The ADD Centre® & The Biofeedback Institute of Toronto®

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ADD Centre® and The Biofeedback Institute®
"F.A.Q."

What is Neurofeedback?
EEG neurofeedback is a form of biofeedback that uses a brain-computer interface to measure electrical activity of the brain (EEG) and present this information in a form that enables the individual to perceive changes in the state of the brain and learn to modify EEG patterns. To rewire the brain, we make use of neurofeedback-therapy. This treatment stimulates metabolism and blood flow, strengthens dendritic connections as well as influencing neurotransmitters, which accounts for improvement in the patient’s ability to carry out cognitive tasks successfully. Treatment with EEG neurofeedback is based on the theory that, once individuals understand their brain activity and learn to manipulate their own brain waves, they will be able to continue to do so, long after the therapy has ended. Some studies have followed people with ADHD for as long as 10 years after being treated with EEG neurofeedback and have shown no significant loss of treatment gains.

We apply electrodes to the scalp to listen in on brainwave activity. We process the signal by computer, and we extract information about certain key brainwave frequencies. We show the ebb and flow of this activity back to the person, who attempts to change the activity level. Some frequencies we wish to promote. Others we wish to diminish. We present this information to the person in the form of a video game. The person is effectively playing the video game with his or her brain. Eventually the brainwave activity is "shaped" toward more desirable, more regulated performance. The frequencies we target, and the specific locations on the scalp where we listen in on the brain, are specific to the conditions we are trying to address, and specific to the individual.

What is Biofeedback?
Biofeedback is a type of non-invasive treatment that provides real-time information on brain or body functions. It uses computer technology to record physiological activity that is normally outside conscious awareness (e.g. heart rate variability, breathing rate, muscle tension, skin temperature, and skin conduction) and to display this activity to the person being recorded. The goal of biofeedback is to teach people to build awareness of patterns of physiological stress and to voluntarily control their physiological activity.
How do children and adults with ADD/ADHD benefit from neurofeedback training?
This training procedure has been shown to increase the ability to pay attention, focus and concentrate. Studies have demonstrated that students with Attention Deficit Disorder who have completed this training have also shown significant improvements in classroom performance. Dr. Joel Lubar, the originator of these training procedures, reported that 80% of the first 250 children they worked with demonstrated grade point average improvements of approximately 1.5 levels. I.Q. scores on the WISC also show significant improvement after training.

Does Neurofeedback / Biofeedback hurt?
No, it does not hurt. Monitoring the EEG is a fairly simple process. At the minimal level, it involves placing one or more electrodes/sensors on top of the head, and one electrode /sensor on each ear. Before placing the electrodes, we prep the skin and then use a conductive gel to obtain a good contact between electrode and skin.

How do you measure Brainwave activity?
An electroencephalogram (EEG) is a measure of electrical activity from the brain. An EEG tracks and records brain wave patterns. Monitoring the EEG is a fairly simple process. It typically involves placing one or more electrodes on top of the head, and one electrode on each ear. The wires from the sensors transmit the electrical information from the scalp to an instrument which analyzes the brainwaves. Using a brain-computer interface, the information is fed to a computer screen which allows clients to learn when their brainwaves are in an optimal state and when they are not. There are many different feedback screens which can be selected. Young children may select puzzles and mazes while adults often prefer gauges and displays that give quantitative data. Children enjoy taking home printouts of their brainwave’s amplitudes (learning curve) demonstrating how they are learning to control them. The skill must be practiced until it becomes automatic (unconscious). In addition to acquiring self-regulation of brain waves, clients receive instruction in metacognitive strategies - thinking processes involved in learning how to learn and remember.

