychiatric disorders, ADHD is primarily diagnosed using subjective behavioral observations and ratings. There is currently no single diagnostic test for ADHD, although the American Academy of Paediatrics describes QEEG brain mapping as a valuable diagnostic tool that can improve our understanding of the fundamental neurophysiological disruption underlying ADHD. Currently, ADHD is defined along two distinct but correlated dimensions of symptoms: inattention and hyperactivity-impulsivity. As many as 80% of children diagnosed with ADHD continue to suffer from attention problems in adolescence and adulthood; with as many as 50% having significant difficulties. As well, over 50% of adults with ADHD suffer from one or more comorbid behavioral disorders such as: learning disabilities, autism spectrum disorders, sleep disorders, conduct disorders, depression, bipolar disorder, substance use disorders, tic disorders, and borderline personality disorder. Adults with ADHD have a greater than 75% chance of having at least one child with ADHD.

Stimulant medication and behavior therapy (BT) are the two most widely accepted treatments for ADHD and these treatments are commonly reimbursed by healthcare insurers. While both are considered to meet the highest standard for 'evidence-based treatment' of ADHD, and have been recognized as such by the American Academy of Child and Adolscent Psychiatry and CHADD (i.e., the leading ADHD advocacy group), the actual evidence is that both medications and behavior therapy fail to result in sustained benefit for the vast majority of children who receive them as clearly demonstrated in the eight-year long U.S. National Institutes of Mental Health-funded MTA Cooperative study (MTA 1999, 2004, 2007), the gold standard study in ADHD treatment effectiveness research. In this study's 22-month follow-up assessment of the currently recognized best treatments for ADHD, no sustained benefit was evident for any of these treatments as compared to those ADHD children who had simply been referred to community-based professionals and may or may not have actually followed through with treatment. Even after 14-months of free intensive multi-component behavior therapy combined with systematic medication management followed by referral to community-based treatment professionals for continuing care, ADHD was found to be an ongoing debilitating illness and the societal costs that are associated with it included 10.4% of such "optimally-treated" children requiring psychiatric hospitalization one or more times during follow-up.

Furthermore, even during initial treatment, a full third or more of children do not respond adequately to ADHD medications and/or experience significant adverse side-effects from these medications that result in added behavioral and health problems and not infrequently, the addition of other medications. As a matter of fact, by the third year of stimulant treatment, as many as 8% of pre-school/early elementary school ADHD children will have antipsychotic medications added to their stimulant drugs (a percentage that appears to be steadily increasing). The 750% increase over the last decade in the use of antipsychotic medications with children is especially troubling given their well-known risk for weight gain and development of diabetes and the lack of actual research evidence of their safety and effectiveness in children.  

While the exact causes of ADHD remain unclear, most researchers agree that it is a largely inherited brain disorder associated with a disruption or dysregulation of the functioning of certain neural networks in the brain.

While ADHD is hereditary in more than half of the cases, with 30% of those affected having at least one parent with ADHD, the condition may in some cases be caused by or worsened by birth trauma or early minor brain trauma, emotional and dietary factors, and inadequate sleep. Also, children with ADHD frequently exhibit a variety of physical problems such as headaches and immune system deficiencies, resulting in frequent illness, as well as various co-morbid psychobehavioural conditions such as sleep disorders, anxiety disorders, depression (MDD), bipolar disorder (BPD), conduct disorder as a precursor to antisocial personality disorder, oppositional-defiant disorder (ODD), tic disorders, and obsessive-compulsive disorder (OCD). There is also a significant overlap between ADHD diagnoses and diagnoses of autistic spectrum disorders (ASD) and non-verbal learning disorders.

It is necessary to note that ADHD has neurobiological origins; therefore, it is not caused by shortcomings in upbringing or by the4 increased expectations and demands of modern society.

For more information on the signs and symptoms of ADHD please click on this link...  ADHD Symptoms

One important current theory about the biological basis for ADHD is that it results from underactivity in those brain areas that are most directly involved in behavioural inhibition—that is, the ability to refrain from acting immediately on impulse. The brain areas that are believed to be most important in the ability to inhibit or self-control behaviour are in the frontal cortex. Certainly, the fact that a majority of children and adults with ADHD are treated with and respond to stimulant medications indicates that this disorder is characterized by insufficient brain arousal.

