Mental Health Performance - ADD / ADHD, Trauma & Neurofeedback: Review & Analysis
About the Author
Ben Foodman is a licensed psychotherapist & performance specialist. He owns his private practice located in Charlotte North Carolina where he specializes in working with athletes to help them overcome mental blocks (the yips), PTSD, ADD / ADHD and achieve flow states through the techniques of Brainspotting & Neurofeedback. If you are interested in services, use the link here! Enjoy the article below!
Introduction: Deeper Conversations On ADD/ADHD
Attention Deficit Disorder and/or Attention Deficit Hyperactivity Disorder (ADD / ADHD) are controversial mental health diagnoses that spark a wide range of opinions. Some people believe that these diagnoses aren’t real and that people can just ‘will power’ their way through these issues, while other people are too quick to diagnose any young child with the disorder as soon as inattentive behavior is present. The truth is that ADD / ADHD is far more complicated than most people understand.
For this series of the Training Report, I want to take some time to explore the diagnosis of ADD / ADHD. First, I will give my opinions on the diagnosing process and why it is so flawed. Second I will talk about the way I believe this issue needs to be examined and handled on a macro level within our society. Finally, I will review a non-invasive treatment option called Neurofeedback which I have talked about in previous Training Report issues. First, let’s begin by exploring the diagnosing process.
Part I. Trauma, ADD / ADHD & Clinical Assessments
In my experience, boys are over-diagnosed with ADD / ADHD while many girls are either under-diagnosed or misdiagnosed. Both of these situations are incredibly problematic and will inevitably create more problems for individuals who experience this. But the reason this is so important to discuss this is because it highlights our lack of understanding about this issue. When looking at the current DSM diagnostic criteria, I have found in my work there are far more co-occurring symptoms that are associated with ADD / ADHD then listed in the DSM. For instance many of the clients I have worked with that have ADD / ADHD present with symptoms such as sleep dysregulation, sensory issues (e.g. highly sensitive to food textures, highly sensitive to certain clothing fabrics, etc.) but were never diagnosed because they were successful in school or asked questions about those issues.
Another critical problem with the diagnosing process is that it is conducted mostly through questionnaires or basic surveys that go through the criteria listed in the DSM, but not a thorough mental health history. There are vitally important questions that clients are rarely ever asked which are important towards understanding the diagnosis. These questions include the following: could the client be having focus issues because this is a coping mechanism; could the client have focus issues because they have sustained trauma (either physical or mental) which could be causing symptoms; could the client be in need of more physical activity, hence the client’s need for movement due to ‘hyperactivity’; could the client be having difficulty with focus because of the environment. All of these points are crucial towards understanding people, yet they are hardly ever asked or evaluated.
Another problem in our understanding of ADD / ADHD is that there is a broad section of the mental health community that refers to this issue as a ‘chemical imbalance’ or only a ‘neurological condition’. I myself used to be a member of this crowd but over time have stepped away from this way of thinking for several reasons. First, while there may very well be a genetic factor in ADD / ADHD there is no way to definitively prove this. Furthermore, when we see symptoms of ADD / ADHD in young children, we can’t be sure if this is just a stage in their neurologic development (eventually they may grow out of it). Maybe most importantly, we underestimate the impact that trauma can have on the brain, especially preverbal and infant trauma. During pregnancy and infancy, the connections that are created through healthy mother / child attachment can AND will have a profound impact on the child from a neurodevelopmental perspective. While we have now discussed important introductory concepts of ADD / ADHD lets discuss what may be happening on a neurologic level.
Part II. Brainwaves & ADD / ADHD
Attaining client history and self-reporting is absolutely critical whenever you are trying to understand someone’s mental health concerns. But if we stop at just asking questions and never try to find out what is actually happening INSIDE the brain, it’s safe to assume we might be missing important details. One way in which we are starting to enhance our understanding of what is happening inside the brain is by identifying the electrical activity that is occurring throughout the different regions of the brain. This electrical activity is referred to as brainwaves.
One technique that is used to measure brainwaves is called a QEEG assessment. A Quantitative EEG assessment (AKA Brain mapping) is used to analyze how different areas of an individual’s brain are functioning & interacting with one another. There are different names for certain brainwaves, but overall research suggests that the speedier brainwaves are used for thinking while the slower brain waves are used for relaxation and maintaining involuntary bodily functions. Most importantly, there is a significant body of research that supports the correlation between certain brainwave readings AND how they may represent ADD / ADHD patterns. As you can imagine, having this additional information is critical towards fully understanding what is happening in an individual’s brain. So what can be done from an intervention standpoint to actually help with this issue?
Part III. Neurofeedback As A Possible Intervention For ADD / ADHD
Neurofeedback is a noninvasive, neuroscience intervention which measures & trains brainwaves. This approach provides real-time feedback about where the client’s brain is functioning efficiently versus where their brain needs training. Ultimately, this mind-body approach can help clients develop neural stability which leads to an increased stress-threshold tolerance. As previously mentioned, once the QEEG is conducted, this information tells us where the client’s brain needs to speed up or slow down, and we are able to design an individualized neurofeedback training program with the intention to help clients optimize their brain wave functioning while also alleviating adverse symptoms of ADD / ADHD. Neurofeedback works through Operant Conditioning, which is a form of learning that uses a reward to modify behavior. For example, during a neurofeedback session as the brainwaves change in a healthier way, you may hear a bell ring or you will see a visual image changing on a computer screen .
This feedback encourages the brain to more easily move into healthier functional ranges over time. Research shows that neurofeedback promotes healthier blood flow to the cortex of the brain, and after repeated sessions long standing changes are maintained long after Neurofeedback training is complete. Regardless of the intervention that clients use to understand ADD / ADHD, all of us need to recognize that this is a very complex issue. Furthermore, ADD / ADHD is only one very, VERY small piece about someone’s story. A mental health diagnosis does not tell us WHY someone is dealing with certain issues. It’s important that anyone working with individuals in the ADD / ADHD population be patient, and remember that this issue is far more complex than has initially been presented to us.
Note To Reader:
If you are an athlete reading this segment of the TRAINING REPORT, hopefully this content was helpful! I put the Training Report together because I felt like many of the discussions on issues such as the Yips/mental blocks, strength training & other subject matter on athlete performance concepts were really missing the mark on these ideas (e.g. how trauma is the direct cause of the Yips). If you are interested in learning more, make sure to subscribe below for when I put out new content on issues related to sport psychology & athlete performance! Also, if you are looking to work with a mental performance specialist, you are in the right place! USE THIS LINK to reach out to me to see if my services are the right fit for your goals!
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