Israel Psychologist: Neurofeedback, An Alternative Therapy for Attention-Deficit Disorder

By Israel News Agency Staff

Sara Silber, an educational psychologist in Israel, a specialist in family and marriage and serves as a court appointed therapist in divorce mediation, says secure control of your brain wave state and you can then control your mood, concentration, and state of consciousness.

Silber visited the Galim Institute in Ramat Gan, Israel, and spoke to Yael Langford, founder and director of the institute. Here is how neurofeedback works and how you can use it for yourself and your children.

Attention Deficit Disorder, (ADD), affects 7-12% of the population in both the US and in Israel and is usually recognized and diagnosed by age 7. With or without hyperactivity, it will affect many areas of functioning, including school performance, social skills, emotional development, marriage stability, family responsibility, and work performance.

Much research attests to the disorder having a neurological basis in the form of a biochemical imbalance which affects how the brain transmits and receives important messages from its 'neurotransmitters. Many cases have a genetic component with either a parent or a sibling also sharing the disorder.

The disorder, which can been seen among hundreds of children in Israel, can also appear as a result of difficulties during birth such as lack of oxygen. ADD adults and children are characterized as having a short attention span, difficulty completing a task that demands sustained attention, difficulty following directions, forgetfulness, disorganization and poor motivation for tasks deemed "boring" or irrelevant.

In the last 30 years it has been shown that when a person learns to monitor the pattern of his brain waves, as he can in neurofeedback training, he can improve his ability to focus and complete the task at hand. Neurological functioning will become normalized, learning ability will be enhanced and reactions to sensory input will become more efficient. It has been found that people with ADD have different brain wave patterns from other people.

To understand this let us first have a general understanding of brain waves. Don't panic - you don't have to be a neurologist to understand this simplified explanation. Different activities that we do coincide with different brain wave activity. They reflect different levels of demanded concentration and consciousness. Brain waves are measured in herzes which is a quantification of the electrical charges emitted by the brain. These can be displayed by an EEG test in Israel.

The slowest waves are delta waves which occur when we are in deep sleep. Right before we fall asleep, in the transition period before actually falling asleep, theta waves predominate. These should occur for only a few minutes a day and are related to imaginative and creative processes and to our subconscious.

The next level of activity is alpha waves which occur during relaxed wakefulness when the brain is not engaged in any specific mental or emotional activity. They can be present when mental activity is habitual and required concentration is minimal and can be achieved when eyes are closed.

Moving up, we get to beta waves which are emitted when we are alert and doing concentrated mental activity. These are the waves that correspond to school learning and performance. They are also present when we are anxious and apprehensive. ADD people have a higher predominance of theta waves than they should have - they are walking around a large part of the day in a pre-sleep wave state. Alongside this they have a much lower activity of beta waves, just those that are needed for concentrated school learning.

Some medical research in the US, Europe and in Israel has found as much as a 30% imbalance. Brain waves are moods. A person can change his mood by controlling his brainwaves. You can learn what each wave feels like and consciously bring it about. In the ADD person the goal would be to bring about a higher frequency of beta waves and lessen the frequency of the theta waves.

In biofeedback therapy, which is administrated in Israel, the person is hooked up to body monitors and to a computer and he sees in a visual display on the screen how different things that he does, such as slow breathing or visual imaging, affect various parameters of his body, such as his pulse and body temperature. Neurofeedback is a form of biofeedback where we are looking particularly at how his actions affect his brain wave pattern. Anything that can be brought to my awareness can be changed if I have an instrument telling me if I am succeeding or not. In an actual session the child sits at a monitor with a sensor on his scalp; this is painless and noninvasive. His task is defined as a computer game.

The therapist has previously analyzed his typical brain wave pattern in the diagnostic session. The child may be given the game of pushing fish in a maze on the screen. This task necessitates the use of the desired beta waves, our goal. The computer is programmed by the therapist beforehand so that whenever the child's brain achieves the desired waves that normally elude him, the fish will move forward while gobbling black dots and beeping. (the feedback to the child). The therapist gives him cues which will help him - perhaps he has to stop moving a nervous hand or stop humming.

