New and Promising Areas of Research
As the ADHD research base grows, an increasing number of studies are focusing on finding effective treatment options. The following are some of the most promising. Promising means the preliminary research findings are hopeful but inconclusive at this time. Because they are so new, there hasn't been sufficient volume of studies to form a definitive conclusion regarding their safety and effectiveness. Still, they are noteworthy enough to merit mention.
Neurofeedback (EEG Biofeedback)
Neurofeedback is a very specific form of brain training known as EEG biofeedback. The definition of biofeedback is the use of electronic equipment to monitor people's internal physiological states. The equipment provides feedback that enables someone to learn how to control these internal states. For ADHD, the physiologic states of interest are symptoms such as inattention. These states are revealed by various types of brain waves. Brain waves vary depending on the current mental state of the person. For example, a person in a focused, attentive state will produce different brain waves than someone in a drowsy or daydreaming state. Neurofeedback has its basis in neuroscience. It is a treatment method that encourages self-regulation. Neurofeedback provides real-time feedback to a person about the state of their brain. Video and auditory feedback provides rewarding messages about the person's success in correctly detecting and changing these internal states. This encourages or trains the person to create the desired brain wave activity.
Research with ADHD individuals demonstrate a dominant pattern of low levels of arousal in the brain's frontal lobe. This sluggish performance in frontal lobe affects attention, planning, organization, time-management, and impulse-control (Swatzyna , 2014). Neurofeedback treatment focuses on making the person aware of these brainwaves as they are being produced. As astonishing as it may seem, once someone can identify the type of brainwave activity they are experiencing, they can learn techniques to consciously change it.
Various software systems have also been designed to teach and exercise attention skills. Research demonstrates that neurofeedback is an effective intervention for ADHD. In fact, several studies show that the improvements obtained through neurofeedback last for extended periods of time. In some cases, improvements were maintained up to two years after treatment had ended. In contrast, improvement from medication lasts only while the medication is at a therapeutic level.
Initial results of neurofeedback are encouraging. However, most professionals temper this optimism with a healthy degree of caution. CHADD (Children and Adults with ADHD) is a membership organization whose mission is to improve the lives of people affected by ADHD. Members include persons with ADHD but also ADHD educators, researchers, healthcare professionals, therapists, and families. Neurofeedback has become so popular that CHADD created a fact sheet entitled, "What We Know: Complementary and Alternative Treatments: Neurofeedback (EEG Biofeedback) and ADHD."
In summary, CHADD reports that neurofeedback continues to be an intervention that generates much interest. There is sufficient evidence to warrant the continued study of neurofeedback as a possible treatment for ADHD. However, current research does not support conclusive claims about its efficacy. Given the cost associated with it, cautious evaluation of its efficacy should be carefully considered. For more information, see the helpful fact sheets on the CHADD website www.chadd.org.
New and Promising Areas of Research: Computer-Assisted & Other ADHD Interventions
A company called SmartBrainGames, has collaborated with NASA to use EEG neurofeedback equipment that was originally developed for training astronauts. This system was modified to address the needs of children with ADHD. It helps children learn to monitor their attention and concentration levels. Two different game console systems operate using biofeedback techniques. There are two versions: the S.M.A.R.T. Home System and, the S.M.A.R.T. Clinical System. The home version can be used with most home television gaming systems and a variety of video games. The clinical version is designed for use by psychologists or other mental health professionals. It can be adjusted to target specific ADHD symptoms for each individual. Research data examining the effectiveness of this technology looks extremely promising. More information is available at: (Dombeck, (2006) or Smart Brain Technologies.
Self-regulation of brain waves is taught through neurofeedback (see above section). Other types of self-regulation are taught through biofeedback. The definition of biofeedback is the use of electronic equipment to monitor and display people's internal physiological state. The equipment provides feedback that enables a person to learn how to control these internal states. The game, "Journey to the Wild Divine" is a readily available software system that uses biofeedback to teach people to control their tension levels. It measures a player's Skin Conductance Level (SCL) or sweat gland activity and Heart Rate Variability (HRV). HRV is the calculated difference in heartbeat from the intake of a breath to the exhale. Greater HRV is associated with longer life. The Journey to the Wild Divine has not been evaluated with regard to ADHD (wilddivine.com). However, it can effectively teach people to lower their levels of tension and anxiety. The utility of this application to individuals with ADHD in reducing tension is apparent. It is less clear if reduced tension will result in a reduction of ADHD-related symptoms.
A company called Brain Train has developed two software products for ADHD. SmartDriver is a non-violent driving game. It designed to build cognitive skills and self-esteem in individuals, ages 5 through adult, who have difficulty processing information. This difficulty may be due to brain injuries, ADHD, visual processing disorders, or learning disabilities. SoundSmart was designed by a clinical psychologist and a psychiatrist. Its purpose is to improve: listening skills; ability to follow directions; phonemic awareness (an understanding that spoken language is broken down into discrete sounds); working memory (the ability to retain information over a short period of time); mental processing speed; and, impulse control (braintrain.com).
Interactive Metronome Training is another new treatment. It is based on an understanding that motor planning and timing deficits, common in ADHD, are related to problems with behavioral inhibition. While there has only been one well-conducted study, its results were promising.
Massage is also being used to help those with ADHD to learn to regulate tension levels. It is believed that a calm, relaxed mental state allows people to better manage their symptoms. Massage is likely a healthy practice. It may facilitate better self-regulation. However, it is unlikely to reduce ADHD symptoms directly (Sarkis, 2013).
Regular exercise can also be very beneficial for people with ADHD. This is because it helps to reduce tension and excess energy. A new study found that regular exercise decreases symptom severity and increases cognitive abilities (Jacobson, 2014).
A healthy and varied diet will improve overall health, but not necessarily ADHD symptoms specifically. A healthy diet is one that reduces sugar, cholesterol, salts, and alcohol. This strategy would likely improve everyone's health (Sarkis, 2013).
When combined with other symptom management strategies, these tools could help someone improve self-regulation. This in turn reduces the negative impact of ADHD symptoms. These are just a sampling of some intriguing research areas. There are many ongoing clinical trials that examine a variety of issues related to ADHD. These include: medication response, alternative treatments, brain function and circuitry, assessment tools, genetic patterns, and behavioral patterns in ADHD. More information about these and other studies can be found on www.chadd.org.