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Text Box: Biofeedback, the “un-drug” for Attention deficit disorder and

Melissa A. Carr






Ø    What is biofeedback?

Ø    How does the treatment work?

Ø     What is Attention Deficit Disorder (ADD) / Attention

     Deficit Hyperactivity Disorder (ADHD) and why use biofeedback?

Ø     How does biofeedback helps ADD and ADHD?

Ø    How does EEG and brain wave activity work?

Ø    Case Studies

Ø    Conclusion



Biofeedback is a treatment developed during the 1940’s to monitor the internal functions of a person so that they can use that information to improve or change a health problem. During the experimentation of the 1960’s the procedure was used in experimental training for altering the brain activity, heart rate, blood pressure, and other bodily functions. ( Early research was also done on biofeedback’s affects on epilepsy. It has since expanding to include the treatment of chronic pain, including arthritis, muscle spasms, and headaches.  Studies have shown that biofeedback also reduces tension and anxiety, reduces hyperactivity and attention deficit disorder, and in the aids improvement of chronic insomnia and fatigue, the alleviation of depression.  Surprisingly, some people have even found it helpful for controlling the sensations of alcoholism and problems related to the bronchial system and digestive disorders. 

Bette Runck, a staff writer for the U.S. Department of Health and Human Services described feedback in simpler terms by comparing it to:

You've used it if you have ever taken your temperature or stepped on a scale. The thermometer tells you whether you're running a fever, the scale whether you've gained weight. Both devices "feed back" information about your body's condition. Armed with this information, you can take steps you've learned to improve the condition. When you're running a fever, you go to bed and drink plenty of fluids. When you've gained weight, you resolve to eat less and sometimes you do. (

To detect a person’s internal bodily functions, clinicians use muscle tension (EMG feedback), skin temperature (thermal feedback), brain waves (EEG feedback) and respiration machines to feed back information that other would be difficult to retrieve through human observation (  The patience is able to monitor their performance, and control their activity through the adjustment of mental processes.  Once they know what needs to be changed, they work with the clinician to create a program that is suitable to their needs, such as learning methods of relaxation or imagery.

During the procedure’s beginning, experimental psychologist Neal Miller first demonstrated that the brain could be trained to alter some bodily functions scientists predicted that biofeedback would eventually allow patients to “Take a fully active and direct role in literally learning not to be sick” (Dienstfrey, 1991), therefore “changing the world.” (   The purpose and goal of the procedure has become teaching patients how to control their bodily functions eventually without the machine. Hence, biofeedback is considered to be a “mind over matter” form of treatment, a naturalist medicine method.  The patience must be an active participant in his treatment or it will not be affective.



One may ask, how does the procedure work?  Like all other medical procedures the patience first comes in for a preparatory meeting which addresses what his issues are and give a background history of his family and lifestyle. Those factors are taken into consideration because behavior and lifestyle have been found to significantly affect health.   Next, once the physician knows that the disorder is he decides what type of biofeedback to give the patient.  Most probable instruments that would be utilized for feedback are electromyographs, skin temperature gauges, galvanic skin sensors, respiration feedback devices, electrocardiographs, and electroencephalographs (

Electromyographs measure muscle tension; they are often used to relieve muscle stiffness, treat incontinence, and recondition injured muscles.  Skin temperature gauges displays modifications in the amount of heat given off by the skin, this change is an indication of the rate of blood flow; this method treats Raynaud’s disease, high blood pressure, anxiety, and migraines. Moreover, galvanic skin response sensors control anxiety by monitoring the amount of sweat produced under stress.  Similarly, respiration feedback devices center on the rate and rhythm of breathing to help lesson symptoms of anxiety, in addition, the symptoms of asthma, and hyperventilation.  Electrocardiographs examine the heart rate, enabling the patience to control high blood pressure and relieve an overly rapid heartbeat. Lastly, electroencephalographs assess brain-wave activity; that training would benefit tooth grinding, head injuries, depression (including bipolar and depression and seasonal affective disorder), and learning disabilities, attention deficit and hyperactive disorders. (