Soon the child is able to control the fish at will by recognizing the way it feels when it moves and gobbles. While he is succeeding with the game, the child's brain is growing more stable. Positive changes will be seen after the first few meetings and will be reinforced over time but in order to become permanent at least 30 sessions will be needed. After all, the brain has to learn new behavior.

A change in the EEG will be seen when permanent change has been effected. Some experts believe that regular brain-wave training improves blood flow to particular brain regions, fostering stronger connections between cells.

Treatment in Israel is not cheap and can cost 385 shekels per session (75 USD). Parents should note that there is only a small amount of research on the technique which is why some experts dismiss the treatment Proponents in Israel and abroad counter that since neurofeedback carries no risks and has been used successfully by thousands of people, there is no reason to suppress it until costly clinical trials can be performed. Practitioners claim an 80% success rate after screening initial candidates.

For the purpose of this article the writer spoke to two parents who had had their children treated by neurofeedback, one at Galim Institute in Israel and one at an institute in the US. Both parents were very pleased with the results in which they saw significantly improved school performance and decreased impulsive behavior. They recommended the treatment if the child and parents were able to persevere. In the view of this writer, neurofeedback shows much promise in helping the ADD child with a major obstacle and should certainly be considered as an approach to treatment in those children who show high motivation to help themselves and who will persist with the many treatment sessions.

This therapy should then be undertaken in conjunction with other aspects of a complete treatment plan outlined by the child's educational psychologist. In my experience in both New York and here in Raanana and Tel Aviv, Israel with ADD children, the more encompassing the approach the more effective the total management of the ADHD problem. Neurofeedback can greatly help the attention issue and reduce the need for medication for focusing and learning.

The ADD problem, however, also needs to address family issues and the school environment. The total treatment plan will need to consider other aspects that may be responsible for the attention difficulties such as undiagnosed hidden allergy and sensory-sensitivities. Guidance will need to be given to parents and teachers as well as individual sessions with the child to see where he specifically wants help and to address his individual concerns. ADD is a multidimensional problem which requires a few tracks of help operating simultaneously.

A study which was published in 2003 in the Journal of Applied Psychophysiology and Biofeedback, a respectable journal, and the scientist was T. Fuchs et al. It says that results from this study indicate that both stimulant medication treatment and neurofeedback treatment resulted in statistically significant and clinically meaningful improvement in children with ADHD. These gains were evident on laboratory assessments of attention and on behavior ratings from parents and teachers. The improvement reported by teachers is especially noteworthy because teachers - unlike parents - were not aware of which treatment children had received. Overall, the benefits obtained by children receiving each treatment appeared to be comparable. This study adds to a growing body of literature supporting the efficacy of neurofeedback as a treatment for ADHD. Results from this study suggest that neurofeedback can be an effective treatment on its own.

No one recommendation will cover all the aspects of the difficulty; that is why parents find it so difficult to tackle the problem and get exhausted in the process. It is heartening that another approach can offer so much help to ADHD children and adults. Choices, of course, also make the decision harder as to which therapy to try first. Your professional advisor will help you determine your priorities in the total treatment plan. Understanding neurofeedback and maximizing its benefits will require years of research but the future looks bright.

Sara Silber has dealt with many ADHD children and their families in her Raanana Israel family psychology clinic, since 1981. Her practice in psychology, family therapy counseling and therapy has led her to search out alternative methods for dealing with the disorder and she has interviewed many practitioners in her research for the ideal treatment modality.
In her clinic parents are informed of various ways of approaching the problem, alongside being given her expertise on the facets that she herself deals with - behavior modification techniques, classroom modifications, sensory sensitivities, parental guidance, and family and individual counseling. Silber unique, total treatment psychological approach has brought light, success, and hope to many born-again children in Israel.