I don\u2019t use the term ADD\/ADHD any more than absolutely necessary.\u00a0 It is so broad as to be almost meaningless \u2013 rather like saying, \u201cwe\u2019re having soup for dinner.\u201d\u00a0 It\u2019s technically accurate but not very descriptive, covering such a broad range of behaviors and problems that I would have a hard time saying what one should do to train it.<\/p>\r\n\r\n\r\n\r\n
Is every ADHD client you see the same?\u00a0 The people who come to me with that diagnosis are so different that I find the diagnosis basically worthless. \u00a0One sits quietly in a chair and looks at you but doesn\u2019t hear anything you say, can\u2019t complete a task because he keeps going into his thoughts.\u00a0 Another can\u2019t stay in his chair, looks all over the room but hears everything and completes tasks but so fast that he makes many mistakes. They both have the same diagnosis.<\/p>\r\n\r\n\r\n\r\n
In the Brain-Trainer system we split ADHD into two groups that are ends of a continuum: \u00a0Filtering and Processing.\u00a0 Filtering people can\u2019t manage the interface between the outside world and their inside world. They are easily distracted by things around them, act and speak impulsively, often have quick mood changes, often have difficulty falling asleep, move around a lot in bed and may grind their teeth.\u00a0Many have allergies or asthma. \u00a0As they get older, they are more likely to experience anxiety. Processing people can\u2019t maintain their attention outside their heads and have difficulty processing language. They keep drifting away into daydreams, are very creative and intuitive but can\u2019t process things in sequences and have difficulty with details. \u00a0They often sleep very easily but have a difficult time waking up. \u00a0They are more likely to wet the bed.\u00a0 As they get older, they are more likely to experience depression.<\/p>\r\n\r\n\r\n\r\n
Part of the problem may well be the endemic and poorly defined diagnosis of ADHD.\u00a0 When guys like Dan Amen are able to subsume almost every malady known to man under ADHD, we have lost most of the intended precision that language is supposed to have.\u00a0 Anxiety and depression and rage effects, inattention and hyper-focus, hypo-activity and hyperactivity are all part of the same diagnosis.\u00a0 It\u2019s a nice marketing tool, but it\u2019s not much help to those who want to train for changes.\u00a0 Anyone who believes that simply training up beta and down slow activity on the left or SMR up on the right will resolve ADHD (whichever flavor a person presents) is likely to experience a fair amount of disappointment.\u00a0 That\u2019s the reason I so strongly recommend forgetting the diagnosis and looking at the connections between the desired behavioral changes and the brain\u2019s activation patterns.\u00a0 Someone who does that is much more likely to deal with the underlying issues and get lasting results.<\/p>\r\n\r\n\r\n\r\n
Do you suppose a person who was emotionally upset because of fights between parents at home \u2013 or post-divorce \u2013 or bullies at school \u2013 might have difficulty paying attention?\u00a0 How about an adult with a history of trauma, or pretty strong anxiety, or inability to sleep effectively, or a level of depression, or obsessiveness that made it difficult to complete a task or a noisy mind or any of a dozen other things.<\/p>\r\n\r\n\r\n\r\n
Attention and memory, which are probably in the top 3 issues for every client who comes for training \u2013 even those who admit in their Client Reports that they have serious issues in one or more of these other areas \u2013 are third-level problems for many clients \u2013 and most adults. Anything can destroy your ability to focus and pay attention to relatively uninteresting (to you) stuff over a period of time. And anything you weren\u2019t paying attention to when it came in won\u2019t be remembered. Or if you have difficulty sleeping properly, it won\u2019t be remembered. \u00a0Or if your hippocampus is Swiss cheese because of long-standing levels of high stress dissolving them with cortisol.<\/p>\r\n\r\n\r\n\r\n
Look at the whole brain instead of falling into the \u201ctake an aspirin for a headache\u201d simplification. See what\u2019s going on, especially at the more primary levels related to subconscious drive and autonomic function, work on that and remarkably most problems with memory and attention will get better.<\/p>\r\n\r\n\r\n\r\n
