Neurofeedback as a method for addressing attention problems has a 30-year history. It is one of the "classic" alternative methods used either by itself or in conjunction with medications, cognitive exercises, nutritional supplements and dietary regimens. The condition known, as ADHD is one of the most investigated in all of the neurofeedback practice and research literature.

Traditionally, forty has been held as the standard number of sessions needed to establish improvement. Some people need less and some need more. Improvements are not necessarily evenly gained and may be seen in other areas (e.g. sleep and mood) before attention increases.

The results have been shown to be increasingly promising and those who engage in a course of neurofeedback to work on attention problems generally can be seen to show improvements in focus which helps them with school work and life tasks. These improvements usually produce other more global changes because the stress and humiliation of failure is relieved.

The field of neurofeedback has been assailed by mainstream medical proponents for not producing research that shows definitive results. This criticism is valid, on the one hand, and misleading on the other.

Attention itself is a fragile item in our conscious experience. It can be compromised by situations (stress, grief, fear) and also by one?s constitutional disposition. The current psychiatric opinion has focused on ADHD as an inherently neurological condition that is primarily (or exclusively) ameliorated by psychopharmacological interventions. The current diagnostic manual (DSM IV) offers three varieties of ADHD.

Clinicians and practitioners in other medical and allied health fields see ADHD somewhat differently. The isolation of the problem ?in-the-person? is an assumption that not all share. The fact that the criteria used to diagnose ADHD are common to most everyone, to one degree or another, raises questions about where the reliable cut-off is in such a spectrum. The fact that the common stimulants used to treat ADHD have the same effect on control (normal) subjects as they do on those afflicted casts doubts on the security of the category. Medication trials easily show a high degree of efficacy on a very selected population but the effectiveness with a wider clinical population is, admittedly, only 60-70%. Additionally, individual reactions to medications and their side effects diminish their motivation to continue on them.

Neurofeedback shows some clear efficacy in selected research populations but seems to evidence more meaningfully in wider clinical effectiveness. That seems likely if one broadens the scope of diagnosis to factor in the possibility that ADHD is not homogenous and that what we observe behaviorally as a singular entity may have numerous causations neurologically. Recent investigations using neuroscience technology (i.e. MRI, PET, SPECT) promote this viewpoint. Also, the notion that we are capable of ?surgically? modifying one aspect of behavior predictably is probably overrated and subject to as much anecdotal triumphalism as any of the more suspect and less accepted alternative methods. The brain and the body are far more complicated than we have ever before imagined.

As far as the permanence of neurofeedback training effects, that too is difficult to assess. Very few lengthy longitudinal studies have been done in the whole field of attention intervention. While methylphenidate has been used for at least fifty years to address what we now call ADHD, it was only in the past four years that an outcome study of two-years duration was published. To the credit of the field of neurofeedback, Vincent Monastra did publish a study showing permanent improvement after two years in a population treated with neurofeedback.

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