DESCRIBE THE THREE RECENT NON PHARMACOLOGICAL TECHNIQUES IN ADHD CHILDREN . THESE ARE NEUROFEEDBACK SESSIONS, CRANIAL ELECTROSTIMULATION SESSIONS AND COMPUTERIZED COGNITIVE TRAINING SESSIONS

1. Non Pharmacological
treatment of ADHD
Prof.Dr.Hussein Abdeldayem
Prof of Ped Neurology, Alex University
Member of AAN, AAP, ICNA
Dr. Samia Hussein Abdeldayem

3. What is the best protocol for
treatment?

5. Agenda
Should we treat ADHD?
How do we treat ADHD?
Opinion

6. • School underachievement
• Impulsive
• Smoking,etc
• Careless, accident
• Opositional defiant disorder/conduct
disorders
• Carrier underemployment
• Impulsive life decisions
• Addiction
• Serious accident
• Antisocial personality
AdultsChildren
Untreated ADHD
Rule 1

7. Untreated ADHD
Parents’ consequences
• Chronic stressed or worried about child’s
ADHD
• Frustration
• Blaming, guilt
• Social isolation
• Parents’ marriage has been negatively affected

8. No “magic cure”
• There is no “quick fix”.
• No single intervention will correct the
problems for every child-need a toolbox
Rule

9. <6 ys 1-Behavior modification sessions
2-Family counseling*
6-12 ys 1-Behavior modification sessions
2-Family counseling*
3- drugs
>12 ys 1-Drugs
2-Family counseling
• American academy of pediatrics guidelines
• ATTENTION-DEFICIT SO. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children
and adolescents. Pediatrics. 2011 Oct 14:peds-2011.

10. WHY non pharmacological treatment?
• However, concerns have been raised about the potential limitations of
ADHD medications, including age limit, their side effects, the necessity
to continue use to maintain beneficial effects, low treatment adherence,
stigmatization and uncertain long-term effectiveness and safety.
• The demand for non-pharmacological treatments for ADHD is, therefore
high.

11. Components of Non Pharmacological treatment:
1- Behavioral therapy with
cranial electrotherapy
stimulation(alpha)
2- Cognitive computerized
training
3- Neurofeedback training

13. Advantages of Non Pharmacological training
• Permanent & Long-term effect unlike medication.
• Treatment of Comorbidities that can be associated with
ADHD as anxiety, depression and migraine.
• Raises self Confidence.

14. Disadvantages
• Requires compliance from the parents.
• The cost of the sessions are expensive (in USA) and not
covered by the insurance, to the extent that it is joked that
buying the device is cheaper than paying for the sessions.

15. Duration and Schedule of sessions
• Recommended Duration: 3 months with a target total of 40-
50 sessions.
• Time per session: 15-30 min according to training module.
• Number of sessions per week: 3-4 sessions on school days,
daily on holidays for optimal results.

17. 1-NEUROFEEDBACK
TRAINING FOR ADHD
• EEG BIOFEEDBACK
• BRAIN TRAINING
• NEURO-TRAINING
• ATTENTION TRAINING
• A SELF-REGULATION TECHNIQUE THROUGH WHICH PATIENTS
LEARN TO VOLUNTARILY CONTROL WHAT WERE ONCE
THOUGHT TO BE INVOLUNTARY BODY PROCESSES
•

18. Neurofeedback training
• Neurofeedback, is an intervention for ADHD based on findings
that many individuals with ADHD show low levels of arousal in
frontal brain areas, with
excess of theta waves and deficit of beta waves.
The brain can be trained to increase the levels of arousal
(increase beta waves and reduce theta waves) and thereby
reduce ADHD symptoms.
•

19. REQUIREMENTS
• SPECIALIZED EQUIPMENT TO CONVERT PHYSIOLOGICAL
SIGNALS TO MEANINGFUL VISUAL AND AUDITORY CUES
(DIGITAL EEG)
• TRAINED BIOFEEDBACK PRACTITIONER TO GUIDE THERAPY

23. NEUROFEEDBACK ASSESSMENT: (Fish racing BETA %)

27. Advantages of Neurofeedback training
• The idea is that as your child does this, he learns how it feels when
he's concentrating. This might give him more control to "create" beta
brainwaves that can reduce ADHD symptoms.
• make long-term improvements in self-control and attention because
their brain learns to make healthier patterns.
• 85% of clients with ADD or ADHD learn to increase focus, reduce
impulsivity, and manage their behavior when they train with
neurofeedback on a consistent basis.
• Another reason that neurofeedback is so effective for ADHD and ADD
is that it appeals to children – it seems just like a computer game!

31. Behavior therapy + cranial electrotherapy
stimulation ‘Alpha cranial stim.’
• It is a Cranial Electrotherapy Stimulation (CES) device that uses low-
level electrical current to safely and effectively treat mainly anxiety,
depression, and insomnia.
• Electroencephalographic studies show: Increased alpha activity,
Decreased delta activity, Decreased beta activity
• CES is approved by FDA that it can improve attention spans and
behavior among kids with ADHD.

32. cranial electrotherapy stimulation
‘Alpha cranial stim.’

33. Advantages of cranial electrotherapy
stimulation
• succeeding treatments are said to cause less anxiety, improved focus,
and long attention spans.
• Children who respond positively are also known to sleep better and
experience a heightened sense of well-being
• As a result the child is more receptive to behavior training.

34. Cognitive computerized training
• A computerized program designed to initially screen for the areas of
defect, provide training modules to work on the area of defects with
increasing difficulties, and a final reassessment following the training.

35. Cognitive computerized training
• It helps children with their attention and concentration, in their
performance of various memory and planning task
• The training parameters (i.e. trained functions of divided attention,
concentration, verbal memory, topologic memory, reaction behavior,
memory of words and planning capacity trained with a shopping task)

36. Screening Report

37. Reassessment

38. Reassessment

40. <6 ys 1-Behavior modification sessions
2-Family counseling*
6-12 ys 1-Behavior modification sessions
2-Family counseling*
3- drugs
>12 ys 1-Drugs
2-Family counseling
• American academy of pediatrics guidelines
• ATTENTION-DEFICIT SO. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children
and adolescents. Pediatrics. 2011 Oct 14:peds-2011.

41. No drugs
Age more than 6
S/E
Refused by parents
School holiday
No effect

42. Finally
A. In order to achieve adequate long term results, it requires:
• A trained professional
• Adherence to the program
• Motivation and encouragement from the parents
B. The results have a long-term effect, teaching the child
• To recognize when he lost focus
• Provide other methods to help the child focus
• Improve confidence level