Anatomically, in terms of brain organization, many ADHD children exhibit immature development of the frontostriatal circuitry along with other structural and functional brain disturbances involving the cerebellum and parietal cortices (deBeus & Kaiser, 2011).

Numerous EEG studies have shown that approximately 80-90 percent of persons diagnosed with ADHD display signs of “cortical hypoarousal,” quantitatively described as elevated relative Theta (4-8 Hz) power, reduced relative Alpha (8-12 Hz) and Beta1 (12-20 Hz) power, and elevated Theta/Alpha and Theta/Beta power ratios as compared to “normal” age and gender peers. These patterns are typically observed over frontal and central midline brain regions. A smaller subgroup of persons diagnosed with ADHD exhibits an EEG pattern suggestive of “cortical hyperarousal,” with greater relative Beta fast-wave activity, decreased relative Alpha activity, and decreased Theta/Beta power ratios diffusely across much of the cortex. This hyperarousal group has been found to respond poorly to stimulant medications.

Chabot and Serfontein (1996) noted that QEEG brain maps of children with ADHD show increased focal theta activity localized within the frontal and/or midline regions about 92% of the time; increased alpha localized within posterior and/or midline regions about 84% of the time; and increased beta localized in frontal and/or posterior regions about 13% of the time. Levesque (2006) reported that functional MRI brain mapping showed successful neurofeedback to result in significant activation of the right anterior cingulate cortex (ACC), right ventrolateral prefrontal cortes, right dorsal ACC, left caudate nucleus, and left substantia nigra whereas no significant changes were seen in the control group.       


The figure above shows an EEG brain map (Nx-Link) and LORETA images of the brain activity of an ADHD child. The left hand figure shows excess theta slow wave activity in the frontal lobes (see centre head) marked as yellow/orange. The right hand figure shows LORETA images localizing the maximum density of this theta activity to the frontal lobes.   

The executive functions of the frontal lobes allow the person to focus, pay attention, concentrate, control their impulses and emotions, exercise judgment, plan, organize, and regulate motor behaviour (i.e. inhibit their impulses and sit still). Cortical hypoarousal disables the executive functions, severely compromising the person's ability to pay attention, focus, and inhibit their impulses. Brain imaging research has demonstrated that the brains of ADHD children and adults can best be described as “sleepy brains”, as their brains are typically like the brains of sleepy “normals”, with a preponderance of the drowsy brain wave frequency. 

EEG neurofeedback training in ADHD seeks to normalize aberrant EEG activity. The stability of changes resulting from neurofeedback might be explained by normalizing of brain functions that are responsible for inhibitory control, impulsivity and hyperactivity. Neurofeedback appears to be an alternative or complement to traditional treatments. 

To see a YouTube video of a news report on whether EEG neurofeedback therapy is a cure for ADD/ADHD, please click on this link…  http://www.youtube.com/watch?v=mjr_dibomvU 

To see a YouTube video by Dr. Clare Albright on treating ADD/ADHD with EEG neurotherapy, please click on this link... http://www.youtube.com/watch?v=VEJmbLAkZmY&feature=mfu_in_order&list=UL


How is EEG Neurofeedback Done and What Can I Expect?

EEG neurofeedback refers to a form of behavioral therapy that combines real-time measurement of neuronal electrical activity (i.e., EEG rhythms or brain waves) with the scientifically established principles of operant conditioning to teach trainees how to better self-regulate brain functioning. As such, EEG neurofeedback is uniquely suited to treat the neuronal dysregulation that lies at the heart of ADHD.

In EEG neurofeedback, healthy, age-appropriate brainwave activity is rewarded with visual, auditory, or even tactile stimulation, and undesirable activity is ignored or punished. There is no requirement for conscious awareness in neurofeedback training and following neurofeedback training, individuals do not need to willfully and consciously modify these specific EEG patterns in order to effect behavioral change.

