Der folgende Artikel ist ein Zitat aus einem neuen kanadischen Buch über das Phänomen Aufmerksamkeits-Defizit-Syndrom (ADS) - amerik. A.D.D. attention deficit disorder. In diesem wird die Methode des Neurofeedback bei Kindern detailliert und anschaulich beschrieben. Das Buch heisst "The A.D.D. Book", Autoren William Sears und Lynda Thompson.
Brain Wave Patterns and A.D.D.
The brain wave pattern of individuals with A.D.D. looks immature because there are more slow waves. This pattern is independent of the person's intelligence level. It is important to note that the EEG is not abnormal in persons who have A.D.D.; there is just a different balance between slow and fast waves.
There is more than one pattern possible in individuals with A.D.D., but they all have in common excess slow wave activity. In the future, it may be possible to classify types of A.D.D. according to brain wave patterns. For example, one pattern is an immature pattern, with more slow waves (theta) throughout the brain. In another pattern, it is mainly the frontal portions of the brain, the seat of the executive functions (including directed attention, critical thinking, and impulse control), that show excessive slow waves.
The difference in brain wave patterns between a child who has A.D.D. and a child who does not have A.D.D. is more pronounced when they are doing school-like tasks, such as reading. Children who do not have A.D.D. produce more fast waves when they focus in on a reading task. Children with A.D.D. usually produce more slow waves. This means the brain is still in resting mode.
Bright daydreamers. Most individuals with A.D.D. tune out in theta waves. Some people show a different kind of slow wave activity (8 to 11 cps) when they tune out. We call this the resting/daydream wave. Traditionally, it has been called alpha. Dr Lynda Thompson has given these alpha producers the nickname "bright daydreamers." They are often highly creative people.
Brian was an example of this pattern:
Brian, age eighteen, had dropped out of his final year of high school. He had tried working but did not last at the jobs he tried. He explained, `I just can't keep my mind on what I'm being told. If I try to read the instruction manual it takes ages. I have to keep going back over and over each paragraph. I guess I'm just not smart enough."
Brian's intelligence was assessed using the WechslerAdult Intelligence Scale. It was in the superior range. On the EEG his problem was immediately apparent. After only a short time reading, he suddenly produced a very high-amplftude alpha rhythm. He just tuned out, as if meditating or in a daydream. This pattern also appears in people who have smoked marijuana recently, which Brian had not. He was just a natural alpha producer. If he was reminded of the task, he would focus on it again for a short time, but then the resting/daydream state would reappear and he would tune out.
Using the computer monitor and watching his own brain waves, Brian rapidly trained himself to stay out of that alpha pattern when listening and reading. When he managed this and was working on some academic subject, the predominant wave pattern became his faster "thinker waves" (beta; 16 to 20 cps). He returned to high school in September and also got a part time job, which he held on to. Later that year he was awarded a prize for his excellent results in Physics. His was a remarkable turnaround.
Hyperactive children. Neurofeedback helps the hyperactive child by teaching him to become calm and able to suppress the urge to move. Certain brain waves (calin waves, or sensorimotor rhythm) are seen when a person inhibits the urge to move around. Hyperactive, impulsive children can be taught to produce these waves. In our experience, the hyperactive child often takes longer to benefit from neurofeedback training than the child with the inattentive type of A.D.D.
Sometimes the child is not physically "bouncing off the walls" but is just verbally impulsive, as in bturting things out. This type of child may have never had a behavior problem at all. Cathy, age nine, was a good example of this. She was a very active and impulsive girl. She would constantly do things without reflecting first. When asked, "Why did you do that?", her shrug and "I dunno" were completely honest. There was no thought-out reason behind her behavior. She just acted without thinking. Cathy's mother gave this description of her daughter prior to neurofeedback training:
We're so discouraged. Cathy has been put on Ritalin on the recommendation of her teacher. It has helped slow her down and keep her at h~r desk, but she is still going to be placed in special education for the fourth grade. She thinks of this as being demoted. Even though we couldn't really af ford it, we put her into a good private school, but that didn't solve the problem. She is at the bottom of her third grade class. Cathy has been tested on the Wechsler Intel ligence Scale for Children, and the psychologist said she was bright. She has also had special tutoring. We know she's smart, but she just cannot sit without fidgeting. She is so impulsive! We are proud that she answers questions in class, but she does it before the teacher even finishes tbe question.
She never thinks about what she is going to say. She seems to just blurt out whatever thought has come into her mind. Being bright, she sometimes will happen to give the right answer, but more often than not she is wrong. This behavior irritates not only the teachers but her classmates as well. She can read beautifully if you make her sit and do it. But she keeps skipping things, and if you aren't right beside her, she will say she is finished but will have missed the main points and just have remembered all the funny little things that don't matter. We just don't know what to do.
