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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.

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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??

Sources In Conversation

I have been collecting numerous sources the past few weeks to supplant my research about ADHD and neurofeedback therapy. The most controversial debate I have found has been whether ADHD in adults exists, which is relevant to my research as I am investigating whether neurofeedback therapy would be able more helpful in treating adult ADHD or childhood ADHD.

There are two articles that I have found that are interconnected in their subject area. I found one article from the British Medical Journal by Asherson P., an esteemed psychologist from the University of Buffalo (“Is ADHD a valid diagnosis in adults?”), and another from Association for Psychological Science by Stephen Faraone from SUNY Upstate Medical University (“Attention Deficit Hyperactivity Disorder in Adults: Implications for Theories of Diagnosis. Current Directions in Psychological Science”). Both deal with adult ADHD and whether there is any truth to its existence. The first article provides two perspectives, one from a Yes to the existence of ADHD and one to the No answer. They theorized the rejection of adult ADHD is due to the ambiguity of diagnoses for ADHD, reliance on observational date of family relationships, and traits that could be entwined with personality. While childhood ADHD is backed by more studies, and has been widely regarded as a childhood disorder, published in the Diagnostic and Statistical Manual of Mental Disorders as such. The source from the Association for Psychological Science corroborates this article. The authors discussed the controversy surrounding ADHD in adults. This article also referenced the DSM-IV, a certified manual for diagnosing mental disorders. This article claims that DSM-IV states that ADHD is a "developmentally sensitive disorder". Thus, this article further proved that ADHD in adults does exist, but its difficulty to diagnose is the major reason for ambiguity.

Both sources are from esteemed publications and authors from renowned universities. Both found that ADHD in adults is indeed a gray area. I hope my research can fill this gap, and attempt to prove the viability of neurofeedback therapy for both adult ADHD and childhood ADHD.  With this perspective in mind, I can ascertain that I need to take a stance on how to define adult ADHD before I can even compare it to childhood ADHD. I do not know how to really approach this, as sources like these exist in all academic spheres, which confuses me. If it is not definite, should I include in it my research? Or is this incentive to do so, because it is so unclear and existing within a grey area? As I research more throughout this week, I am attempting to answer this question, but also any ideas would be helpful!  

 Word Count: 442 words

The Beginning of the Literature Review

This week I spent most of time trying to analyze sources and discern if they can add meaning to my argument. As we went over what a literature review entails in class, adapting it to my own research area became more and more relevant but also daunting. The only way you can avoid being afraid is to understand and learn more about that thing. Some people are scared of spiders, but the more you read up about them the more you realize that most (!) are harmless. Some people are afraid of the dark, but when you turn on the lights you will realize nothing unknown was even there. So, to face the literature review, I needed to understand what it meant, deconstruct its value so it would not be so overwhelming.

A literature review in general means the definition, context, and established sources to help a reader's understanding of existing literature and research. For my paper specifically, a literature review meant a definition of ADHD as a mental disorder, a cohesive summary of its symptoms, general treatment plans, and occurrences in the general population. With that established, I need to define and trace the history of neurofeedback therapy. To understand its use today I need to track its origins and developments to contextualize its importance in comparison to other treatment options. Additionally, I need to research literature that notes the difference (scientific and behavioral) between childhood ADHD and adult ADHD to account for its relevance as a focus for my paper. Only once all this context is establish, can I finally introduce a research question and pinpoint the gap (how no research has been done comparing the success of neurofeedback therapy of adults with results with children) and go about detailing a method. All sources I read are not only fodder for me to understand, but should be used later so the audience can be aware of why this research not only has significance, but exists in reality.

The important source that I was able to find was by Joel T. Nigg of the Psychiatry department at Oregon Health and Science University called "Attention-Deficit/Hyperactivity Disorder: Endophenotypes, Structure, and Etiological Pathways".  Nigg defined ADHD with major characteristics that emerge in regards to temperament and personality, markers to help distinguish people who have ADHD. This source was crucial for me in understanding ADHD symptoms (spatial orienting, impulsivity, inattention, disorganization, etc.) and the disorder itself. This is the source that has provided me with a expansive definition according to the DSM-IV. In regards to finding a gap, this source discuses prescription medication but the mention of neurofeedback therapy is limited and fleeting, showing how that area has not been explored extensively as demonstrated by this pivotal source, While this is a crucial source definition-wise, I need to find more sources to understand neurofeedback therapy and its history in general. 

Finally, I think the John Oliver activity would be an interesting way to prove what we have been learning and hone our argumentative skills. This could serve as a break from collecting sources and a means to stay on our toes during this long, arduous process.

Word Count: 523