EEG neurofeedback treatment of ADHD essentially trains the brain to engage self-regulatory processes to normalize brainwaves; especially in those brain regions thought to be responsible for attention and behavioral control. Essentially, the brain learns to decrease production of Theta slow-wave activity and increase Beta1 fast-wave activity in the frontal and central midline regions of the brain.


In a typical EEG neurofeedback training session, the trainee is seated in a comfortable chair in front of a computer video screen. One or more EEG electrodes are attached to the scalp by means of a sticky electrode paste and reference and ground electrodes are attached to the ear lobes with ear clips. These sensor wires are then connected to a signal amplifier and a computer with software capable of analyzing the EEG signals, performing various transformations, and displaying the relevant signals to the trainee on the computer screen in “real-time”. The trainee watches a computer-generated video display that provides continuous visual and auditory feedback and uses this information about how his/her brain is changing from moment-to-moment to unconsciously learn increased control over the EEG signal.

For example, the trainee might be sitting in front of a computer screen watching a favourite movie that is responsive to his/her brain waves; playing when the desired EEG activity occurs and pausing whenever undesirable EEG activity occurs. In this way desirable EEG activity is "rewarded" by the movie playing and undesirable EEG activity is "punished" by the movie stopping. Over the course of repeated training sessions, the threshold for maintaining the "reward" condition is carefully adjusted upward by the trainer and "operant learning" occurs.  

To see a video on “What is Neurofeedback?” please click on this link… http://www.isnr.org/#!neurofeedback-introduction/c18d9

A typical course of EEG neurofeedback therapy involves at least 25-35 biofeedback training sessions, each lasting about 30-45 minutes, and administered over the course of about 8-16 weeks. With older children and adults, who are more cooperative and positively motivated, it may be possible to accomplish a greater amount of actual neurofeedback training in a shorter period of time. Each biofeedback training session is typically divided into a number of relatively short (5-10 minute) training trials or epochs with brief breaks between and a typical session will comprise anywhere from 3 to 6 training epochs. Typically, it takes about 10-15 minutes to prep the skin and attach the electrodes and ensure appropriately low electrical impedance before beginning the actual training.

Although rates of progress vary from client to client, some benefit is often observed within the first few weeks of therapy (i.e., approximately 10-15 therapy sessions) but for training effects to maintain over the longer period, 30-40 training sessions are usually required. If the client has multiple comorbidities or is on medication during treatment, it is common for more than 40 sessions of training to be necessary. In general, EEG neurotherapy is more effective when training sessions occur more often in the week (3-5 times) as opposed to less often (1-2 times). That said, training too often or for too long in a session or for too many sessions can be counterproductive. Progress is determined by calculating, graphing, and reviewing quantitative markers of patient performance (e.g., microvoltages of EEG frequencies being trained, frequency power ratios, percent of time above or below thresholds, etc.)  after each session and comparing changes from session to session. As well, repeated completion of behavioral ratings over the course of training will also help determine efficacy of training. 

Numerous treatment outcome studies, replicated in many different clinical settings over the last 35 years, have shown that 75-85 percent of ADHD children treated with EEG neurofeedback typically increase their tested IQ scores by 10-15 points and improve significantly on measures of attentiveness, hyperactivity, academic performance, and parent/teacher behaviour rating scales. Meta-analyses of the current research base for the efficacy of EEG neurofeedback in the treatment of ADHD have shown large effect size statistics for inattention and impulsivity and medium effect size statistics for hyperactivity.

More recently, the Journal of Attention Disorders published an updated review of neurofeedback treatment for ADHD (see Lofthouse, et al., 2011) The research base for the Lofthouse review included 14 studies of neurofeedback treatment for children with ADHD in which the participants were randomly assigned to neurofeedback or a control condition. Lofthouse, et al. reported and average treatment effect size of 0.79 (large) for measures of "inattention", and 0.71 (moderately large) for measures of hyperactivity/impulsivity. Five of the reviewed studies showed neurophysiological changes that were specific to neurofeedback treatment.

