Plans!!!!!!!!!!!!!!!!!!!

My research will need to be conducted over 2 months period of time. All the patients at the clinic that I seek to employ as participants have already been at the clinic at least 4 months and I will not use brand new patients. Thus, I will check the 15th, 30th,  and 50th session if possible, conducting a diagnostic test (Conners Adult Rating Scale or TOVA test) if necessary and not already conducted by the clinician. I will be looking back into patient records to check their progress at specific points. I will start conducting research the first week of January. I already work at the clinic after school, so I will able to start as soon as possible. I will then collect data up until mid-February. I will then spend the next month up till early March to analyze the results and formulate the paper.

Chronologically, first I will attempt to get consent from as many patients as I can (I am hoping close 12 adults and 12 children with a close to equal number of females and males). Then I will look into their patient records to see their progress, marking how many sessions they have done and taking note of past Conners Adult Rating Scale or TOVA results for my data set. If there has not been a progress checked at certain points of treatment (preferably close to session 15, 30, or 50), then I will conduct the test myself. I am going to only use data of training on the two most common places on the brain that are targeted to reduce ADHD: CZ and FZ .

While most of the project will be data collection after the clinic has already conducted test (possibly conducting test myself if information is missing/patient is in the midst of treatment), a complex component is analyzing these results to ensure statistical significance and logic. From beginning/mid-February to early March, I will be working on the analysis of these results and the writing of the paper. A connection will be drawn between number of neurofeedback sessions and number of symptoms that have decreased (seeing if according to the rating scales more questions were answered differently, more positively), I can see if there is a correlation. If more sessions means less symptoms exhibited according to the patient, I can identify there is a trend. I can compare the correlation coefficient of the adult group and child group to compare the effectiveness of neurofeedback therapy. The Hedges G’ measure could be calculated by taking the mean  (in this case the mean number of neurofeedback sessions and mean number of symptoms reduced) divided by the standard deviation of the results, thus calculating the effect sizes for neurofeedback therapy sessions. I can use the Hedges G’ measure final number of the adult group and child group to compare the effectiveness of neurofeedback therapy. Then I will analyze these results, determining if neurofeedback therapy affects adults or children equally or impacts both differently. I will present these results in a table with a description/explanation underneath to describe the success rates of neurofeedback therapy on adults and children.

I think I will be able to complete this plan and this is enough time to procure results. The data collection does not take much time and the analysis can be done at home with all the information I collect throughout the month of January. I think I have left enough time for room for any inconvenience that could happen.

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Video!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I finally reveal my face! Oh and pretend to ask for money to fund my research.

https://www.youtube.com/watch?v=MTjGOPbkwsY

Methods!!!!!!!!!!!!!

This week we were able to analyze four studies' methods to see what they did well and what could have been improved. Going through such an in-depth study of the procedure and seeing how well it aligned with the research question was interesting. It gave me ideas that changed what I had originally planned for my methods (which was too simple in regards to noting what ADHD symptoms were still present based on DSM-IV criteria), and set a more directed course for what I plan to do.

So far, what I feel most positive about is the way I can see if neurofeedback therapy had an effect: using personality/behavior scale or ratings, which are already certified, pre-determined ADHD diagnostic testing. Using the Conners Rating Scale or Wender Utah Scale are widely administered, so are easy to find online and are provided by the clinic I use. I am confident that this would be the best way to determine what symptoms persist or have lessened/been eliminated since the assigned number of sessions has transpired (usually around 30-40). I would be drawing a link between the test that was administered before the session started that my clinic does to show the patient their current psyche, and then I could administer the after test after the different number of sessions, hopefully with some patients closer to the end of their yearly treatment plan, so I can have a wide breadth and compare fewer sessions with more sessions on both adult and children groups. Of course, logistics have to be adjusted based on the patients that do end up consenting to be a part of this research.

What I am most nervous about is basically administering the tests myself. I do not know really why I am nervous, but I think I just generally get nervous doing things alone with people I do not know. Especially, in regards to gaining consent with the patients, even though I have come to know many of them, I can't rely on that knowledge to know for sure that they will be willing to be part of my study. I think I am most nervous about the asking part and explaining, because um, social interaction and that always makes me a little scared? But other than that, I am not so nervous about my procedure or my methods or even connecting to my research question. I hope I can glean some meaning from the results that actually make sense statistically. Making sure my method accounts for only the variable I want to know that was affected (number of ADHD symptoms) could also end up being a worry. But, I think it is best if I address this when I am analyzing the results, because I can find a statistical method to taking into account the correlation without the extraneous variables.

