Neurofeedback Combined with Training in Metacognitive Strategies Effectiveness in Students with ADD

As published in:The Journal of Applied Psychophysiology and Biofeedback (vol. 23, number 4)

L. Thompson, Ph.D.

A review of records was carried out to examine the results obtained when people with Attention Deficit Disorder (ADD) received 40 sessions of training that combined neurofeedback with the teaching of metacognitive strategies. While not a controlled scientific study, the results, including pre- and post-measures, are consistent with previously published research concerning the use of neurofeedback with children.

A significant addition is that a description of procedures is included. The 111 subjects, 98 children (age 5 to 17) and 13 adults (ages 18 to 63), attended fourty 50-min sessions, usually twice a week. Feedback was contingent on decreasing slow wave activity (usually 4-7Hz, occasionally 9-11 Hz) and increasing fast wave activity (15-18 Hz for most subjects but initially 13-15 Hz for subjects with impulsivity and hyperactivity).

Metacognitive strategies related to academic tasks were taught when the feedback indicated the client was focused. Some clients also received temperature and/or EDR biofeedback during some sessions. Initially, 30 percent of the children were taking stimulant medications (Ritalin), whereas 6 percent were on stimulant medications after 40 sessions. All charts were included where pre- and post-testing results were available for one or more of the following: the Test of Variable of Attention (TOVA, n=76), Wechsler Intelligence Scales (WISC-R, WISC-III, or WAIS-R, n=68), Wide Range Achievement Test (WRAT 3, n=99), and the electroencephalogram assessment (QEEG) providing a ratio of theta (4-8 Hz) to beta (16-20 Hz) activity (n=66).

Significant improvements (p<.001) were found in ADD symptoms (Inattention, Impulsivity, and Variability of response times on the TOVA), in both the ACID pattern and the full scale scores of the Wechsler Intelligence Scales, in academic performance on the WRAT3 and in reading comprehension. The average gain for the full scale IQ equivalent score was 12 points. A decrease in the EEG ratio of the Theta/Beta was also observed. These data are important because they provide and extension of results from earlier studies (Lubar, Swartwood, Swartwood, & O’Donnell, 1995; Linden, Habib, & Radojevic, 1996). They also demonstrate the systematic data collection in a private educational setting produces helpful information which can be used to monitor students’ progress and improve programs.

Because this clinical work is not a controlled scientific study, the efficacious treatment components cannot be determined. Nevertheless, the positive outcomes of decreased ADD symptoms plus improved academic and intellectual functioning suggest that the use of neurofeedback plus training in metacognitive strategies is a useful combined intervention for students with ADD. Further controlled research is warranted.

ADD and the term Attention Deficit Disorder are used in this paper to refer to students who meet diagnostic criteria for Attention-Deficit/Hyperactivity disorder; Inattentive type, Hyperactive-Impulsive type or Combined type. (American Psychiatric Association, 1994)