In a Lake County classroom just a year ago, 10-year-old Scott (not his real name) would sporadically digress from what his teacher was saying, his focus diverted to a classmate shuffling papers or to footsteps in the corridor, or he simply daydreamed, staring out a window.
When Scott was in 2nd grade, doctors in North Chicago had diagnosed his short attention span, behavioral problems and impulsive actions as attention deficit disorder (ADD), a chronic impairment linked to a neurological and biochemical condition that impairs concentration and can impede a child’s progress in school and social settings.
A psychiatric journal estimates that 3 to 5 percent of the school-aged population nationwide, or 2 million children, is afflicted with ADD.
Children with ADD can be easily distracted, have difficulty following instructions and starting and completing assignments on their own. These kids can be highly tactile and have trouble sitting still for any stretch of time. While their intelligence levels are normally average or above, these children can find themselves suspended at an immature emotional level in relationship to their peers.
Compounding the complexity of this condition, ADD can occur in parallel with hyperactivity or learning disabilities.
In the past, ADD has been dismissed and discounted within the medical community and in the school system as psychosomatic or behavorial. But recent passage of an amendment to the federal Education for Handicapped Children Act adds ADD to its definition of developmental disorders and requires schools to provide services for these children.
Therapeutic intervention is a long haul for these children and should incorporate a broad base of treatments, the experts say.
Major treatment options are counseling and education of the parents in symptom management strategies; family courses; behavioral modification and classroom adjustments; medication, such as the stimulant Ritalin (medication is, of all the treatments, the only one that brings behavior to normal in the shortest span of time, but it is not without side effects); mandated availability of special education resources.
Within the last couple of years, technology has made it possible for EEG (electroencephalogram) biofeedback treatment, a relatively obscure form of therapy pioneered by Dr. Joel Lubar, a biopsychologist at the University of Tennessee in the 1970s, to reach the masses. It is being touted by its proponents as a powerful tool in the management of ADD.
The first clinic to offer EEG biofeedback as part of a treatment plan in the Chicago area is the Institute for Attention Deficit Disorders, with offices in Northbrook and Buffalo Grove.
Sandra L. Scheinbaum, a licensed clinical psychologist and a certified biofeedback therapist, joined forces with pediatrician Norman E. Segal, who has 20 years of experience in diagnosing and treating children with ADD, ADHD (attention deficit and hyperactivity disorder) and learning disabilities after the pair trained under Lubar at the Southeastern Biofeedback and Neurobehavorial Institute in Knoxville, Tenn., last January.
The Northbrook clinic, housed in the North Shore Center for Behavioral Medicine, opened last March and offers comprehensive evaluation, diagnostic testing and multimodal treatment planning that is case specific.
While many parents of children with ADD would argue that schools, in general, have been traditionally shortsighted in recognizing and dealing with ADD in the classroom, Segal, co-founder of The Institute for Attention Deficit Disorders, said that in his private practice he has been able to form partnerships with schools in Lake County to help patients diagnosed with ADD. That was a motivating factor when he and Scheinbaum were targeting the optimum site for their clinic, according to Segal.
“From Wauconda to Round Lake Beach, from Deerfield to Highland Park, it has been my experience that the Lake County schools have, for the most part, been quick to pick up and suggest the diagnosis of ADD and refer these children for further diagnostic evaluation,” Segal said.
“Once the diagnosis is made, the Lake County teachers have been easy to work with and give us good feedback,” he said.
“In my own personal experience, I have friends and acquaintances whose children have this problem, and the responses to all the treatments that are used are so variable,” said Segal, a Deerfield resident.
“I feel the treatment we are using could be an important adjunct to other therapies and provide the final missing piece to the puzzle of ADD,” Segal said.
Candidates for the EEG biofeedback must meet criteria essential for the efficacy of this therapy, Scheinbaum said. The EEG biofeedback is always an adjunct to other treatments.
“The numbers will grow as the demand grows, but what we want to be careful to say is that this is not a cure,” Scheinbaum said.
There are currently 20 clients enrolled in the institute’s multimodal treatment program that includes EEG biofeedback. They are between the ages of 7 and 17 and undergo 50-minute sessions, usually once or twice a week at $90 per session, which usually run during the academic year. There is an accelerated summer program involving 50-minute sessions five days a week. These are all children whose primary diagnosis is ADD or ADHD.
Based on the premise that a child with pure ADD has more slower theta, or daydreaming, waves in contrast to the fast-wave beta activity that is associated with concentration, EEG biofeedback, according to its practitioners, trains children to alter their brain waves to improve concentration and behavior.
Telling a child, such as Scott, that the two EEG sensors that are positioned on his scalp to amplify and monitor his brain-wave activity are similar to a radio tuner or antenna, the therapist tunes the child in on what is going on in his own brain. As the therapist diversifies the session’s segments-from computer games to reading or listening to a story being read, the child is taught to turn on his beta waves. The common vernacular to what the child is learning to do is to “turn on your brain.”
The object is for the child to focus on not letting anything get past him. As the child practices, he will hear a beep that signals him to self-correct if his mind begins to wander. Progress is charted and the child racks up higher scores the more he concentrates.