But, overall, I really am excited to actually start enacting the methods. It is something I have never done before like a real-life experiment almost. I have been a part of a lot of research projects and written science papers and stuff, but actually conducting the research by myself with actual people will be a whole new experience.

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Reflection!!!!!!!

Trimester 1 often felt longer than necessary. But now that is over and we are in mid-November, it is crazy how fast your perspective changes based on your vantage point. The last first trimester of my high school is over and just thinking about that feels scary, but also exciting, which I guess the best things in life are a mix of both.

When I first walked into AP Research, I had some idea of where my research was to go. I had spent the summer at the ADHD clinic, constantly amazed at the possibilities this promising, innovative work provided. But, even with a little direction, any research can be daunting. There was logistics to think of, permission to acquire, and preliminary investigation to be done. One basic, but wholly true lesson I have taken away from this first trimester is that for something to be done right, it needs to be done in pieces, with the most focus and effort put into each stage as you progress. If you want the best, you have to do your best one step at a time.

Finding sources that could provide more of an insight into the history of neurofeedback therapy and its efficacy in the medical world was hard. It is always hard taking details from research studies, and attempting to formulate them into a cohesive whole. However, I do think that was my favorite part of this trimester: the researching era. The learning and reading of various scientific articles, examining credibility and study execution. It is fascinating to know that you can always learn more. Even working at the clinic, there were details that I only found out about through scouring through the history of the therapy and reading about how biologically the process could be successful. More than anything, this research solidified my interest and it is really comforting to know that when you truly love and know a subject, you can still be excited by the new things you discover.

Putting sources in conversation was a little trickier. I had to interweave these different esteemed researchers and then these global studies with scientific organizations and national surveys. It was this crisscrossing of various data that I had to connect to make sense. It was challenging, but it kind of opened my mind to the numerous stances on the topic. There were so many different therapies, people supporting Ritalin (ADHD medication) to those who believed ADHD was confined to the childhood years. Everyone had a unique background or thought to add to the discussion. I think my work was better for it, because I was able to hopefully coalesce all these ideas, in a way that made sense, while disregarding and challenging the ones that warranted opposition. Adding more voices brought more to the argument.

Finally, the literature review, the finish line for this trimester. The literature review marked the transition from the exploring, the outlines, and the preliminary research into the real, concrete dive into the actual paper. It felt like a lot of pressure, but, again, the breaking up into stages really helped to ease the tension. I knew I had to take it seriously, but I had time to carefully work on it day by day, referencing the previous outline and my Excel sheet of sources and my annotated bibliography. It was not just this document I was producing out of nowhere. The literature review represented the fundamental starting point for the paper, the introduction for the reader to understand your topic and your question. I hope I was able to express and establish this start to my research paper in an effective way.

I hope in the next trimester I am able to create a method that is reproducible and logical. I think with the information I have collected, I have the means to find a method that can answer my question. I hope I can learn from the studies I have read to apply to the method of my research paper. I am looking forward to delineating the steps and the organization of what is to come. Then this will lead into the actual proposal plan and researching, which I am excited to begin. To take all this information collecting and exploring and actually start doing something is very thrilling to think about.

I know there are a lot of challenges ahead like finding out exactly how to examine the results, using the TOVA, IQ test, or even just logic-based performance test? How do I analyze the data? Through some sort of statistical method or success rate based on the clinic's parameters or number of sessions? There is so many specifics that I have to figure out.

Ultimately, this trimester really did feel like the beginning to a hopefully captivating journey ahead. I know that it gets harder, that the next few stages are pivotal and can be arduous to plan out and implement, but I do feel confident with this solid base of an introduction into the world of AP Research. With the experience of AP Seminar from last year and the exploration of trimester 1, I hope I am prepared and ready for the rest of my senior year!!!!!!!!!!

(867) 

FEELINGS!!!!!!!!!!!!!!!!!!

So, last week we were able to identify the weak points of my question. Ultimately, I have decided to leave in the comparison of adult and child in my question. I wanted to do this because this is where the gap is in the research. Research has already been done on whether neurofeedback therapy works, albeit controversial still. But no one has looked at whether it is beneficial for children and adults or for what age group it would be most beneficial, and thus what symptoms it best treats, because symptoms manifest differently in children and adults. This has to be included to ensure that my research question is asking something new and relevant.

