Brain Training

Boost Your Brain Waves: 6 Brain Training Therapies for ADHD

These brain-boosting treatments — electrotherapy stimulation, low-energy neurofeedback, working memory training, and interactive metronome — help some adults and children manage their ADHD symptoms. Learn more, and speak with your doctor.

Brain boosts for ADHD

Ben is a 12-year-old with ADHD who used to have trouble in school. His grades were below average, and he was easily distracted, unable to remember much of the material taught in class. Ben struggled with homework assignments and studying for tests. He felt defeated, and was frustrated by his parents’ attempts to get him to study harder. He put in the extra effort, but nothing seemed to help.

Ben’s parents decided to try brain training for ADHD by working with Ari Tuckman, Psy.D., a clinical psychologist in West Chester, Pennsylvania. Tuckman uses Cogmed, a computer-based brain-training program, in his practice. In five weeks, Ben completed 20 training sessions, playing the science-based computer games at Tuckman’s office four times each week.

The results were surprising. His working memory improved, he retained more information in class, and he got higher grades on tests and quizzes. And the success made Ben feel better about himself.

“Working memory is the ability to hold information in your mind for several seconds, manipulate it, and use it in your thinking,” Tuckman says. “It is central to concentration, problem solving, and impulse control.”

People with ADHD can’t always hold on to information because their attention gets hijacked. They are distracted by things around them and by new thoughts that come to them. Improving your working memory capacity enables you to pay attention, resist distractions, manage your emotions better, and learn.

Based on early studies suggesting a correlation between working-memory training and improved standardized-test results, researchers developed high-tech therapies like Cogmed. These brain-training programs are not designed to replace ADHD medication, which helps manage core symptoms. They are adjunctive therapies, and they are controversial. Though proponents of working-memory training point to two dozen studies that suggest it boosts IQ and improves test scores, detractors say those studies are faulty. Researchers from several universities have applied more stringent controls and more varied tests, and they have been unable to reproduce the same positive outcomes.

According to “Brain Games Are Bogus” by The New Yorker, “A pair of scientists in Europe recently gathered all of the best research — twenty-three investigations of memory training by teams around the world — and employed a standard statistical technique (called meta-analysis) to settle this controversial issue. The conclusion: the games may yield improvements in the narrow task being trained, but this does not transfer to broader skills like the ability to read or do arithmetic, or to other measures of intelligence. Playing the games makes you better at the games, in other words, but not at anything anyone might care about in real life.”

The Journal of Clinical Psychiatry published a study in 2016 that compared the effects of ADHD stimulant medication (methylphenidate) to those of neurofeedback for ADHD. The researchers concluded “that optimally titrated methylphenidate is superior to neurofeedback and physical activity in decreasing ADHD symptoms in children with ADHD.”

These studies, however, don’t dissuade all medical professionals from recommending brain-training treatments to their patients as a supplementary treatment and from optimistically anticipating the results of further research.

“The potential for brain training as a new therapeutic tool is phenomenal,” says Amit Etkin, Ph.D., assistant professor in the department of psychiatry and behavioral sciences at Stanford University. “By understanding brain circuitry, we can tailor interventions that medication or psychotherapy do not access or improve. The great advantage is that these programs are not invasive, have minimal side effects, and are, for the most part, fun.”

“People with attention deficit have an interesting brain wave profile,” says Richard Brown, M.D., author of How to Use Herbs, Nutrients, and Yoga in Mental Health Care. “Parts of the brain — areas responsible for planning and sequencing, making decisions, and maintaining focus — aren’t functioning as they do in other people.”

Read on to learn about six brain training techniques that may help adults and children with ADHD improve focus and memory, and decrease impulsivity, hyperactivity, and other ADHD symptoms.

Interactive Metronome

Developed in the early 1990s to help children with learning and developmental disorders, Interactive Metronome (IM) is used to improve planning and sequencing. The end result for individuals with ADHD: increased focus for longer periods, and the ability to filter out internal and external distractions. Sessions can be done in an office with a trained coach or occupational therapist, at home under a coach’s supervision, or virtually at home.

