Does ADD medication actually work

Is Neurofeedback Really A Better Choice?

In September last year, the "Süddeutsche Zeitung" launched an attack against the ADHD drug methylphenidate (MPH) that had washed itself out:

The drug is compared to coke, to which it is "chemically related"; it can be addictive, is "prohibited as doping in sport" and has serious side effects.

One could just as well have written: What kind of wicked parents must they be who treat their child with such devil stuff?

According to the article, there is now a method with which ADHD can not only be treated, but even cured: neurofeedback. The example of the ADHD patient Tim shows how well the alternative method works.

In fact, this gentle form of ADHD therapy has its charm: The children can learn through play to improve their brain activation.

Think of it like this: The patient sits in front of a neurofeedback computer to which he is connected via electrodes attached to his head.

A movie or a computer game is playing on the screen, in which, for example, an airplane is losing altitude. If you activate yourself well, you can let the plane go up using just your imagination.

If this is done frequently, brain frequencies are trained that correspond to a state of calm concentration or active attention.

These frequencies, which can be represented as "fast waves" in the EEG, are too low in many ADHD patients when they want to concentrate.

Millions of patients treated with MPH

Tim apparently managed to conquer his illness in 25 sessions, just by the power of his thoughts. "If self-regulation succeeds, then ADHD is completely gone, the brain tuned up," says the author of the feature.

Then why pills at all when they seem to do more harm than good, one might ask as a layman.

The main problem is the polemics that are being pursued at the expense of a tried and tested drug: methylphenidate bad - neurofeedback good; so it gets stuck in the mind.

Reports like these "catapult up a fear of stimulants that is completely inappropriate," says neuropediatrist and neurofeedback therapist Dr. Hans-Jürgen Kühle from Gießen to the "Ärzte Zeitung".

Kühle reports that millions of patients have already been treated with MPH for decades; it has been repeatedly tested in studies, precisely because it stirs minds.

There are now long-term studies with periods of more than 30 years in which the safety of the drug as a supportive therapy has been proven.

The prerequisite is always the intended use under medical supervision. You have to be aware that you are dealing with a drug that can have side effects.

The correct dosage is therefore very important, emphasizes Kühle. With a good attitude, "the core symptoms can be reduced so that the patient can lead a life that corresponds to his academic abilities".

The pediatrician does not want to leave the comparison with coke standing: "It's like comparing cholesterol with cortisone." It looks so similar, but its effect is completely different.

About 95 percent of patients respond to MPH therapy - if the dose is accurate to 2.5 mg (J Atten Disord 2007; 10: 350).

In the case of neurofeedback, which is one of the alternative therapies and is currently not reimbursed by the cost bearers, initial studies suggest response rates of around 50 to 75 percent.

"Not all of them manage to learn how to control brain activation themselves," says Kühle. ADHD is also a "lifespan condition". She accompanies the patient throughout their life.

Especially when children reach puberty, according to the expert, "a lot can get mixed up". Long-term studies are therefore essential in order to assess the success of a therapy. However, the available studies on neurofeedback therapy in ADHD cover a maximum of two years.

Neurofeedback as a supplement to the stimulant

Kühle has been using neurofeedback in his own practice for about eight years, mostly in addition to the stimulant. With many ADHD patients he also achieves success with this, but only if the children are motivated and continue to practice at home.

Then MPH can be dispensed with in some patients. However, the pediatrician considers it premature to speak of a cure. The term "remission" would be much more applicable.

Conclusion: Neurofeedback can usefully complement drug therapy, but rarely replace it completely. Both procedures are intended to help the patient learn appropriate problem-solving strategies, even if only by noticing how he can cope better in everyday life and regaining confidence.

In any case, children with ADHD and their families are not served by playing off the two therapy options against each other.