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.

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“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.”

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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.”

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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 problem with pornography. 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 pornography, and has a clear career path.”

How to Get Started Two compani