Learning Discoveries
Psychological Services

Rosemary Boon
Registered Psychologist
M.A.(Psych), Grad. Dip. Ed. Studies (Sch.Counsel),
Grad. Dip. Ed., B.Sc., MAPS, AACNEM.

Sydney (+61 2) 9637 9998
Sydney (+61 2) 9637 8799


P.O. Box 47
Harris Park NSW 2150

Neurofeedback (QEEG based)

ADHD, Learning Disorders and Other Conditions

What is Neurofeedback?

EEG Biofeedback (or neurofeedback) is a learning strategy that works to improve the brain's ability to produce certain brainwaves. You can think of it as exercise for the brain much like the way exercise works to strengthen muscles. When information about a person's own brainwave characteristics is made available to him/her, they can learn to change them. Neurofeedback instruments show the kind of waves a person is producing, making it possible for the individual to learn to change in ways to improve attention. It is essentially self-regulation training. It is ideally suited to those with ADHD and those with specific learning disabilities. The same training protocol is usually appropriate for both conditions.

Neurofeedback is based on the work of Professor M. Barry Sterman of the UCLA School of Medicine, Departments of Neurobiology and Behavioural Psychiatry. Professor Sterman recognised how brain function can be altered and normalised by operant conditioning of the EEG. QEEG and neurotherapy has been endorsed by the American Psychological Association as within the realm of psychologists with appropriate training. Neurotherapy training to decrease slow wave activity and increase fast, desynchronised EEG activity has been used for over twenty years to ameliorate ADHD and epilepsy and is well documented in scientific literature. More recently, EEG operant conditioning has been successfully applied to patients with miild traumatic brain injury. Since 1976, several hundred clinicians, most notably Dr Joel Lubar at the University of Tennessee, Susan and Seigfried Othmer (EEG Spectrum) and Len Ochs in California, have used neurofeedback to produce dramatic improvements in ADHD children. Clinicians report that more than 80% of hundreds of children they have treated using biofeedback have achieved significant improvements.

What are Brainwaves?

Brainwaves are the electrical wave patterns found in every person's brain. An electroencephalograph (EEG) is an instrument which can detect brainwaves and discern whether they are strong or weak (amplitude) or fast or slow (frequency). Scientists commonly identify brainwaves in four categories:-

Beta, the fastest brainwaves, above 13 cycles per second (or hertz). Focused day-to-day activities and focused attentiveness are carried out in this state.

Alpha, a slower brainwave, ranging from 8 to 12 hertz. This rhythm is characteristic of a relaxed yet alert state of awareness.

Theta, the next slower waves range from 4 to 8 hertz. This rhythm is often associated with dreamlike imagery, sleepiness and deep relaxation.

Delta, the slowest waves, from 0 to 4 hertz, predominates during dreamless sleep.

 What are the Characteristic EEG Patterns of ADHD?

Children with ADHD appear to be less able to produce Beta activity above 14 hertz and experience excessive slow wave activity especially in the Theta region from 4-8 hertz. In fact, when challenged with academic tests, such children show greater increases in Theta and decreased Beta from baseline readings. In order to concentrate and learn at peak performance, your brain needs to emit a high level of Beta waves. No wonder ADHD children have such trouble concentrating! A small percentage of ADHD children also exhibit excess high beta activity (greater than 23 Hz). It is these children who also have rumination, anxiety and sleep disorders.

 What about Assessment & Treatment?

The assessment procedure begins with the proper evaluation and/or review of previous evaluations to determine that the clinical picture is consistent with ADHD and usually involves a QEEG (quantitative electroencephalogram - computerised EEG evaluation). If this pattern is present, neurofeedback training proceeds. Through neurofeedback training it is possible to increase Beta and decrease Theta, allowing for more focused learning in most children.

Does Neurofeedback Training Cause Any Discomfort?

None at all! Sensors used in training are attached to your skin to detect outgoing information from the brain. Nothing enters you or your brain.

Can You Become Attached or Addicted to Neurofeedback?

No! The equipment is used to learn abilities which are independent of it. Individuals learn to voluntarily control their brainwave activity through operant conditioning.

How Long Does the Training Take?

Neurofeedback training typically takes 30-40 sessions depending on the severity of the disorder and other comorbid symptoms present. The first six sessions are completed as quickly as possible and then the frequency of training reduces to two or three times per week. With regular attendance, total training can be completed in four to six months. Each training session lasts approximately 30-45 minutes.