 The Association for Applied Psychophysiology and Biofeedback reports that when EEG neurofeedback is used to treat ADHD, up to 80% of patients show "significant improvement in the condition and a marked reduction in medication requirements."

EEG neurofeedback has also been shown to be at least as effective as treatment with medication alone or behaviour therapy alone. Moreover, these positive EEG changes appear to be long term.

 One recent study examined the effects of EEG neurofeedback on a sample of ADHD children with another brain scanning technology—functional magnetic resonance imaging (fMRI)—and found that EEG neurofeedback resulted in a distinctive activation of the right anterior cingulate cortex on the fMRI, which was not observed in untreated control subjects.

According to a recent article in Psychiatric Times, biofeedback is used at more than 1500 clinics and treatment centres in the United States for various psychiatric conditions--including ADHD.

Yet, despite the clinical success neurofeedback has shown, it is still not a widely accepted treatment for ADHD children and adults. The medical community continues to be skeptical and resistant to accepting this technique without even clearer and more objective research documentation.

A Few Recently Published Research and Review Papers

Arns, M., de Ridder, S., 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 & Neuroscience, Vol. 40, pp.180-189.

Arns, M., Heinrich, H., Strehl, U. (2013). Evaluation of neurofeedback in ADHD: The long and winding road. Biological Psychology, Vol. 95, pp. 108-115.

Arns, M., Gunkelman, J., Breteler, M., Spronk, D. (2008). EEG phenotypes predict treatment outcome to stimulants in children with ADHD. Journal of Integrative Neuroscience, 7: 421-438.

Arns, M., Drinkenburg, W., Kenemans, J. (2012). The effects of QEEG-informed neurofeedback in ADHD: An open-label pilot study. Applied Psychophysiology & Biofeedback, 37(3): 171-180.

Bakhshayesh, A., Hansch, S., Wyschkon, A., et al. (2011). Neurofeedback in ADHD: A single-blind, randomized control trial. European Child & Adolescent Psychiatry, 20: 481-491.

"Compared to EMG biofeedback, neurofeedback significantly reduced inattention symptoms on the parent rating scale and improved reaction time and concentration on the neuropsychological measures." (Bakhshayesh, et al., 2011).

Chabot, R., Merkin, H., Wood, L., Davenport, T., Serfontein, G. (1996). Sensitivity and specificity in children with attention deficit or specific developmental disorders. Clinical Electroencephalography, 27(1): 26-34. 

Chabot, R., Serfontein, G. (1996). Quantitative electroencephalographic profiles of children with attention deficit disorders. Biological Psychiatry, 40: 951-963.

Clarke, A., Barry, R., McCarthy, R., Selikowitz, M. (2001a). EEG differences in two subtypes of attention-deficit/hyperactivity disorder. Psychophysiology, 38: 212-221.

Clarke, A., Barry, R., McCarthy, R., Selikowitz, M. (2001b). Excess beta in children with attention-deficit/hyperactivity disorder: An atypical electrophysiological group. Psychiatry Research, 103: 205-218.

deBeus, R., Kaiser, D. (2011). Neurofeedback with children with attention deficit hyperactivity disorder: A randomized double-blind placebo-controlled study. In: R. Coben & J.R. Evans (eds)(2011). Neurofeedback and Neuromodulation Techniques and Applications. Chapter 5, pp.127-152. New York, NY: Academic Press. ISBN: 978-0-12-382235-2

Duric, N., Assmuss, J., Gundersen, D., et al. (2012). Neurofeedback for the treatment of children and adolescents with ADHD: A randomized and controlled clinical trial using parental reports. BMC Psychiatry, 12: 107.

"Neurofeedback produced significant improvement in the core symptoms of ADHD, which was equivalent to the effects produced by methylphenidate, based on parental reports. This supports the use NFB as an alternate therapy for children and adolescents with ADHD. (Duric, et al., 2012)

Fox, D., Tharp, D., Fox, L. (2005). Neurofeedback: An alternative and efficacious treatment for Attention Deficit/Hyperactivity Disorder. Applied Psychophysiology & Biofeedback, Vol 30, Nr 4, pp 365-373.

