Positive Feedback : 2 O.C. Doctors Use Obscure Therapy on Children With Attention Disorder

Susan Callison will never forget how terrified she was when at the beginning of second grade, it took her son, Chad, two hours to complete a simple homework spelling assignment.

“I remember working with him on the word boat. I used pictures, everything, to try to help him recognize the word,” said the El Toro mother and former teacher. “But after 20 minutes of working, he still didn’t have a clue. It was frightening.”

Chad’s condition was diagnosed as attention deficit disorder (ADD), a neurological and biochemical condition that is often associated with hyperactivity and learning disabilities, leaving children unable to concentrate or sustain attention.

For Chad, it was impossible to focus on his work at school. Vision problems hindered his ability to read and write. And even though his teacher said he had bright ideas and was a likable boy, he used to just sit at his desk and do nothing.

Today, the Callisons say they have seen significant improvements in Chad’s learning abilities and attention span. Chad’s mother attributes the success to EEG (electroencephalogram) biofeedback treatment, a relatively obscure form of therapy offered in Orange County by doctors at Mission Psychological Consultants in San Juan Capistrano.

Drs. Michael Linden and Thomas Habib, clinical psychologists at the facility, contend that EEG biofeedback trains children to alter their brain waves to improve their concentration and behavior.

Three to five days a week, Chad sat in front of a computer screen at their office. EEG electrodes were positioned on his scalp to amplify and monitor his brain-wave activity while he played games such as Pac-Man, read or listened to a therapist read to him.

The object was for Chad to try to concentrate as hard as he could on playing the game, reading or listening. If his concentration drops, the game stops. If his mind begins to wander during the reading, the monitor will reflect his loss of concentration and the therapist will encourage him to pay better attention. He receives high scores for good concentration, and his progress is charted during every session.

To further encourage him, Chad was rewarded with baseball cards or movie passes for high scores. Callison said that after her son completed close to 60 such 45-minute sessions, she saw a dramatic change in him.

Despite the skepticism of some psychiatrists and psychologists who doubt the therapy’s effectiveness and are concerned about the lack of research on it, Callison insists that “without the biofeedback, Chad, now 9, would not be where he is today. He is attentive and he is reading.”

Although EEG biofeedback has been around since the late 1970s, Linden and Habib are two of only about 100 practitioners nationwide using the method to treat children with ADD and hyperactivity.

They admit that the treatment is not for all children and that the successes vary widely--for example, mentally retarded children could not be helped. And the program is expensive. The San Juan Capistrano doctors charge about $3,900 for the program, including testing and evaluations. Nationally, the costs range anywhere from $3,000 to $5,000. Depending on individual policies, some insurance companies will pay for the treatment, according to psychologists.

The doctors said they are completing the first control-group research study of its kind in an effort to determine how effective the therapy is in training ADD children.

Although much more research needs to be done to determine its long-term effect, Habib said, preliminary results of the study indicates EEG biofeedback “looks like a possible cure” for ADD. If it is proven to be effective in controlling the symptoms of ADD, Habib said, it could be a major breakthrough in helping these children live more normal, productive lives. Habib said the doctors plan to publish their research in professional journals within the next couple months.

“We realize how much frustration is out there in dealing with some of these kids. The management of them is incredible. Some of them have taken apart our waiting room more times than you would think,” said Habib.

Left untreated, it becomes a “lifelong problem,” he said. “As they grow older, we see problems with self-esteem, problems with peer adjustment, poor marriages and years of failure.”

ADD children who have learning disabilities or behavioral problems are unable to filter out noises and other distractions and typically have abnormal brain-wave patterns, Linden said. Their EEG patterns generally have an excess of the slower theta waves associated with daydreaming, and a shortage of beta waves associated with alertness and concentration.

Using EEG biofeedback, he said, they are able to train children to alter their brain-wave patterns so they become more like those of normal children.

By increasing the beta waves and normalizing the theta waves, the EEG treatment can increase the youngster’s ability to focus and concentrate, which can lead to improvements in classroom performance, achievement test scores, IQs, as well as their social and behavioral skills, they contend.

The drug Ritalin has been used for years in helping children and adults manage the symptoms of ADD and hyperactivity. But many parents are reluctant to give Ritalin to their children because of its side effects: loss of appetite, sleeplessness and a decrease in growth.

Family therapy, combined with a variety of training and teaching techniques, is also often used to help manage children with ADD.

In fact, EEG biofeedback is not intended to be an alternative to Ritalin or counseling therapy but can be used in combination with the other methods.

