ADHD Contributions by Olivia Cerf

Neurofeedback is a form of biofeedback which uses either electroencephalograms or fMRIs to measure brain activity. Sensors are placed on the scalp in a noninvasive way to determine which types of waves the brain is producing and the ratio between the types of waves. There are many techniques of neurofeedback, also known as neurobiofeedback, neurotherapy, and EEG biofeedback. The basic structure is that brain activity is measured and displayed on a monitor. The patient is given tasks such as simple games or concentration challenges which affect the kinds of waves being produced. When brain waves change favorably, the patient hears a pleasing tone or other sensory reward.

Because only 60-75 % of ADHD cases respond to Ritalin treatment, and some parents and patients find the use of pharmaceutical treatment objectionable, it is important to study and develop alternative treatments of this common condition. Neurofeedback has been shown to have an effect comparable to Ritalin. ¹ Neurofeedback has been studied for the treatment of ADHD, epilepsy, autism, headaches, insomnia, anxiety, substance abuse, pain disorders, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), concussion and other illnesses and disorders of the mind and body.

Neurofeedback is a form of biofeedback which uses either electroencephalograms or fMRIs to measure brain activity. Sensors are placed on the scalp in a noninvasive way to determine which types of waves the brain is producing and the ratio between the types of waves. There are many techniques of neurofeedback, also known as neurobiofeedback, neurotherapy, and EEG biofeedback. The basic structure is that brain activity is measured and displayed on a monitor. The patient is given tasks such as simple games or concentration challenges which affect the kinds of waves being produced. When brain waves change favorably, the patient hears a pleasing tone or other sensory reward.

Because only 60-75 % of ADHD cases respond to Ritalin treatment, and some parents and patients find the use of pharmaceutical treatment objectionable, it is important to study and develop alternative treatments of this common condition. Neurofeedback has been shown to have an effect comparable to Ritalin. ¹ Neurofeedback has been studied for the treatment of ADHD, epilepsy, autism, headaches, insomnia, anxiety, substance abuse, pain disorders, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), concussion and other illnesses and and behavioral disordersdisorders of the mind and body.

A 2011 study compared the efficacy of methylphenidate (commonly known as Ritalin) and neurofeedback in the treatment of ADD/ADHD. Participants studied were 39 children with ADD/ADHD in three groups – one receiving methylphenidate, one receiving neurofeedback, and one receiving no treatment.

• Inattention and hyperactivity were improved by both treatments.
• Ritalin was found to be more effective than neurofeedback in improving the behavioral measures reported by parents in the SNAP IV behavioral questionnaire, one of the outcome measures of this study.
• Response inhibition, i.e. the suppression of

• behavior that is inappropriate to the environment, was improved in this study only in the group receiving neurofeedback.
• The average magnitude of the effect of treatment by all measures was greater in the methylphenidate group, but to such a slight degree that it was not statistically significant. ¹

A series of six case studies found that of the six patients, five students measurably improved in parent/teacher report and/or objective data in congruence with neurofeedback treatment. This improvement seemed to be related to the ratio between theta and beta waves. Of the six, one

After 7-10 neurofeedback sessions,

• One student was able to discontinue medication

• Four students reduced medication to half the original dosage.

• • Of these four, two maintained consistent success in stabilization of medication reductions,

• • Two with severe theta/beta ratios were inconsistent in measures and returned to two-thirds and original dosage levels. ²

ADHD is a disorder of neural regulation. Neurofeedback training assumes that neural deficiencies are amenable to change using behavioral methods.

The information gathered by both the technician therapist and the patient during neurofeedback sessions supports understanding of how emotions, thoughts, and behavior affect physiological wellbeing. This allows the patient to exercise, strengthen, and regulate the central nervous system.

Neurofeedback is a form of biofeedback which uses either electroencephalograms or functional MRIs fMRIs to measure brain activity. Sensors are placed on the scalp in a noninvasive way to determine which types of waves the brain is producing and the ratio between the types of waves. There are many techniques of neurofeedback, also known as neurobiofeedback, neurotherapy, and EEG biofeedback. The basic structure is that brain activity is measured and displayed on a monitor. The patient is given tasks like such as simple games or concentration challenges which affect the kinds of waves being produced. When brain waves change favorably, the patient hears a pleasing tone or other sensory reward.

Because only 60-75 % of ADHD cases respond to Ritalin treatment, and some parents and patients find the use of pharmaceutical treatment objectionable, it is important to study and develop alternative treatments of this common condition. Neurofeedback has been shown to have an effect comparable to Ritalin. ¹ Neurofeedback has been studied for the treatment of ADHD, epilepsy, autism, headaches, insomnia, anxiety, substance abuse, pain disorders, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), concussion and moreother illnesses and disorders of the mind and body.