Friel, P. (2007). EEG biofeedback in the treatment of Attention Deficit/Hyperactivity Disorder. Alternative Medicine Review, Vol 12, Nr 2, pp 146-151.

Fuchs, T., Birbaumer, N., Lutzenberger, W., et al. (2003). Neurofeedback treatment for Attention Deficit/Hyperactivity Disorder in children: A comparison with methylphenidate. Applied Psychophysiology & Biofeedback, vol 28, Nr 1, pp 1-12.

Gani, C., Birbaumer, N., Strehl, U. (2008). Long term effects after feedback of slow cortical potentials and of theta-beta amplitudes in children and adolescents with ADHD. International Journal of Bioelectromagnetism, 10(4):209-232.

"EEG self-regulation skills were maintained for the children in both age groups when assessed 2 years after neurofeedback treatment ended." (Gani, et al. 2008)

Gevensleben, H., Holl, B., Albrecht, B., et al. (2009). Is neurofeedback an efficacious treatment for ADHD? A multisite, randomized controlled clinical trial. Journal of Child Psychology & Psychiatry, Vol 50, Nr 7, pp 67-768.

Gevensleben, H., Holl, B., Albrecht, B., Schlamp, D., Kratz, O., Studer, P., et al. (2010). Neurofeedback training in children with ADHD: Six-month follow-up of a randomized controlled trial. European Child & Adolescent Psychiatry, Vol.19, pp.715-724. 

Hammond, D. (2011). What is neurofeedback: An update. Journal of Neurotherapy, 15: 305-336.

Heinrich, H., Gevensleben, H., Freislander, F.Moll, G., Rothenberger, A. (2004). Training of slow cortical potentials in attention deficit/hyperactivity disorder: Evidence for positive behavioral and neurophysiological effects. Biological Psychiatry, 55: 772-775.

Heinrich, H., Gevensleben, H., Strehl, U. (2007). Neurofeedback: Train your brain to train behaviour. Journal of Child Psychology & Psychiatry, Vol 48, pp 3-16.

Hirschberg, L. (2007). Place of electroencephalographic biofeedback for Attention Deficit/Hyperactivity Disorder. Expert Reviews in Neurotherapeutics, Vol 7, Nr 4, pp 315-319.

Hodgson, K., et al. (2012). Nonpharmaceutical treatments for ADHD: A meta-analytic review. Journal of Attention Disorders, published online May 29, 2012. 

Holtmann, M., Grasmann, D., Clonek-Szpak, E., et al. (2009). Specific effects of neurofeedback on impulsivity in ADHD. Kindheit und Entwicklung, 18: 95-105.

"Only neurofeedback resulted in normalization of key neurophysiologic correlates of response inhibition." (Holtmann, et al., 2009).

Hong, C., Lee, I. (2012). Effects of neurofeedback training on attention in children with intelectual ability. Journal of Neurotherapy, 16(2):110-122.

Kirk, L. (2007). Neurofeedback protocols for subtypes of attention deficit/hyperactivity disorder. In J.R. Evans (Ed.), Handbook of Neurofeedback: Dynamics and Clinical Applications. (Chapter 11, pp.267-300). New York, NY: Sage Medical Press.

Leins, U., Goth, G., Hinterberger, T., Klinger, Ch., Rumpf, N., Strehl, U. (2007). Neurofeedback for children with ADHD: A comparison of SCP and theta/beta protocols. Applied Psychophysiology & Biofeedback, 32, 73-88. 

Levesque, J., Beauregard, M. (2011). Functional neuroimaging evidence supporting neurofeedback in ADHD. In: R. Coben & J.R. Evans (eds)(2011). Neurofeedback and Neuromodulation Techniques and Applications. Chapter 13, pp.353-380. New York, NY: Academic Press. ISBN: 978-0-12-382235-2 

Levesque, J., Beauregard, M., Mensour, B. (2006). Effect of neurofeedback training on the neural substrates of selective attention in children with Attention Deficit/Hyperactivity Disorder: A functional magnetic resonance imaging study. Neuroscience Letters, Vol 394, pp 216-221.

