Neurofeedback for Attention Deficit and Executive Functioning – Part 2
- joshuamorrow244
- Apr 30
- 14 min read
Updated: May 9
Starting out, I am going to share the neurofeedback protocols that are commonly used in addressing ADHD, general attention issues, and deficiencies in executive functioning, and then I’m going to take a hard left turn, but all so that we can return full circle at the end to truly understand what these protocols are doing and why it matters to you. So here we go:
1. Delta Down Training: This is on protocol I have found to be the easiest to reach lowest hanging fruit for improving brain functioning when an individual has excessive delta waves. Delta waves are the wave that predominates while in deep sleep, and is not something you want to see elevated in a conscious state. Oftentimes those with ADHD have elevated slow-wave activity in their brains, specifically in that region I brought up in Part 1, the Prefrontal Cortex. (1, 2).
2. Theta/Beta Ratio TBR) Training: This protocol developed by pioneer Joel Lubar aims to decrease the ratio of theta to beta waves, typically by reducing theta activity and increasing beta activity in the frontal areas of the brain. Theta waves are slower waves just faster than delta waves, and beta waves are fast waves above alpha waves (See chart below). The goal is to normalize the excessive theta and insufficient beta pattern often seen in ADHD (2-5).
*Disclaimer: All brainwaves have positive functions, for particular states and within a particular balance. Theta waves are very important for creativity, but excess in the frontal lobes or other regions can lead to dysfunction. Beta waves are important for conscious processing and verbal thinking, but in excess there is likely over-arousal and anxiety that predominates, and in deficit the individual is likely processing things slowly, or under-aroused, or having difficulties with attention and executive functioning. The goal of these protocols and all forms of neurofeedback are to bring them back into a state of proper balance and coordination, which is often felt by the client as a positive experience within their body and mind.
3. Sensorimotor Rhythm (SMR) Training: This method enhances oftentimes low SMR activity (12-15 Hz, a low-beta frequency) which is associated with calm focus and reduced hyperactivity, and found to be effective for helping those with ADHD (6-7). It was one of the earlier neurofeedback protocols used for ADHD, originally discovered by chance. Joel Lubar seeing that kids training SMR for epilepsy control also saw a reduction in hyperactivity, subsequently ran numerous studies to see the effects on children with attention deficits and hyperactivity problems and found clearly beneficial results. A very good overview of this is found in Chapter 2 of the book “Restoring the Brain” edited by Hanno W. Kirk (8).
4. Slow Cortical Potential (SCP) Training: SCP neurofeedback is based on learning self-regulation of cortical activation and inhibition, as individuals with ADHD often exhibit abnormal SCP patterns, specifically a reduced ability to generate negative SCP shifts. This is a training method that I will cover in another article, so all you have to know here is that it has been applied to treat ADHD with evidence of efficacy and significant improvements in multiple studies (9-11).
5. LORETA Neurofeedback: This advanced technique uses a full 19-channel electrode cap to localize the source of electrical events in the brain by using databases build from QEEG and fMRI scans, which allows software to accurately infer activity in brain regions deeper than the surface of the brain… and then train them. Numerous studies have shown sustained improvements in attention following this type of training (12-14).
Honorable Mention: Low-Energy Neurofeedback System (LENS) – I know less about this as it is actually a form of neuromodulation and know it primarily as support for treating autism, but I have seen there are a small number of studies out there that show it can have positive outcomes in attention-related symptoms.
Ok, so now for the hard left turn.
As I have been working on writing this article, I have also been listening to quite a good book called “The Art of Impossible”, a self-described peak performance “primer” that is loaded full of information, history, stories, inspiration, and practical steps to how to maximize flow states, creativity, productivity, and personal excellence. One very fascinating thing struck me regarding what I have been studying about ADHD as it relates to what the author Steven Kotler has written about the functioning of the brain in flow states.
In the brain, there are many brain networks, but there are three in particular the author brings up that are quite important for our conscious, deliberate mind.
The Central Executive Network (CEN): Also commonly known as the “task-positive network”, it shifts on when there is a task outside of us to be done, like a job at work or chores at home, or attention needs to be oriented towards external-processing needs such as paying attention to someone talking or analyzing a situation.
The Default Mode Network (DMN): Also commonly known as the “task-negative network”, meaning that this is the network that is online when there are no external tasks to be done, and attention can then be oriented inward towards internal tasks or internal-processing needs, such as autobiographical planning, self-reflection, or daydreaming (which some amount of is actually healthy for you!)
