ADHD: Biofeedback and Neurofeedback: An Introduction

What are Biofeedback and Neurofeedback?

Feedback is an process which reflexively changes itself using its own forceful flow. The classic feedback device is the steam valve. As the steam causes a rotor to turn the centrifugal force of the rotation causes levers to rise, or strings to fly out, in the same way that if you rapidly turn yourself, your arms fly outward.

The levers on a steam device control the flow of steam, the faster the rotation the smaller the steam vent, the smaller the vent the slower the rotation. The size of the vent, the speed of rotation and the force of the arms closing the valve can all be adjusted so that the rotating axle maintains a consistent speed, so long as the supply of steam is constant.

Over one hundred years ago, French physiologist, Claude Bernard, who was characterized by Louis Pasteur “Physiology Itself” noted that most all of the human body’s systems are feedback regulated. In fact, they remain quite constant regardless of changes in the external environment. In 1932, Walter Cannon coined the term homeostasis to describe internal dynamic constancy.

A man eats food, his mouth fills, juices flow, his stomach fills, and his sensors send a signal, “satisfied.” He stops eating. A woman trots upstairs a bit too fast, her oxygen sensors are starved, and she starts breathing more deeply and quickly.

I glance out the window, the sun has moved to bounce off the white wall of the bank next door, my pupils contract, and I turn back toward the darkest wall of the room, or dash into my dark room. My pupils dilate.

Generally, body systems regulate through positive and negative feedback loops. The body has sensors that detect deviation from its normal internal range. This deviation activates effectors that essentially reverse the condition.

Such ordinary biological feedback of daily living can be enhanced by using mechanical transducers (devices which measure energies). I can press a piece of plastic against my palm which turns color depending on my temperature. Quickly I learn to make the color redder and redder (the color is arbitrary, it could be bluer and bluer). If I am prone to headaches I can prevent, inhibit, or relieve a headache by warming my hand. I may measure the way my skin conducts electricity and can learn to make my own skin less conductive which tends to relax me. The plastic has fed the information back to my conscious mind and my brain has learned consciously to warm my hand. My body is responding to a feedback loop. According to Merriam Webster, biofeedback is: “the technique of making unconscious or involuntary bodily processes (as heartbeats or brain waves) perceptible to the senses (as by the use of an oscilloscope) in order to manipulate them by conscious mental control.”

Early in the development of biofeedback attention was first focused on temperature (TEMP) change. Temperature is easily and cheaply monitored and learned change is markedly reliable. Muscle tension (EMG) soon came along. The techniques of measuring muscle tension are perhaps as easily done as temperature measurement; but the equipment is more costly. TEMP and EMG are the most widely practiced forms of biofeedback.

In 1970 Barry Sterman noted that he could readily train cats to strengthen the amplitude of signals at 13 pulses per second generated in the brain’s Fissure of Roland. Later he observed that cats trained to make stronger 13-14 Hz signals resisted epileptogenic drugs (specifically, injected hydrazine). D.A.Quirk, a Canadian penologist, and G.von Hilsheimer, a Florida neurofeedback specialist, applied Sterman’s 1970 method to 2776 felons imprisoned in the Ontario Correctional Institute near Toronto and to about 10,000 clients seen in hospital and in outpatient care. The recidivism in these prisoners (15% in 3 years after discharge, compared to 40 – 100% in typical prisons) reduced significantly.

Subsequently a professional movement has been created using EEG biofeedback in the treatment of ADHD (pioneered by Professor Lubar at the University of Tennessee). In Europe a significant network of practitioners has been organized by Prof. Dr. Jiri Tyl of Prague who has significantly contributed to the proof of the efficacy of EEG biofeedback (see EEG Biofeedback FAQ)

Neurofeedback is a specific type of biofeedback that makes brainwaves perceptible through the use of sensors attached to the head. The brain operates by sending minute electrical impulses to the many cells that comprise it. When the brain is excited it emits a specific frequency range of waves. The same is true if it is tired or focused. This process is similar to a radio tower that gives off radio waves. Brainwave sensors called electrodes monitor brainwaves emanating from the brain much the same way a radio receiver monitors different radio frequencies – if I change my car radio from 101.5 FM to 107 FM, I get to listen to a different station. So, the sensors pick up these signals like little radio antennae. A receiver, like a radio receiver, amplifies them and sends them to a computer where they are changed to sound and/or pictures on the computer monitor. The pictures and sounds make the current state of the brain perceptible because that information is displayed via sound and pictures on the computer screen. So, if a person is overly excited, she can see this on the screen in a graph or perhaps a screen character rapidly buzzing around. If she wishes to calm herself, she learns to slow the computer character which is reflecting the necessary relaxing brainwave pattern. By repeating this process many times, she can eventually learn to place her brain and body in a calm state without the neurofeedback equipment. This learning achieved by biofeedback is robust, stable, reliable, and readily acquired.