If regularly attended, promising changes are often observed around the 10th session.

What Are the Results?

Parents and teachers of children who receive neurofeedback training have reported dramatic behavioural improvements such as:-

 finishing tasks

 listening better

 less impulsivity

 greater motivation and focus

 higher self esteem

When children are successfully trained to increase SMR activity (12-15 Hz) they show decreased activity levels. When they are taught to increase 15-18 Hz (beta) and reduce slow wave theta activity (4-7 Hz), their attention span and ability to learn maths improves.

Over the past decade, several small controlled and moderately large clinical studies show that neurofeedback significantly helps children with ADHD who have problems with maths. EEG biofeedback training was rated as having an efficacy rating of 4 on a scale of 1-5 (with 5 being the best).

EEG biofeedback was shown to be as effective as Ritalin on numerous measures in two small studies conducted by clinicians Rossiter & LaVaque in 1995, and Fuchs, Birbaumer, et al, 2003. Alhambra et al in1995 demonstrated that 16 of 24 patients taking medication were able to lower their doses or discontinue medication totally after successful training.

Linden et al in1996 compared 16 children trained with neurofeedback to those on a waiting list. Results from parent behaviour rating scales indicated increased intelligence scores and a decrease in inattentive behaviours. This result confirmed the earlier findings of Lubar et al in 1995 who demonstrated an increase in intelligence scores and academic performance with successful neurofeedback training.

A larger study by Kaiser and Othmer (2000) with 1,089 ADHD clients with moderate pre-training deficits also showed that neurofeedback training of sensorimotor and beta waves led to significant improvement in attentiveness and impulse control. These positive changes were measured on the test of variables of attention (TOVA).

In 2002, Monastra, et al worked with 100 children taking Ritalin who also received academic support and whose parents were receiving counselling. Half of these children received EEG biofeedback. Results on the TOVA and an ADD evaluation scale indicated similar improvements to the previous studies . Only those children who had completed neurofeedback training were able to sustain their improvements without Ritalin.

How Long Do the Results from Training Last?

Long term follow up of adults who, as children, received neurofeedback training for ADHD indicates that, in most cases, the improvement appears to be permanent. A follow up at six months is recommended for those who undertake the training.

What other Conditions Can Be Treated with Neurofeedback?

Neurofeedback has a wide application including:

 Specific Learning Disabilities
Anxiety and Panic Attacks
Post Traumatic Stress Disorder
Asperger's Syndrome
Tourette's Syndrome
Chronic Fatigue Syndrome
Sleep Disorders
Chronic Pain

Epilepsy - see the article on epilepsy

What Does Training Accomplish?

Essentially three tasks:-

(1) it enhances the ability of the individual to access and maintain different states of physiological arousal

(2) it enhances and supports the mechanisms by which the brain manages cortical hyperexcitability

(3) it reinforces equilibrium states i.e. homeostasis/allostasis

Thus, neurofeedback training can be seen as education of the brain - i.e. harnessing the brain's intrinsic ability to learn about itself!

What is EEG Biofeedback Training all about?

Answers for Children & Adolescents

From an article by Sue and Seigfried Othmer - EEG Spectrum

 Do you sometimes have the experience of working through a problem, and you just lose your thought?

 Does it seem like your brain is changing channels on you?

 Do you know the feeling of wanting to listen to somebody, but pretty soon you catch yourself thinking about something else?

 Have you ever experienced wanting to follow through on a project, but one thing or another keeps distracting you?

 Have you been criticised for doing something and you don't remember doing it?

 Are you sometimes bothered by your own behaviour?

 Do you think the way others judge you is unfair?

Your brain is part of who you are, but sometimes it may seem like your brain has a mind of its own. Sometimes your brain doesn't do what you want it to. Perhaps you and your parents/teachers have never thought about it in those terms. When people complain about your behaviour, or your inattention, they are talking to you, and blaming you. They are not saying, perhaps your brain is not functioning well today.

