Updated: Oct 24
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Perspective on Why Barkley's ADHD Video is Controversial
Biofeedback has long been referred to as involving self-regulation, with neurofeedback addressing self-regulation of brain states. How does that happen? Biofeedback and neurofeedback (BFB and NFB) may strengthen the body’s ability to regulate its own physiology. Additionally, a person who benefits from BFB and NFB learns behavioral skills, their regulation or application of which enables feedback to occur. Application of those skills in situations outside training can recruit brain states that contribute to more effective behavior in real-life settings. Specific training in behavioral self-regulation skills (e.g., use of salient visual reminders) can further improve the real-life performance of ecologically valid activities to mitigate the disability and handicap associated with ADHD. Self-regulation is probably best accomplished when addressed at two levels, physiological (e.g., neurofeedback or medicine) and behavioral, which reciprocally influence each other, leading to both neuroplastic and functional behavioral changes. It might reasonably be surmised that neuroplastic changes are more likely with neurofeedback, whose effects are durable following the conclusion of training, than with medicine, whose benefits stop with the discontinuation of drug treatment.
Russell Barkley is an accomplished neuropsychologist and behavioral scientist specializing in understanding and treating ADHD. His efforts have advanced the ethical treatment of children and adults with ADHD. As a scientist, he has been trained in skepticism. As a health care provider, he has devoted himself to helping those with ADHD know which treatments survive scientific skepticism and are effective. One treatment to which Barkley has directed significant skepticism in past years, however, is EEG biofeedback. His well-known review article (Loo & Barkley, 2005) was highly critical of the quality of neurofeedback research, but improvements in research designs of subsequent neurofeedback were noted (Loo & Makeig, 2012).
In a very clear excerpt of Barkley’s 2009 presentation to the Centre for ADHD Awareness, Canada (CADDAC), he presents helpful information about the behavioral neurology underlying ADHD and treatments that address the neurodevelopmental deficits in the condition. In particular, Barkley describes the frontocortical and frontosubcortical circuits that are associated with impulsivity and self-regulation deficits in ADHD and how these mature over time, with different symptoms becoming prominent as an individual ages into adulthood.
Barkley concludes that the best evidence supports treatments involving medication (e.g., methylphenidate) and behavior therapy (training self-regulation skills that are prompted by environmental cues). Barkley’s perspective on ADHD and its treatment are not inconsistent with those of neurofeedback practitioners (e.g., Thompson & Thompson, 2015), who also assert that the outcome of biological treatments for ADHD (e.g., methylphenidate, EEG biofeedback) can be significantly improved by integrating behavioral treatments to improve self-regulation.
In sum, this excerpt of Barkley’s talk gives excellent information about ADHD and its treatment that can be of great value to neurofeedback providers who wish to improve the lives of their clients with ADHD by enhancing their self-regulation through changing the brain with neurofeedback and behavioral methods. Barkley’s entire presentation is available on YouTube. Loo, S. K., & Barkley, R. A. (2005). Clinical utility of EEG in attention deficit hyperactivity disorder. Applied Neuropsychology, 12, 64-76.
Loo, S. K., & Makeig, S. (2012). Clinical utility of EEG in attention-deficit/hyperactivity disorder: a research update. Neurotherapeutics, 9, 569-587.
Thompson, M., & Thompson, L. (2015). Neurofeedback book: An introduction to basic concepts of applied psychophysiology (2nd edition). Association for Applied Psychophysiology and Biofeedback.
Synopsis of The Neuroanatomy of ADHD
"At the Transitions Conference in 2014 at Lynn University, Dr. Russell Barkley summarized the research on the neuroanatomy of ADHD. He outlines the importance of multiple brain systems working in networks to support self-regulation, executive functioning, working memory, speech, inhibition, and more. People with ADHD do not perceive more distractions than those without ADHD. Instead, they respond to them differently. As such, he compassionately describes ADHD as a performance disorder rather than an attention disorder, offering treatment strategies that modify the brain (i.e., medication) and environment (e.g., sticky note reminders) to produce modification of behavior."
"Dr. Russell A. Barkley is a prominent clinical psychologist and researcher known for his extensive work in the field of Attention-Deficit/Hyperactivity Disorder (ADHD). His research has greatly contributed to our understanding of ADHD, focusing on the neuropsychological and cognitive aspects of the condition. Dr. Barkley's work emphasizes the role of executive functioning deficits in individuals with ADHD and has led to the development of effective interventions and treatment strategies. He has authored numerous books and scholarly articles, becoming a leading authority on the subject and a key figure in advocating for a more comprehensive and compassionate approach to addressing ADHD in both children and adults. His research and insights have significantly influenced the diagnosis, assessment, and treatment of ADHD, making a substantial impact on the lives of those affected by this condition."