Clifford Marks of Encinitas, a clinical psychologist who tested children who had undergone the biofeedback at EEG Spectrum in Encino, said he found their IQ scores increased an average of 20 points because their ability to focus and concentrate during the testing had improved.

“In all my 25 years as a clinical psychologist working with children, the results of (EEG biofeedback) has been the most dramatic and the most consistent,” he said.

Skeptics, however, continue to question the treatment’s effectiveness, saying the research is too scarce and too flimsy.

Critics such as Dr. Russell Barkley, a leading expert on ADD and director of psychology at the University of Massachusetts Medical Center, scoffs at what he calls the “sweeping claims” being made by the biofeedback practitioners.

Barkley, who heads a group of leading scientists and experts on ADD, said the research has not been scientific, and he believes EEG biofeedback is “an unproven treatment at this point.”

Unfortunately, he said, “it will become the fad of the ‘90s” because of all the publicity the therapy has gotten, despite the the lack of data on it.

Claims that it can permanently elevate IQs or alleviate behavioral problems “border on being unethical,” said Barkley.

Sandy Thomas of Children With Attention Deficit Disorder, an international parent support group, says the organization has not endorsed EEG biofeedback because there is not enough research to substantiate the claims made by its proponents. And reviews from parents whose children tried the therapy have been mixed.

“There were some parents who thought it was a total waste of money . . . and some who became advocates for it,” she said. We have to be careful because parents of ADD children are very vulnerable. Sometimes they are desperate and they will jump at anything.

“Before our organization backs any kind of treatment, it needs to have the blessing of the scientific communities.”

Countered Habib: “Some criticism is legitimate. The research isn’t up to snuff yet.” Research money is scarce, the cost and availability of computer equipment needed to study the therapy is prohibitive, and the research so far has been generally published in relatively obscure journals, he said.

Joel Lubar, a psychology professor at the University of Tennessee and one of the pioneers in the use of EEG biofeedback since the late 1970s, said that the data is there to prove its effectiveness but that many professionals in the mental health area just aren’t bothering to review it.

There is a reluctance by some to accept a technique that doesn’t employ pharmaceuticals or the use of traditional counseling therapy, said Habib.

Lubar noted that he has worked with “over 700 children and we estimate there are well over 1,000 children in treatment at any one time around the country. They are reporting success rates above 70%.”

Jacqui Mershon said the skeptics won’t knock her confidence in the therapy.

She remembers with frustration the daily battles she once had with her rebellious twin girls, whose conditions have been diagnosed as ADD.

“Day in and day out, everything was a battle,” recalls Mershon, of Foothill Ranch, near Lake Forest. “They didn’t even look at me as a mother figure. They ignored me. I would tell them something 3,000 times and they wouldn’t get it. Now, we know my little girls just didn’t have the capacity to understand.”

After daughter Rachel received the EEG biofeedback, Mershon said, “it didn’t perform a miracle, but she is much more understanding now. Now 9, Rachel has a longer attention span. She is not as defiant as she once was.” Pleased with the changes she observed in Rachel, Mershon has now enrolled Rachel’s twin, Crystal, in the program.

EEG biofeedback has been successful in treating some children with behavioral problems that include aggression behavior and depression, said physicist Siegfried Othmer, who directed the Encino project.

Daniela Alloro, a clinical psychologist working with a group of troubled children in two foster homes in Los Angeles, said she saw “spectacular results” in the case involving a 12-year-old boy who had emotional problems. A victim of neglect and emotional abuse, the child was defiant, depressed and had a history of running away.

“He was very negative about his own identity and would do anything to push people away from him. I was very worried about him because he would say things like, ‘I wish I were dead.’ ” His parents died in an accident and he told Alloro he didn’t care that they were dead.

After he began receiving EEG biofeedback, he changed, Alloro said. “He was pleasant and cooperative. He still has some problems, but he is not negative, he doesn’t express self-defeating (thoughts). He has a new attitude.”

Teachers who worked with students who had the treatment generally said they saw some improvements in attention span and ability to focus and complete work.

But some, like Pam Patterson-McDonald, who teaches first grade at Mary Fay Pendleton school at Camp Pendleton, said she “can’t say wholeheartedly that it was the biofeedback” that was the primary factor in improving the abilities of one of her pupils.

Although the child did blossom academically in her class and did improve behaviorally after the biofeedback, Patterson-McDonald said she believes his achievements were based on a combination of factors, including her teaching methods.

Yet, she says, “the biofeedback did help him get self-control. It gave him the tools to excel in learning.”

“I know it can work,” said Susan Callison, Chad’s mother. “Our pediatrician told us not to waste our money on it. But I’m glad we did.”