I am feeling most confident about my background information and sources, which sounds kind of lame. But I have all the relevant and needed sources to explain what ADHD is and what neurofeedback therapy entails. I have collected numerous credible sources to back up my definitions and to help put my research into context. I think at this point this introductory part of my paper is strongest, because I can clearly detail all the groundwork for readers. And in this way, it has made me very knowledgeable about my topic itself, versed enough to be able to explain it to someone else through all these simplified, but accurate ways I have learned to look at my topic. The sources I have collected have been a great help in allowing me to look at the issue from other perspectives and other points of view. I think we are inherently biased, but researching and reading all these different articles and books has helped me realize that all sides of the argument of neurofeedback therapy have relevance and significance.  All these counterarguments have to be addressed, because they bring up understandable criticisms. All my sources have played a huge role in making me more knowledgeable about my topic.

I feel most neutral about probably my question’s wording? I know I have to do some justifying and work on it in regards to why children and adults have to be looked at some more. Right now I think it is okay, but can be made better and more specific. In the coming weeks, I will try to work on phrasing or later justification in the literature review itself instead of the question. 

I am feeling most terrified about my method. The way I analyze success rates might have to involve complicated statistics and I am not sure if I am ready for that. Right now, the plan I have for my method is confusing to say the least? I know I have to incorporate the “scores” that are calculated by the computer at the end of the session to determine whether the patient has consistently and effectively trained their brainwaves. But, I also wanted to incorporate other means like looking at brain maps and seeing if the patient has truly able to make permanent changes on their brain, or their performance at school or work through interviews to see the real world applications of this therapy. And then there is the TOVA (Tests of Variable Attention) means of determining success of a session. This uses a 11-22 minute test which involves patients clicking to respond to a target. There are so many different ways to measure the success of this therapy, but I need to pick the best way that will communicate the results most effectively. So, the method seems really complicated and daunting and like I am going to have to do math and lots of work so ew? I mean fun times?

Overall, I know there is a lot more work to be done and a lot more to be proud of. Research, more than anything else, is a process.  Sometimes a painstakingly arduous process, but probably also rewarding and satisfying as a result.

(643) 

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So, this week we have to make the “research question” and eliminate all the ambiguity that that entails.

My research question as of right now: Is neurofeedback therapy a viable, alternative treatment for both children and/or adults with ADHD in Arizona?

Scope

I tried to limit my scope to just focus on neurofeedback therapy as an alternative with the necessary context of ADHD medication. At first, I didn’t know if I wanted to put medication in the question itself, but I think neurofeedback therapy would not even be considered as an option if I didn’t. I think because it is such a new, emerging form of therapy, advertised and used as an alternative, it has to be mentioned in comparison to the most used and common form of treatment, which for ADHD is medication.

I am going to try to investigate the difference between therapy on adults and children in the United States, or specifically in Arizona. Is it necessary that I mention Arizona or does that make my question end up sounding too specific? My research is going to be conducted in Arizona, so I thought it was necessary to include in my question so the scope isn’t too unmanageable. 

Key Terms

I have to define what neurofeedback therapy is, because even I had no idea about a year ago. Neurofeedback therapy is according to “A Symphony in The Brain”, "Neurofeedback helps guide the patient, but the brain does the rest". Essentially, neurofeedback therapy is using computer programming and electrodes placed on the brain, so a patient can see their own brain activity and “feedback” is perceived through a screen or speaker according to frequency parameters set by a clinician. According to author Jim Robbins, "physiological functions thought to be automatic can be brought under conscious control” with neurofeedback therapy. As a certain frequency is upregulated or downtrained, more blood will flow to that area of the brain, and thus neural connections are enhanced, strengthening certain areas of the brain.

In my literature review is where I will provide most of my definitions, which I get from the National Institute of Mental Health, esteemed neuroscientists (Russell Barkeley, the “ADHD expert”, and other publications. According to NIMH, is “Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development."

I also have to elaborate with what I mean by “viable, alternative option”. By viable I mean it will significantly reduce ADHD in patients, resulting in more concentrated individuals according to brain maps, logic/reasoning tests, and possible performance at school.

By treatment, I am referring to what the patient uses to mediate/reduce symptoms and the disorder itself. I will be comparing neurofeedback therapy loosely to medication, which is the most common form of treatment. ADHD medication is primarily amphetamine and methylphenidate (stimulants) ranging from short-acting Adderall to more longer-acting Ritalin LA, both common medication to treat ADHD and other mental disorders.

Children I would define as under 16 years old, which is how my clinic defines a “child” brain map, as at that point their brain has mature/change the most it will that will show up in a brain map by that time. I would define adults anywhere from 16-60, depending on how old the oldest patient I use in my study is.