“I think what interested me in EEG biofeedback was the potential for children to be able to have a sense of what they can control. Rather than (just) taking a pill to make it better, with EEG biofeedback, they can make changes,” Scheinbaum said.
Scott’s mother, who declined to be identified, said she has noticed a change in her son since he started the EEG biofeedback at the Northbrook clinic last March.
Midpoint in the therapy, Scott told his mother that somehow he felt different, and she told him “that’s the way all people feel.” Prior to the EEG biofeedback, Scott was being treated with drugs and a variety of therapies. His mother has discontinued the use of the drugs.
“When he first started school last fall, he said, `Mom, I’m able to listen to the teacher and block out kids talking around me,’ ” Scott’s mother said.
And that is no small achievement for a child with ADD. What Lubar, Scheinbaum and many of their colleagues are quick to reiterate is that EEG biofeedback is not a panacea or cure for ADD. In fact, there are no guarantees that a patient who has undergone EEG biofeedback will not still need medication after the therapy.
“ADD can’t be treated in a vacuum. You can’t just provide any one remedy and think that’s a solution. I like to see three things handled when you address ADD. Those are the school environment, the home environment and the child’s social environment,” said Rachel Reich of Highland Park.
Reich, a licensed clinical social worker who is in private practice with offices in Libertyville and Palatine, was in the Gurnee school system for 12 years. Reich has a 13-year-old son, Adam, who was diagnosed with ADD while he was in 4th grade.
“I don’t think biofeedback will hurt the ADD child, but I would want to be careful because parents with ADD children are very vulnerable. They want answers after hurting for a long time and will try anything,” Reich said.
“Teachers are coming around. There are some who believe in ADD, but there are others who don’t believe in ADD, or LD (learning disabilities) for that matter,” Reich said.
“Generally there is not a single treatment that is an answer. We advocate a multimodal approach,” said Marty Anderson of Lake Bluff, coordinator of the North Suburban chapter of Children with Attention Deficit Disorder (CH.A.A.D.), which encompasses much of Highland Park and Deerfield.
“I don’t want to ever mislead. The purpose of neurofeedback is to help the child process information in their brain more like normal children do and that, if in the process of treatment, we find the child can tolerate a change in their medication level, then we’re able to try it and see how far it can go,” Lubar said.
“This is not an alternative to medicine. But there are cases where we have eliminated medication or reduced it,” Lubar said.
“There is no cure for ADD. You can only control it,” he said.
The leading manufacturer of instrumentation and software used in EEG biofeedback is Autogenic Systems in Wood Dale, which devised an exclusive computer program in collaboration with Lubar. The machinery and software package costs $4,295.
“We were approached by Lubar, who said it was a growing area, he was getting a lot of demand for his services, and there was a need for commercially available treatment. There was nothing adequate or affordable before we developed this,” said Doug Miller, president of Autogenic.
There are now 125 independent centers nationwide, and more than 1,000 children have been treated using this technique.
While EEG biofeedback seems to be gaining some momentum in public acceptance as a viable treatment, it has its share of detractors within the medical community who, at the very least, refute its established scientific merit and, at the extreme, assail it as a fad and a fraud.
“Saying that it has something to do with theta and beta brain wave activity, well, that’s the same thing as saying there is green cheese on the moon,” said Dr. Alan Zametkin, senior staff psychiatrist at the Laboratory of Cerebral Metabolism of the National Institute of Mental Health in Bethesda, Md.
Zametkin is a much-lauded expert in the field of ADHD who through his research for the government scientifically established the latest theory that this neuro-psychiatric disorder is associated with a lower rate of glucose metabolism in certain areas of the brain.
“EEG has no part in the treatment of ADHD where there is no suspicion of seizure. No one has done the necessary research to prove it works, and it is costly. It drains the family reserves,” Zametkin said.
Although there has been some limited research done on EEG biofeedback, even proponents concede the need for more controlled studies.
“I think there’s validity in what’s being said. There is a substantial body of research to show that what Lubar is doing should work, but there aren’t many clinical or research studies using the neurofeedback protocol that have controlled groups and large sample sizes,” said Miller of Autogenics.
“My prediction is that in the next three years, there will be a number of studies to determine the effectiveness of neurofeedback in ADD. In my opinion, if the subjects-children, adolescents or adults-in the study are chosen based on our position statement, I think they will find that neurofeedback in and of itself helps a significant number of them,” Lubar said.
But until that time, skeptics continue to question the scientific basis for some practioneers’ claims that EEG biofeedback equates to permanent improvements in IQ, scholastic achievement and acceptable social behavior.
But the doubters will never convince Lynne A. of Glen Ellyn that packing up five of her seven children to take her 10-year-old son, Andy, down to Lubar’s Knoxville clinic three years ago wasn’t a pragmatic investment in her son’s future.
“My son is a testimonial to the neurofeedback treatment. There was definitely a change. It has helped him focus his attention. Last year he was on the honor roll in regular classes. This year is a little harder, but he is getting B’s and C’s,” said Lynne A.