If you are working with a young child who has difficulty sitting still and focusing even on the screen, then finding the appropriate calming\/SMR frequency at C4\/A2 or Cz\/A2 can give you a very good starting point\u2013getting the parents excited about some sign of control on the child\u2019s part. It can also get your client to the point where you can actually assess the brain to see what to train.<\/p>\r\n\r\n\r\n\r\n
12-15 or 12-16 Hz are good frequencies for SMR with adults. Most children will have a lower frequency, and the younger they are, the lower the SMR band is likely to be. You can adjust the trining band on-the-fly, during the session; tweak it until you find a frequency where the client calms.<\/p>\r\n\r\n\r\n\r\n
F7 and F8 offer some potential benefits. F7 is, among other things, an impulse control area and F8 can be helpful with social regulation and emotional inhibition \u2013 often issues with kids who get the ADHD label. But the problem with just throwing a windowed squash at those areas is, without having done much assessing, you don\u2019t really know where to put the window. You can easily end up training too high and have the same kind of results that were mentioned by a previous trainer: the client becomes MORE disregulated, rather than less.<\/p>\r\n\r\n\r\n\r\n
For training attention and self-control issues, HEG is always a good option, fast and easy to set up and easy for the client to do.\u00a0 Then training in the sensorimotor cortex (between C3 and C4) can be very helpful. \u00a0If you are training C4\/A2 or Cz\/A2, you will usually inhibit slow (2-9 or thereabouts, depending on the EEG) and fast (19-38 Hz) and reward SMR. \u00a0If you are training bipolar (e.g. C3\/C4, then usually you will inhibit 2-38 to quiet the whole EEG and increase 12-15.<\/p>\r\n\r\n\r\n\r\n
People who fit the ADHD category frequently have what we call a \u201cscooped out\u201d EEG pattern.\u00a0 If you look at a spectrum of all the activity from slow (2-8 pulses per second\u2013also called Hertz or Hz) to fast (16-38 Hz), you will see lots of activity in the very slow speeds (difficulty staying focused outside your own thoughts) and lots in the very fast speeds (anxiety, obsessive or compulsive), but the middle speeds, which are related to stillness and being present in this moment are very low.\u00a0 Alpha (8-12 Hz) is one of those middle speeds, and so is Sensory Motor Rhythm or SMR, which relates to physical stillness and relaxation, ability to deal with distractions, ability to fall asleep easily, etc.)<\/p>\r\n\r\n\r\n\r\n
It is important to recall that, if you accept the brain-trainer concept that, as the Othmers noted in the mid-90s, there are plenty of people with impulsive or hyperactive type ADHD (the type we call Filtering) who have LOW theta\/beta ratios which rise (into the target range) at task (or with training).\u00a0 Since many of these also have little or no alpha\/SMR\u2013middle frequencies\u2013this metric will have the same weakness that the Lubar\/Monastra theta\/beta ratio work has.\u00a0 It will pick out those with a high level of inattentive issues but not necessarily capture those with distractible\/impulsive problems, many of whom do NOT have learning or language processing concerns.<\/p>\r\n\r\n\r\n\r\n
I don\u2019t think the issue is tonic (standard state) vs. phasic (activated state).\u00a0 Tonic levels of arousal can be too low \u2013 or too HIGH.\u00a0 Either way, performance will suffer.\u00a0 Low tonic levels would be consistent with what the TQ calls Processing problems\u2013dominant slow activity and often a tendency to de-activate (increase theta\/alpha levels relative to beta at task).\u00a0 High tonic levels would be related to what we call Filtering problems \u2014 lots of slow AND fast wave activity but lacking middle frequencies\u2013and many clients in these cases actually de-activate at task\u2026and become more effective and functional.\u00a0 I don\u2019t think there\u2019s any confusion about this.<\/p>\r\n\r\n\r\n\r\n
Anyone who works with arousal issues can certainly agree that there are underaroused (primarily inattentive) and overaroused (impulsive\/hyperactive) people who fall into this rather broad diagnostic category.\u00a0 Why would we expect that a child who can sit in a chair for hours during a class, staring out the window, without bothering anyone, drifting in and out of contact with the task at hand would have the same brain activation patterns as someone who cannot stay in a chair for 2 minutes, is aware of everything around him\u2013even hyper aware in some cases \u2013 and tends to be a sharp, fast multi-tasker?\u00a0 That makes no sense intuitively.<\/p>\r\n\r\n\r\n\r\n