Thus, the patient’s choice of instrument is based on his problem. From that instrument the sensors are attached to the body; the placement is dependent upon the problem that needs treating, and a computer, polygraph, or another piece of monitoring equipment monitors the functions.  For example, if the person has migraines the electrodes would be attached to the scalp; to treat heart problems and muscle tension, they would be placed on the skin, as well as hands, feet, and fingers. Subsequently, the machines would respond with a graphical computer display or beeps, buzzes, or blinks to signify the strength or level of the function being targeted.  The therapist will teach mental or physical exercises that help control the function that is giving problems, and the patience becomes more familiar with the signals of intensity, volume, and speed of signals for the instrument he will be able to focus and control the responses.  ( As the treatment proves effective to the person’s needs, his thoughts of success and desire to continue transforming will aid in the treatment.  The skepticism of ancient Greek, Chinese, and Indian naturopath medicine, which also focused on the influence of the mind on healing, is eliminated in biofeedback because the procedure is supported by modern instrumentation; measurable changes can be scientifically recorded.



A British pediatrician first discovered Attention Deficit Disorder in 1902. ( The disease was not given a name until the 80’s when it was decided that there are a “psychiatric ‘bible’ of symptoms.” A brain chemistry disorder, ADD and ADHD (Attention Deficit Hyperactivity Disorder) patients metabolize glucose in their brains at a slower rate then others. For focus and concentration the brain needs these energy packets, which are made up of glucose. Without this energy people with ADD or ADHD become frustrated with tasks or are unable to absorb concepts, missing key details.   Often exceptionally intelligent, and despite there best intention while thinking intently and creatively they tune out from a moment in time.  Keep in mind that nearly all ADD and ADHD children are above average IQ but their symptoms suppress that natural ability. This neurological based developmental disability is estimated to affect between 3% and 7% of school-age children; a diagnosis is usually made during early childhood. ( It was first thought that children outgrow the problem but later research has shown that the disorder can cause serious lifelong problems if not treated. Diagnosis is based upon two main factors: impulsivity which is characterized by acting or speaking without thinking, and distractibility which is characterized by an inability to properly “filter” the important messages being sent to the brain and ignore the rest. A psychologist at the University of California devised one test for ADD and ADHD called the SNAP IV Rating Scale, as seen at these sites ( and (





In order to explain why biofeedback is a good choice for treating ADD and ADHD we must first consider all options of treatment. “There are three types of recognized professional treatment for ADD/ADHD used today by different clinicians:


1.    Drug treatments. These drugs are called "speed" on the street and are highly illegal. They do help education authorities to "control" your child while at school. Some schools even get a subsidy for every Ritalin user. Perhaps a conflict of interest? This type of "medication" does NOT "cure" anything. Suppressing symptoms   can also suppress potential. (Look at the dangers of ritalin and similar drugs by clicking on pills to the left.)


2.    Allergy treatments. For several years, [this Clinician] worked with another researcher developing End-Point-Titration in a Florida allergy clinic. During that time, [he] used this technique along with others to successfully treat ADD/ADHD in several children. However, this EPT therapy is very expensive, ranging up to $10,000 in expensive "doctor" time to diagnose and treat. There are also some alternate treatments which also treat allergy, such as NAET and others, which have shown some mixed success.


3.    EEG Biofeedback training. Starting in the 70's, more and more clinicians have found that training to raise the SMR works to alleviate or remove those symptoms of attention and concentration deficit, impulsive and hyperactive behavior, and even autism type symptoms.” (


Electroencephalograph, or EEG, Biofeedback has been found very effective in studies done on Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder. EEG Biofeedback is also one the safest methods of treatment that corrects instead of camouflages the problem, without destroying the intelligent minds.  Most importantly, clinical data is emerging that suggest ongoing remission of ADD and ADHD symptoms after the discontinuation of neurofeedback treatment.