Cathy underwent a neurofeedback concentration, except she was trained to increase the production of brain waves referred to as SMR, or sensorimotor rhythm (12 to 15 cps). Research studies have shown that these brain waves are at work when the motor system is less active and the impulse to move is suppressed. Facilitating this state in children who do not naturally produce much SMR is helpful. Cathy learned how to voluntarily produce more sensorimotor rhythm waves. To do this she had to sit still and not even think about mov ing. The trainer said, "Cathy, pretend that your brain moves into your fingers every time you move those fingers. Where do you want your brain to be when you are thinking about a problem?° Cathy said, with a laugh, that it should be in her head and not in her hands.
Three months after beginning training, Cathy was off Ritalin, ranking in the top half of her class and no longer on the list for special education for fourth grade. When we followed up three years later, she was an A student in seventh grade who was well liked by both her teachers and her peers. The only modification to her school program at present is enrichment
classes in math.
Impulsive children. For some children with A.D.D., impulsivity is the most critical problem. Impulsivity is a difficulty that is seen in children with A.D.D. with or without hyperactivity. "Impulsivity° does not mean that the person demonstrates a behavior problem. It refers to acting without thinking (reflecting) first.
Children with this problem appear to have too little of the faster SMR calm waves. These brain wave frequencies are associated with inhibitory functions in the brain. Donald is another example of this kind of problem:
Donald was thirteen years old. His mother, a school teacher, noted, `Donald is a good boy. He has never been a behavior problem. But I get so, so frustrated with him. I end up screaming at him. He is so bright (IQ above 130), but he just doesn't read the problem. It doesn't matter what subject it is, he just doesn't do what the question is asking him to do. He jumps to conclusions! If he is given a math problem, he blurts out an answer. He is very bright, so often it is the correct answer. However, if it is a word problem and he has to listen or read for a minute, then he will miss something and the answer will be the wrong one. If I force him to slow down and read carefully, he will get it right. It's very frustrating. He is so bright, but he constantly makes careless Iit tle errors."
Donald also had difficulty concentrating. His EEG pattern, as expected from mother's description of his style, showed a lot of slow wave activity. In addition, he demonstrated a dip in brain wave activity in the calin wave (SMR) range. Neurofeedback training for Donald emphasized decreasing the tuned~ut slow wave activity and increasing the faster calin wave (SMR) activity. When he learned to do this, he also demonstrated a marked increase in his ability to read questions carefully, note the facts, and then answer the question that was being asked. He became calmer and didn't rush into things or blurt things out.
Children with social problems. Donald was also a rather difficult child socially Other children shunned him. He did not appear able to maintain friendships.
Donald's constant questions were quite assertive and inappropriate. He said what ever came into his mind. He found it difficult to maintain friendships, and adults found him irritating, even rude. He never meant to say anything wrong. He behaved with the best of intentions. Donald really wanted to do the right thing and be liked and appreciated. But his behavior was, in a word, obnoxious. Hfs parents tried medtcations. They tried behavior modification. They spoke with him about how he seemed to turn people off. Nothing seemed to have any significant effect on their young motor mouth.
When Donald increased his calm waves, it changed not only his approach to school work but also his social interactions. He became considerate and polite and started making frtends and maintaining frtend ships. This was a happy carryover effect of the training. Perhaps paying more attention to the external world caused him to notice people's reactions more, so that he modified his own behavior accordingly.
Anxious and inattentive children. Matt's story provides an example of how a child with A.D.D. and anxiety was helped with neurofeedback. Regular biofeedback to teach him how to regulate his finger temperature (an indicator of relaxation) was also part of his program:
Matt, a bright fifteen year-old, was in neuro feedback training primarily to Iearn how tc control his impulsive style of doing probIems in school and to learn to remain focused when studying. At the same time, he was also attempting to pass a di~icult, figure skating exam that would put him at the national level for competition. He had faited twice. His third and final try for some time was coming up in just a few weeks. In practice, the double jumps and other required maneuvers were easily accomplished. In competition, he missed. In the initial evaluation, Matt's mother had mentioned, flpart from not being able to focus in class, my son does figure skating, and he doesn't seem to do what the coach has just explained to him. Also, he gets very an~ious before competitions."