There is significant evidence that hyperactive boys tend to make high amplitude slow brain waves which are associated with inefficient faster brain waves. The child can be taught to reduce the amplitude of signals slower than 7 pulses per second (<7 Hz for Hertz) and to increase the strength of the signals running 13-14 Hertz. Such children tend to become more social, more effective at school work, and they perform more adroitly on IQ and other tests. One can think of this process as switching radio stations at will. Neurofeedback students learn to switch from inattentive (daydreaming) states to focused states at will.

See www.drbiofeedback.com, www.aapb.com, www.isnr.org, www.pocket-neurobics.com

George von Hilsheimer, Ph.D., F.R.S.H., and Peter Freer, MAEd

Adult ADHD Life Strategies

ADHD Strategies for School & Work

Diffused attention during the learning process greatly decreases the amount of information that can be transferred from short-term memory to long-term. When questioning an ADHD student about the material just presented during a lesson, typically he’ll recall bits and pieces of the material presented, but seldom a holistic perspective. Other areas of life are affected including everything from personal interactions to work or school.

School

Diffused attention also makes reading a challenge as the student must read a passage two to four times before he can gain fundamental meaning from the text. Academic work becomes tiring and tedious. Children often claim homework is ‘boring’ after failing to be successful at simple assignments they are highly capable of accomplishing in short order if their attention were not diffused. Equating boredom with academic work is usually the result of lack of success and an assignment that is not highly stimulating.

Social Interactions

Socially, diffused attention causes an inability to perceive social cues. A look of disapproval, a simple shake of the head meaning NO, and other social cues are overlooked. For adults, this can cause conflict between workers or embarrassing situations at social gatherings. For a child, peers tend to shy away from kids who cannot recognize social cues. ADHD kids are labeled as nuisances and are often excluded from parties, etc. ADHD kids also discern themselves from their peer which results in reduced self-esteem.

Adults

 Typical symptoms of ADHD such as hyperactivity, poor organizational skills, distractibility, impulsivity, etc., often are challenges for the adult in the workplace. A recent article in WebMD.com reports that Joseph Biederman, MD, professor of psychiatry at Harvard Medical School, has surveyed ADHD adults and found that the incomes of households with an ADHD member are substantially lower than households without an ADHD member. Biederman calculates that households with an ADHD member have incomes that are $10,791 lower for high school graduates and $4,334 lower for college graduates. This extrapolates to an annual revenue loss of close to $77 billion in the US.

Biederman reports that an adult with ADHD has greater difficulty keeping a job due to lack of organizational and social skills. In fact, he thinks the disorder may actually make it more difficult to get an appropriate education to obtain a job that offers a higher pay scale. Lost days at work due to ADHD also provide a negative financial impact. “About 50% of the people with ADHD who had jobs in the survey said they lost work directly related to their ADHD symptoms,” says Biederman. “The symptoms of ADHD are very difficult for employers to deal with.”

However, there are strategies that can be employed to maximize function, skill, and satisfaction in the workplace.

Know your strengths and weaknesses

It is important to realize that many ADHD adults have successful careers. Edison, Mozart, and even Einstein may have had AD/HD.  Success seems to be linked to employing good coping strategies once you’ve discovered your strengths and know your weaknesses. Once you become aware of your specific set of challenges, it will become easier for you to plan a strategy. Therefore, consider your unique characteristics as you design your strategies. Below is a checklist describing many of the symptoms typically associated with ADHD. Strategies for coping are listed below each symptom.

Distractibility – people walking by your desk, or talking near you, distract you from your work

  • Try to place yourself in the least distracting environment. This may be a private office or cubicle with little foot travel by other office workers. You may retreat to a conference room if possible.
  • Maintain a memo pad to keep ideas and assignments from slipping away if you become distracted. Use the memo pad to jot down notes when you receive a phone call.
  • Come in early or do your work when others are not in the office.
  • Don’t multi-task. Set a goal to finish your current task before starting another.
  • Background noise, sometimes known as “white noise” can be effective. Special white noise CDs, audio tapes, or earphones are available for this purpose. Simple classical or new age music may also help.