The Salience Network (SN): This brain network is focused on what we call...unsurprisingly… “salience”, which is another term for emotional relevance. It basically refers to the quality of something standing out or being more noticeable than other things. The things that capture one’s attention have high salience, and the things that go unnoticed have low salience. This brain network is active when helping your brain detect and filter out what is important to put your attention on. You could call it a “relevance detector”, and monitors both internal states (hunger/pain/emotions) and external stimuli (people, places, things). When the SN detects something significant, it helps switch between the CEN and the DMN. Lets say you’re walking/driving and maybe not the safest but you’re daydreaming a little, and all of a sudden you feel the grumble of hunger (DMN, internal state). Then you start to notice all the restaurants and food vendors around you (CEN, external stimuli). That’s your SN helping you out!
Another network that is crucial for attention and executive functioning that works with the Salience Network is the Fronto-Parietal Network (FPN). This network is interesting in that it couples with either the Central Executive Network (externally-oriented processing) or the Default Mode Network (internally-oriented processing) depending on the needs of the cognitive task required (15,16). Essentially, this network acts like a type of switch, helping the conscious mind shift between different networks and states as needed. Dysfunction in this network means that switch doesn’t work in an ideal manner, and you’ll be off daydreaming even though you know you need to be working on this one thing that really needs to get done.
When an individual and the brain inside of them is in flow, it is highly coordinated with itself, with the FPN switching smoothly between the CEN and the DMN as the need demands, and the salience network working diligently to filter out all irrelevant stimuli to the task at hand and maintaining focus, and surprisingly a thing called transient hypofrontality occurs, which is where the prefrontal cortex actually deactivates and goes quiet for the period of time when we are in flow (17).
Remember how previously we shared that many of those with ADHD have high levels of slow-wave activity in the prefrontal cortex? Well, the dorsolateral prefrontal cortex (DLPFC) is a core region in the Central Executive Network, the medial prefrontal cortex (dmPFC and vmPFC above) is a core region in the Default Mode Network, and the dorsal anterior cingulate cortex (dACC above) is a structure directly below the prefrontal cortex, and is a core region in the Salience Network. The Fronto-Parietal Network core structures in the prefrontal region are the DLPFC, the ventrolateral prefrontal cortex (VLPFC), and the anterior cingulate cortex. So basically what does this all mean? It means that your forehead is an area where so many of these networks that are central to attention and executive functioning converge, and in those with ADHD they have a lot of brain cells firing at a unusually slow pace…
So this is what I found so fascinating, it seems that the complete opposite direction away from the flow state… is ADHD! With the high slow-wave activity in the prefrontal cortex, with substantial evidence for abnormal connectivity in the brain regions within the CEN, DMN, FPN, and SN, on top of which there is poor coordination between the networks themselves (18-32). So does this mean that if we were to help these brain regions function better and networks coordinate better, that these things would improve…? Would people previously trapped without the ability to experience the wonderful state of flow be better able to tap into “the zone” with all its life-giving benefits...? What if there was just some way to help these brain regions and networks reorganize into a more effective pattern of connecting and firing…
Well, this is exactly where the neurofeedback and those previous protocols I shared about come into the picture, this is how we help restore functioning and connectivity to a brain that is dysregulated. By training the brainwave patterns via neurofeedback in specific ways, we can do just this, to help the brain change the firing patterns in the brain for the better and engage the brain’s natural capacity for neuroplasticity.
The mechanism of neurofeedback has historically been difficult to determine, as it mostly evolved out of a clinical environment that showed clinical results, not scientific results. Since its birth in the 1960’s and increasing use over the years, many have tried to uncover the secrets to why and how it works.
Tomas Ros and Patrik Vuilleumier at the University of Geneva in Switzerland, along with colleges Bernard Baars and Ruth Lanius in North America, aimed to present a credible bases for the central thesis “that NFB tunes brain oscillations toward a homeostatic set-point which affords an optimal balance between network flexibility and stability” (33).
This very fascinating paper goes into a lot of different things, but specifically for us here and now they go into a theory of how neurofeedback affects plasticity. The first is what is called ‘Hebbian Plasticity’, better known with the colloquial phrase – “Neurons the fire together, wire together”. The idea is the neurofeedback training sessions people undergo “conditions the neuronal circuits to produce the same pattern with a higher probability in the future”. Basically, we decrease or increase a frequency band in a region, we are training the neurons in that area to wire together on a new frequency. This can also be done to wire with other neurons in different areas of the brain on that same frequency through the use of coherence or synchrony training.