How long are the training sessions and what happens during the session?
Training sessions at the ADD Centre are 50 minutes long. During the session a trainer works individually with each client. While sitting in front of a computer screen the client receives audio and visual feedback concerning their brainwave activity (with EEG electrodes in place). The feedback gives positive reinforcement and trains the client to:
• relax physically and mentally
• increase alertness
• focus
• concentrate
• decrease fidgeting
• decrease an impulsive approach to tasks.
During each training session, the client has opportunities for combined visual and auditory feedback. Other periods of time during the training session are used for audio feedback combined with academic tasks such as reading comprehension, mathematics and other subjects. These sections of the training session may include listening, reading and written work. At these times the client is taught meta-cognitive learning strategies that may include, study skills and time management. At the end of the session the trainer and the client review the scores and the graphs which show how well the student was concentrating during each part of the training session.

Do Neurofeedback and medications do the same thing?
No. Medications have an advantage in that they act immediately. They can be very useful and helpful with some children to control disruptive behaviors which might otherwise cause negative reactions and a lowering of their self esteem. Medications, however, act only while they are at sufficient dosage levels in the blood stream. Dr. Swanson's team at the University of California, Irvine, summarized their usefulness "(1) a short term benefit for the management of behavioral symptoms of inattention, impulsivity, and hyperactivity; and (2) a lack of demonstrated long-term effects on learning, achievement, or social adjustment". Neurofeedback takes much longer to produce change (2 to 6 months) but appears to give long term benefits in all the key areas of attention span, impulse control, academic achievement and social adjustment.

Can adults benefit?
Yes! ADD/ADHD symptoms do not necessarily go away as a person gets older and adults benefit from neurofeedback training to the same extent as children. They can achieve long term improvement in attention span, impulse control, reading, listening skills, and time management. In addition, many adults also want assistance with stress and tension. For decreasing tension, neurofeedback of brain waves can be combined with biofeedback.


What are the advantages of EEG training?
With EEG training the client is empowered to take control of both attention and concentration. There are none of the side effects associated with medications. Training helps attention to be maintained when the person chooses; for example, during the evening study hours when medications, if used, may interfere with sleep. Training also is a step towards not requiring medications in order to concentrate on one's work in future years.

How long does training take?
Training takes approximately 40-60 sessions depending upon the severity and complexity of the symptoms. However, clients may begin to observe changes around the 20-25 session mark. Frequency of training is usually twice per week for a period of at least 5 months. Each training session lasts approximately 50 minutes. Condensed schedules are available, especially during the summer.

How soon will progress be noticed?
Progress can generally be noticed after about twenty training sessions. Changes in behavior in the classroom can usually be noticed after 2-4 months of training (or approximately 20-40 sessions). Keep in mind, each client is unique, and may need more time depending on their learning curve, and complexity/severity of symptoms.

How is progress measured?
At the initial assessment clients complete a comprehensive intake which includes questionnaires, online neurocognitive testing, computerized tests of attention, an EEG brainwave recording, and a clinical interview. All measures are repeated at progress test to measure changes that have taken place. If more training is needed, new goals are defined at a new training program is put in place.

How long do the results of training last?
Long term follow-up with adults who, as children, received EEG feedback training for ADD/ADHD, indicates that the improvement appears to be permanent in most cases.

How long has this training method been used?
EEG training for attentional problems has been used for more than 40 years. Improved instrumentation in the last few years is allowing the procedure to be more widely utilized. The feedback techniques used at the ADD Centre have evolved from those developed by M. Barry Sterman, Ph.D. (UCLA) and Joel Lubar, Ph.D. (University of Tennessee). More than 700 centres provide neurofeedback in North America, Australia and Europe. In Canada, research and training was first carried out at the University of Alberta in 1991 through their Cognitive Re-regulation Program. The programs at the ADD Centre reflect the Director's initial training with Dr. Lubar in Tennessee and subsequent training with Dr. Sterman in California, Dr. Fitzsimmons from the University of Alberta and with other neurofeedback practitioners across North America and in Europe.

Is training covered by insurance?
Our training is not a medical procedure and is not covered by OHIP. However, psychological assessments are covered by most private insurance companies. Some insurers request a diagnosis or a referral from the Family Doctor. Our training may be covered by certain insurance companies depending on the nature of your extended health insurance plan.

