Attention deficit has multiple types. The 3 prominent types involve difficulty holding attention (ADD), difficulty with impulsivity (hyperactive) and combined difficulty holding attention with additional difficulty controlling impulsivity (ADHD).
Currently 11% of US children have some form of attention deficit. Twenty percent or 1 in 5 boys has the disorder. Over the past 2 decades the percentage steadily increased with no end in sight. Fully 60% of children with ADD/ADHD will continue to have symptoms into adulthood. While more boys develop ADHD, equal numbers of adult males and females have the disorder.
There are several dietary and lifestyle factors thought to contribute to ADD/ADHD including food sensitivities, environmental toxin reactions (heavy metals, chemical food additives, pesticides), vitamin/mineral deficiencies, amino acid deficiencies and low protein/high carbohydrate diets.
Several genetic variations have been identified that increase the risk of developing ADHD. Many of the gene variations are in genes that have the code to make an enzyme used in the brain to produce a neurotransmitter or a similar protein that brain cells use to communicate.
An interesting discovery is that these genetic variations still allow the enzyme or protein to be produced but that these enzymes function somewhat weakly. Once a gene “codes” or makes an enzyme it is inactive and must be activated by “cofactor” which is typically some combination of different vitamins and/or minerals. One of the more important discoveries has been that these weak enzymes can be activated at levels of normal enzymes but that they need higher amounts of the cofactors to do so.
For the above reason, those with ADHD often need much higher levels of specific vitamins, minerals and amino acids that are involved in proper function of different brain areas. They may also need greater amounts of specific amino acids that are used to make brain neurotransmitters.
A diverse combination of nutritional supplements has been shown to importantly improve standardized testing scores in children with ADHD equal to that of Ritalin. Similar results have been found also in adults with attention deficit.
The other triggering factors in ADHD such as food sensitivities, chemical sensitivities/toxicities, and heavy metal toxicity work through a common mechanism; that of inducing neuroinflammation or inflammation in the brain.
Food sensitivity can be a potent trigger of chronic inflammation in the brain. With time the inflammatory reaction in the brain activates a stress response which overworks an area of the brain called the frontal lobes that are involved in holding attention and controlling impulses. As these areas deplete certain neurotransmitters such as dopamine and norepinephrine, they will intermittently inactivate interrupting attention and impulse control.
Interestingly, all medications used to treat ADHD increase the levels of these two neurotransmitters in the brain. Some work by stimulating greater release and others by trying to delay removal of dopamine and norepinephrine in the brain extending their effect. While they can be helpful in controlling symptoms, they are not an ongoing solution nor are they without potential for adverse effect. If the problem is poor production of a neurotransmitter, it is ideal to ensure that this is managed with the nutrients discussed above.
Once the causative factors discussed above are found and properly managed and specific nutritional imbalances such as vitamin/mineral and amino acid insufficiencies are addressed the brain has to be re-balanced. This is done with neurofeedback or EEG guided brain training to rebalance brain signaling patterns.
The brain is our most metabolically active tissue using more glucose per gram of tissue than any other in the body. As could be expected, metabolic problems as discussed above greatly affect brain activity.
The brain has 4 main frequency ranges for the electrical signals it emits during cell activity. The slowest, delta waves are dominant during deep sleep and maintain the communication between the brain cortex and the brainstem where signals are generated that maintain heart, lung and other functions that we do not have to think about controlling. Theta waves are slightly faster waves and are dominant when we are either waking up or falling asleep and when we are daydreaming.
Beta waves are the fastest brain waves and are used for higher brain processing function. When they get too low, the area of the brain affected will not perform its tasks well. The left frontal lobe must sustain high activity to hold attention span. When it struggles, attention deficit occurs particularly when increased slow wave activity such as delta or theta waves occurs.
This same pattern of too much slow wave (delta and/or theta) and too little beta in the right frontal lobe impairs the control of impulsivity which creates hyperactivity. Below is a QEEG showing the altered brain wave pattern common in ADHD.
The green lobes are within the normal range. Red lobes are moderately high in activity, while yellow is very high. Light blue is moderately low, while dark blue is very low. Notice the left frontal lobe (F3) theta is very high, while the beta is low.
The other factor that contributes to ADHD is the low occipital lobe (O1/O2) values across all frequencies. The occipital lobes process visual information, and often poor visual processing further causes trouble with attention. This phenomenon is similar to watching a movie which keeps pausing for a split second repeatedly.
Neurofeedback training uses a method called operant conditioning to “teach” the brain back into a more balanced activation pattern. Monitoring EEG electrodes are worn over the lobes to be trained, and this is integrated with a computer movie. If the target is to inhibit theta waves and increase beta waves, the brain is rewarded when it can cause this pattern of activation. The reward is that the movie is very clear and the sound is normal. If the brain wanders to the old pattern of activation, the movie and sound dull causing the brain to try to rebalance the activation again.
Operant conditioning is a sophisticated extension of Pavlov’s original theory where he conditioned dogs to salivate to an auditory tone. The dogs were observed to salivate when they received food in the same fashion repetitively. Over time they began to salivate simply when they observed the person who would always feed them. A tone was then played at the time they would see the feeding preparation. Over time the dogs could be made to salivate simply when the tone was played. Pavlov’s conditioning was the beginning of a primary school of psychology called behaviorism which dominated treatment for most of the 20th century.
With time the brain learns to maintain its balanced pattern without the stimulation. Unlike medications that lose their effect when they are discontinued, neurofeedback generates a lasting effect once rebalancing occurs provided the original factor such as a food sensitivity is controlled.
The importance of using non-drug treatments for ADHD centers around the potential for adverse events associated with the commonly used medications including elevation of blood pressure and pulse, sleep disturbance, and others. One of the evolving understandings which is seldom expressed to patients and parents is the increased risk of developing substance abuse.
A recent study of over 550 children with ADHD found that they were more likely to develop a substance abuse problem as an adolescent. In those who did develop an adolescent substance abuse problem, they were 1400% more likely to abuse alcohol and 348% more likely to abuse drugs as adults. There are two theories of why these risks occurred. The first is that the poorly functioning brain in ADHD creates a desire for “stimulants” to raise brain activity. The other is that the use of stimulant drugs in treatment may increase the need to do this at greater levels over time.
While the reasons for the above numbers remain to be fully examined, their implication suggest the greater need for non-drug therapies of which neurofeedback is ideally suited.