A Sharper, Faster, Stronger ADHD Brain?
Brain training companies promise to improve attention, working memory, and focus in ADHD brains. But how well do brain training games and tools work — and how well do they improve ADD symptoms?
Search “Brain Training” and you’ll find countless apps, games, and tools promising to make you smarter, slow cognitive decline, and/or boost creativity. These days brain training is in the mainstream and has become a part of ADHD treatment plans — through at-home apps, in-office neurofeedback programs, and everything in between — claiming to improve attention, lower impulsivity, or boost brain-based skills, like processing speed or working memory.
But what do these tools do, and do they have a measurable impact on attention deficit disorder (ADHD or ADD) symptoms? Let’s dive into what brain training comprises, and what you or your child can expect from its applications.
What Is Brain Training?
“Brain training” covers a vast and diverse range of solutions, programs, exercises, and tools meant to strengthen the brain — either by changing its structure, altering brain waves, or improving specific brain-based skills. Brain training is based on the idea of “neuroplasticity,” a relatively recent theory that suggests that the brain is malleable, and can be changed by experience (for better or for worse) at any age.
How Does Brain Training Apply to ADHD?
Brain training can mean a lot of things. When we talk about it in terms of ADHD, however, we’re typically referring to one of two things: neurofeedback or cognitive training. (Some ADHD experts, like Sandy Newmark, M.D., don’t consider neurofeedback to be a type of brain training.) Each of these can be done in an office with a professional, or at home, with or without a trained clinician.
“Brain training is an umbrella term that accompanies so many different applications that generalized conclusions about its value for ADHD are essentially meaningless,” says David Rabiner, Ph.D. “It is important to examine the claims and evidence of specific applications. Making a general conclusion about brain training for ADHD is like making a general conclusion about medications for ADHD. Some treatments include not just meds specifically developed for ADHD, but a wider range of medications.”
What Is Neurofeedback?
Neurofeedback is a form of biofeedback — the process of learning how to change physiological activity using real-time monitoring of biological data — that uses electroencephalography (EEGs) to help patients train their brains to improve focus, impulse control, and executive function.
Brain scans show that ADHD brains produce more low-frequency delta or theta brain waves than do neurotypical brains. They often show a shortage of the high-frequency beta brain waves linked to focus and impulse control. The goal of neurofeedback is to increase the brain’s production of beta waves, while diminishing the frequency of delta and theta waves.
To achieve this, individuals are given real-time feedback on their brain-wave patterns, and they are taught to produce and maintain patterns consistent with a focused, attentive state. This is done by collecting brain-wave data from individuals as they focus on stimuli presented on a computer screen. Their ability to control the stimuli—for example, keeping the “smile on a smiley face”—depends on maintaining the brain-wave pattern being trained. Neurofeedback proponents believe that learning this skill during training applies to real-world situations, and results in improved attention and reduced hyperactive and impulsive behavior.
What Is Cognitive Training?
When people refer to “brain training,” they’re usually referring to some type of cognitive training. Cognitive training programs focus on building specific skills — like attention, problem-solving, or reading comprehension — often through the use of games and exercises. Most modern brain-training programs (especially those available for home use) use video- or computer-game formats; some in-person programs use physical games or worksheets.
What Is Working Memory Training?
Working memory training is a type of cognitive training aimed at improving that particular skill, which is thought to be critical for learning. This type of training is commonly used for people with ADHD, many of whom struggle with working memory. Working memory training makes use of memory exercises, like N-back training — in which subjects try to remember a stimulus they saw earlier in a sequence — to (in theory) increase memory capacity over time. The program Cogmed markets itself as ADHD-specific working memory training.
What Are Brain Training Apps?
Brain training apps — Lumosity, Peak, and countless others — have become increasingly popular over the last decade, growing in lockstep with the proliferation of smartphones. Though few claim to specifically target ADHD, many claim to build cognitive skills that people with ADHD often find deficient, like visual processing, problem-solving, or attention. Some of these claims have been challenged by the Federal Trade Commission, however. (The FTC sued Lumosity successfully in 2016 for making false claims in its advertising.)