I have to tackle the assumptions. I think by only mentioning neurofeedback therapy and medication, I imply that these are the only two options when a myriad of different behavioral therapies, lifestyle changes, and other medications may exist. I think I need to clarify that medication is the most common method, and neurofeedback therapy is the newest, least invasive method that exists as of yet. Neurofeedback can also be differentiated by the fact that it is permanent change without intake of any stimulants or lifelong changes to the way a person lives. In this way, neurofeedback is a temporary treatment that lasts a lifetime.

Variables

The variables would be different “success rates” of the neurofeedback session of a patient, the age of the patient, and possible change in brain map/reasoning test/education that results after. Because I am investigating neurofeedback therapy as an option, I need to prove it is viable or not viable by somehow mentioning medication success rates. I do not have the means to do a direct comparison, as I cannot see how well ADHD medication is working, but there needs to be some sort of link I can make here. I need some help with this? I know that I have to talk about medication, because if I do not I feel like it is a hole in my research, but does it have to be in my question? Or can I mention it in my literature review without making a direct comparison?

Hopefully sex of the patient is not a confounding variable that makes things confusing, but I will try to address it if it is.

Researchability

I think it is possible to hopefully find patients to agree to let me use their sessions and progress to see if neurofeedback therapy is helping them. I would try to get at least 5-10 patients of different ages and monitor their progress/look at their previous month’s progress to determine whether their success rate is going up an their brain maps are getting better. I think this is possible, as a previous student has conducted research at my clinic and was able to get patients to agree to his research. My backup plan if I cannot get patients to agree is to at least possibly due and interview patients to see if they mentally feel more focused and are academically doing better. And interview clinicians to see if they have seen improvement.

Gap

There are no in-depth studies showing if neurofeedback therapy works and is successful. There are papers and articles about its existence and how it works, but not anything that I have seen about how well it works or comparing how well it works in adults and children. Studies mainly attempt to compare it to medication.

Significance

If neurofeedback therapy is a viable option that leaves permanent effects, then people with ADHD would not have to resort to ADHD medication. Through my research I have found that medication, especially stimulants for ADHD, are abused, used inappropriately and over the needed amount. Furthermore, using ADHD medication can lead to dependency on other stimulants. Medication can be expensive and are a means of not curing the disorder, but rather limiting and reducing severity of symptoms. With neurofeedback therapy, I am proposing that people can be cured and be affected not just temporarily. Medication has to be ingested, altering your biochemical levels, while neurofeedback therapy can be seen as a noninvasive treatment, a means of training the brain but not adding additional chemicals to your system. Oftentimes college students are misdiagnosed and abuse ADHD medication to stay up later and study more, but that may be out of my scope to discuss. Basically, neurofeedback therapy is a new type of treatment that is not researched enough, because it has real potential to change the way we treat mental disorders, not just ADHD. If its possible to actually train our brain to re-cement certain connections between neurons, its amazing how many possibilities this opens humans up to. This can lead the way to unlocking the full potential of the brain to becoming the best versions of ourselves possibly, enhancing our mood, concentration, cognitive skills, and even motor skills in the future. I think this is the most exciting field in medicine today, and if this method of neurofeedback therapy is more researched, made better, and more widely available/applicable it truly is the future of neuroscience.

(1311)

Outline

Constructing an argument depends on whether it can flow logically within its structure. Outlining a literature review sounds daunting, probably because it is.

Before I do anything, I must define ADHD according to the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), the newest edition of the publication by the American Psychiatric Association, which is nationally employed by clinicians and physicians around the United States. The DSM defines ADHD as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.” To contextualize the prevalence and importance of ADHD as an issue in the United States, I will present the source by Faraone S., Sergeant J, Gilberg C, and Biederman, J from the World Psychiatry Journal that states “Attention-deficit/hyperactivity disorder (ADHD) is a behavioral disorder that affects up to 1 in 20 children in the USA."

While a source from Schlachter, S. Peabody Journal of Education states, "This report describes the results of that analysis, which indicated that, in 2003, approximately 4.4 million children aged 4--17 years were reported to have a history of ADHD diagnosis; of these, 2.5 million (56%) were reported to be taking medication for the disorder.” I need to find a source with number of adults with ADHD in America. I instead have comparisons of the two, but no real number for adults specifically.

After defining and contextualizing, the argument can be delineated.

Subtopic 1: ADHD

First I have to provide information of ADHD and what part of the brain it affects.

Premise 1: ADHD is associated with certain increase of specific frequency of waves at certain parts of brain.

