Through neurofeedback training, children with ADHD learn to decrease excess theta wave activity in the prefrontal cortex and increase beta wave activity, which helps them better sustain attention and focus. Neurofeedback works by operantly conditioning the brain's EEG patterns over time from an "ADHD" state to one more similar to typically developing children. Studies show neurofeedback can remediate ADHD symptoms by helping children gain control over their thalamocortical brain rhythms and alertness levels through biofeedback of their EEG measurements.

1. Neurofeedback is a biofeedback method based on the rationale that there is a relationship
between surface EEG and the underlying thalamocortical mechanisms responsible for its
rhythms and frequency modulations. Variations in alertness and behavioral control are directly
related to thalamocortical generator mechanisms. The principle of neurofeedback is that over
time, participants learn operant control of their EEG and change from an “ADHD” state to one
resembling that of typically developing children. This process has been shown to eventually
remediate the symptoms associated with ADHD.
In the case of children with attentional difficulties, e.g. ADHD, brain research has documented
an excess amount of slow-wave activity, called theta waves, in the pre-frontal cortex.
Illustration below of EEG patterns.
Theta waves are especially predominant when children with ADHD try to engage in an active
concentration task, which makes it very difficult for them to focus and sustain their attention on
the task over a prolonged period of time. This is illustrated in the brain maps below. Through
neurofeedback training, children are taught to decrease their amount of theta activity and
increase faster beta frequencies, which enable them to sustain attention and focus on the task at
hand.

2. Findings from EEG studies provide the rationale for applying the neurofeedback paradigm in
ADHD. In the resting EEG (relaxed awake state), increased slow wave activity (theta, 4–8 Hz)
and/or reduced alpha (8–13 Hz) and beta (13–30 Hz) activity, especially in central and frontal
regions, might be associated with ADHD. This indicates cortical under arousal. Thus, it seems
plausible that in a paradigm often applied in ADHD, the goal is to decrease activity in the theta
band and to increase activity in the beta at the vertex (electrode Cz), i.e., activating and
maintaining a state of cortical arousal.
In individuals with ADHD, there is second pattern of excessive “beta” activity or “hyperarousal”
over frontal regions. EEG analysis has revealed increased relative beta power, decreased relative
alpha power and in the frontal regions compared to healthy peers.
Below is a typical setup for a neurofeedback session. The helmet is set up with the EEG leads
internally. There are special programs that help “train” the child to increase desired EEG patters.

3. More traditional EEG scalp applications can be used so that the US probe could be applied for
neuromodulation purposes. One concern is the possibility that the US device will create 60-cycle
interference. 60-cycle is an electrical field produce by most electrical devices.
An experimental design to assess the effects USNM on EEG is a sound approach to begin to
understand the effect US has on the brains electrical activity, and eventually attentional abilities.