ADD and EEG Neurofeedback

14 Comments:

• Posted by jcfried - Jul 29 2009 @ 6:08 PM
  Neurofeedback works!
  I was diagnosed with ADHD at the age of 48. After trying numerous medications that had significant side effects, i tried neurofeedback in the hope that at the least it would have no negative side effects. To my surprise and joy it worked. I attended weekly neurofeedback sessions for 5 years, at the end of which i was sufficiently healed of ADHD that i no longer needed the therapy sessions. When i started the sessions i was barely holding onto my engineering job. One year after completing the therapy sessions i was managing 9 engineers on the first of several financially successful projects. As for the claim by Dr. Larry Silver that neurofeedback has "no research" showing its effectiveness, i have to agree with others who have written commments here. There is more than enough studies showing that neurofeedback works for ADHD. I suggest you go to http://www.isnr.org/ or the Journal of Neurotherapy at http://www.informaworld.com/smpp/title~content=t792306937~db=all?tab=subscribe. I have to wonder why Dr. Silver claims expertise in this area when he clearly demonstrates ignorance on this very successful non-drug therapy.
• Posted by bayarea925 - Sep 19 2008 @ 2:55 AM
  ADD & NeuroFeedback
  The reason neurofeedback is not widely accepted: Medication = $$$ = Drug Companies
• Posted by Laurence Hirshberg - Nov 20 2007 @ 8:02 PM
  Evidence base for EEG biofeedback for ADHD
  Dr. Silver's mistaken understanding of the research on EEG biofeedback for ADHD is understandable in that mistaken reviews have been published recently in pediatric journals. But a careful search of the research literature shows ample research support for the effectiveness of EEG biofeedback for ADHD. More than 20 studies have been published showing the effectiveness of EEG biofeedback for ADHD. These studies include more than 700 subjects. 13 of them have been controlled trial studies, involving more than 400 subjects. 3 have been random controlled trials. Two double blind placebo controlled trials with similar results have been presented at professional meetings and are in preparation for publication. Overall these studies showed effectiveness of EEG biofeedback with 70-80% of subjects, with an improvement equivalent to that shown by stimulant medication documented by well validated measures of attention, impulsivity, and hyperactivity as well as changes in brain function as documented by increases in frontal activation shown by EEG, functional MRI and ERPs. The specificity of the treatment is clearly indicated by the fact that the degree of improvement in symptoms and in neurophysiological measures was highly positively correlated with the amount of change in the EEG shown during the training sessions, as shown in three studies. Clearly this represents a substantial evidence base, although it is also clearly true that none of the studies published so far meet current scientific criteria for "gold standard" research. So more work needs to be done. But to dismiss all this research as is done here by Dr. Silver just does not square with the facts described above. And here are a few more relevant facts: several studies (Including the MTA study)have shown that between 50% and 66% of children with ADHD are no longer taking their medications one year after diagnosis. Studies have also shown that a significant percentage of children do not respond to stimulant medication or have significant side efects. (30-60% depending on the studies) So without question, research clearly shows the need for evidence based options beside stimulant medication. Given this need and the research showing the effectiveness of EEG biofeedback for ADHD, EEG biofeedback is more accurately viewed as a research supported but not yet conclusively proven treatment option for ADHD. Using criteria established by the American Academy of Child and Adolescent Psychiatry to evaluate the research support for psychiatric interventions, EEG biofeedback meets the criteria as a "Cliniclal guideline", the second level of evidence based support: "EEG biofeedback meets the AACAP criteria for clinical guideline (CG) for treatment of ADHD, seizure disorders, anxiety (OCD, GAD, PTSD, phobias), depression, reading disabilities, and addictive disorders. This suggests that EEG biofeedback should always be considered as an intervention for these disorders by the clinician. Clearly there is stronger evidence of efficacy...for the use of EEG biofeedback for ADHD in children and adolescents. Due to this high level of empirical support, the use of EEG biofeedback for ADHD will (with the publication of the second RCT) meet the most stringent APA criterion of efficacious and specific, which requires two independent RCT’s among other factors." I would be more than happy to send to Dr. Silver reprints describing this research as well as an editorial from a neurology journal I recently wrote summarizing this research. I can be reached by email at lhirshberg@neurodevelopmentcenter.com. I sincerely hope that future comments by Dr. Silver will take these facts into account. Laurence M. Hirshber, Ph.D. Brown University School of Medicine
