Introduction

In today’s fast-paced world, ADHD diagnoses are becoming increasingly common across all age groups and professions. Once thought to primarily affect “naughty kids,” we now understand that ADHD can impact anyone—from school and university students to blue-collar workers. While the core symptoms of difficulty in focusing and impulsivity is consistent, individual experiences of ADHD vary widely. Factors such as age, gender, and life stage can all influence how ADHD manifests and how it should be managed.

What is ADHD?

ADHD, or Attention-Deficit/Hyperactivity Disorder, is a neurodevelopmental disorder characterised by inattention, hyperactivity, and impulsivity. These symptoms significantly impact daily functioning and quality of life. While commonly diagnosed in childhood, nowadays, more and more people are being diagnosed in their adulthood and even later in life. The prevalence of ADHD is estimated to be about 5 to 7 percent among children, but this number seems to be increasing rapidly, potentially due to increase in awareness, but could also be due to modern lifestyle factors.

Why is ADHD Heterogeneous?

The term "heterogeneous" means that ADHD manifests differently in various people. This variability is due to broad diagnostic criteria in addition to diverse genetic, environmental, and neurological factors. Also, ADHD often coexists with other diagnoses such as anxiety, depression, OCD, and autism, making the diagnosis and management more complicated. 

Every brain is different, and so is its response to medication. While many people find medications life-changing, others report no benefit or bothersome side effects that affect their quality of life. What underlies these differences, and is there a way to improve outcomes with fewer side effects? Enter brain mapping, an advanced technique that offers insights into the ADHD brain. Combined with neurofeedback, a non-medication solution, brain mapping can help alleviate symptoms while enhancing focus and overall functioning.

QEEG (Quantitative Electroencephalography) or brain mapping allows us to understnd the brain's unique characteristics. It helps us to understand different subtypes and their varied presentations. Research has established that certain QEEG profiles in ADHD correlate better with response to specific classes of medications, while others predict a higher likelihood of side effects. Below are some common patterns observed in people diagnosed with ADHD and their unique characteristics.

Common QEEG Patterns in ADHD

1. Elevated Theta-Beta Ratio

• Description: This pattern is often associated with 'classical' ADHD, a subtype where individuals report dreaminess and lack of focus right from childhood.

• Implications: Research has shown that an elevated Theta-Beta ratio profile correlates with good response to stimulant class of medications.

2. Fast Peak Alpha

• Description: The posterior regions of the brain generate a brain wave called Alpha rhythm when we close our eyes. Although Alpha ranges from 8 to 12 Hz, there is always a dominant alpha frequency which usually peaks around 9.5 to 10 Hz in most individuals. When the Alpha peak frequency is high i.e. around 11-12 Hz or more, it indicates an overactive brain.

• Implications: People with a fast Alpha peak often report anxiousness, hypervigilance, fidgetiness, and sleep onset issues. Individuals with this profile tend to experience more side effects with stimulant medications.

3. Eyes Open Alpha 

• Description: Normally, Alpha rhythm is noticed when we close our eyes and is absent with eyes open. However, some individuals generate significantly high amounts of Alpha rhythm with eyes open which leads to inattentiveness due to frequent tuning out.

• Implications: Those with chronic insomnia, substance abuse, or dissociation due to psychological trauma are more likely to have this pattern. Their response to stimulants might not be robust, and they may respond better to non-stimulant medications.

4. Excessive Spindling Beta

• Description: Faster brain rhythms called Beta rhythms are associated with an awake and alert brain. Individuals who are making high amounts of Beta will report heightened awareness and anxiety. "Spindling Beta" is another name for this profile and this is commonly linked with broken sleep, impulsivity, anxiety, and substances use.

• Implications: Stimulants actually worsen symptoms in these individuals.

5. Frontal Alpha Asymmetry (FAA)

• Description: FAA refers to higher amounts of Alpha in the left frontal vis-a-vis the right frontal region. This pattern is often associated with low mood, poor motivation, and a negative perceptual style, in addition to ADHD symptoms.

• Implications: This 'limbic' presentation may not respond well to ADHD medications or addition of antidepressants, whereas neurofeedback can achieve excellent results. 