However, scientists today are discovering ways of seeing the brain in action when it is working on a problem. And we can see differences when some brains have problems with learning disabilities, with paying attention, with behaviour etc. By putting electrodes on the scalp, we can listen to the electrical activity of the brain. This is called the "electroencephalogram" or EEG. The electrical noise the brain puts out can tell us how well it is working. Much of the brain's activity is rhythmic, like music, or like waves on the ocean. And just as the ocean has rough and quiet times so the brain also shows us rough (difficult) and easy times. With a little feedback to the brain we can begin to train the brain to calm the rough seas and work more smoothly.

What is feedback all about?

Apart from all the other things the brain has to do, it also has to watch itself do it. It has to pay attention to itself, and control itself. This is called internal feedback. We can now add external feedback loops which tell the brain how it is doing.

Your brain can be taught to raise the temperature of your hand. This is called biofeedback. If we give the brain feedback on its own electrical activity, we call it EEG biofeedback or neurofeedback. With EEG biofeedback your brain can learn to control itself better.

EEG biofeedback is being used by clinicians and scientists to help with a variety of conditions such as attention, learning and behaviour problems. However, there is still more research needed to answer questions like what distinguishes those who benefit from training; what changes really take place in the brain as a result of training; what are the long term benefits of training; how does this training compare to the effects of medication for certain conditions. This training is offered on the basis of past work where results have shown that it has helped children with their homework, do better in sports and improve their relationships with family and friends. It is also recognised that children have problems today that will not wait until researchers have sorted everything out.

Training is guided along the way based on the results that we get. We need to work out the best kind of training to do for each person. Since our brain has two hemispheres, or halves, and because they function differently, we have to train them differently, and then we have to train them to talk to each other more easily. Everyone may be just a little different to everyone else, and we have to work that out too.

Testing will be done at the outset, and throughout the training process in order to monitor progress in the training. Other testing or referral to other specialists may be necessary to guide the training and to achieve the maximum benefits. You will probably have lots of questions as you go through training. Please feel free to ask them at any point as the training works best if you know what it is all about, and if it has your full commitment and interest.

The training won't feel like work to you, but your brain will be working all along trying to figure things out. Your part is to pay attention to the process as best you can, and that may not be easy for you. It helps if you care about the results. The program is about making your brain function better for you, so that some of the things that are difficult for you now will function better in auto-pilot mode. This program is something you can do for yourself. No one can make you do it, or make you care. That has to come from you. But if you go through the program, I believe that you will benefit from it over the long term, and in fact you may just end up being very proud of what you have achieved.

What can you expect to get out of the training?

You are the captain of a sort of team--- namely all of the mental and emotional resources that your brain possesses. This training is about making you a better captain, and also about making all the players on the team know their jobs and be able to cooperate better. Whilst in most children with learning, attention and behaviour problems, all the different players on the team are by themselves capable, it is the working together and the interaction that isn't going well. This training is about getting the internal teamwork going.

When the brain is trained and functional, it doesn't have to worry about getting things done. Things simply get done. For example, if you ride a bicycle well, you don't even have to think about what to do while you are riding. You do it automatically.

So, brainwave training, as EEG Biofeedback is also called, is about making a better auto-pilot.

Things need to run on automatic pilot. You shouldn't have to work at paying attention; you shouldn't have to strain at reading; you shouldn't have to force yourself to be interested in something. If your brain works well, then these things should take care of themselves. However, you have lived with your brain all your life, and you may not be aware that what is hard for you may be easy for lots of other people. It may seem almost unfair that when your brain is working well, it is also not working very hard. Success in this training should mean that the hard things get easier for you.

Putting things into auto-pilot mode is also important because the brain has to take care of many things at once. For example, while you work on a maths problem in class, you can still be attentive for the moment when the teacher wants your attention back. So, the more we can make things easier for your brain to handle, and the more we can put things into auto-pilot mode, the more your brain can pay attention at the higher levels to what is really important.

In summary then, this training can be very important for your future. We are talking about the brain you will be depending upon for the rest of your life.

 See the extensive reference list on the Links Page

 Read the Jay Gunkleman article on QEEG Neurofeedback

For further information or appointments for assessment please contact:

Rosemary Boon Registered Psychologist
M.A.(Psych), Grad. Dip. Ed. Studies (Sch.Counsel),
Grad. Dip. Ed., B.Sc., MAPS, AACNEM.

Learning Discoveries
Psychological Services

Sydney (+61 2) 9637 9998
Sydney (+61 2) 9637 8799


P.O. Box 47
Harris Park NSW 2150