¹ Nazari, Mohammad et al. “Effectiveness of EEG Biofeedback as Compared with Methylphenidate in the treatment of Attention-Deficit/Hyperactivity Disorder: A Clinical Outcome Study,” Neuroscience & Medicine 2, (2011): 78-86. doi:10.4236/nm.2011.22012 .

²Warwick, Shannon. “Six Case Studies Examining the Effectiveness of a Comprehensive Adaptive Approach to Neurofeedback for Attention Deficit in an Educational Setting,” www.zengar.com, 2000-2011, http://www.zengar.com/research.

A 2011 study compared the efficacy of methylphenidate (commonly known as Ritalin) and neurofeedback in the treatment of ADD/ADHD. Participants studied were 39 children with ADD/ADHD in three groups – one receiving methylphenidate, one receiving neurofeedback, and one receiving no treatment.

• Inattention and hyperactivity were improved by both treatments.
• Ritalin was found to be more effective than neurofeedback in improving the behavioral measures reported by parents in the SNAP IV behavioral questionnaire, one of the outcome measures of this study.
• Response inhibition, i.e. the suppression of behavior that is inappropriate to the environment, was improved in this study only in the group receiving neurofeedback.
• The average magnitude of the effect of treatment by all measures was greater in the methylphenidate group, but to such a slight degree that it was not statistically significant. ¹

A series of six case studies found that of the six patients, five measurably improved in parent/teacher report and/or objective data in congruence with neurofeedback treatment. This improvement seemed to be related to the ratio between theta and beta waves.

After 7-10 neurofeedback sessions,

• One student was able to discontinue medication
• Four students reduced medication to half the original dosage.
  • Of these four, two maintained consistent success in stabilization of medication reductions,
  • Two with severe theta/beta ratios were inconsistent in measures and returned to two-thirds and original dosage levels. ²

ADHD is a disorder of neural regulation. Neurofeedback training assumes that neural deficiencies are amenable to change using behavioral methods.

The information gathered by the therapist and the patient during neurofeedback sessions supports understanding of how emotions, thoughts, and behavior affect physiological wellbeing. This allows the patient to exercise, strengthen, and regulate the central nervous system.

r Neurofeedback is a form of biofeedback which uses either electroencephalograms or fMRIs to measure brain activity. Sensors are placed on the scalp in a noninvasive way to determine which types of waves the brain is producing and the ratio between the types of waves. There are many techniques of neurofeedback, also known as neurobiofeedback, neurotherapy, and EEG biofeedback. The basic structure is that brain activity is measured and displayed on a monitor. The patient is given tasks such as simple games or concentration challenges which affect the kinds of waves being produced. When brain waves change favorably, the patient hears a pleasing tone or other sensory reward.

Because only 60-75 % of ADHD cases respond to Ritalin treatment, and some parents and patients find the use of pharmaceutical treatment objectionable, it is important to study and develop alternative treatments of this common condition. Neurofeedback has been shown to have an effect comparable to Ritalin. ¹ Neurofeedback has been studied for the treatment of ADHD, epilepsy, autism, headaches, insomnia, anxiety, substance abuse, pain disorders, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), concussion and other illnesses and disorders of the mind and body.

Genetics

ADHD is strongly associated with genetics. One in four children with ADHD has a close relative with the disorder whereas, parents and siblings of ADHD kids are two to eight times more likely to develop the disorder themselves.¹ Molecular genetic studies have identified several genes that are believed to be associated with the disorder including those involved with the release, reuptake and transformation of dopamine and norepinephine. That said, of genes that have been identified, none have been found to have much effect, leading researchers to conclude that the disorder is likely linked to several.²

ADHD is believed to have a heritability rate of 76 percent. However, how much of the disorder is nature over nurture is questionable. Some researchers estimate that between 40 and 80 percent of the genetic variance for personality may be nature-based.³ Thus while ADHD has a strong genetic influence, environmental factors such as food additives, toxins and excessive stimulation play a significant in the disorder’s development and evolution.

Neurotransmission

ADHD symptoms are believed to be associated with what is known as the executive functions of the brain.⁴ Acting as a conductor, the executive functions prioritize, integrate and regulate the brain’s other cognitive processes such as planning, mental flexibility, abstract thinking, rule acquisition, initiating actions (both appropriate and inappropriate) and selecting relevant information.⁵ Non-localized, these executive functions are linked through a complex nerve network that communicates through neural transmission. A problem with the network of the chemicals used to send and receive messages can cause a breakdown in communication.

