Gray Matters, a new clinic in Westport, is introducing a new type of therapy here to treat children who have been diagnosed with ADD/HD (attention deficit disorder with or without hyperactivity disorder), and it’s the only one of its kind in the state. Gray Matters is collaborating with Living in Harmony (LIH), a Westport-based center for psychotherapy, family systems therapy, counseling and coaching, to help with broader psychological issues. Gary Pearson, founding member of LIH, says he was intrigued by Gray Matters and finds working with these children rewarding. “We work with the whole family. We start with an initial conversation to see what the family is dealing with, and then we help them readjust as the ADD child begins to adapt. It sets up a new set of circumstances.”
Anthony Silver, director of Gray Matters, adds, “Children with ADD or ADHD don’t just require additional support in the classroom, they also tend to dominate the family dynamic. They require a great deal of patience.”
Talk about an unlikely ADD therapy: video games. But now there may be reason to believe in this seeming contradiction — especially because it began with NASA scientists. They realized the neurofeedback technology they were using with flight simulators to optimize pilots’ attention could be applied to help children with ADD/HD. For these children, sitting still, focusing on one particular task, controlling impulsivity is next to impossible. With training, though, it is possible.
The system, called Smart BrainGames, uses technology developed, tested and patented by NASA; but it isn’t any off-the-shelf video gaming system by PlayStation 2 (PS2) — though the games are. The system includes a programmable minicomputer, called a “smart box,” that links the specially adapted PS2 game consoles to sensors that are dipped in water and fitted under a visor the child wears. “The kids are fine with it,” says Silver. “They think of it as a baseball cap.” This modified system allows the user to get constant feedback about his/her ability to focus — he’s having fun while learning how his brain works. “It’s really building stamina for concentration and it’s tiring,” says Silver.
Children control the speed of the car in “Grand Turismo,” a PS2 auto racing game, for example, using the game console as usual, but the car accelerates only when the user exhibits management over his/her brainwaves. When children have the correct amount of concentration — if they are calm and focused and their brain waves are in a set target area — their car will go fast. The specially adapted PS2 game console is wirelessly linked to an unobtrusive brainwave sensor, or EEG (electroencephalogram). Silver is then able to track the user’s real-time brainwave activity on a nearby computer monitor. (What are bouncing bars of green, yellow and red to onlooking parents are endlessly fascinating data to him.) “The brain contains a vast mass of nerves whose electrical activity is determined by its functional state,” he explains. “The brain constantly emits electrical current in a range from 1 to 40hz.” Specifically, the level of activity is divided as delta (1-2hz, deep sleep); theta (3-7hz, subconscious, distracted); alpha (8-12hz, inwardly focused, daydreaming, calm); SMR (13-15hz, alert but relaxed); and beta (16-42hz, analytical and focused). Silver sums it up, “Neurofeedback uses EEGs to help the user become aware of what electrical state his/ her brain is in, and learn to control it.
“We ‘down train’ the theta and alpha brain frequencies that are associated with daydreaming, anxiety and distractibility and ‘up train’ the beta waves that reflect focus and concentration. Too much alpha and theta and the game controller vibrates — while beta is directly correlated to speed with the car racing games,” he says. The vibration in the child’s hands is a signal for them to refocus. When he does concentrate, his beta brain waves will rise (associated with higher cognitive processing), and Silver will see levels on the monitor still in constant flux but, overall, more balanced. “The protocols are adjusted until they can find and maintain the high beta states that are equated with sustained attention and performance. Children rapidly learn the ability to calmly focus their minds.”
You might think that a kid playing a racing game would get “amped up” zooming around the track, but such a response would only slow down the car with Smart BrainGames. The user has to stay absorbed by the game and in control of the way he is thinking — it is more than just getting around the track quickly, it is staying aware of how to concentrate. This way, the brain is learning to self-regulate, and building the stamina to concentrate. “When you have ADD or ADHD, that type of focus is really difficult,” says Silver. “These are the kids who get up and walk around class or who are given an assignment and twenty minutes later, there is still nothing on the paper. They’re typically very smart kids, but their inability to concentrate and maintain focus at school limits their potential. This teaches them how.”
