ADHD affects 8.4 percent of children and 2.5 percent of adults, according to estimates, and is one of the most common neurodevelopmental disorders. It is most known for abnormal levels of hyperactive and impulsive behavior. When it comes to young children, ADHD is frequently initially detected when it causes disruptions in the classroom or difficulties with schoolwork.
There are three subtypes of ADHD: inattentive, hyperactive/impulsive, or combined.
ADHD is still a mystery to scientists, who have yet to discover its root cause. There is strong evidence that genetics have a role in the development of attention deficit hyperactivity disorder. Other variables that may contribute to the development of ADHD include premature birth, brain damage, and the use of tobacco, alcohol, or experiences of stress during pregnancy.
Unfortunately, there is currently no single laboratory test available to diagnose ADHD. Defiance, aggressive behavior, nor inability to comprehend a task or directions, are the cause of the symptoms of ADHD. Diagnosis includes obtaining information from key stakeholders, completing checklists, having a medical assessment to rule out any underlying medical issues.
Brain imaging techniques have advanced dramatically in the last two decades, and the use of neurofeedback is showing real promise in determining proper and effective treatment quickly.
Neurofeedback, sometimes referred to as EEG Biofeedback, is a technique for training the brain’s functional activity to restore brain function and treat mental health conditions. Electrical signals traveling between brain cells are measured by electrodes on the scalp.
Electrodes are metal disks that are temporarily glued to your scalp. They are connected to cables that detect electrical signals (nerve impulses), which then provide data about the electrical impulses to an EEG machine. The impulses are recorded using lines (traces) that depict brain wave patterns on the EEG equipment.
Although this method has gained popularity, the topic of whether it could be considered an evidence-based treatment has always remained unclear. First identified for treating epilepsy, this technique uses real-time feedback to train the brain to inhibit or generate a specific type of activity. Operant conditioning principles (behavior influenced by the consequences of an action) are used to develop brain plasticity.
Scalp electrodes send real-time EEG data, and after the intended EEG activity is achieved, the patient receives positive feedback through the program. Each session reinforces hundreds of identical occurrences in the brain, resulting in long-term change akin to any acquired skill. EEG patterns can be used to identify ideal EEG patterns for therapy.
At ADD Institute, we perform a detailed assessment which includes methods used in research conducted by Bazanova et al. in 2018. Our assessment may integrate different forms of analysis, which could involve a combination of the following:
Psychometric Assessment
Modern examinations usually involve a psychometric test, sometimes known as an aptitude test. Psychometric assessments come in a variety of forms, and the term refers to any measurement that elicits information about an individual’s cognitive ability or personality. An attention-testing task called the Go/No-Go task was used, as was an impulse-control (delayed gratification) test in addition to a Parent and Teacher Rating Scale interview (SNAP-VI) was used to measure hyperactivity, impulsivity, and inattention.
A 21-channel EEG and forehead EMG recordings will consist as part of the evaluation. Parents and instructors will need to complete behavioral assessment scales.
Go/no-go task
One of the most common types of attention tasks is the one in which participants are required to keep their attention focused on a constant stream of stimuli. Participants complete a “go/no-go” activity known as a Sustained Attention to Response Task (SART), in which they must restrain behavioral responses until a single, infrequent target is displayed amid several frequent non-targets.
An inhibitory reaction is required when the participant’s attention is diverted to a non-target. When a target is seen, the person must be able to overcome the predominant motor reaction and refrain from hitting the button. This is required for good performance. Working memory, sustained attention, and impulse/inhibitory control are all shown to be influenced by the SART, according to research.
Delayed Gratification task
Self-regulation of affect-motivation-arousal (delayed gratification) is one of four executive neuropsychological functions affected by the presentation of ADHD. This task can be completed at home, conducted by a guardian. A cake or preferred dessert is presented to the participant with the choice of two options: eat the dessert now or wait until later to eat two. The amount of time that the participant can resist the immediate reward is recorded.
Real-Time EEG and EMG (Electromyography)
Electromyography (EMG) is a diagnostic procedure used to evaluate the health of muscles and the nerve cells that control them. Motor neurons are the name given to these nerves. They communicate with muscles by electrical signals, causing them to contract and relax. Decreasing Theta-Beta Ratio (TBR) has been studied as a treatment for impulsivity and hyperactivity in ADHD. In order to collect EEG data, participants must be able to keep their eyes closed.
Neurofeedback Training Procedure
The neurofeedback training procedure is another means of diagnosing ADHD. However, it is not very efficient when used alone. During our research, we followed the standard NFT procedure for ADHD to reduce TBR and the location of the Pz was identified using specific criteria.
In our study, the participants were given ten sessions of NFT with their eyes open, each lasting 16 minutes. Participants sat in front of the monitor during training and used their TBR to control a video game. From a pre-training baseline of one minute, thresholds for each participant were established for each training session. It was determined that 70 percent of the sampled events in a 1,000-ms period had to meet reward thresholds, and TBR had to range significantly above these levels in 30 percent of the observed events.
Participants practiced their TBR skills while sitting in front of a computer display. They were given verbal instructions in identifying and implementing a strategy/imagery that would help them enable the growth of flowers on the screen. Flowers began to bloom as soon as the TBR fell below the threshold. Within seconds of connecting the electrodes, more instructions were given to provide visual cues for imagery: “It will be easier to relax and let flowers grow up, if you just imagine yourself being a steady, heavy rock. Quiet, steady, and heavy. Relax and let your eyebrows down!” Positive verbal reinforcement was provided every 2–3 minutes and the instruction with a visual cue was repeated every 5 minutes.
The findings of this study underscore the significance of adjusting alpha activity parameters for each individual patient before NFT evaluation. Pre-, post-, and six-month post-NFT assessments will be completed on all patients.
Most people agree that visual stimulation is one of the most comprehensive and important inputs to the brain. It is expected that the EEG activity will be significantly different when the eyes are open or closed. Your brain cells interact with each other via electrical impulses even when sleeping. At the pre-, post-, and follow-up sessions, the resting state EEG recordings in 1-minute eyes closed (EC) and 1-minute eyes open (EO) conditions will be compared.
Using data from the last 30 seconds of EC (eyes closed) and the first 8 seconds of EO (eyes open) conditions, individual alpha peak frequency, and alpha frequency band limits are calculated at each electrode site for each patient. WinEEG software is used to analyze the EEG results.
The clinical efficacy of NFT is determined by the percentage improvement in response time and the number of missed stimuli in the Go/no-Go task, as well as the duration of delayed gratification in the post-NFT and follow-up sessions.