Poor Memory – you can’t recall dates, names, or appointments.

  • First and foremost, buy a day planner and use it religiously to keep track of your schedule and upcoming tasks.
  • Many freeware and commercial computer programs are available that automate scheduling and task reminders.
  • Make use of pocket recorders. Current recorders no longer need audio tapes as they record on microchips. These are effective for personal reminders or note taking at meetings.
  • Write checklists and set reasonable goals for projects.

Poor Organization – you can’t seem to finish projects on time or you fail to keep good records.

  • If possible, find a job that does not require long-term task management.
  • Set goals for your current task by breaking it into a series of manageable tasks. Mark the deadline for each mini-task with a timer. Computer programs are available for this or you may use a simple kitchen timer.
  • Reward yourself when you reach a goal.
  • Use an automated computer scheduler to set meeting times. These usually come with an alarm. Set it alert you five to ten minutes before each meeting.
  • Allow adequate time between meetings or projects to you do not overload or overbook your schedule.
  • Partner with a co-worker who has good organizational skills. This person may act as your coach. The coach will help set goals and reward you as you achieve your goals.

Impulsivity – you respond, at times, without thinking of consequences, sometimes your respond with outbursts

  • Have a trusted co-worker provide constructive feedback about your interactions with other staff. This co-worker may also act as a personal coach to role-play appropriate responses to common office dynamics.
  • From this feedback, develop strategies to be used when you become frustrated.
  • Yoga and some martial arts classes may prove effective in teaching relaxation and concentration skills. A meditation class may be effective, too.

Procrastination – you put things off until the last minute sometimes frustrating or angering colleagues

  • Set goals for your current task by breaking it into a series of manageable tasks. Mark the deadline for each mini-task with a timer. Computer programs are available for this or you may use a simple kitchen timer. Reward yourself when you reach a goal.
  • Use an automated computer scheduler to set meeting times. These usually come with an alarm.
  • Partner with a co-worker who has good organizational skills. This person may act as your coach. The coach will help set project goals and reward you as you achieve your goals.

Hyperactivity – you find it very difficult to sit still during meetings or at your desk o Maximize your personal time like breaks, lunch, etc. to exercise and burn off some energy. This can include walking around the block or trips up and down the stairwell.

  • Break up your day to include trips to the mailroom, photocopier, fax, and restroom. o Bring a notepad to meetings and take copious notes.
  • A rubber band or paperclip in your free hand can provide stimulation while you take notes.

Daydreaming – when you find something boring you block out the stimuli and think of something more fun.

  • Remember, if you have a job you truly enjoy, you’ll find you’ll daydream less. o A job with challenging responsibilities will provide less opportunity for daydreaming than a job shuffling papers.
  • Set goals for your current task by breaking it into a series of manageable tasks. Mark the deadline for each mini-task with a timer. Computer programs are available for this or you may use a simple kitchen timer.
  • Reward yourself when you reach a goal.

Avoiding details – details like paperwork bore you and you find them virtually impossible to finish o Rule number one; if you can get someone else to do it properly (like an office assistant), let them handle paperwork.

  • Make filing more fun by color coding folders and using catchy labels. o Personalize your filing (sensibly) by using fun labels and folders – possibly color coded.
  • For paperwork that requires immediate attention have your filing system close at hand, perhaps directly on your desk

Poor social skills – your interactions with your colleagues are marked by your interruptions, blunt comments, or poor listening skills.

  • Have a trusted co-worker provide constructive feedback about your interactions with other staff. This co-worker may also act as a personal coach to role-play appropriate responses to common office dynamics.
  • Pay particular attention to social cues and work on them with a personal coach to develop awareness and appropriate response.
  • From this feedback, develop strategies to be used when you become frustrated.
  • Learn to pick up on social cues more readily. Some adults with ADHD have a hard time picking up nonverbal cues that they are angering a co-worker or supervisor.

Summary

A person with ADHD must develop skills and strategies that will enable him/her to function optimally in the workplace. Should skills and strategies fail, it may be necessary to switch careers after careful assessment of your work attributes and skills.