The second factor is what they call ‘Homeostatic Plasticity’, or also referred to as ‘meta-plasticity’. There are times in neurofeedback training where changes in EEG synchronization can occur in the opposite direction as is being trained, and therefore the opposite as would be expected according to Hebbian plasticity, or what I call when I see it, the “rebound effect”. The example used in the paper is a study of individuals with PTSD, who often have significantly reduced alpha wave power at baseline, but after engaging in a “alpha-desynchronization” protocol actually showed increased alpha synchrony compared to baseline (with a resulting increasing sense of well-being I might add). This goes to show there are other mechanisms at work that are oriented towards maintaining homeostatic stability within the brain, and alterations in brainwave activity brought about by neurofeedback training can activate this form of plasticity (33). It also gets into cross-frequency coupling and induced phase transitions, but this is jargon for the lay reader and this article is already getting too long.
And this is just one of the peer-reviewed literature papers discussing this. There are many other that attempt to explain the scientific principles and mechanisms of neurofeedback (34), or ones that demonstrates scientifically the changes in the brain following neurofeedback training, such as in the white and grey matter (35), in connectivity of functional brain networks (36), neuronal mechanisms underlying improvements in impulsivity in ADHD (37), changes in brain connectivity in adults with ADHD (38), and long-term benefits to training (39).
The problems of ADHD, attentional deficits, and executive dysfunction are more than just in the brain. They translate into real life problems, with these problems starting with difficulties staying focused and on task, with this easily leading to conflict with family members and loved ones, maybe over tasks and chores, maybe over not being present or listening well, maybe over impulsive behaviors. And this too leads to challenges in school performance or productivity at work, and these things together can lead to compounding financial problems and emotional difficulties and further psychological dysregulation. The problems pile up and up until its not ever clear where to begin.
This is why I have studied this and provide this service. There are many people out there trying to treat the surface problems, or provide band-aid solutions that only temporarily take care of the problem. Neurofeedback cuts straight to the root of at least one primary aspect of the problem – self-regulation of attention and action. This is something that neurofeedback excels in helping people rediscover in their experience of life.
For those struggling with ADHD or attention difficulties, this represents a path toward not just managing life's challenges, but potentially rediscovering what it feels like to experience flow, focus, and presence—abilities that may have seemed out of reach before or only come in fits and starts. The journey toward better brain functioning isn't necessarily quick or easy, but the science continues to support that it's a journey worth taking.
If you're interested in learning more about how neurofeedback might help you or someone you care about, I encourage you to reach out. Together, we can explore how this powerful tool might fit into your path toward improved cognitive functioning and a more fulfilling life.
Stay tuned for more articles exploring the fascinating intersection of neuroscience, psychology, and holistic approaches to the renewal of the Self!
References
1. Barry, R. J., Clarke, A. R., & Johnstone, S. J. (2003). A review of electrophysiology in attention-deficit/hyperactivity disorder: I. Qualitative and quantitative electroencephalography. Clinical Neurophysiology, 114(2), 171-183.
2. Snyder, S. M., & Hall, J. R. (2006). A meta-analysis of quantitative EEG power associated with attention-deficit hyperactivity disorder. Journal of Clinical Neurophysiology, 23(5), 440-455.
3. Arns, M., de Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: The effects on inattention, impulsivity and hyperactivity: A meta-analysis. Clinical EEG and Neuroscience, 40(3), 180-189.
4. Monastra, V. J., Lubar, J. F., & Linden, M. (2001). The development of a quantitative electroencephalographic scanning process for attention deficit-hyperactivity disorder: Reliability and validity studies. Neuropsychology, 15(1), 136-144.
5. Lubar, J. F., Swartwood, M. O., Swartwood, J. N., & O'Donnell, P. H. (1995). Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in TOVA scores, behavioral ratings, and WISC-R performance. Biofeedback and Self-regulation, 20(1), 83-99.
6. Fuchs, T., Birbaumer, N., Lutzenberger, W., Gruzelier, J. H., & Kaiser, J. (2003). Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: A comparison with methylphenidate. Applied Psychophysiology and Biofeedback, 28(1), 1-12.
7. Thompson, L., & Thompson, M. (1998). Neurofeedback combined with training in metacognitive strategies: Effectiveness in students with ADD. Applied Psychophysiology and Biofeedback, 23(4), 243-263.