• Posted by Laurence Hirshberg - Nov 20 2007 @ 7:42 AM
  Evidence base for EEG biofeedback for ADHD
  Dr. Silver's mistaken understanding of the research on EEG biofeedback for ADHD is understandable in that mistaken reviews have been published recently in pediatric journals. But a careful search of the research literature shows ample research support for the effectiveness of EEG biofeedback for ADHD. More than 20 studies have been published showing the effectiveness of EEG biofeedback for ADHD. These studies include more than 700 subjects. 13 of them have been controlled trial studies, involving more than 400 subjects. 3 have been random controlled trials. Two double blind placebo controlled trials with similar results have been presented at professional meetings and are in preparation for publication. Overall these studies showed effectiveness of EEG biofeedback with 70-80% of subjects, with an improvement equivalent to that shown by stimulant medication documented by well validated measures of attention, impulsivity, and hyperactivity as well as changes in brain function as documented by increases in frontal activation shown by EEG, functional MRI and ERPs. The specificity of the treatment is clearly indicated by the fact that the degree of improvement in symptoms and in neurophysiological measures was highly positively correlated with the amount of change in the EEG shown during the training sessions, as shown in three studies. Clearly this represents a substantial evidence base, although it is also clearly true that none of the studies published so far meet current scientific criteria for "gold standard" research. So more work needs to be done. But to dismiss all this research as is done here by Dr. Silver just does not square with the facts described above. And here are a few more relevant facts: several studies (Including the MTA study)have shown that between 50% and 66% of children with ADHD are no longer taking their medications one year after diagnosis. Studies have also shown that a significant percentage of children do not respond to stimulant medication or have significant side efects. (30-60% depending on the studies) So without question, research clearly shows the need for evidence based options beside stimulant medication. Given this need and the research showing the effectiveness of EEG biofeedback for ADHD, EEG biofeedback is more accurately viewed as a research supported but not yet conclusively proven treatment option for ADHD. Using criteria established by the American Academy of Child and Adolescent Psychiatry to evaluate the research support for psychiatric interventions, EEG biofeedback meets the criteria as a "Cliniclal guideline", the second level of evidence based support: "EEG biofeedback meets the AACAP criteria for clinical guideline (CG) for treatment of ADHD, seizure disorders, anxiety (OCD, GAD, PTSD, phobias), depression, reading disabilities, and addictive disorders. This suggests that EEG biofeedback should always be considered as an intervention for these disorders by the clinician. Clearly there is stronger evidence of efficacy...for the use of EEG biofeedback for ADHD in children and adolescents. Due to this high level of empirical support, the use of EEG biofeedback for ADHD will (with the publication of the second RCT) meet the most stringent APA criterion of efficacious and specific, which requires two independent RCT’s among other factors." I would be more than happy to send to Dr. Silver reprints describing this research as well as an editorial from a neurology journal I recently wrote summarizing this research. I can be reached by email at lhirshberg@neurodevelopmentcenter.com. I sincerely hope that future comments by Dr. Silver will take these facts into account. Laurence M. Hirshber, Ph.D. Brown University School of Medicine
• Posted by Dr-ADD - Nov 15 2007 @ 5:09 PM
  "Old School" thinking