In his book Attention Deficit Disorder: The Unfocused Mind of Children and Adults, Thomas E. Brown suggests that ADHD is the result of a defunct network. Thus, even in the case where the individual has an ample supply of the chemical that fuel the system—neurotransmitters—messages still aren’t getting through. According to Brown, this conclusion is supported by more than 200 well-controlled medication studies that show that stimulants temporarily reestablish this circuitry:

The results from these many medication studies clearly indicate that ADD syndrome is essentially a chemical problem, specifically an impairment in the brain’s management system. Just as diabetes is a disease that reflects impairments in the body’s processing of insulin, ADD syndrome is a disorder that reflects impairments in the brain’s processing of dopamine and norepinephrine.⁶

Brain abnormalities

The brains of individuals diagnosed with ADHD are different than those in people without the disorder. One study showed that the brains of children with ADHD were slightly reduced, particularly in the prefrontal cortex on the left-hand side of the brain.⁷ Additional studies show abnormalities in the fiber pathways that connect the frontal lobes and the cerebellum.⁸ ADHD has also been linked to decreased levels of blood flow to the brain and low levels of cerebral glucose. In a 1990 study using proton emission topography (PET), researchers found that cerebral glucose metabolism was 8.1 percent lower in adults who had been diagnosed with ADHD as children than in normal adults.⁹ However, when the authors of this study repeated it three years later with adolescents, no significant differences were found between the “hyperactive” and “normal” brain.¹⁰

Diet

An exhaustive number of studies have linked ADHD to dietary factors such as low levels of essential fatty acids, mineral deficiencies, synthetic additives, food additives and refined sugar.

• Essential Fatty Acids (EFAs): EFAs play an important role in the development of the protective surface coating that insulates the nerve fibers. Indeed, dietary intake is directly related to EPA levels in the nerves. As early as 1981, researchers observed that children who were hyperactive, particularly boys, struggled to absorb and metabolize essential fatty acids. They also found that many of the foods that the hyperactive children reacted to contained substances blocked the conversion of EPAs to eicosanoids, the signaling molecules used in the regulation of the central nervous system. Additionally, EPA supplementation relieved many of their symptoms.¹¹ A great deal of research is now underway to verify the link between EPA supplementation and the reduction of ADHD symptoms.

• Mineral deficiencies: Children with ADHD have a greater propensity to be deficient in zinc, iron and magnesium.
  • Zinc is vital in the growth of the developing brain. In addition to helping maintain the ongoing functioning of the brain, it plays a role in the production and modulation of serotonin and the metabolizing of dopamine. In a paper summarizing the finding of nine zinc studies conducted around the world, the authors found that not only were children more likely to be low in zinc but lower zinc levels also correlated to the severity of their symptoms.¹² High Fructose Corn Syrup consumption also results in lowered zinc levels.
  • Important for the structure and function of the central nervous system, iron plays a role in neurotransmission and is associated with cognitive development. Studies show that not only are children with ADHD more likely to be low in iron but that the severity of their symptoms correlated to lower iron levels. Iron deficiency is also linked to a higher rate of absorption of lead and restless leg syndrome.¹³
  • Suboptimal levels of magnesium have been linked to reduced energy metabolism, synaptic nerve cell signaling and cerebral blood flow. Several studies have linked children to low levels of magnesium.¹⁴

• Food allergies, additives, preservatives and dyes: The link between ADHD and food intolerance remains controversial. In 1982, the U.S. National Institute of Health concluded that elimination diets helped just 5 percent of children diagnosed with ADHD. However, more recent studies suggest that children’s reactions to certain foods and additives may be more pronounced.¹⁵ Additional, Dr. Benjamin Feingold has shown that 50 percent of hyperactive respond favorably to his elimination diet which recommends eating only those foods free of artificial flavors, dyes, preservatives and salicylates (a commonly used preservative derived from salicylic acid).¹⁶

• Refined sugars: The role of refined sugars in ADHD is hotly debated. Whereas numerous studies show no connection between the consumption of refined sugars and behavior, one study showed that children with ADHD are more likely to be hypoglycemic. In a study of 261 children, 74 percent were found to have abnormal levels of glucose tolerance.¹⁷ Metabolically, these children’s pancreases’ were releasing an abnormal amount of insulin to metabolize the sugar. As a result, their high insulin levels caused their epinephrine and norepinephrine levels to spike resulting in ADHD-like symptoms. While void in nutrients, sugar calls on a number of nutrients in its processing. Thus, sugar may play an indirect role in ADHD by robbing the body of the nutrients needed to support the cognitive functions of the brain.¹⁸