Can Neurofeedback be combined with other approaches?
Yes, absolutely! Multi-modal approaches are recommended, especially for children with ADD/ADHD. Neurofeedback may improve your child's response to educational interventions, behavior management strategies, and individual and family therapies. Good nutrition should always be practiced and some children have special dietary needs and sensitivities. Neurofeedback can be combined with medication. Children who are on medication when they begin neurofeedback training continue with their dosage until their parents, in consultation with their physician, determine that the dosage can be reduced as training takes effect.

Why aren't these procedures better known?
These procedures require (1) extensive post-doctoral training and (2) expensive sophisticated equipment that only became available for office practice in the early 1990's. The techniques have been researched at University Centres for more than 40 years. To learn more about Neurofeedback please visit the website for the International Society for Neurofeedback and Research https://www.isnr.org/ (ISNR), the Biofeedback Certification International Alliance http://www.bcia.org (BCIA), and the Association for Applied Psychophysiology and Biofeedback https://www.aapb.org (AAPB).

Can I be on medication while I do training?
Yes. Clients will sometimes begin the training program while on stimulant medication, with the eventual goal to go off medications. We do request that clients avoid taking stimulant medications on the morning of their assessment (the dose for the day can be taken after the assessment) as medications may influence EEG recordings. Once the client starts to notice improvement, and has begun to change their brainwave patterns (around the 20-25 session mark) they may notice that the dose of the medication may need to be adjusted. We recommend that you consult with your primary care physician to reduce these doses gradually as training effects continue to strengthen.

How can I check if a person is a certified provider?
We recommend that you always consult with providers who are certified by the Biofeedback Certification International Alliance (BCIA). You can follow the link http://certify.bcia.org/4dcgi/resctr/search.html to find a provider in your city.

How are you different from other Neurofeedback providers?

The ADD Centre leads the field in Neurofeedback.

1. Lynda Thompson's work in collaboration with her husband, Michael, has been honoured by Major International awards:
• Lifetime Achievement Award from the Biofeedback Federation of Europe - 2010
• Distinguished Scientist Award from the Association for Applied Psychophysiology and Biofeedback - 2016


2. We offer the most comprehensive assessment. In addition to single channel EEG we offer, as appropriate: 19 channel Electroencephalogram; Evoked potentials (ERP’s); Heart rate variability analysis; Continuous performance tests; Balance Analysis using a European system (Meditech’s Force-Plate analysis); Neurocognitive and / or psycho-educational testing, including IQ testing.

3. Lynda Thompson is co-author of the basic textbook (used internationally) in this field:

Michael Thompson & Lynda Thompson (2015) Functional Neuroanatomy: Organized with reference to networks, lobes of the brain, 10-20 sites, and Brodmann areas.
Wheat Ridge, CO: Association for Applied Psychophysiology and Biofeedback

Michael Thompson & Lynda Thompson (2015) The Neurofeedback Book: An Introduction to Basic Concepts in Applied Psychophysiology, Second Edition.
Wheat Ridge, CO: Association for Applied Psychophysiology.

4. Additionally, she has co-authored 4 books, 9 chapters, 20 peer-reviewed articles and has given 171 invited presentations and workshops in 24 countries on 5 continents.

5. Training at the ADD Centre combines both Neurofeedback (NFB) and biofeedback (BFB), done with one-to-one coaching in metacognitive strategies.

6. Progress testing involves the same objective measures as the initial assessment

7. Additional treatment modalities are available to be used when appropriate. These include: Transcranial Direct Current Stimulation (TDCS); Electro cranial stimulation modalities (ECS); Sound and Light entrainment; Passive infra-red (PIR) training and Haemoelectroencephalograhy (HEG); Cogmed Working Memory training program; Home training suggestions that include: Diet, sleep, exercise, on-line cognitive training, and heart-rate-variability training.

At the ADD Centre you receive the highest quality intervention from the most highly qualified professionals.

Come Train with the Best!