Support: According to Biederman, ADHD originates in the frontal-subcortical pathways and often develop with anxiety disorders, mood disorders, and learning disabilities. Through analysis of fMRI’s Vaidya for the American Journal of Psychiatry found that waves associated with ADHD were less prominent in the frontal-stratal-temporal-parietal network of the brain. Certain parts of the brain of children with ADHD exhibited lower task performance.

Another source from Clinical Psychiatry Journal found through EEG imaging that increase in frontal lobe theta activity (slow brain wave activity) when patients with ADHD were concentrating v. decreasing activity normally.   

Subtopic 2: ADHD in Adults

I need to show ADHD does exist in adults as there is controversy surrounding this issue.

Premise 2: ADHD is often defined as a “childhood disorder”, but does persist and can develop in adulthood.

Support: According to an article by the British Medical Journal, "A more robust evidence base is surely required before accepting a concept such as adult ADHD, which departs from established views of the nature of behavioral problems, has a large overlap with other diagnoses, and has only a tenuous association with childhood disorder”. However, several research studies prove that ADHD can be evidenced in adults, despite the DSM-IV stating ADHD is “a developmentally sensitive” disorder.

According to Faraone S., a study was conducted with families to see if relatives also had ADHD, and its relation to adult ADHD with 49% correlation. Furthermore, in a study by BMC Psychiatry, it was found through testing of 119 adults and 403 controls, that the most prominent traits for adults with ADHD were different from children. Adults were more likely to exhibit high novelty seeking (decision making based on impulse, exploratory activity, and reward cues) and harm avoidance (worrying, fear, fatigue), while children were more afflicted with inattention problems. Thus this shows that ADHD in adults exists and is different, therefore not a continuation or rather an evolution of the disorder into adulthood. Maybe if I can find a source that somehow manages to find a record of people who report ADHD in adulthood and did not have it in childhood. This would strengthen my argument, so any help in finding specific sources like that would be greatly appreciated. 

Subtopic 3: Medication Treatment for Children v. For Adults

Premise 3: Medication leads to harmful side effects, abusive behavior, and injurious dependency.

Support: According to Setlik, Randall, and Ho for the Journal of Pediatrics, sales data reflects that medication abuse for adolescents is on the rise. According to this source, "calls related to teenaged victims of prescription ADHD medication abuse rose 76%, which is faster than calls for victim of substance abuse generally and teen substance abuse." And in another source by UCLA research Susan Smalley, it was found that, "as skyrocketing numbers of children are diagnosed with ADHD and prescribed drugs, researchers are falling under increasing pressure to explain this disorder."

I need more sources here detailing how ADHD medication can lead to dependency and abuse. Also the harmful side effects and toxicity issues it can cause. I have already found some, but need to read through them.

Subtopic 4: Neurofeedback Therapy/Why it is better

Premise 4: Neurofeedback therapy may be the future for treating ADHD with minimal harmful effects compared to ADHD medication.

Support: Neurofeedback therapy aims to normalize abnormal EEG frequency by down-training certain wave frequencies. This is done by attaching electrodes to the scalp. A client can then watch their EEG as they play a game, watch a movie, or listen to tones. When they successful are training their waves down or up, based on their protocol dictated by their brain map, they will achieve points in the game, be able to see movie clearer, or the tones will be less high pitched. Thus, they are consciously controlling their brain waves, increasing concentration and relaxing their minds.

According to the ADNC Neurofeedback Centre of BC, “in another investigation (Fuchs, Birbaumer, Lutzenberger, Gruzelier, & Kaiser, 2003), children who had ADHD were given either medication or neurofeedback. After about 40 neurofeedback sessions the two groups were compared on a variety of traditional ADHD measures. Findings indicated that the groups performed at a comparable level.” In “A Symphony in the Brain”, it was stated that “as frequency is enhanced during a neurotherapy session and the brain is activated, more blood than usual streams to that area in the brain, the nutrients may be strengthening or reorganizing existing connections."

I need to collect more sources comparing ADHD medication to neurofeedback therapy. I will look more into this. 

Thus these sources detail the merits of neurofeedback therapy, specifically with children with ADHD. 

Gap: This is where a gap exists in the research, as no research has been done comparing adults and children being treated with neurofeedback therapy.

This all leads to my research question: Is neurofeedback therapy a viable treatment option for adults and children? Or something along those lines.

Hopefully, that was not too dense and made sense.

Word Count: 1091.. um.... oops, sorry. It is a lot of quotes??