Lofthouse, et al. (2011). A review of neurofeedback treatment for pediatric ADHD. Journal of Attention Disorders.

Lofthouse, N. et al. (2011). Biofeedback and neurofeedback treatments for ADHD. Psychiatric Annals, 41(1): 42-47.

Loo, S., Makeig, S. (2012). Clinical utility of EEG in ADHD: A research update. Neurotherapeutics

Micoulaud-Franchi, J., Geoffroy, P., Fond, G., et al. (2014). EEG neurofeedback treatments in children with ADHD: An updated meta-analysis of randomized controlled trials. Frontiers in Human Neuroscience, 8: 1-7.

Molina, B., Hinshaw, S., Swanson, J., et al. (2009). The MTA at 8 years: Prospective follow-up of children treated for combined-type ADHD in a multisite study. J. American Academy of Child & Adolescent Psychiatry, 48(5): 484-500.

Monastra, V. (2005). Electroencephalographic biofeedback (neurotherapy) as a treatment for Attention Deficit/Hyperactivity Disorder: Rationale and empirical foundation. Child & Adolescent Psychiatry Clinics of North America, Vol 14, pp 55-82.

Monstra, V., Monstra, D., & George, S. (2002). The effects of stimulant therapy, EEG biofeedback and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder. Applied Psychophysiology & Biofeedback, 27: 231-249.

Monastra, V., Lynn, S., Linden, M., et al. (2005). Electroencephalographic biofeedback in the treatment of Attention Deficit/Hyperactivity Disorder. Applied Psychophysiology & Biofeedback, Vol 30, Nr 2, pp 95-114.

Perreau-Linck, E., Lessard, N., Levesque, J., Beauregard, M. (2010). Effects of neurofeedback training on inhibitory capacities in ADHD children: A single-blind, randomized, placebo-controlled  study. Journal of Neurotherapy, Vol.14(3), pp.229-242.

Riddle, M., Yershova, K., Lazzaretto, D., et al. (2013). The preschool attention-deficit/hyperactivity disorder treatment study (PATS) 6-year follow-up. J. American Academy of Child & Adolescent Psychiatry, 52(3): 264-278.

Schubart, C. (2011). Neurofeedback as a treatment for attentiond-deficit/hyperactivity disorder: A sytematic review of evidence for practice. Journal of Applied School Psychology, 27:221-227. 

Sherlin, L., Arns, M., Lubar, J., Sokhadze, E. (2010). A position paper on neurofeedback for the treatment of ADHD. Journal of Neurotherapy, 14(2): 66-78.

Steiner, N., Frenette, E., Rene, K, et al. (2014). In-school neurofeedback training for ADHD: Sustained improvements from a randomized control trial. Pediatrics, 133(3): 483-492.

"Neurofeedback participants made more prompt and greater improvements in ADHD symptoms, which were sustained at 6-month follow-up, than did cognitive therapy or those in the control group."  (Steiner, et al., 2014)

Thompson, L., Thompson, M. (1998). Neurofeedback combined with training in metacognitive strategies: Effectiveness in students with ADD. Applied Psychophysiology & Biofeedback, 23(4): 243-263.

Thompson, M., Thompson, L. (2006). Improving attention in adults and children: Differing electroencephalography profiles and implications for training. Biofeedback, 34(3), 99-105.

Van den Bergh, W. (2010). Neurofeedback and State Regulation in ADHD: A Therapy Without Medication. Texas: BMED Press.

Wang, G., Boraud, T., Volkow, N., et al. (2013). Long-term stimulant treatment affects brain dopamine transporter level in patients with attention-deficit/hyperactivity disorder. PloS One, 8(5): e63023.

Wangler, S., Gevensleben, H, Albrecht, B., et al. (2011). Neurofeedback in children with ADHD: Specific event-related potential findings of a randomized controlled trial. Clinical Neurophysiology, 122: 942-950.

Williams, J. (2010). Does neurofeedback help reduce attention-deficit hyperactivity disorder? Journal of Neurotherapy, Vol. 14(4), pp. 261-279.