Matt learned quite rapidly to increase his focus by watching the computer monitor and listening to the audio feedback while doing academic tasks. However Matt was a very tense and anacious boy. A sensor on his little finger registered a skin temperature of only 73 degrees instead of a normal 94 to 96 degrees. This was a physiologic sign of inner tension. Some days when he came into training, his finger temperature would be as high as 89 degrees, but the moment anyone mentioned skating or a school problem, it would drop precipitously to the 70s. As he relaxed, his finger temperature would rise, and this feedback was displayed on the computer monitor. Gradually he be gan to be able to keep his finger temperature in the 90s even when presented with an academic task. i~hen the time for the skating competition came, he passed. His mother reported back, "He finally remembered what he was supposed to be doing - for example, holding his hands correctly. He seemed to be totally into his skating and not attending to the audience and the judges. It was really different. He actually looked relaxed!"
Matt produced another interesting result after neurofeedback training. At the end of the training sessions, he was retested on the Wechsler Intelligence Scale for Children. He scored 22 points higher than he had before training. Intelligence as measured on standardized tests is not expected to shift like that. Wechsler results are supposed to be largely independent of teaching and learning. Research on IQ changes with neurofeedback indicate average gains of around 10 points, so Matt's gains were unusually good. Perhaps his initial scores were lower due to the combination of A.D.D. and anxiety and they shot up when both these conditions improved. We do not think that neurofeedback training makes people smarter, but they do seem better able to utilize their potential. This shows up in the classroom and also on standardized tests, including intelligence tests. Matt was certainly a much more confident student when he completed training than he had been when he started. Additionally, his mother reported that he talked to her more, shared his feelings more, and generally seemed more cheerful. "I actually like having him around now," she reported with a laugh.
One could argue in each of the above cases that it was not the neurofeedback training that made the difference but other things the trainer was also working on, such as coaching in learning strategies. This is a possibility. However, these children had previously had extensive tutoring. Two of the mothers were teachers. All of the parents worked with their children and modeled logical approaches to schoolwork. The children had been taught similar strategies again and again, but nothing had sunk in. With neurofeedback they were in a different state of mind while thinking about using the strategies, and fmally things clicked. The most pleasing thing about the neurofeedback approach is that the changes seen in training sessions do translate to the real world. Parents tell us that for the first time, their children settle down to do homework without being nagged. The students tell us they can listen and learn more easily in class.
Adolescents who fall asleep in class. The brain waves produced just before a person falls asleep are slow waves. These are exactly the wave patterns that are often seen when the student who has A.D.D. tries to listen to a teacher or when the student tries to study Students with A.D.D., if they get to college, may find it difficult to remain awake during lectures. In the classroom, the production of slower waves means they are becoming less and less attentive to the external auditory and visual stimuli of teacher, chalkboard, and textbook. The student who is actively engaged in listening to the teacher, by contrast, is inhibiting slow wave activity and may be increasing fast, thinker-wave activity
There is another observation that is impor tant here. Children and adults with A.D.D. demonstrate a very low, a very high, or a labile electrodermal response (EDR). EDR can be measured with two tiny sensors placed on the palin or on two fingers of one hand. EDR is a measure of skin conduction, which changes when the hand perspires. If a student is drifting off and becoming sleepy, the EDR will be low. It will shift in a dramatic fashion if the student is suddenly startled by a noise or someone entering the room. Sitting up straight also produces an increase in EDR.
Students quickly understand how well this simple measurement can reflect their alertness level. With biofeedback training using the EDR feedback, they become more aware of when their alertness drops and learn how to increase it. This EDR training can be done at the same time as neurofeedback.
Andy was a pleasant and polite seventeenyear old boy. He was getting failing grades in his final year of high school. His parents said, "He just doesn't care." Andy had been diagnosed with A.D.D. when he was younger. He complained that he was constantly falling asleep during classes and when doing homework. Beneath his unmotivated, lazy exterior, Andy really did want to do well, but he was discouraged. In training when he was given a textbook to read, he kept drifting of :' If he was left alone for even a short time, the alpha and then theta wave activity would increase markedly. His EDR was very low. Occasionally Andy would actually fall asleep in the chair.
Andy trained himself to increase his EDR in order to stay awake and alert. Being able to do that encouraged him to believe that he could also improve the balance between his slow and fast brain waves. Gradually, over the course of forty sessions, he began to re main alert, focused, and actively learning for longer and longer pertods of time. As he did this, his calm waves and thinker waves increased. When he was being creative, he produced more of the slower, more synchronous alpha (creative daydreaming waves When he was actively listening or organiz ing, writing, reading, or expressing his ideas, he demonstrated more of the faster, less synchronous (thinker wave) beta activity.
As he proceeded with training, Andy raised his grade in English from a D to a B. He said, "I'm just turning on my concentration when I'm in class and studying."Andy had been hanging out with a difficult group of kids who were on drugs. He decided to stop meeting with them. It wasn't easy to stay at home rather than going out with the group, and his parents worried for a few weeks thatAndy was depressed. Eventually he found a new group of friends. He said, "The A.D.D. training gave me hope."
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