  The Journal of the American Academy of Child and Adolescent Psychiatry (2007;46(8):989-1002) published the results of a 3-year follow-up to the Multimodal Treatment Study of Children With ADHD sponsored by the National Institute of Mental Health. The study concluded that medications have relatively short-term benefits when compared to other treatments. HOWEVER, after three years of medication use, there were NO significant differences on ANY measure between the children taking medications verses the children who did not take medications. One would think Dr. Silver - The “go to” guy for Attitude Magazine - would, at the very least, be familiar with a study that was reported in the top ranking journal in his exact field of expertise; especially a NIMH study that cost the taxpayers of over 11 million dollars. Nevertheless, all we hear from Dr. Silver is drugs, drugs, and more drugs; no one has a treatment of value to offer the ADD person other than drugs. About two years ago, I wrote a letter to the editor of Attitude Magazine in response to Dr. Silver’s negative reaction to a subscriber who reported a positive response to Neurofeedback. My letter was published! Of course, Dr. Silver had a little “P.S.” after my comments wherein he stated he was open to learning more about Neurofeedback. Here we are, two years later, we see there has been no education of Dr. Silver. Actually, we should not be surprised Dr. Silver cannot speak intelligently about research OUTSIDE his field since he does not correctly report findings in the field in which he claims expertise. The cornerstone of credibility is accurately reporting scientifically verified facts. In reality when a patient goes to see a psychiatrist for any disorder, the psychiatrist guesses which medication will work best. That does not satisfy the NIMH or the FDA nor should it satisfy us. Medicine is moving in the direction of discerning both genomic and neuromarkers to tailor the proper treatment to each individual based on the patient’s biological, neurological, and psychological makeup. Just as Dr. Silver wrote off Dr. Amen’s breakthrough work, he writes off the field of Neurofeedback. However, as science moves forward the Dr. Silver’s of the world will become increasingly irrelevant. I only hope that one day we can dismiss them as easily as Dr. Silver dismisses the powerful gift that Neurofeedback provides to many people. Gary J. Schummer, Ph.D. Clinical Director A.D.D. Treatment Centers Torrance and Mission Viejo, CA
• Posted by Dr Grant Bright - Nov 15 2007 @ 9:41 AM
  ADD and EEG Biofeedback
  An informed view of ADD suggests, there is no simple answer to treating this multifaceted behavior. It is a complex behavior but it responds well to multi-disciplinary treatments. Dr. Silver's answer suggests he does not read outside his discipline, have a working knowledge of EEG, or have an awareness of other complimentary treatments. There are two ways to advance the treatment of ADD and other psycho/social/physiological problems: 1) Medical and mental healthcare providers expand their knowledge by reading outside our own fields, 2) Use a genuine holistic approach by aligning with and referring to other healthcare providers who in turn can deal with another significant facet of these multifaceted behaviors. There is no ONE simple answer.
• Posted by Joseph O'Donnell, Ph.D. - Nov 15 2007 @ 8:43 AM
  Dr. Silvers Comments
  Not wanting to get personal, but it appears that Dr. Silver is either not familiar with the literature, and peer reviewed research that is available on the efficacy of neurofeedback, or is prejudiced against it dismisses it because of that prejudice. All he needs to do is go to PubMed and type the key words and a plethora of references will be listed. I have worked with over a thousand children with various disorders the most being ADD and have had significant results, sometimes startling positive outcomes. If he is going to make such blanket comments about such a powerful treatment modality he should be willing to present the facts not just opinion.
• Posted by Nicholas Dogris, Ph.D. - Nov 14 2007 @ 4:50 PM
  The Third Reason
  As a Neurofeedback professional who has treated well over 500 children with ADHD over the past seven years with EEG Biofeedback I question the statement made by Dr. Silver. The research does exist which shows that EEG Biofeedback is as effective, if not more effective, for the treatment of ADHD than medication. When I see posts like the one made by Dr. Silver I question whether he has read the existing literature or if he is simply blinded by the biochemistry smoke screen that big pharmaceutical companies would have you believe. As health care professionals we have the ethical obligation to report data accurately to the best of our knowledge. Dr. Silver missed the boat when it came to knowing the research and is misleading the public in my opinion. So what is the third reason why doctors don’t prescribe EEG Biofeedback over the use of medication? In my humble opinion it is because they are heavily influenced by drug companies and have lost a sense of ethical integrity that guides the hand of healing. Why else would they prescribe medications that have known side effects that include stunted growth, cardiac problems, and chromosomal abnormalities that place one at risk for cancer? We need to re-think our approach to healing and the people who claim to know how to heal our children.