8. Othmer, S. (2015). History of neurofeedback. In H. W. Kirk (Ed.), Restoring the brain: Neurofeedback as an integrative approach to health (pp. 23-55). CRC Press.
9. Gevensleben, H., Holl, B., Albrecht, B., Vogel, C., Schlamp, D., Kratz, O., ... & Heinrich, H. (2009). Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial. Journal of Child Psychology and Psychiatry, 50(7), 780-789.
10. Strehl, U., Leins, U., Goth, G., Klinger, C., Hinterberger, T., & Birbaumer, N. (2006). Self-regulation of slow cortical potentials: A new treatment for children with attention-deficit/hyperactivity disorder. Pediatrics, 118(5), e1530-e1540.
11. Mayer, K., Wyckoff, S. N., & Strehl, U. (2013). One size fits all? Slow cortical potentials neurofeedback: A review. Journal of Attention Disorders, 17(5), 393-409.
12. Cannon, R., Congedo, M., Lubar, J., & Hutchens, T. (2009). Differentiating a network of executive attention: LORETA neurofeedback in anterior cingulate and dorsolateral prefrontal cortices. International Journal of Neuroscience, 119(3), 404-441.
13. Cannon, R., & Lubar, J. (2011). Long-term effects of neurofeedback training in anterior cingulate cortex: A short follow-up report. Journal of Neurotherapy, 15(2), 130-150.
14. Kropotov, J. D., Grin-Yatsenko, V. A., Ponomarev, V. A., Chutko, L. S., Yakovenko, E. A., & Nikishena, I. S. (2005). ERPs correlates of EEG relative beta training in ADHD children. International Journal of Psychophysiology, 55(1), 23-34.
15. Vincent, J. L., Kahn, I., Snyder, A. Z., Raichle, M. E., & Buckner, R. L. (2008). Evidence for a frontoparietal control system revealed by intrinsic functional connectivity. Journal of Neurophysiology, 100(6), 3328-3342. https://doi.org/10.1152/jn.90355.2008
16. Spreng, R. N., Stevens, W. D., Chamberlain, J. P., Gilmore, A. W., & Schacter, D. L. (2010). Default network activity, coupled with the frontoparietal control network, supports goal-directed cognition. NeuroImage, 53(1), 303-317. https://doi.org/10.1016/j.neuroimage.2010.06.016
17. Kotler, S. (2021). The Art of Impossible: A Peak Performance Primer. Harper Wave.
18. Castellanos, F. X., & Proal, E. (2012). Large-scale brain systems in ADHD: beyond the prefrontal–striatal model. Trends in Cognitive Sciences, 16(1), 17-26.
19. Sidlauskaite, J., Sonuga-Barke, E., Roeyers, H., & Wiersema, J. R. (2016). Default mode network abnormalities during state switching in attention deficit hyperactivity disorder. Psychological Medicine, 46(3), 519-528.
20. Lin, H. Y., & Gau, S. S. F. (2015). Atomoxetine treatment strengthens an anti-correlated relationship between functional brain networks in medication-naïve adults with attention-deficit hyperactivity disorder: a randomized double-blind placebo-controlled clinical trial. International Journal of Neuropsychopharmacology, 19(3), pyv094.
21. Castellanos, F. X., Margulies, D. S., Kelly, C., Uddin, L. Q., Ghaffari, M., Kirsch, A., ... & Milham, M. P. (2008). Cingulate-precuneus interactions: a new locus of dysfunction in adult attention-deficit/hyperactivity disorder. Biological Psychiatry, 63(3), 332-337.
22. Fair, D. A., Posner, J., Nagel, B. J., Bathula, D., Dias, T. G. C., Mills, K. L., ... & Nigg, J. T. (2010). Atypical default network connectivity in youth with attention-deficit/hyperactivity disorder. Biological Psychiatry, 68(12), 1084-1091.
23. Sripada, C., Kessler, D., Fang, Y., Welsh, R. C., Prem Kumar, K., & Angstadt, M. (2014). Disrupted network architecture of the resting brain in attention‐deficit/hyperactivity disorder. Human Brain Mapping, 35(9), 4693-4705.
24. Cortese, S., Kelly, C., Chabernaud, C., Proal, E., Di Martino, A., Milham, M. P., & Castellanos, F. X. (2012). Toward systems neuroscience of ADHD: a meta-analysis of 55 fMRI studies. American Journal of Psychiatry, 169(10), 1038-1055.