In the early days of the 90s, when I was working closely with Joel, we used FCz\/CPz one-channel bipolar montages with theta down and beta up for inattentive type, and C3\/C4 theta and high-beta down and SMR up for greater control.\u00a0 We also trained at C3\/A1, Cz\/A2 and C4\/A2, so I don\u2019t think Joel was fixed on any one thing. I try different options and find which tends to work best.<\/p>\r\n\r\n\r\n\r\n
Lubar (and I was one of the co-authors of the early study with Monastra on the T\/B ratio of 4-8 Hz \/ 13-21 Hz) focused much more heavily in his practice on the inattentive type client. Meanwhile the Othmers, who were still in their extremely valuable sensori-motor cortex phase, worked a great deal with the hyper-aroused kids.\u00a0 When I studied with them in 1994 or 1995, they commented that they had no idea what Lubar was talking about with his high theta\/beta ratios. Their experience was that many of their clients had LOW ratios (more dominated by beta) and actually increased as the training progressed. The more I worked with the ADHD population, the more I realized they were BOTH right.<\/p>\r\n\r\n\r\n\r\n
This is a subject that is normally kind of taboo.\u00a0 After all ADHD was one of the starting points and one of the most-researched areas for neurofeedback training, especially with children.\u00a0 It is one of the major sources of clients for many trainers and one of the main draws for many parents who get into the field to work with their own children.<\/p>\r\n\r\n\r\n\r\n
I personally agree.\u00a0 Maybe I\u2019m just getting too old, but I find that increasingly I would a dozen times rather work with an anxious adult (or child) than with a hyper-active or just ADHD client of any age.\u00a0 Not because I find the ADHD folks more unattractive or that I don\u2019t like their energy levels, etc.\u00a0 I just don\u2019t find I get as clear results as quickly (or sometimes at all) with the ADHD.\u00a0 Certainly there are some who respond well to HEG.\u00a0 Others calm right down with SMR training that tracks to find their \u201cright\u201d frequency for SMR.\u00a0 But there is a significant population of these people who come bouncing in session after session, do whatever training you give them to do (though often with complaints of boredom, difficulty staying in the chair, having to touch everything, mess with the computer, etc.), seem to calm down (even for a time) during the session, then bounce right back up and require a team of sheepdogs to get them out of the office without careening into everything they should not touch.<\/p>\r\n\r\n\r\n\r\n
Question<\/strong>:\u00a0 Has anyone tried or had success with Joel Lubar\u2019s placement at FZ for ADD, reward 16-22, inhibit 6-10.\u00a0 It was recommended by Lubar in a 2001 workshop.<\/p>\r\n\r\n\r\n\r\n Answer<\/strong>: \u00a0I think Joel speaks of this as working with adolescents, not younger kids.\u00a0 Like any \u201cone-size-fits-all\u201d protocol, it will no doubt work well with some clients and not so well with others.\u00a0 What is the reference for this hookup?\u00a0 We used to use a protocol for beta up\/theta down between FCz and CPz.\u00a0 This would be likely to work on the executive attention center and the medial forebrain bundle, which brings dopamine forward, so it you had a straight ADD\/ADHD kid, it might have a good effect.<\/p>\r\n\r\n\r\n\r\n Monastra, Lubar et al published in Neuropsychology in the mid 90s a large multi-center study that showed Theta\/Beta ratios (4-8 Hz\/ 13-21 Hz) that purported to be the cutoffs for various ages for ADHD.\u00a0 My practice was a major participant in that study, and I\u2019ve always had problems with it, because it assumes that there are only ratios that are \u201ctoo high\u201d; we saw, and I still see, many people whose ratios were very low, who also had problems with attention, anxiety, obsessive thinking, etc.<\/p>\r\n\r\n\r\n\r\n Theta and beta relationships are good to look at, but so are alpha and theta.\u00a0 Some people like to look at SMR to high-beta ratios as well.\u00a0 And there are others.\u00a0 I think of any of these as being descriptive rather than diagnostic, but certainly many people who prefer the diagnostic model use them that way as well.<\/p>\r\n\r\n\r\n\r\nRatios<\/h2>\r\n\r\n\r\n\r\n
ADHD Article<\/h2>\r\n\r\n\r\n\r\n