For this specific neurofeedback procedure, various steps are involved. Besides the initial interview and the common questions about symptoms and the health history, some test may about be run.  The first EEG training session is done at that time and then reviewed by the clinician and patient; that visit is approximately two hours. Succeeding training last about 40 minutes to an hour, and are conducted one to five times per week based on the severity of the problem.  In general, within ten sessions improvement can been seen and the positive changes are permanent. (  Since children are often the focus of attention deficit disorder or hyperactive treatment video games or other video displays, along with audio signals are employed to present the feedback on their brain wave activity. ( This operant conditioning method leads to the “learning” of new brain wave patterns because as the activity in a desirable activity band increases, a reward is given, and as activity in the adverse band increases, the video game is inhibited.  As Leslie Seiden, M.D. said, “You’ll feel like you are playing "pac man" with your brain.” She gave an example of a game in which your brain waves actually guide a pac man-like icon through a maze, as in the picture to the left. “When your brain is making desirable beta waves pac man moves through the maze quickly and you hear a sound that tells you the right waves are being made.” (click picture for link to sight) The brain begins to pick-up these cues. The new brain wave pattern that forms resembles an individual without disabilities.



The ElectroEncephaloGraph (EEG) measures, in millionths of a volt, several different frequency bands that emanate from the brain. Depending on the subjects state of mind, each band is rather different from the other.  These bands have been given Greek letters.  They are named as follows: Delta waves (0-3 Hz), Theta waves (4-7 Hz), Alpha waves (8-12 Hz) and the focus of EEG Biofeedback, Beta waves (12-38 Hz).  The brain emits Beta waves it is active, thinking.  Low Beta (usually considered 12-16 Hz) is a subdivision of Beta, “characterized by good steady thinking.” (  This frequency band, also called SMR (SensiMotor Repsonse), is the focus of EEG Biofeedback training for ADD and ADHD.  The typical symptom of those disorders is low incidence of waves in that region.  EEG Biofeedback training in the 12-14 Hz range helps or even eliminates that marker.  To scientifically provide reason for this learnt brain behavior, researchers have discovered a 12-14 Hz rhythm in the EEG which mimics the rhythm associated with motor activity humans. ( An increase in SensoriMotor Rhythm Text Box: Figure 1. Two Extremes of Imbalance in Beta waves

context blocking

input blocking            (Distractibility)

input blocking

(Inattention)	       context blocking  


(SMR), a similar frequency to Beta waves, reduces the symptomatic behaviors of associated with ADD and ADHD.  This band governs body sensation and voluntary movement, a process which researchers believe causes problems when the operating speed of someone’s brain is either too low (underarousal) or too high (overarousal) (see Figure 1 – links to detailed scientific basis of neurofeedback). The goal of neurofeedback is “to stabilize the brain, to render it more robust, so that it does not easily tip into underarousal or overarousal.” (



In an early case study, three subjects were monitored based on their social, undesirably and desirable behaviors.  The individuals’ percent of time with SMR increased from 5-35%, 13-25%, and 10-32%. Desirable behaviors such as increased attention span and cooperation increased from 7-40, 12-40, and 12-28 occurrences per day, while the undesirable behaviors decreased from 50-12, 30-12, and 38-12 occurrences per day. This observation led to the extension of EEG biofeedback as a technique for handling attention deficits and hyperactive. In a clinical study done Lubar and Lubar (1984) EEGs effectiveness with those disorders was thoroughly examined.  ( The cases exhibiting EEG abnormalities were given training with 15-18Hz  which activated the EEG in general, and raised arousal and focus. Power spectral measurements compared the EEG levels of ADD and hyperactive subjects’ with those of normal subjects.  The neurofeedback was also accompanied by academic training.  All six subjects under study acquired the desired EEG characteristics; documentation shows that they all had significant improvements in academic performance. “Five if the six children were receiving such academic training prior to the onset of the EEG biofeedback training, with no significant improvement over several years.” (  With the minor addition of EEG biofeedback treatment, the subjects’ improvements were drastic. 

