It looks like something out of Stranger Things. Wearing a bright-blue skullcap festooned with electrodes, 22-year-old Vince sits in an armchair facing a TV. The screen lights up and darkens—Vince is controlling it with his brain. The goal is to keep the screen lit for the 40-minute session. When he loses focus, the screen darkens and Vince has to channel his brainpower in the right direction. This is neurofeedback, the brain-training therapy being used to treat a variety of disorders, including ADHD and the anxiety and depression that often accompany it. Vince suffers from all three.
He was a 19-year-old Saint Joseph’s University student when he first consulted with a psychiatrist about his ADHD and mood disorders. In a two-year span, he was prescribed three different SSRIs and Adderall, the medication used to treat ADHD symptoms. None of them were helpful, and all had side effects. When he learned of the holistic ADHD treatment at Bryn Mawr’s Yang Institute of Integrative Medicine, Vince signed up immediately.
After completing a medical history and doing blood work to evaluate his thyroid, hormones and vitamin deficiencies, Vince had a quantitative electroencephalogram (QEEG) to measure his alpha, beta, delta and theta brain waves. As opposed to MRI and CAT scans that measure a brain’s structure, QEEG assesses physiological functioning to see which areas are over- or under-stimulated. ADHD is in a certain part of the brain, but different patients have it in different degrees, manifesting as verbal or auditory processing disorders or other diagnoses.
With Vince’s diagnostics in hand, Dr. Jingduan Yang, founder and medical director of the Yang Institute of Integrative Medicine, created a treatment plan that combines neurofeedback with acupuncture. Patients typically do 40 minutes of each in one visit. Sessions can be once or several times per week. Neurofeedback focuses on the brain, while acupuncture hones in on the kidneys. “Chinese medicine believes that the energy and essence of kidneys are responsible for the development of the brain,” Yang explains. “Fundamentally, if someone is deficient in either energy or essence—what we call hormones, proteins and neurotransmitters—they have trouble concentrating and have other cognitive deficits. Acupuncture helps the kidneys be more efficient and preserve energy.”
Parents with years of experience dealing with their kids’ ADHD may raise skeptical eyebrows at Yang’s ideas. “Medication and behavioral therapy are the gold standards for treating ADHD, and most kids use both,” says Dr. Roger Harrison, a psychologist and pediatric behavioral health specialist at Nemours/Alfred I. duPont Hospital for Children.
Behavioral therapy instills reinforcement and reward systems, and also teaches families to create good environmental conditions where distractions are minimized and attention is promoted. That therapy is used in conjunction with ADHD medications—neurostimulants that work on dopamine levels and the brain’s frontal lobe to increase focus. While FDA approved and clinically proven effective, the medications are somewhat controversial because of their side effects, namely appetite suppression and insomnia. Many parents medicate their kids reluctantly while searching for vitamin supplements, food, music and holistic treatments that can help their children.
Harrison understands parents’ quests for answers and acknowledges the frustration that is often tinged with guilt. Like autism, ADHD is thought to be genetic, but could also have biological and environmental causes. “The science about ADHD is not new—it goes back to the 1930s,” Harrison says. “But it still isn’t clear that ADHD has a single biological pathway. Different genes have been implicated. Most of the research has examined the role of dopamine in the brain, but there is no single hypothesis about that.”
The science is still out on cures, too. But in the meantime, Harrison doesn’t completely dismiss QEEG or acupuncture. “I never tell families not to try them,” he says, “but I caution them against spending money on alternative treatments based solely on testimonials. Is there evidence that this intervention works better than a placebo? Are there blind clinical trials, and have they been replicated? QEEG studies have not been replicated. It is new and promising, but there’s not enough established science to recommend it.”
Skepticism is nothing new to Yang. Placebo effects are still real, he argues. “The majority of the drugs presented to the FDA—99 percent—cannot beat the placebo effect,” he says. “If there’s a treatment that can beat the medicine, do it.”
Yang also explains the nocebo effect, which is when people don’t believe a treatment will work, but it does. “More than 80 percent of my patients come to acupuncture with nocebo mindsets,” he says. “They try it even though they don’t think it will work, because nothing else has.”
Vince believes his treatments are making a difference in his ADHD, anxiety and depression. Acupuncture worked for him after just one session. Following three weeks of sessions—some of them two-and-a-half hours long—Vince felt the effects of the neurofeedback, seeing improvements in his schoolwork, relationships, moods and sleep.
Declaring himself done with medication, Vince is grateful for the treatment he gets at the Yang Institute. But he understands why so many people doubt the effects of holistic care. “It’s American culture,” he says. “People look for gratification in five minutes. They look at a bottle of Xanax and think it will cool them off in that moment. Pharmaceutical drugs are only a Band-Aid. Dr. Yang puts in stitches to fix what’s really wrong.”