most exciting advance I have seen in working with all
forms of Attention Deficit Disorder has been the use of
EEG (electro encephalographic) Biofeedback (also called
Neurofeedback) in both identification and treatment.
If you're not familiar with Biofeedback, it's an elegant
approach to treating a wide variety of problems and conditions
that works simply by improving the patient's ability to
sense their own physiologic responses. For the most part
we have pretty good perceptions of the world around us,
but we don't always fare quite as well with our awareness
of our internal environment.
Biofeedback measures the extremely small responses of
our body that contribute to many stressful or difficult
situations. EEG Biofeedback measures patterns of electrical
activity in the brain that appear to relate back to certain
Our brains produce complex electrical signals which seem
to be indicative of many of the brain's functions. With
EEG we can place electrodes on the surface of the scalp
and measure the electrical energy being produced by the
brain. To be sure this method only allows us to measure
the outer couple of millimeters of the cerebral cortex
(outer part of the brain), but we have found quite a bit
of useful information there.
In an area about the size of a nickel around a location
on the surface of the brain called the Rolandic Fissure
we have discovered that there can be some fairly specific
unique patterns that show up in people with attentional
disorders. In this small area when people who can focus
"normally" concentrate, the faster beta wave
energy increases while the slower theta wave energy decreases.
(There are several types of electrical waves found in
the brain which are assigned Greek letters.) People with
ADD and ADHD have a variety of variations of this response
all of which can be indicators of poor focusing and distractibility.
Once we have found a pattern signature of ADD or ADHD
we can program the EEG recording device to inform the
patient when the incorrect pattern shifts in the more
focused direction. Generally, this "feedback"
from the EEG to the patient takes the form of scores on
a computer screen.
The skill of the Biofeedback Clinician is in accurately
identifying the brainwave patterns and in structuring
the biofeedback therapy itself. As a rule of thumb it's
a good idea to find out if your clinician has been certified
by the Biofeedback Certification Institute of America
(B.C.I.A.) (phone: 303/420-2902; Web address: www.bcia.org),
and it's even better if they have a certified subspecialty
in EEG. There are several different protocols currently
being used, and all of them have had reasonable successes.
I personally favor the protocols based on the Autogenics
A620 which is quite simple to use and readily understood
by the patient. In support of the biofeedback therapy
a positive home/school/work environment is essential.
In our society the use of punishment in all forms, both
obvious and subtle, is the most prevalent method of behavior
modification. Unfortunately, ADD and ADHD does not respond
favorably to punitive measures. Since self-identity has
usually been severely compromised in people with ADD or
ADHD, the use of negative experience will frequently serve
to add to the problem rather than correct it. In my experience
most people with either ADD or ADHD are bright and creative.
Their difficulties in such areas as schoolwork gives them
the false impression that they are not smart. This incorrect
assumption is only made worse by the behavioral issues
that can arise when we consider the added difficulty most
of these people have sitting still and resisting impulsive
My book, The A.D.D. Quest for
Identity: Inside the Mind of Attention Deficit Disorder
(ISBN 1-890669-01-6), offers a rare opportunity to experience
first hand the private mental processes found in A.D.D.
and to learn how to manage the disorder simply and effectively.
The most important point I try to make is that the identification
of ADD or ADHD is not an excuse for problems but rather
provides an essential explanation that can help us work
with these people to be valuable contributors to society.