Despite the occasionally weak research behind some of the biggest apps, they’ve exploded in popularity because they’re easy to access, relatively cheap, and (usually) fun for those using them.
Does Brain Training Work for ADHD?
This is a complicated question. “Brain training encompasses a wide range of different approaches and applications,” Rabiner says. “Rather than relying on any general conclusions about the effectiveness of brain training, parents should carefully investigate the claims and research support for the particular approach they are considering.”
Many programs have demonstrated that they do produce improvements in certain brain-based skills, like working memory or visual processing, but the studies evaluating the results have been criticized for being poorly designed or for being conducted by representatives of the programs. Many of the studies were done over a short time period, making it unclear whether any gains would last long after a particular brain-training program concluded.
Even given the studies that used adequate controls or were undertaken independently, experts continue to disagree about whether any noted gains apply outside the context of the brain-training programs. In other words, a child (or adult) may improve his scores in a working memory game, but not necessarily show working memory improvements in his or her day-to-day life.
One particularly striking example of this is a 1980 study in which a college student was able to repeat numbers up to 79 digits in length that were read aloud to him, after weeks of practice. But when asked to do the same with letters, he could recall just six at a time, suggesting to the researchers that he had improved only the skill of repeating numbers. His working memory capacity appeared unchanged.
An article entitled “Brain Games Are Bogus” was published in The New Yorker in 2013. It said, “A pair of scientists in Europe recently gathered all of the best research—23 investigations of memory training by teams around the world—and employed a standard statistical technique (called meta-analysis) to settle this controversial issue. The conclusion: The games may yield improvements in the narrow task being trained, but this does not transfer to broader skills, like the ability to read or do arithmetic, or to other measures of intelligence. Playing the games makes you better at the games, but not at anything in real life.”
Many Parents Believe in Brain Training
Counterbalancing studies such as these are many parental reports of significant ADHD symptom control, sustained beyond the end of neurofeedback sessions. These testimonials, combined with positive study results touted by solution providers, like Cogmed, have persuaded some medical professionals to recommend brain training to their patients as a supplementary treatment. Many anticipate the results of further research.
A meta-analysis, published in February 2018 in European Child & Adolescent Psychiatry, came to a positive conclusion. According to the study, “There are sustained symptom reductions over time in comparison with non-active control conditions. The improvements seen here are comparable to active treatments (including methylphenidate). As such, [neurofeedback] can be considered a non-pharmacological treatment option for ADHD with evidence of treatment effects that are sustained when treatment is completed and withdrawn.”
“The potential for brain training as a new therapeutic tool is phenomenal,” says Amit Etkin, M.D., Ph.D., associate professor in the department of psychiatry and behavioral sciences at Stanford University. “By understanding brain circuitry, we can tailor interventions that medication or psychotherapy do not access or improve. The great advantage is that these programs are not invasive, have minimal side effects, and are fun.”
The Consensus on Brain Training
So far, data makes it impossible to say whether brain training, as a whole, works to improve ADHD symptoms. In their ADDitude webinar, David Rabiner, Ph.D., and Ed Hamlin, Ph.D., cite four encouraging though small studies of neurofeedback on children and young adults with ADHD. The meta-analysis of these studies, and others, demonstrated a not-insignificant reduction in inattention and hyperactivity. But Rabiner and Hamlin still advise patients to approach (and budget for) neurofeedback cautiously. Not all solutions work equally well for all people, so judgments about the efficacy of brain training in general are not helpful.
“Existing research does suggest that neurofeedback can result in improved attention, diminished hyperactivity, and enhanced executive functions, including working memory, for some patients,” say Rabiner and Hamlin. “However, some of the most important researchers in the ADHD field would argue that the efficacy of neurofeedback for ADHD has not been conclusively established. The bottom line is that research support for both stimulant medication therapy and behavior therapy is stronger than it is for neurofeedback at the moment.”
Before investing money or time in a brain-training program for yourself or your child, it’s important to do your homework—and be wary of biased testimonials or skewed or incomplete research.