In the growing controversy about how best to treat kids with attention deficit disorders, neurofeedback emerges as an alternative to psychotropic drugs - albeit a controversial one.
Wired for Attention
Picture being able to win a video game like Pac Man using your brain - not your hand - to control the joystick. It's not a game of telepathy; the exercise really works. Some kids, and even some adults, do it several times a week.
It's all part of a kind of therapy known as neurofeedback, an increasingly popular and controversial non-medical treatment for individuals with neurological conditions such as Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder. And while the treatment has been heralded by some as an alternative to stimulants like Ritalin and Adderall, it is viewed skeptically by others because the long-term benefits of neurofeedback have not yet been proven in clinical trials.
Here's how it works: A patient stares at a computer screen while electrodes attached to an ear lobe and scalp measure brain-wave activity. The more activity the better; it means the brain is concentrating. The idea is to get the individual to learn how to control movements on the screen using only his brain. When this happens a beep sounds, indicating a boost in the higher-level brain waves called beta waves and a decrease in the lower type called theta waves. If the patient stays focused he scores points but if he drifts off, his score stays the same.
Some say the technology and methods used in neurofeedback can be applied to everyone from athletes to the elderly to increase physical performance levels and mental acuity. There is even an attempt by entrepreneurs to seemingly bypass medical professionals to combine neurofeedback with hip concepts for interactive software. At the core of it all is the child or adult struggling to learn how it might be possible to control a thing like brain waves.
The National Institutes of Health estimates between 3 to 5 percent 2 million kids daily take prescribed drugs at school. Psychotropic medication like Ritalin and Adderall is not factored out from other medications prescribed for conditions like asthma or diabetes. Still, teachers, medical health professionals and parents agree psychotropic use for ADD/ADHD is more widespread than ever, comprising most of the daily medicine doses administered in schools. It's common for kids to hop off the bus and head straight to the nurse's office to get their meds.
Throughout the 1999-2000 school year, Richmond City Public Schools administered a total of 135,786 doses of medicine to all school-age kids in kindergarten through grade 12. In Chesterfield County last year, 4.8 percent of nearly 51,000 children took some kind of medication while at school. Henrico County Schools, like Richmond's, track medication rates by the total number of doses school nurses dole out. Last year's totals weren't readily available. "It's our job," says Frona Colker, supervisor of health services for Henrico County Public Schools, to make sure the kids get the medicine prescribed to them and to look out for possible side effects. "You read in the literature that there's more medicated kids, but it's only a problem if they miss minutes from class. I don't think it's our call to recommend changes," says Colker.
But Dr. Steven Butnik, Ph.D., a licensed clinical psychologist with Dominion Behavioral Healthcare, hopes changes come soon - at least in how ADD/ADHD is diagnosed, monitored and treated. "Sadly, if you look at the number of primary care physicians making [ADD/ADHD] diagnoses, many are not being properly assessed." It's this that Butnik and others say has helped create a school climate of kids too quickly placed on psychotropic drugs. Neurofeedback, he says, is not a stand-alone treatment for attention deficit disorders. Still, because it's non-invasive and because it reinforces positive focusing, Butnik maintains that neurofeedback appears safer and its results are believed to last longer than those produced by psychotropic medication.
Butnik is one of only a handful among Richmond's medical professionals using neurofeedback as a means of ADD/ADHD treatment. He's so committed to its results, he's starting a new clinical practice this January called Addvantage. He says it will deal primarily with neurofeedback as a component in ADD/ADHD treatment. "When I looked at it eight years ago it seemed too good to be true," says Butnik. Back then, he says, clinicians placed neurofeedback in the same category as homeopathy. Even so, Butnik became intrigued with the alternative treatment after studying the findings of University of Tennessee scholar Dr. Joel Lubar. He found patient concentration levels consistently increased after multiple neurofeedback sessions, often decreasing the patient's need for medication or altering significantly the needed dosage level. "It teaches the brain how to better conduct itself," says Butnik, who says 50 to 70 percent of patients who go through neurofeedback go off medication or require less to get the same results.
Butnik has used neurofeedback in the ADD/ADHD treatment of more than 25 patients and says 75 to 90 percent have shown significant improvement. "Practically speaking, they get their homework done. We're showing people what's going on in the brain so they can better regulate it themselves. It also provides a working definition of attention and concentration," he says. "How does a seven or eight year-old know how to concentrate?"
Neurofeedback requires multiple sessions - anywhere from 30 to 60 one-hour sessions that cost $80 to $100 each. The treatment is not usually covered by insurance companies. But Dr. Roger de Beus of Riverside Neurotherapy Health Systems in Newport News says that could change as early as next year. Legislation sponsored by Del. Alan Diamonstein of the 94th District in Newport News could force insurance companies to cover mental health care treatments such as neurofeedback more comprehensively. "We're working on the legislation because neurofeedback is a very, very viable means of treating ADHD," says de Beus.
But not everyone is as convinced of neurofeedback's success. As a clinician, Dr. Bela Sood, associate professor of psychiatry and director of training in child psychiatry at VCU's Medical College of Virginia is also the director of MCV's Attention Deficit Disorder Clinic. Sood says she was naturally curious about neurofeedback or EEG biofeedback, as she refers to it. "You're always looking for new effective treatments." But after studying literature on neurofeedback dating back to 1956, Sood says she isn't sold on the idea. "It's very clear that the mainstream ignored it as a tool. That's why I became very interested in seeing why. There are flaws in the methodologies."
In order for Sood to recommend neurofeedback to her patients, she says she must have more empirical proof that it works. And that means more studies, longer studies, more controlled studies - and conclusive findings. Sood says parents and kids are likely to believe that personal experience represents a more generalized truth. "If it's happened to my child I become a believer. But that doesn't mean it's based on scientific evidence." Ultimately, she says, it's every clinician's aim to explore all possible treatments for disease. "If this turns out as a great method of treatment - great! Show me the proof and then I'll buy into