How It Works This program challenges the user’s working memory by synchronizing a range of hand and foot exercises with a precise computer-generated tone heard through headphones. A child tries to match the rhythmic beat with repetitive motor actions. An auditory-visual guidance system gives immediate feedback, measured in milliseconds, and keeps score. IM improves the brain’s timing through exercise and practice. Better timing sharpens focus, coordination, planning, and processing speed.

“Neurons that are firing are engaged in cognitive activities,” says Kevin McGrew, Ph.D., director of the Institute for Applied Psychometrics/Research and science director for Interactive Metronome. “If we can increase neuro-efficiency with different types of environmental manipulations, the neurons will fire more frequently and process cognitive information more efficiently. It’s like spraying WD-40 on the brain cells, to better synchronize the communication system that affects executive functioning and controlled attention.”

It takes persistent, consistent training to create new neural pathways, say IM proponents. “I ask kids to do a minimum of 30,000 repetitions over the course of treatment,” says April Christopherson, OTR-L, a neurological and developmental occupational therapist and director of occupational therapy at The Shandy Clinic, in Colorado Springs. “With the IM home system, I access each child’s hours and scores online, to see how many repetitions he’s done and how many days he has trained this month. If he’s not keeping up, I lock his program until he comes into the office and gets back on track.”

Christopherson says that one of her clients, a 6-year-old named Peter, had been receiving speech and occupational therapy for two years, but his problems still held him back in school. Peter was enrolled in a 6-week course of 18 IM sessions. Sometime around the fifth week, Peter’s mother observed that he communicated his needs more clearly, was less frustrated, and was able to complete tasks without being reminded to do them. In school, he paid more attention in class. At a parent-teacher meeting, Peter’s teacher asked his mother if she had changed his medication. The only thing that was new was the IM therapy.

How to Get Started IM practitioners teach the therapy to children and adults in clinical and educational settings, including hospitals and schools. Visit interactivemetronome.com for more information on finding a practitioner.

Cost Sessions range from $30 to $150 each. IM is sometimes covered by insurance.

Cogmed Working Memory Training

Working memory is the ability to hold onto information long enough to accomplish a specific goal; you keep a task in mind as you work to accomplish it. Several studies conducted in 2001 and 2002 by the Karolinksa Institute, a medical university based in Stockholm, showed that five weeks of working-memory training reduced symptoms of inattention and hyperactivity in children. One of the researchers involved in these studies went on to co-found Cogmed.

The recommended protocol for Cogmed is 25 sessions over five weeks. Trained professionals instruct a child in using the software and coach him through the tasks and goals, if needed. Training is done at home or in school. (Cogmed for Schools is supervised by a teacher.) The program is web-based and compatible with any computer that supports Flash.

When a child sits at his computer, he is presented with eight tasks (games) to do. He must complete all of the tasks in each session, doing them in any order he chooses. The Cogmed program automatically adjusts the degree of difficulty based on the user’s performance, so that the child is always challenged but not overwhelmed. “Parents tell me that their child seems more mature after doing Cogmed training, which is a way of saying that the child is easier to parent,” says Tuckman.

Since 2002, more than 25 articles have been published in scientific journals about double-blind, placebo-controlled studies of Cogmed. The studies show similar results — around 80 percent of those who finish Cogmed training see significant improvement in working memory capacity, which leads to improved attention, behavior, and the capacity to learn. However, during that same time period, other scientists have criticized this research for using inadequate controls and shallow testing. At least two university-based research teams have attempted to reproduce the results of these pro-Cogmed studies, but with more careful controls and more cognitive-skills tests. Teams from Georgia Tech and Case Western Reserve University both found insufficient scientific evidence to support the claim that working-memory training improves intelligence or ADHD symptoms like inattention any more than adopting a more healthy lifestyle, for example.

“[Brain-training companies] claim to grow the brain compared to doing nothing, but they don’t show that brain training is better than just doing healthy things,” says Joel Nigg Ph.D., a clinical psychologist and a professor in the departments of psychiatry and behavioral sciences at OHSU. “Are you better off spending half an hour doing brain training, or are you better off spending a half hour taking a walk?”

