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Attention and Concentration Problems

Attention and Concentration Problems:  Biofeedback and Neurofeedback as Alternative  Therapies for Helping Your Kids Perform Better in School, Sports, and Life

ADD ADHD BiofeedbackFew of us have gone an entire day without hearing a commercial for neurofeedback training as an alternative to medication for children’s attention and concentration problems.  For parents who are fearful about the lack of long-term research about the effects of medications, especially stimulants, on their children’s brain, the idea that a non-drug treatment could impact their child’s attention and concentration problems is highly appealing.  However, there are also questions about whether or not neurofeedback works,  how much it costs, how long it takes, and whether or not there are any negative effects of the treatment.

Neurofeedback has its roots in electroencephalography (EEG), which is technology that allows us to measure different types of electrical activity in the brain.  EEGs have proven very useful in diagnosing brain disorders such as epilepsy.  Interesting sidelines such as the fact that our brain wave patterns change several times a night while we sleep have led to developments in sleep research and improvements in our thinking about the importance of Rapid Eye Movement (REM) sleep in the daily restoration of vital chemicals in our brains.  In fact, I will devote the next article in this series to sleep research, and its implications for treating various other disorders related to trauma and mood problems.

For this article, let us begin by noting that the brain produces electrical waves, we have methods of measuring these waves, and various patterns of brain electrical activity are  more productive when associated with different kinds of activites.  For example, initial research indicated that, if we are relaxed, then our brain is more likely to produce Alpha waves (8-12 Hz).  Subsequent research has indicated that Alpha waves are generated for different reasons by different parts of the brain, and that the location of the electrodes that monitor the Alpha waves may be critical in determining how important they are both in relaxation and in various stages of sleep.  Let’s keep it simple for our purposes here and conclude that some patterns of brain waves are more associated with relaxation than others. Thus, if we can train our brains to produce these waves that are associated with the relaxed state, then we can increase our ability to deal with the stress and tension in our lives by manufacturing our own mental and, eventually, physical relaxation.

Similarly, if we are doing work that requires a lot of attention and concentration, then brain activity in the 12-18 Hz range, often called Sensorimotor Rhythm (SMR), waves are generally found to predominate.  Again, if we could learn to produce these waves, then it follows that our attention and concentration should improve.  This is the underlying rationale for neurofeedback.  The student learns to control the brain waves to increase their attention and concentration.  It sounds like a simple solution to a very complex problem, and one wonders why everyone does not try this before they prescribe medication for a child who is having attention or concentration problems.

The three answers that I have gotten most often when attempting to answer why not biofeedback or neurofeedback before medication are cost, time, and the newness or lack of understanding about neurofeedback.  As mentioned above, there are few long-term studies of the effects of medication, especially stimulant medication, on the developing brain.  However, neurofeedback is even newer on the scene than medication, and insurance companies are often more willing to pay for medication, which is perceived as a tried-and-true treatment and/or remedy than they are to pay for neurofeedback, which seems to be the new kid on the block, treatment-wise, and thus gets assigned to the “experimental” category, which translates into “we won’t pay for it.”

In terms of cost, most neurofeedback sessions cost between $50 and $100 per hour or more, and the patient is often told that it will probably take as many as twenty to forty sessions to learn the techniques well enough to impact the child’s attention problems and make a difference in his or her school performance.  However, even if this becomes an “out of pocket” expenditure, is the peace-of-mind that comes with not having to give your child medication worth the money?  Of course it is.

Perhaps a preliminary evaluation of the child’s brain wave pattern during various activities could somehow allow us to predict whether or not they would be a good candidate for neurofeedback.  According to Michael Linden, Ph.D., of the Attention Learning Centers in San Juan Capistrano, CA, there are such patterns that help to predict who is more likely to profit from neurofeedback training.  My own review of the literature indicates that children who are more of an attention problem, without the added complication of hyperactivity, are more likely to profit from neurofeedback training.

However, the hyperactive children may profit from biofeedback training, which would allow them to learn more control of their voluntary musculature, which could result in their becoming more in control of their ability to remain seated, less impulsive, and to do better in classroom settings.

Neurofeedback and biofeedback have also been used to help athletes achieve peak performance in various sports by learning to increase their focus.  Biofeedback techniques have been used to record muscle tension levels simultaneous at over 30 sites in the body during a golf swing, for example, in order to allow the person being evaluated to see in very precise terms how their muscle tension at various parts of their swing mirrors or differs from those same muscles on PGA touring pros during their swing.  Arizona State University golfers have used mobile EEG neurofeedback devices while practicing their putting in order to improve their performance during tournament rounds (see Crews, D.L., 1989). In fact, Dr. Linden (mentioned above) and his colleague, Dr. Ben Strack, have co-edited a book titled [amazon_link id=”098429791X” target=”_blank” container=”” container_class=”” ]Biofeedback and Neurofeedback Applications in Sports Psychology [/amazon_link]that highlights and details a number of similar uses in sports.

In brief, then, neurofeedback and biofeedback appear to have been well-documented as effective techniques for a number of people with a number of problems, especially in the areas of improving attention, concentration, and enhancing performance, in general. Biofeedback and neurofeedback also appear to have no negative side- or after-effects, and there is a lot of potential upside with both.  If you can get past the time and the expense, they appear to be a good way to approach attention and concentration problems, as well as helping your child reach peak performance in a number of other areas.  If the time and expense are formidable roadblocks, consider taking your child for an initial evaluation in order to get an impression of how much their brain’s electrical activity differs from that of “normal” control groups, i.e., kids who do not present with attention or concentration problems.  Perhaps things will change in the future, and insurance will become more receptive to paying for neurofeedback more often, or market factors will help to bring the cost down to make it more affordable for everyone.

One more example of biofeedback is the use of simple temperature biofeedback provided by a stress indicator card.  Dr Bob Myers uses this technique in his Total Focus program for kids with ADHD.  He uses this biofeedback technique combined with relaxation training and guided imagery to help kids improve concentration, attention, emotional regulation and self-esteem.