ADHD in adults: is neurofeedback the solution?

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Arrived. Take a deep breath. "Oh yes, a coffee would be good," says Claudia Kerst * relieved when she falls on a chair in practice. On the outside, she looks like any mother who has just managed to get a lively nine-year-old to his appointment in time. Hardly anyone suspects how much strength it will cost such a task even if everything runs smoothly.

60 to 70 percent of cases persist beyond childhood.

After all, Kerst now knows why everyday life can quickly become overly exhausting: she has AD (H) S, i.e. an attention deficit disorder. "A few years ago, my siblings both got this diagnosis in quick succession, and because they are very similar to me, I also had them tested," says the 42-year-old. And for the first time, she felt that the result was really right. Although around three percent of adults in Germany are affected by AD (H) S, it is only slowly becoming clear that the problems do not always "grow out", but persist in 60 to 70 percent of cases beyond childhood.

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The long way to diagnosis

Until her attention disorder was recognized, therapists assumed very different things behind Claudia Kerst's problems. "I was treated for depression at first, but that only helped a little because I was really unhappy at that time," she says. "As a young adult, I became increasingly aware that something was wrong with me and felt like a failure because I couldn't finish anything." A psychologist later said that she had social phobia.

"I should consciously look at people in the café because I don't like being around people so much and it quickly becomes too much for me to keep eye contact with a new person," says Kerst. "Then I can no longer think clearly!" This has nothing to do with fear, but with the underdeveloped ability to filter stimuli.

Neurofeedback can help rebalance

Apparently, the level of excitation in the brain is not in balance in AD (H) S. Dr. In her Stuttgart practice, Edith Schneider treats other AD (H) S patients in addition to the Kersts and explains: "Those affected need a lot of stimulation so that their level of activation reaches areas that make focused attention possible at all." This applies even if there is hyperactivity, according to the doctor and occupational therapist: "It is an unconscious self-stimulation in order not to drift completely inside." However, children shoot past the target, get fidgety, loud and often coarse. Adult AD (H) S students, on the other hand, are more likely to experience extreme inner restlessness.

But apparently the ability of the neural networks to regulate can also be developed and improved by adults – for example with neurofeedback, a computer-assisted brain training. Its principle has remained the same since the 1960s, even if there are now more effective variants with the so-called SCP and ILF training: electrodes on the head measure selected brain waves, and the computer gives the brain images, sounds or tactile stimuli translated feedback. This helps it to practice new skills, just like a mirror helps to adjust an unusual posture.

First successes

It is not Claudia Kerst herself who is attending the training in Edith Schneider's practice today, but her son Leon *. With him she sees everything that she went through at his age: his sensitivity, through which he is quickly overwhelmed and reacts gruffly. To face his difficulties when things are not going as they should. His impulsiveness, which gives him many admonitions at school and also keeps him offended by other children. "I would so much like to spare him the feeling of being wrong and of being marginalized," says Claudia Kerst.

Leon has now finished his brain training. He practices with the SCP variant and currently often selects the Halloween game: He has to flap a bat up or down with the activity of his brain. If it worked, a ghost appears as a reward. However, they cannot explain how the trainers accomplish tasks like this any more than a cyclist can balance his saddle. Leon has had twelve units so far and attaches great importance to describing his own development: "Things are going better in school," he says, "and I am doing my things better."

Not a sprint, but a marathon

Edith Schneider knows that it will take many sessions before the ability to regulate yourself better has fully developed. But she is confident: "Especially with AD (H) S there are good research results that show that the training works and the improvements are permanent." From time to time, however, she has to emphasize that the training makes it possible to concentrate on math and vocabulary, but it does not replace practicing.

The personality is not changed either; whoever was impulsive remains so. "However, you develop the power to decide whether you really want to live out impulses," says Schneider. The method can also help with volatility, concentration problems and restlessness, which are not due to an attention disorder, but to stress or the excessive use of electronic media. Nevertheless, it is not yet paid for by all health insurers, and the FDA, for example, has so far only approved neurofeedback as relaxation training.

When Claudia Kerst got the diagnosis, she was only offered tablets as a treatment. In fact, methylphenidate (Ritalin) is increasingly being prescribed for adults. "I felt it was a redemption," she says. "I was thrilled to see how I could suddenly be: much more patient and focused." Nevertheless, she keeps on taking the remedy. "I don't want to swallow pills all my life!" Therefore, she would like to start neurofeedback herself soon.

* Name changed by the editors

Hold the mirror up to the brain

What is neurofeedback?
A specialty of biofeedback. While feedback from the body is used in the latter, brain activity is made visible by EEGs.

When is it used?
In addition to AD (H) S for migraines, epilepsy, autism, depression and anxiety disorders.

How much does therapy cost?
70 to 100 euros per session. Statutory health insurance companies generally only pay if the training is carried out by an occupational therapy practice. Usually 20 to 30 sessions are necessary.

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