Willis, W., Weyandt, L., Lubiner, A., Schubart, C. (2011). Neurofeedback as a treatment for attentiond-deficit/hyperactivity disorder: A sytematic review of evidence for practice. Journal of Applied School Psychology, 27:221-227. 


Dr. Vincent Monstra of the FPI Attention Disorders Clinic in Endicott, New York, studied 100 children between 6-19 years of age with diagnosed ADHD for one year, all of whom were taking amphetamine medications and were getting school and family counselling. But half of these children also received weekly EEG neurofeedback therapy, in which they were hooked up to a device that measures the activity of their brain waves. At the conclusion of treatment, all of those children who underwent neurofeedback were able to cut their medications by at least half - and still enjoy any improvements they derived from the medications. And about 40% of the children who received neurofeedback were able to discontinue their medications completely. The children who did not get neurofeedback treatments had to continue medications to sustain improvements. See Monstra, Lynn, Linden, et al. 2005 in Applied Psychophysiology & Biofeedback


HEG Neurofeedback for the Treatment of
Attention-Deficit Disorder

Hemoencephalography (HEG) is a form of neurofeedback that focuses on intentionally increasing cerebral blood flow within the prefrontal cortex (PFC) of the brain. Prefrontal and frontal lobe hypoperfusion (reduced blood flow) has been shown to be a factor in ADHD.  

Called the "executive brain" for good reason, the prefrontal cortex has neural connections to, and exerts some control over, all other parts of the brain. It plays a central role in controlling attention, blocking distractions in the environment, formulating and carrying out plans and intentions, controlling physical and emotional impulses, and helping to access memory. By increasing blood flow within the prefrontal cortex, HEG neurofeedback can improve the functioning of this critical area of the brain and improve self-control. 

Whereas the goal of EEG neurofeedback is to train the individual to produce and/or inhibit certain brainwaves, the goal of HEG is to increase blood flow to targeted areas of the cortex. Increasing the amount of oxygenated blood perfusing a region of the cortex will result in increased metabolism and allow the targeted brain area to function more optimally.

Edmonton Neurotherapy uses a near-infrared HEG (nirHEG) system originally developed by Dr. Hershel Toomin in 1997. This system uses a spectrophotometer to measure the oxygenated blood flow inside the skull, which is semi-translucent and lets light in. The HEG Instrument measures the amount of blood that is carrying oxygen. This is similar to the "pulse-oximeter" that is used as a finger clip in the hospital, and shines a red light through your skin to measure the blood oxygen level. Like EEG neurofeedback, HEG neurofeedback is completely non-invasive, very safe and drugless.

HEG neurofeedback may be an effective adjunct to EEG neurofeedback training. Unlike EEG neurofeedback, HEG is not affected by eye blinks or facial movement which typically cause signal distortion when using EEG neurofeedback to train frontal locations. EEG neurofeedback focuses on activating neurons and changing neural connectivity whereas HEG neurofeedback increases the supply of oxygen and nutrients necessary to support neural activity.

      xxxxxx      vvvADHD is a brain-based disorder and typically results in dysregulation of the frontal cortex. Brain scanning studies have shown abnormal activity in the frontal cortex of children and adults suffering with ADHD. These scans have demonstrated a deactivation of the frontal cortex during tasks requiring concentrated attention, for which you would normally see an increase in frontal lobe activity. This deactivation results in the symptoms commonly seen with ADHD.

Although there is less published research on the use of HEG neurofeedback to treat such brain disorders as ADHD, over 2000 clinicians internationally have been using HEG neurofeedback for over a decade to improve brain functioning by increasing vascularity and the flow of oxygenated blood to specific regions of the cortex.


Mize, W. (2005). Hemoencephalography: A new therapy for ADHD. Journal of Neurotherapy, 8(3):77-97.


To see a YouTube video by Dr. Clare Albright on "Is there a cure for ADD/ADHD?", please click on this link...  http://www.youtube.com/watch?v=-tsZVIfmYmM&feature=BF&list=ULOy74rq6Q3WQ&index=16




Edmonton Neurotherapy.  Dr. Horst H. Mueller, RPsych, CRHSP, BCN, ICPP.

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