6. Excess Anterior Midline Theta/Alpha

• Description: The anterior cingulate cortex (ACC) is involved in response inhibition and set shifting. Excess theta or alpha in front midline represents dysfunction in the ACC and is associated with perfectionistic or obsessive personality style in what is called ‘overfocused ADHD’.  

• Implications: Individuals with ADHD who exhibit this pattern report becoming hyperfocused with stimulants, this is not always helpful. For instance, many clients notice that medication makes them scroll excessively on social media instead of improving their productivity at work.

In summary, QEEG assessments provide a much more nuanced understanding of brain functioning beyond traditional ADHD assessments. Many QEEG patterns have a strong genetic component, are stable over time, and have significant treatment implications. Even with the right medications, these patterns are not known to change, a fact which has implications for potential relapse after treatment discontinuation, except for neurofeedback which has lasting effects on brain.

Neurofeedback: A Non-Medication Solution

Individuals with ADHD who have failed to respond to medication or are experiencing distressing side effects need not lose hope. Neurofeedback offers a promising alternative especially if you do not wish to pursue long-term medications. It can improve focus and concentration while addressing associated symptoms, all without causing side effects!

Neurofeedback is a cutting-edge technique that allows you to train your brain for optimal performance, much like going to the gym for your mind. Instead of lifting heavy weights or running on a treadmill, we use technology to monitor and improve brain activity. This is not classified as a medical intervention but rather a wellness intervention that anyone can access to improve their brain function. By understanding the unique brain patterns of individuals with the help of QEEG, we can move towards more personalised and effective treatments.

How Neurofeedback Helps ADHD

For individuals with ADHD, neurofeedback aims to promote brain wave patterns associated with focus and calmness. During the session, the brain receives constant feedback on its performance, and by continual course correction and subconscious changes, the brain functioning becomes much more regulated. Changes induced in brain waves as a result of regular training are translated into better attention span, spontaneous memory recall, less impulsivity, and better organization. Associated issues such as sleep disturbances, anxiety, and mood swings often improve as well.

Research and Evidence

Numerous studies support the efficacy of neurofeedback for ADHD. Research has shown that neurofeedback can lead to improvements in attention, impulsivity, and hyperactivity. In 2012, the American Academy of Pediatrics rated neurofeedback as a level-one ‘Best Support’ intervention for ADHD, the highest possible rating, on par with medication treatment or behavior therapy.

Long-Term Benefits

One of the key advantages of neurofeedback is its potential for long-term benefits. Unlike medications that provide temporary relief, neurofeedback focuses on lasting changes in brain function. Research consistently demonstrates that improvements last for years after completing neurofeedback training. Changes induced by neurofeedback, as measured by repeat QEEG assessments, have been shown to be persistent over time.

Overcoming Challenges with Neurofeedback

Like any training, neurofeedback may come with challenges. Some individuals may find it difficult to stay engaged during sessions. To keep engagement high, we send motivational messages, maintain regular two-way messaging with clients, and conduct regular reviews with the provider.

Staying Consistent with Training

Consistency is key to neurofeedback success. Establishing a regular schedule and sticking to it can maximise the benefits. Additionally, involving family members in the process can provide support and encouragement.

The Growing Importance of Personalised Medicine

Personalised medicine is gaining traction across various medical fields, and ADHD is no exception. Tailoring treatments to an individual's unique brain characteristics can lead to more effective outcomes and a better quality of life.

Taking the First Step Towards Better Focus

If you or your child is struggling with ADHD, consider exploring brain mapping and neurofeedback as potential options. Consult with a qualified and BCIA-accredited practitioner to determine if these approaches are suitable for your needs. Personalised ADHD treatments can make all the difference in enhancing quality of life. By understanding your brain and using neurofeedback to train it, you can achieve better focus and improved overall long-term well-being.

For more information and to start your personalised ADHD treatment journey, book a consultation with our experts today!

References

Johnstone, J., Gunkelman, J. & Lunt, J. (2005). Clinical Database Development: Characterization of EEG Phenotypes. Clinical EEG and neuroscience : official journal of the EEG and Clinical Neuroscience Society (ENCS). 36. 99-107. 10.1177/155005940503600209.

American Academy of Pediatrics . Evidence-Based Child and Adolescent Psychosocial Interventions. American Academy of Pediatrics; Itaska, IL, USA: 2012.