How It Works When you improve working memory, you improve fluid IQ — the ability to solve problems or adapt to situations as they occur. Children who complete memory training may become more alert to their surroundings and to social cues. Some parents report that their kids become more “mature.” They take charge of their hygiene and do chores without being nagged. They remember to bring materials to and from school. At six-month and one-year follow-ups, Cogmed reports that about 80 percent of subjects maintained their working memory gains or improved on them.

How to Get Started Cogmed developed software that trains working memory on a home computer. Exercises are in a video-game format, with colorful graphics and crisp sound. In one exercise, a child shoots down floating asteroids; in another, he recalls numbers in reverse order from which they are given. The training takes place over five weeks, five days a week, one hour a day. The Cogmed program does not claim to replace medication, but to manage symptoms that meds don’t. Visit cogmed.com for more information on finding a practitioner.

Cost The cost starts at $1,500, and Cogmed training is not covered by most medical insurance plans.

Electrotherapy Stimulation

A review of studies on cranial electrotherapy stimulation (CES) by Harvard’s School of Public Health suggests that low electrical voltages delivered to a patient may influence neurotransmitter activity — specifically, the production of serotonin and dopamine, which some children and adults with ADHD don’t produce enough of. Brown points out that many studies suggest that CES benefits mood disorders and anxiety. A recent study indicates that CES may benefit those with ADHD.

How It Works CES sends low-energy electrical current — from a small, handheld device powered by batteries — to the skin and scalp muscles. The current changes electrical patterns in the brain. “I see two types of patterns in my patients with ADHD,” says Brown. “Many parts of the brain are sluggish, while some parts aren’t turned on at all. Other parts are hyperactive. The current balances them all out.”

One of Brown’s patients had ADHD, significant mood swings, and learning disabilities. He was rough with kids at school, and he had no friends. He also had a porn addiction. The teen was taking large amounts of Adderall. Brown tried several therapies and reduced his medication dosage. Nothing seemed to help. Finally, he prescribed cranial stimulation. “In a couple of weeks, the teen was a different person,” explains Brown. “He made friends at school, gave up his addiction, and has a clear career path.”

How to Get Started Two companies, Fisher Wallace Laboratories and Alpha-Stim, make cranial electrotherapy stimulators. The low-voltage stimulation is delivered via electrodes or clips attached to a person’s earlobes. Professionals recommend that patients use the device for 20 minutes a day, until you see signs of improvement.

Cost “The devices cost between $700 and $800, but both companies offer a 60-day money-back guarantee,” says Brown. “Most children and adults will see some benefit in two weeks. If it doesn’t work for you, you can return it and get your money back.”

Neurofeedback

Neurofeedback is an alternative ADHD treatment that uses brain exercises to reduce impulsivity and increase attentiveness. The brain emits different types of waves, depending on whether we are in a focused state or daydreaming. The goal of neurofeedback is to teach a person to produce brain-wave patterns that reflect focus. The result: Some ADHD symptoms — namely, impulsivity and distractibility — diminish.

How it works: First, a practitioner takes a detailed history of the patient and then maps the patient’s brain by having him wear an electrode-lined cap while performing a complex cognitive task, such as reading aloud. The brain activity is fed to a computer, which then maps the areas of the brain where there is too much or too little brain-wave activity — the sources, theoretically, of the patient’s ADHD symptoms.

The patient then trains those areas of the brain that are under-aroused by controlling a computer or video game by producing short bursts of sustained brain-wave activity in the target areas. The games only run when the patient exercises that portion of the brain that is deficient in focus.

Research on the efficacy of neurofeedback is still mixed. Inattention is the only area that showed clear positive results, but not every trial could conclude even that. There just isn’t any scientific proof that neurofeedback is an effective, across-the-board treatment for ADHD.

How to Get Started Visit EEGInfo.com to learn more about neurofeedback and to locate a practitioner in your area.

Cost: While sessions are brief (approximately 30 minutes) and painless, they are expensive. The average course of treatment can range from $2,000 to $5,000.

Low-Energy Neurofeedback

The low-energy neurofeedback system (LENS) works differently: It doesn’t try to reproduce a certain brain wave, but rather enhances the brain’s ability to adapt to a task, whether it be taking tests in school or getting along with friends.