• Posted by Kirk D. Little, Psy.D. - Nov 14 2007 @ 3:59 PM
  The Science of Neurofeedback
  Did you know that since the 1970s there have been more than 20 studies conducted involving over 700 subjects? And that at least nine (including Dr. Monastra’s studies) have been controlled trials involving over 400 subjects, with comparisons to sham treatment, nontreatment and stimulant medication controls? And that these include five randomized controlled trials? Go to ISNR.org and see for yourself.
• Posted by kirtley12 - Nov 14 2007 @ 1:00 PM
  adhd & neurotherapy
  Dr. Silver does not know the research in this area. There has been about 18 control group studies and 9 non control group studies showing positive effects, with none reporting negative effects. There are negative effects of medication, resource room allocation, etc. Kirtley Thornton, PHD
• Posted by marvin berman Ph.D. - Nov 14 2007 @ 12:47 PM
  Neurofeedback Efficacy Question
  I have conducted several studies in the Philadelphia mental health and educational systems supported by city government and federal grants. Our findings support the efficacy of these techniques with ADHD, conduct disordered and autistic spectrum disordered children. I would be pleased to send you copies of our studies as well as a bibliography of 500+ studies documenting the efficacy of these techniques. I imagine that your opinion is informed by the fact that most of these studies appear in journals that you and your colleagues don't read like The Journal of Neurotherapy. Please check our website at www.quietmindfdn.org for details.
• Posted by Robert - Oct 20 2007 @ 12:50 AM
  ADHD & Neurofeedback
  I'm not surprised at Dr. Silvers take on Neurofeedback I think it’s very common among doctors. First let me point out there are plenty of research studies Dr Silvers can look at to evaluate the effectiveness of Neurofeedback. Why he can’t find it and a layman such as my self can is interesting. Unfortunately many of the studies are small in scope compared to the ones big pharma does and I certainly don’t see them funding Neurofeedback studies. Many doctors like the” here’s a pill approach” to disease instead of opening their minds to an integrated approach. On a personal note I grew up suffering the effects of ADHD. I took and still currently take a medication for it although at half the dose. The gains I made going for the EEG allowed me to cut the dosage. My focus is the best it’s ever been, my mood is better along with a host of other improvements. For me Neurofeedback has been worth every penny I have spent.
• Posted by Vincent J. Monastra, Ph.D. - Sep 28 2007 @ 10:47 PM
  ADHD & Neurofeedback
  A review paper on EEG Biofeedback for ADHD that was written by me and and published in the Psychiatric Clinics of North America (Monastra, 2005) identified multiple, published, controlled, group studies in which the benefits of EEG biofeedback were found to be comparable to or exceed those occurring in patients treated with stimulant medication. In addition, two of the studies reported neurophysiological and neuroanatomical changes in patients treated with EEG biofeedback in those brain regions responsible for attention and behavioral control. Although ongoing research may lead to the development of training protocols that may result in more rapid improvement in patients, the literature indicates that at least 75% of patients treated in the controlled studies responded positively (a rate that is comparable to stimulant therapy). From my perspective, one of the primary reasons that this type of treatment is not "generally accepted" is because "experts" like Dr. Silver misinform their colleagues about the status of the research. His characterization of the research as indicating that most children treated with EEG biofeedback "show no benefit" is in direct conflict with the reported scientific findings. I would suggest that Attitude Magazine seek input from professionals who will accurately report the scientific literature to their readership, so that they can make an informed decision. After all, isn't that the purpose of an "Ask the Expert" Column?
• Posted by Michael Bolin - Jul 20 2007 @ 2:51 PM
  ADD and EEG Neurofeedback
  Dr. Silver is not entirely correct on this subject. There is a huge body of research that indicate significant effectiveness of neurofeedback. However, there have not been large scale clinical trials similar to drug trials to date. All of the research is positive. In fact, when children who receive this treatment are studied, most show significant benefit. There is not a single published study with negative or neutral findings.