Perinatal/Neonatal Factors

Children born to women who smoke or drank during their pregnancy may be at risk of developing ADHD. Additional perinatal risks include moderate-to-severe physical illness during gestation, symptoms of miscarriage and/or premature delivery and respiratory infections. ADHD has also been linked to a number of issues related to a child’s birth and first month of life. Premature babies are at a greater risk of developing ADHD as are infants who suffer from seizures, decreased levels of oxygen to the brain, mild speech retardation, brain injuries and fever. Finally, studies show that infants who are exposed to lead or manganese and/or are weaned prior to three months are at a higher risk for ADHD.¹⁹

Thyroid Dysfunction

Thyroid hormones are vital to the regulation of nerve maturation. Research shows that roughly 50 to 70 percent of children who are resistant to thyroid hormones have ADHD. Similarly, studies showed that the offspring of rats that had hypothyroidism were more likely to be hyperactive and restless, and prone to panic. (Hypothyroidism is when the thyroid fails to make enough hormones.) Similarly, in a study comparing the children born to women from “moderately iodine deficient” versus “marginally iodine deficient” areas at the time of gestation underscores the critical role of the thyroid of warding off the symptoms of ADHD. The study showed that whereas none of the children bore to the mothers living in the marginally iodine sufficient area developed ADHD, a total of 68.7 percent of children born to the mothers from the moderately iodine deficient area did.²⁰

Trauma

Children with ADHD are more likely to be abused than children without the disorder. According to Thomas E. Brown, author of Attention Deficit Disorder: The Unfocused Mind in Children and Adults, children with ADHD may be more at risk of emotional and/or physical abuse from fed-up friends and family members. In a study of girls with ADHD, a significantly higher number reported having been abused than those in the control groups.²¹ Similarly, researchers found that a greater number of children living in conflict zones such as the Gaza Strip were more likely to have ADHD than those living in areas free of conflict.²² Research shows that abuse is also more prevalent in ADHD adults. In a controlled study of 57 adults, emotional abuse and neglect was more common among the ADHD adults whereas sexual abuse and neglect was more common among the women with the disorder.²³

Societal

A fair amount of evidence suggests that ADHD is a manufactured diagnosis. Child and adolescent psychiatrist Dr. Sami Timimi points out that there is no known cause for ADHD and there exists no specific cognitive, medical and/or neurological markers for diagnosing it. In addition, there is no specific treatment for ADHD and stimulation medication has been said to have the same effect on otherwise normal children. Finally, stimulation medication has generated huge profits for the pharmaceutical industry. “Thus the mainstream dogma on ADHD is contaminated and misleading.” Under the current medical model, ADHD becomes a convenient scapegoat for parents and teachers to shirk from their responsibilities as caretakers and for the community members to disregard societal flaws such as the loss of the extended family, the pressure on schools, the breakdown in the moral authority of adults and increasingly frenetic pace of family life.²⁴

Mercury levels are exposure is among the most commonly cited environmental factors that can contribute to ADD and ADHD, and can also contribute to autism. Mercury is a biproduct of many industrial and waste plants and is can cause individuals problems in functioning including attention deficit disorders.

Often cited in fish, foods with high mercury levels should be avoided so as not to consume too much mercury. Ironically, low levels of omega 3 fatty acids can also contribute to ADD/ADHD, and some of the foods with high omega 3 amounts include fish. Therefore, it is important to know about the fish you consume:

How high are the levels of mercury in the particular kind of fish you are eating? - Some fish have higher levels of mercury, on average, than others. The American Heart Association states that Salmon, Sardines Clams, Crab, Scallops, and Sole have among the lowest levels of mercury, while swordfish, shark, golden bass/snapper and mackerel have some of the highest.²⁵ In general, fish that are predators who live longer have more of a chance of building up mercury levels in their tissues (hence the reason shark and swordfish are among those with the highest levels of mercury)

In what kind of environment did the fish live? - If fishing or farming of fish occurs near industrialized plants, the water may be contaminated with high levels of mercury that are released into the air and can then accumulate in streams and ponds near the plants. The Environmental Protection Agency recommends reading their Fish Advisory Website²⁶ or checking with your state or local health department for information about fish caught near your home.

How was it caught? - Perhaps less applicable to the mercury discussion, it is good to remember how a fish is caught when deciding whether or not to consume it. The repercussions of catching or farming fish in an unhealthy manner include personal or group sickness to the fish or humans, and damage to the natural environment. The Monterey Bay Aquarium's Seafood Watch program offers great information on how to shop for sustainably caught or farmed seafood. They have also partnered with Whole Foods to provide a sustainably caught seafood purchasing experience in their stores. Ask your fish purveyors if they carry sustainably caught/farmed products, and purchase these fish!

What kind of packaging did it come in? - The packaging of fish or any food, like plastic, tin, aluminum etc. is important to note as these can affect the food itself, the person consuming it, and the health of the environment.

Read more about mercury exposure and autism.