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ADHD Research Papers

Overcoming the barriers to effective treatment for
attention-deficit/hyperactivity disorder:
A neuro-educational approach

This paper will be featured in the International Journal of Psychophysiology in 2005.

Vincent J. Monastra, Ph.D.
Clinical Director
FPI Attention Disorders Clinic
Adjunct Associate Professor
Binghamton University

Abstract

Despite specific diagnostic criteria, published practice guidelines for assessing patients, and the availability of effective, pharmacological treatments for children diagnosed with attention-deficit/hyperactivity disorder (ADHD), a review of prescriptions practices in the Unites States indicates that as few as 25 to 50% of these patients receive even minimal medical treatment for this condition. In order to clarify the factors impeding treatment and develop a targeted intervention to overcome these barriers, two studies involving 1,510 families including one child diagnosed with ADHD were conducted. Factors associated with treatment failure or non-compliance with medical advice included dissatisfaction with a diagnostic process limited to brief observation, interview, and review of rating scales, fear of stimulant medication, lack of medication response within the first month, development of side-effects during the first month, lack of understanding of the reasons stimulants were being prescribed for a child, and insufficient clinical response. Based on these findings, an intervention program consisting of a comprehensive evaluation process (that included neuropsychological and neurophysiological tests of attention and medical screening for other health problems associated with inattention and hyperactivity) and parent education about the medical causes of ADHD, the biochemical action of medications, the relationship between dietary habits and attention, and the educational rights of children with ADHD was conducted. Following completion of this three session intervention, 95% of patients complied with medical recommendation, initiated pharmacological treatment, and continued medication for a two-year follow-up period. Three percent of the patients were diagnosed and treated for other medical conditions.

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EEG Biofeedback (Neurotherapy) as a Treatment for
Attention-Deficit/Hyperactivity Disorder:
Rationale and Empirical Foundation

Vincent J. Monastra, Ph.D.
FPI Attention Disorders Clinic
Binghamton University

Abstract

During the past three decades, EEG biofeedback has emerged as a non-pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD). This intervention was derived from operant conditioning studies that demonstrated capacity for neurophysio- logical training in humans and other mammals and targets atypical patterns of cortical activation that have consistently been identified in neuroimaging and quantitative electroencephalographic (QEEG) studies of patients diagnosed with ADHD. This review paper presents the rationale for EEG biofeedback and examines the empirical support for this treatment, using efficacy guidelines established by the Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neuronal Regulation (ISNR). Based on these guidelines, EEG biofeedback is considered to be “probably efficacious” for the treatment of ADHD and merits consideration as a treatment for patients who are stimulant “non-responders”. Although research findings published to date indicate positive clinical response in approximately 75% of patients treated in controlled-group studies, additional RCT’s are needed to provide a better estimate of the robustness of this treatment.

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The Effects of Stimulant Therapy, EEG Biofeedback & Parenting Style on
the Primary Symptoms of Attention-Deficit/Hyperactivity Disorder

Vincent J. Monastra, Ph.D., Donna M. Monastra, C.S.W. & Susan George, M.A.
FPI Attention Disorders Clinic

Abstract

One hundred children, ages 6 to 19, who were diagnosed with attention-deficit/ hyperactivity disorder (ADHD), either inattentive or combined types, participated in a study examining the effects of Ritalin, EEG biofeedback and parenting style on the primary symptoms of ADHD. All of the patients participated in a one-year, multi-modal, outpatient program that included: Ritalin, parent counseling, and academic support at school (either a 504 Plan or an IEP). Fifty-one of the participants also received EEG biofeedback therapy. Post-treatment assessments were conducted both with and without stimulant therapy. Significant improvement was noted on the Test of Variables of Attention (T.O.V.A.; L.M. Greenberg, 1998) and the Attention Deficit Disorders Evaluation Scale (ADDES; S.B. McCarney, 1995) when participants were tested while using Ritalin. However, only those who had received EEG biofeedback sustained these gains when tested without Ritalin. The results of a Quantitative Electroencephalographic Scanning Process (QEEG-Scan; Monastra, et al., 1999) revealed significant reduction in cortical slowing only in patients who had received EEG biofeedback. Behavioral measures indicated that parenting style exerted a significant moderating effect on the expression of behavioral symptoms at home but not at school.

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Differentiating ADHD from Other Psychiatric Disorders Via
A Quantitative Electroencephalographic (QEEG) Scanning Process

Vincent J. Monastra, Ph.D., Donna M. Monastra, C.S.W.
The Family Psychology Institute

Joel F. Lubar, Ph.D.
Department of Psychology, University of Tennessee

Abstract

Recent quantitative electroencephalographic (QEEG) studies have revealed evidence of cortical hypoarousal over frontal and central, midline regions in patients diagnosed with attention-deficit/hyperactivity disorder (ADHD). In order to determine whether these QEEG characteristics were specific for patients with ADHD, a power spectral analysis was conducted on the QEEG recordings obtained from a total of 314 child/adolescent psychiatric patients (176 diagnosed with ADHD, 138 diagnosed with an anxiety, mood or oppositional defiant disorder). Power ratios were calculated comparing picoWatt (pW) output at 4-8 Hz (theta) with output at 13-21 Hz (beta), as recorded at the vertex (Cz), while the patients were involved in academic tasks. Results of the study indicated that patients diagnosed with ADHD exhibited significantly greater theta/beta power ratios than each of the comparison psychiatric groups (p < .001), supporting a cortical underarousal model of ADHD. Examination of the classification accuracy of the QEEG procedure revealed a test sensitivity for ADHD of 78% with test specificity of 95%, suggesting that cortical hypoarousal at the vertex is not a neurophysiological characteristic of oppositional, mood or anxiety disorders.

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