Attention Deficit/Hyperactivity Disorder (ADHD) can manifest in many ways, but typically includes a combination of problems with inattention or selective attention, distractibility, impulsivity, and hyperactivity. While, ADHD is most commonly diagnosed in childhood, it can persist throughout adulthood and affect people of all ages. Individuals with ADHD may struggle with things like organization, maintaining focus, restlessness, and estimating consequences, both in their career/school as well as their personal lives.
These individuals often show measurable differences in brain activity, which may underlie their symptoms. As such, neurotherapy can be helpful for adapting these underlying brainwave patterns and naturally alleviating symptoms. In fact, over 130 studies have examined neurotherapy as an intervention for ADHD, and most have shown medium to very large improvements in inattention and impulsivity/hyperactivity.
Getting to the roots
A number of structural and functional differences have been observed in the brains of individuals with ADHD. Although a variety of factors influence how it show up in each individual’s brain, some of the most common patterns include:
High Theta/Beta Ratio
- QEEG data has frequently observed an excess of theta (4-7 Hz) and a deficiency of beta (13-30 Hz) brainwaves, especially in the central and frontal regions of the brain. These regions play a role in attention, behavior, impulse-control, decision-making, and emotional regulation; as such, an excess of slower brainwaves and/or deficiency of faster brainwaves can make these function more challenging.
Decreased Cortical Thickness and Slowing of Cortical Activity
- The cortex refers to the thin, outermost layer of the brain and is made up of gray matter. Brains of those with ADHD commonly show a decrease in the thickness of this cortex, particularly in networks related to attention, cognition, and motor control. One such network, involving the anterior cingulate cortex, is involved motivation and staying on task. Cortical thinning and slowing within the anterior cingulate can contribute to difficulties with behavioral control and task-related attention.
Dysregulation in Neurotransmitter Systems
- Neurotransmitters are the brain’s chemical messengers and are thought to play a role in many disorders. With ADHD, scientists have noticed atypical activity of both dopamine and norepinephrine, which are responsible for alertness, attention, motivation, and reward estimation.
Altered Communication Between Brain Areas
- When electrical and chemical activity are altered, this in turn alters communication patterns within the brain. Various parts of the brain need to be able to communicate effectively with one another in order to complete complex processes. In cases of ADHD, the brain’s communication pathways can short-circuit or misfire, making many tasks more difficult.
How we can help
At NeuroGrove, the first step of any treatment package is a comprehensive assessment that includes QEEG brain mapping, LORETA 3D neuroimaging, a psychophysiological assessment, neurocognitive testing, and a thorough discussion of symptoms, history, and goals. This allows us to assess for the brain patterns most commonly associated with ADHD as well as other variables that could be contributing to these imbalances.
From there, both neurofeedback and neurostimulation can be used to adapt brainwave activity in the necessary directions (e.g., decrease theta in the frontal cortex), alter neurotransmitters, and improve communication between regions to help the brain achieve optimal functioning.
Pairing neurotherapy with other NeuroGrove services can further enhance the effectiveness of these interventions and support overall brain-body wellness. For example, peripheral biofeedback can be utilized to teach stress reduction skills, improve the ability to be still, and balance the nervous system.
Functional medicine and personalized nutrition can also be utilized to assess for chemical imbalances, digestive issues, or nutritional factors that could be exacerbating symptoms. We will then meet you/your child where you/they are with these services to help implement feasible and appropriate diet and lifestyle changes. Our integrative psychotherapy services can also support the implementation of such changes, as well as provide additional coping skills, strategies, and emotional support.
What the research says
To date, there have been over 130 studies examining the effectiveness of neurotherapy as an intervention for ADHD. Such extensive research has led to a better understanding of the cortical mechanisms related to ADHD as well as a large volume of evidence supporting the efficacy of using neurotherapy and integrative modalities to treat ADHD. Overall, the research suggests that neurotherapy can help to balance out the brain’s electrical activity and improve communication between various brain regions, which in turn reduces symptoms like distractibility, impulsivity, inattention, and hyperactivity. For a few examples:
In 2009, researchers completed a meta-analysis of studies on neurofeedback as a treatment for ADHD that measured changes with impulsivitiy, inattention, and hyperactivity (Arns, de Ridder, Strehl, Breteler, & Coenen). The outcomes showed that neurofeedback as a treatment for ADHD meets the qualifying criteria for the classification of “efficacious and specific”. Overall effect sizes were large for categories of inattention and impulsivity and medium for hyperactivity.
Another study (Mohagheghi et al., 2017) compared the efficacy of two different neurofeedback protocols (theta suppression/alpha enhancement vs. theta suppression/beta enhancement) in sixty children with ADHD aged 7-10 years old. Results showed that both protocols significantly alleviated general ADHD symptoms, as well as hyperactivity, inattention, and omission errors, although the alpha-enhancing protocol showed greater suppression of omission errors. These effects were also maintained at the 8-week follow-up assessment.
A study by Bazanova, Auer, and Sapina (2018) revealed the importance of personalized neurotherapy for ADHD, showing that an individualized neurofeedback training paired with EMG biofeedback produced superior clinical results when compared to a standardized protocol or individualized neurofeedback alone. The combined, individualized group also showed the most sustained changes in alpha brainwave activity at the 6-month follow-up.
A study by Levesque et al. (2006) showed improved functioning in regions related to attention, including the right anterior cingulate cortex, left caudate, and left substantia nigra during a task following neurofeedback training. Baumeister et al. (2016) also found significantly increased activation within an extensive inhibitory network (e.g. right anterior insula, right caudate, right dorsolateral prefrontal cortex, etc.) after neurofeeback training.
For more research studies on this topic, please see our Research page.
Arns, M., de Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity, a meta-analysis. Clinical EEG and Neuroscience, 40(3), 180–189.
Baumeister, S., Wolf, I., Holz, N., Boecker-Schlier, R., Adamo, N., Holtmann, M., … Brandeis, D. (2016). Neurofeedback training effects on inhibitory brain activation in ADHD: A matter of learning? Neuroscience. https://doi.org/10.1016/j.neuroscience.2016.09.025
Bazanova, O. M., Auer, T., & Sapina, E. A. (2018). On the efficiency of Individualized theta/beta ratio neurofeedback combined with forehead EMG training in ADHD children. Frontiers in Human Neuroscience, 12, 3. https://doi.org/10.3389/fnhum.2018.00003
Lévesque, J., Beauregard, M., & Mensour, B. (2006). Effect of neurofeedback training on the neural substrates of selective attention in children with attention-deficit/hyperactivity disorder: a functional magnetic resonance imaging study. Neuroscience Letters, 394(3), 216–221. https://doi.org/10.1016/j.neulet.2005.10.100
Mohagheghi, A., Amiri, S., Moghaddasi Bonab, N., Chalabianloo, G., Noorazar, S. G., Tabatabaei, S. M., & Farhang, S. (2017). A randomized trial comparing the efficacy of two neurofeedback protocols for treatment of clinical and cognitive symptoms of ADHD: Theta suppression/beta enhancement and theta suppression/alpha enhancement. BioMed Research International, 1–7. https://doi.org/10.1155/2017/3513281