Developed by Dr. Len Ochs in 1992, LENS has demonstrated good results using weak electromagnetic fields to stimulate brain-wave activity and restore brain flexibility. A controlled study of 100 subjects with different diagnoses — ADHD, traumatic brain injury, bipolar disorder — showed improvement in 90 percent of subjects after using LENS.

However, a study released in August 2016 in the Journal of the American Academy of Child & Adolescent Psychiatry calls these results into question. It states that, “Evidence from well-controlled trials with probably blinded outcomes currently fails to support neurofeedback as an effective treatment for ADHD. Future efforts should focus on implementing standard neurofeedback protocols, ensuring learning, and optimizing clinically relevant transfer.”

How It Works If you decide to undergo LENS treatment, a practitioner will first take a detailed family history and do a brain map. “The map will show connectivity problems — sites that are under-connected and over-connected,” says Stephen Larsen, Ph.D., author of The Healing Power of Neurofeedback and a LENS practitioner at the Stone Mountain Center, in New Paltz, New York. “Some sites of the brain are like a city in a blackout.”

Based on the map, the practitioner will treat four brain sites per session with radio frequencies, produced by a machine to which the patient is hooked up. The radio frequencies will gently stimulate those areas that are sluggish, and will take the edge off high-frequency sites. “Most of the session is spent talking to the patient about whether the last treatment improved symptoms,” says Larsen.

How to Get Started For more information on LENS, visit stonemountaincenter.com. To locate a practitioner near you, log on to ochslabs.com.

Cost LENS treatments cost between $75 and $150 per half-hour session.

Meditation

Mindful awareness, or mindfulness, involves paying close attention to your thoughts, feelings, and bodily sensations; in other words, developing a greater awareness of what’s going on with you from moment to moment. It can be used as a tool to foster wellness, especially psychological well-being. Similar techniques have been used to lower blood pressure and to manage chronic pain and anxiety.

A 2005 study at Arizona State University found that children who participated in mindfulness exercises had lower test anxiety and ADHD symptoms, and greater attention than kids who did not participate in the exercises.

How it Works: Meditation improves your ability to control your attention. In other words, it teaches you to pay attention to paying attention. Mindful awareness can also make people more aware of their emotional state, so people with ADHD won’t react impulsively as often. 

How to Get Started: The basic practice is very simple: sit in a comfortable place and spend five minutes focusing on the sensation of breathing in and breathing out — pay attention to how it feels when your stomach rises and falls. If your mind wanders to something else — your job or some noise you just heard, label these thoughts as “thinking,” and refocus your attention on your breath.

This practice should be done daily, and every couple of weeks patients should increase the length of time spent on the exercise — up to 20 or more if they feel they can.

Apply the same thinking throughout each day, focusing on your breath for a few minutes as you walk from place to place, or when you’re stopped at a red light or sitting at the computer. The meditation sessions are important practice, but the key is to use mindfulness throughout your daily life, always being aware of where your attention is focused while you are engaged in routine activities. For example, you might notice while you drive that your attention wanders to an errand you must run later that day. Lots of people practice mindfulness while eating. Once you get used to checking in with yourself and your body, you can apply the technique anytime you start to feel overwhelmed.

Training centers can also help explain these basic concepts, and keep you on track.

Cost: $0 if you do it on your own, but training programs and books are available for purchase.

The Future of Brain Training

While there is excitement among researchers about using brain training to treat ADHD, Etkin offers a realistic perspective.

“Right now, the brain training literature is a mess, because people are learning how to do it right,” he explains. “It’s early, and benchmarks are starting to be developed. There’s always hope that there will be some cure that’s easy, fast, and lasting, but, as a clinician and a scientist, I can tell you that cures are never easy, fast, or lasting, and they require a person to do a lot of work themselves. You have to continue doing your homework to make it last.”

That’s an investment many parents — and their children — would be willing to make.

The good news is that as the human brain continues to be mapped and explored, it’s clear that brain training will be a part of a new frontier in treating children with ADHD.

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