Neurofeedback - Out of Focus

In Dr. Gary Schummer’s Torrance office, a young boy sits quietly in a small cubicle, playing a video game that looks a lot like the old Pac man game from the 1980’s. As Pac man eats his way around a maze, the boy racks up an increasing number of points on the screen. It’s not particularly interesting to watch until you notice that the boy isn’t using a mouse or joystick to control the game. In fact, he doesn’t seem to be doing anything but staring intently at the screen deep in thought.  “He’s using his brain to control the action,” Schummer explains.

The psychologist has attached electrodes to both sides of the boy’s head, just above the ears. The electrodes in turn, are connected by long wires to the back of the computer.   On a nearby monitor, Schummer examines a series of squiggly lines that represent the boy’s brainwaves. As the game progresses, the beta waves increase and the theta waves decrease.  Welcome to the 21^st century treatment for Attention Deficit Disorder.

Medical research studies have identified ADD as one of the most pervasive mental disorders in the U.S., affecting between 4 and 12 percent of the population. The most common symptoms include poor sustained attention to tasks, impaired impulse control, and excessive activity and restlessness. The symptoms commonly occur before the age of 7, persist for at least six months, and create difficulties in at least two areas of a person’s life, such as work, home, school, or social settings.

Children with ADD often have difficulties at home, at school, and on the playground. Until recently the disorder was seldom diagnosed, and seldom treated as a health condition. Schummer, who has ADD himself, remembers his own frustrating experiences as a child in the 1950’s.  “I failed the second and fifth grades. I had problems with behavior. My desk was always placed over to the side of the room. I was always in trouble, I got sent to the principal’s office a lot,” he said. “I was taken out of Catholic school and sent to a public school. Years ago they looked on kids with ADD as being lazy and oppositional. It affects you self-esteem profoundly.”

Children with ADD are not lazy. And, contrary to myth, they’re not slow learners. In fact, many ADD sufferers, such as Dr. Schummer, are highly gifted, creative, and intelligent. “These are people who never colored within the lines,” Schummer explained. “We’re the people who think outside of the box.”

That kind of thinking has led Dr. Schummer to create a practice that’s almost exclusively dedicated to helping children with ADD. It’s a practice that relies on the cutting edge of treatment-a process called neurofeedback.  Neurofeedback, also known as EEG biofeedback, is a learning strategy that enables people to alter and regulate their brainwaves. The children hooked up to the machines in Schummer’s office don’t think of it as a medical treatment. They’re just playing Pac man, racing rocket ships, and driving sports cars.

But as they play, the computer program guides them through a series of exercises that helps them activate certain brainwaves. Over time, these exercises can have profound effects on their ability to concentrate and focus.  Schummer is convinced of the effectiveness of neurofeedback.      “We can train the brain to perform normally,” he said. “I have kids who come back years later and say that it changed their life. It allowed them to feel successful in the classroom for the first time in their life. It allowed them to feel competent. Kids who didn’t believe college was on the horizon know have a new perception of what’s possible for them.”

Social skills improve as well.   “Kids with ADD don’t pick up on social cues,” Schummer said. “As they miss cues, they get bad feedback and become the black sheep of the class. They get picked on and ridiculed. After treatment, they start making more friends and having friends over and getting invited to parties. From a child’s perspective that’s more important than going from a D student to a B student.”

Increasingly, research studies are documenting the benefits of neurofeedback, especially for people who have failed to benefit from traditional therapies, such as the medication Ritalin. In a recent study of nearly 1100 adults and children with ADD and other attention and behavior disorders, Drs. Siegfried Othmer and David Kaiser found that 85% improved after 20 neurofeedback sessions. The greatest improvements occurred in those who had the worst scores on a test of attentiveness and impulse control at the beginning of the study.

Schummer generally prescribes between 40 and 50 neurofeedback sessions for patients with mild ADD. Patients with severe cases may receive as many as 200 sessions. As he often combines neurofeedback with other therapies such as breathing techniques and relaxation exercises, results vary from subtle changes in behavior to dramatic improvement.  “But we get some improvement with everyone we work with now,” Schummer said.  Neurofeedback works because ADD isn’t just a behavior problem, it’s a neurological impairment.

Neurofeedback works because ADD isn’t just a behavior problem, it’s a neurological impairment.  “You can’t just look at the person or observe their behavior to determine if they have ADD,” Schummer said. “You have to do testing. I use a behavioral rating scale, a structured clinical interview, test of sustained vigilance and an EEG to make a diagnosis.”  In many cases Schummer also orders brain imaging. “If a patient has ADD, there will be a signature impairment in their brainwave – a slowing of the brainwave.”

In fact, scientists at the National Institute of Mental Health have demonstrated a link between a person’s ability to pay continued attention and the level of activity in the brain.  As Schummer explains it, “When the brain speeds up, the hyperactive child calms down.”  These findings may revolutionize the way ADD is treated in coming years, moving patients away from the array of medications now used to treat the disorder.

The use of Ritalin, for example, has mushroomed in the past decade and now exceeds 11 million doses a year.  Still, most HMO’s and many insurance plans won’t cover the costs of neurofeedback, favoring a pharmacological approach to treatment. Until that changes, the promising therapy may remain a rare alternative treatment.

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