Reports, done by that researcher and others (Lubar, 1992, 1984; Tansey, 1991, 1990, 1983), showed significant increases in IQ scores, grades and educational test scores suggesting that is it a valuable procedure. However, most of the previous studies of EEG Biofeedback treatment with children lack appropriate control conditions and suffer from extremely small sample sizes. (

In a current case study two groups were formed, an experimental group and a control group.  The experimental group received EEG Biofeedback treatment and was compared to a waiting list control group, in order to evaluate the effects of EEG Biofeedback training. Eighteen children between the ages of 5 and 15 were randomly assigned to one of the groups.  They were diagnosed based on DSM-III-R standards and lowa-Conners Behavior Rating Scales.  Neither group received alternate treatment, such as psychotherapy or pharmacological treatment, during the study. A series of test to the were given to the subjects pretreatment and post-treatment to measure intellectual functioning (Kaufman-Brief Intelligence Test/K-BIT Kaufman & Kaufman 1990) and the parents filled out behavioral reports about inattention, hyperactivity, aggressive and defiant behaviors (SNAP Rating Scale; Swanson, Nolan & Pelham, 1981 and Iowa-Conners Rating Scale, Milich, Loney & Landau, 1982). (

Treatment for the experimental group was held twice weekly, totaling 40 sessions of EEG Biofeedback.  The EEG Biofeedback consisted of a computerized reading of brain waves.  The protocol reinforced the enhancement of Beta brain waves (16-20 Hz) and the suppression of Theta brain waves (4-8 Hz). The control group received no treatment during this time. (

An analysis was conducted to verify that the groups did not vary significantly on any of the demographic variable, an indication that the groups were equivalent at the at the entry into the study. This study resulted in a significant increase of the Composite IQ scores of the experimental group, nine points greater than the control group (p<.05; see Table 1 below).  There was also a significant reduction in inattentive behavioral problems as rated by the parents (p<.05; see Table 2 below).  Although there were no significant differences found for hyperactive, aggressive or defiant behaviors the minor decline of hyperactive in the experimental group put them within normal limits.  Aggressive and defiant behavior showed a decline in the experimental group more so than the control group.  Moreover, the subjects in the experimental group, those only diagnosed with a learning disability, had an average increase of IQ by 20 points. (          



Text Box: TABLE 1: Means and Standard Deviations for K-BIT IQ
Changes Pre and Post EEG Biofeedback Treatment

                 Experimental Group            Control Group
                         M       SD               M     SD
	     Pre	101.1	26.2	          99.1	13.2
	     Post	110.4 *	21.2	         100.0	10.1

*p< .05 1

Text Box: TABLE 2: Means for Pre and Post Parent Ratings of
Inattentive, Hyperactive and Aggressive-Defiant Behaviors

	Inattention	11.33	8.11*  12.00   12.44
	Hyperactivity	 8.56	4.77	9.83	9.00
	Aggressive/	 5.66	3.00	8.45	7.45


          This case study appears to further support the effectiveness of EEG Biofeedback.  The results from the experimental group all showed a positive impact on there intellectual functioning and with any repercussions, as those of medication. Even when EEG Biofeedback treatment is compared to treatment with drugs the success of Biofeedback is greater.


In closing, biofeedback supports “The enhancement of 15-18Hz EEG activity as a strategy for activating the arousal and focus mechanisms affecting the sensorimotor cortex, as well as other cortical and subcortical areas of the brain.”  (  Although clinical studies have so far outdistanced scientific research to date, it seems that partial normalization of SNR is a consequence of the biofeedback training.  Further research would stabilize findings, thus eradicating criticisms, and would refine the technique.  Could biofeedback begin the new generation of effective naturopath medicine that will “change the world”?




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Copyright © 2001 Melissa A. Carr







Psychology Department

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