25. Bos, D. J., Oranje, B., Achterberg, M., Vlaskamp, C., Ambrosino, S., de Reus, M. A., ... & Durston, S. (2017). Structural and functional connectivity in children and adolescents with and without attention deficit/hyperactivity disorder. Journal of Child Psychology and Psychiatry, 58(7), 810-818.
26. Francx, W., Oldehinkel, M., Oosterlaan, J., Heslenfeld, D., Hartman, C. A., Hoekstra, P. J., ... & Mennes, M. (2015). The executive control network and symptomatic improvement in attention-deficit/hyperactivity disorder. Cortex, 73, 62-72.
27. Sidlauskaite, J., Caeyenberghs, K., Sonuga-Barke, E., Roeyers, H., & Wiersema, J. R. (2018). Whole-brain structural topology in adult attention-deficit/hyperactivity disorder: Preserved global – disturbed local network organization. NeuroImage: Clinical, 18, 583-590.
28. Cai, W., Chen, T., Szegletes, L., Supekar, K., & Menon, V. (2018). Aberrant time-varying cross-network interactions in children with attention-deficit/hyperactivity disorder and the relation to attention deficits. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 3(3), 263-273.
29. Kucyi, A., Hove, M. J., Biederman, J., Van Dijk, K. R., & Valera, E. M. (2015). Disrupted functional connectivity of cerebellar default network areas in attention-deficit/hyperactivity disorder. Human Brain Mapping, 36(9), 3373-3386.
30. Menon, V. (2011). Large-scale brain networks and psychopathology: a unifying triple network model. Trends in Cognitive Sciences, 15(10), 483-506.
31. Mills, B. D., Miranda-Dominguez, O., Mills, K. L., Earl, E., Cordova, M., Painter, J., ... & Fair, D. A. (2018). ADHD and attentional control: Impaired segregation of task positive and task negative brain networks. Network Neuroscience, 2(2), 200-217.
32. Posner, J., Park, C., & Wang, Z. (2014). Connecting the dots: a review of resting connectivity MRI studies in attention-deficit/hyperactivity disorder. Neuropsychology Review, 24(1), 3-15.
33. Ros, T., Baars, B. J., Lanius, R. A., & Vuilleumier, P. (2014). Tuning pathological brain oscillations with neurofeedback: A systems neuroscience framework. Frontiers in Human Neuroscience, 8, 1008. https://doi.org/10.3389/fnhum.2014.01008
34. Sitaram, R., Ros, T., Stoeckel, L., Haller, S., Scharnowski, F., Lewis-Peacock, J., Weiskopf, N., Blefari, M. L., Rana, M., Oblak, E., Birbaumer, N., & Sulzer, J. (2017). Closed-loop brain training: The science of neurofeedback. Nature Reviews Neuroscience, 18(2), 86-100. https://doi.org/10.1038/nrn.2016.164
35. Ghaziri, J., Tucholka, A., Larue, V., Blanchette-Sylvestre, M., Reyburn, G., Gilbert, G., Lévesque, J., & Beauregard, M. (2013). Neurofeedback training induces changes in white and gray matter. Clinical EEG and Neuroscience, 44(4), 265-272. https://doi.org/10.1177/1550059413476031
36. Megumi, F., Yamashita, A., Kawato, M., & Imamizu, H. (2015). Functional MRI neurofeedback training on connectivity between two regions induces long-lasting changes in intrinsic functional network. Frontiers in Human Neuroscience, 9, 160. https://doi.org/10.3389/fnhum.2015.00160
37. Bluschke, A., Broschwitz, F., Kohl, S., Roessner, V., & Beste, C. (2016). The neuronal mechanisms underlying improvement of impulsivity in ADHD by theta/beta neurofeedback. Scientific Reports, 6, 31178. https://doi.org/10.1038/srep31178
38. Zilverstand, A., Sorger, B., Slaats-Willemse, D., Kan, C. C., Goebel, R., & Buitelaar, J. K. (2017). fMRI neurofeedback training for increasing anterior cingulate cortex activation in adult attention deficit hyperactivity disorder: An exploratory randomized, single-blinded study. PLoS One, 12(1), e0170795. https://doi.org/10.1371/journal.pone.0170795
39. Van Doren, J., Arns, M., Heinrich, H., Vollebregt, M. A., Strehl, U., & Loo, S. K. (2019). Sustained effects of neurofeedback in ADHD: A systematic review and meta-analysis. European Child & Adolescent Psychiatry, 28(3), 293-305. https://doi.org/10.1007/s00787-018-1121-4
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