When the American Academy of Pediatrics announced its first guidelines for diagnosing kids with attention deficit/hyperactivity disorder (ADHD or ADD) last month, a primary reason was to help prevent doctors from overprescribing drugs such as Ritalin for treatment.
The fear is that too many doctors and parents alike turn to medications as the main option for handling what might be a child's misbehavior problems and not illness.
Joel Lubar, for one, isn't surprised about the guidelines, which reportedly were three years in the making and debating. He saw it coming.
Lubar is a professor and researcher at the University of Tennessee in Knoxville who has been using a form of biofeedback called neurofeedback -- basically brain wave therapy -- to treat ADHD/ADD for more than 25 years. What started as his idea is now a therapy practiced by more than 2,000 professionals in the United States.
"When we first started training people [at the Southeastern Biofeedback Institute in Knox-ville], we saw psychologists or social workers," recalls Lubar. "Then we started seeing nurses and medical educators. In the last five years, the majority of people we have trained are psychiatrists, neurologists and pediatricians."
Neurofeedback works this way: A person is evaluated by electroencephalogram (EEG) to determine his or her brain wave patterns.
Next, depending on the EEG, one or two electrodes ("We like to call them sensors," says Lubar) are attached to the person's scalp; no hair shaving is necessary. Clips are also put on the ears. The procedure is quick and painless.
As a session begins, the patient works on one of 520 possible game/puzzle displays. Examples might include a 16-piece puzzle of a hawk or an elaborate space-trip game with a traveling rocket.
The patient is rewarded when he focuses, which produces high-frequency beta waves in the brain. A piece of the hawk puzzle might be put in place, or the rocket might move skyward. The patient makes no progress when low-frequency theta (more common in kids) or alpha waves (problematic for adults) are produced in the brain, which are related to daydreaming, loss of concentration and lack of attention.
Neurofeedback training can require somewhere between 30 and 50 sessions for patients to learn how to recruit beta waves when they need them. Part of the training process is getting the patients to apply their new brain-control skills to such tasks as solving math problems, reading and listening. The work can be tiring and frustrating at times.
"We insist that practitioners stay in the room at all times during the session," says Lubar. "The whole thing is like learning a complex computer program."
But in this case the brain acts as the virtual joystick or mouse.
Lubar is careful not to claim neurofeedback as a substitute for prescribed drugs. He says the treatment should be an adjunct to Ritalin and vice versa.
"We're all concerned that medications are overprescribed for ADHD," he explains. "The MDs we train are not completely happy with the medication. They worry it works while in the system, but kids regress once they stop taking it. There is concern about possible long-term effects [not yet studied]. They come here thinking there must be a better way."
Neurofeedback represents a reasonable alternative -- and might prove to be the therapy for parents hoping to get their kids off Ritalin and related drugs.
Lubar, who has published and presented a number of research papers, says 40 percent of children and adults with ADHD/ADD are able to stop taking Ritalin and other medication after the appropriate number of neurofeedback sessions, and another 20 percent can significantly decrease drug use.
"We are finding kids improve their grades in school and scores on achievement tests," says Elsa Baehr, a clinical psychologist and neurofeedback practitioner in Evanston, Ill.
Dr. Angelo S. Bolea, a neuro psychologist practicing near Columbia., has been using the procedure for 10 years, and has treated at least 300 patients , according to his wife, Grace Bolea, who manages the office in Dayton.
Most of Bolea's patients sought neurofeedback with the goal of ridding themselves of Ritalin and other medications, she says. Not only does neurofeedback work, Bolea adds, it's well-suited to children.
"The kids really enjoy working with it. They look forward to coming," she says. "It's a fun, learning-type therapy."
(The Society for Neuronal Regulation lists eight doctors in Maryland using the neurofeedback technique. For a list of providers, visit the society's Web site at www.snr-jnt.org, or call 800-488-3867.)
Baehr operates the NeuroQuest clinic in Evanston with her psychologist husband, Rufus. The Baehrs are among about a dozen neurofeedback practitioners in Illinois associated with Lubar's training program (check out www.brainwavebiofeedback.org/ for more information).
Baehr says cost for neurofeedback sessions are on a sliding scale for each patient, though a general guideline is $75 to $125 per session. Some insurance carriers will pick up some of the costs, but others do not.
"We get a lot of word-of-mouth referrals," says Baehr. "There are some parents who just don't want their children on medications."
One of the advantages of neurofeedback training is the individual has developed a lifelong skill, says Lubar.
"Some people might need booster sessions from time to time," he says. "For the most part, we are succeeding in moving people with up to 90 percent difference [in brain wave activity] back to normative patterns."