The in-office sessions take place once a week; additional work is done at home daily for thirty minutes. Results are saved and forwarded electronically to Silver, who can monitor progress and adjust treatment as needed. Training, he says, typically takes about forty sessions and the results have been dramatic, both at school and at home, and as effective as stimulant medication but without the side effects, such as loss of appetite and stunted growth. “The results are also permanent — once the brain develops the ability for extended concentration, it doesn’t lose it,” he says. “And the training is fun.”
Medication vs. Biofeedback
Silver knows ADD from personal experience — his son was diagnosed with the condition three years ago. Diagnosis, in general, is a point of contention. According the National Resource Center on ADHD, “There are no biological, physiological or genetic markers or independently valid tests that can reliably identify the disorder … the symptoms must be more frequent or severe than in other children the same age.” According to neurologist Dr. Fred Baughman, a child neurologist in private practice for thirty-five years, 500,000 children in the United States were diagnosed ADHD in 1985; today, the number is between 5 and 7 million. Some are concerned, too, that doctors are turning to drugs too quickly.
“Medication can be hugely helpful, but I feel it should only be used as a last resort,” says Silver. “Children with ADD/HD generally show lower levels of brain stimulation and frequently seek activities or show behavior that act as stimulants for them. Psychiatric medications generally focus on increasing dopamine in the brain, most commonly Adderall (amphetamine and dextroamphetamine) and Ritalin (methylphenidate). These drugs stimulate the central nervous system and affect chemicals in the brain and nerves that contribute to hyperactivity and impulse control. Silver says, “They directly increase the brain’s ability to work in the higher frequencies associated with better cognitive functions, focus and concentration.”
But that’s not the end of the concerns. “Medicating the brain does not resolve the underlying issue,” he says. “It masks the problem until the medication wears off. Neurofeedback training teaches children to control their own brain state, tackling the actual problem. You are addressing the underlying issue.”
Neurofeedback therapy has been around since the 1920s. Researchers at the Ohio State University College of Medicine are conducting a double-blind study in the country to examine the effectiveness of the Smart BrainGames system. “Double-blind” is a term used to describe a study in which both the investigator and the participants are unaware of the nature of the treatment the participants are receiving — and, as such, are thought to produce objective results. (The research is being funded by the National Institute of Mental Health, and because the study is in the early stages, there are no results to present yet.)
“We are hoping that as a result of this study, parents will have an alternative to medication,” says Dr. L. Eugene Arnold, principal investigator of the study and a child psychiatrist at the Research Unit on Pediatric Psychopharmacology (RUPP) at the Ohio State University Nisonger Center in Columbus, Ohio. “The research [on neurofeedback] is promising but not conclusive. Medications make the same sort of changes in brain waves, but I don’t think the evidence is quite there yet to justify ordinary families making sacrifices to pay for [neurofeedback therapy] in general.”
Silver responds, “Study after study has proven that neurofeedback is an effective treatment for ADD/HD — many suggesting that it is equal to stimulant medication — but side-effect-free. The difference with our training is that the technology has brought the price down, and the bulk of the training is done at home. What we’re doing intuitively makes sense: We’re training children who can only concentrate intermittently to maintain their focus for much longer. In this way, their lives and prospects are radically changed.”
What about time spent on regular video games? Arnold suggests that game time should come in the evening. He says, “During the day, children would probably benefit more from going outside and playing.”
To parents worried about children already playing too many video games, Silver says, “In this case, they are exercising their brain by adapting their own brain state to activate the game. The process really is tiring. I couldn’t see a child playing this for more than half an hour. It’s like how you feel after an exam at school; you know your brain has done work.”