Is it ADHD or is it something else?

folder_openADHD, QEEG

According to the Centers for Disease Control, currently 6.1 million children are diagnosed with ADHD – almost 10% of all U.S. children. But ADHD is not a disease, it’s simply a description of difficulties – difficulties that can be caused by an almost infinite number of issues.

Despite the subjective nature of an ADHD diagnosis, its prevalence has increased dramatically over the decades, roughly doubling in children between 1997 and 2017¹. Among adults, the increase has been even more dramatic, with one study finding a 6-fold increase in the proportion of office visits in which stimulants were prescribed between 1994 and 2009².

What’s behind this huge increase in ADHD diagnosis? We believe that the diagnosis is too broad, and that medication only resolves a small percentage of those diagnosed.

Medicating children is a significant step: ADHD medications are almost all formulations of amphetamine – a powerful drug that is banned without a prescription. At Gray Matters we don’t argue against medication, but believe it should be used carefully, with the foreknowledge that it’s the right choice.

Stimulant medication works by increasing cortical arousal, something that’s easily measured with EEG. By matching brain function to the known effects of stimulant medication, it’s relatively easy to predict medication response. That’s why, in 2013, the FDA approved the use of EEG theta/beta ratios as a valid diagnostic marker for ADHD.

Under-aroused brain (responds to stimulants)Under-aroused brain (responds to stimulants)

Over-aroused, dysregulated brain (doesn’t respond to stimulants)Over-aroused, dysregulated brain (doesn’t respond to stimulants)

The impact of stimulant medication on developing brains is profound. A recent study in the Journal of Neuropsychopharmacology³ found a greater than 8-fold increase in the risk of basal ganglia and cerebellum diseases (such as Parkinson’s) in middle-aged patients prescribed stimulants as children. Our experience supports the idea that long-term changes to dopamine levels caused by stimulant medication have a subsequent impact on the brain’s ability to self-regulate.

Many of the children we see have tried a series of stimulant medications before turning to us for a QEEG. Most often, issues with medication tolerance were simply because the medication was wrong. Difficulties commonly described as “ADHD” can be used by an almost infinite number of issues, very few of which are improved by ADHD medications. Brain imaging identifies these issues and clarifies treatment.

What is qEEG?

Quantitative EEG (qEEG) measures actual brain activity, comparing it to a database of normal brain function used by hospitals all over the world. By mapping the complexity of individual brain function, we can understand the cause of difficulties with incredible accuracy. This allows us to make informed treatment recommendations based on predicted medication response (or neurofeedback, if a medication-free approach is preferred).

Gray Matters has almost 12 years’ experience in QEEG, mapping over 10,000 brains and acquiring data and expertise that’s unrivaled in the region. Our QEEG reports contain detailed analysis and actionable treatment recommendations. [For a sample report, click here.]

This is ADHD

This is Anxiety

What is Neurofeedback?

Neurofeedback uses our understanding of brain plasticity (the brain’s ability to change itself) to directly train the brain to improve function. By measuring brain activity and linking it with a reward, we’re able to improve the ability to focus, reduce anxiety, or improve a wide variety of functional issues. Essentially, neurofeedback can change any brain function that can be measured by EEG.

ADHD Medication

  • The brain is chemically altered from the outside
  • Affects entire central nervous system
  • Dependency and rebound effects
  • Appetite loss, sleep issues, irritability
  • Improvements require continuing treatment
  • No long-term evidence of efficacy
  • Concerns with long term impact

Neurofeedback

  • The brain is directed to change itself
  • Targets specific brain areas and networks
  • Gradual but progressive change
  • No side effects
  • Improvements continue after treatment
  • Improvements appear to endure
The Gray Matters Difference:

QEEG and neurofeedback are new approaches, with little oversight or regulation and a huge variation in the nature of services provided. While many clinicians offer the neurofeedback equivalent of the Ford Model T, we strive to be the Tesla – always pushing ourselves further. From our training, to our equipment and software, everything we do is geared towards improving treatment outcomes:

  1. Detailed QEEG’s using SW LORETA 3-D imaging, to identify dysregulated brain areas anywhere in the brain.
  2. Comprehensive QEEG reporting, to inform treatment and collaborate effectively with other providers.
  3. The most advanced neurofeedback software available, able to train internal brain structures and functional networks – for more targeted training, and better results, achieved more quickly (and more cost effectively).
  4. Ultra-fast gaming computers to ensure that feedback received during neurofeedback is contemporaneous to measured brain activity.
  5. Advanced gel-less EEG caps, allowing patients to have neurofeedback without needing to wash their hair afterwards.
1. JAMA Network Open. 2018;1(4):e181471. doi:10.1001/jamanetworkopen.2018.1471
2. Trends in office-based treatment of adults with stimulants in the United States. Olfson M, Blanco C, Wang S, Greenhill LL J Clin Psychiatry. 2013 Jan; 74(1):43-50. https://psycnet.apa.org/doi/10.4088/JCP.12m07975
3. *Curtin, K., Fleckenstein, A.E., Keeshin, B.R. et al. Increased risk of diseases of the basal ganglia and cerebellum in patients with a history of attention-deficit/hyperactivity disorder. Neuropsychopharmacol 43, 2548–2555 (2018). https://doi.org/10.1038/s41386-018-0207-5  
Tags: ADHD, QEEG

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