Pay Attention to Julian Keith's Neurofeedback Research

Though two and a half million American children currently take medication for ADHD, as well as one and a half million adults, individuals with the disorder face several difficult truths. Prescription medication will not provide relief for as many as forty percent of them. The remainder may experience adverse side effects that outlast or overshadow benefits. Among students, meanwhile, evidence is slim that prescription medication leads to better academic performance. But Professor Julian Keith, a neuroscientist in the Department of Psychology, has good news to share. Julian Keith demonstrating neurofeedback in the Teaching Lab Building UNCW

Keith is conducting research into neurofeedback, a treatment model unlike medication in that it targets the symptoms of ADHD and the underlying condition itself. Participants in his study, each of whom have an ADHD diagnosis, have volunteered for their brains to be monitored by sensors placed on the scalp-one on the temple, another on the earlobe. For two dozen 30-minute sessions over the course of about two months, participants are asked to keep their attention focused on their present state. If they are successful, sensors will record high-frequency brain waves and reward them points for their concentration. If participants' attention wanes, however, those same sensors will detect lower-frequency brain waves, alert subjects back to self-awareness, and subtract points for a lapse of attention. The goal is to accumulate as many points as possible.

"When we drift off," Keith explains, "we often don't notice. But we lose contact with what's happening right here and now. When that happens, [brain] patterns change." To monitor these patterns, Keith relies on software capable of displaying them to subjects on a computer monitor, in real time. "You're actually monitoring physiologically what they're doing, and you're giving them feedback," he explains.

Most participants in Keith's study begin to notice improvement in their attention after 12 or so sessions. As well as become more mindful of precisely where their attention is directed, they also learn to self-correct if they notice a lapse in concentration. Alongside these habits of greater cognitive self-awareness, participants exercise the stamina required to follow through with them. "Thirty minutes is a long time for someone with ADHD to sit and concentrate on one thing," Keith describes. "It's just like anything else. It takes practice."

Keith is quick to acknowledge that occasional lapses in concentration occur for everyone, and are not inherently harmful in moderation. But the frequency of these lapses in an ADHD mind can distract a person too frequently from his surroundings, which is the central challenge of the disorder. At their best, medications can mitigate these lapses, but they cannot offer the opportunity of neurofeedback: to empower a healthy retraining of the brain.

Neurofeedback is already in use clinically in some parts of the United States, and initial research has already suggested its potential. But no study-until now-has included a placebo mechanism sophisticated enough to support a double-blind, placebo-controlled study. In collaboration with a manufacturer in California, Keith has helped to design precisely such a mechanism: a method deliberately generating counterfeit feedback, indistinguishable to participants and test administrators from the real thing. This innovation has allowed Keith to measure the effect of neurofeedback in an unprecedented and quantifiable way.

In addition to identifying a more effective ADHD treatment, Keith intends for his research to provide a framework for that treatment's implementation. Due to its exciting possibilities, Keith describes that some clinicians have rushed to administer neurofeedback without fully understanding how it works. Keith plans to address this misapplication by codifying an ideal treatment model. "Part of what we're doing is trying to establish a standard for the way people administer it," Keith explains. "We want systems that are known to work, and a system to train people."

Already Keith's research has yielded new understanding of neurofeedback and its potential. His research has also yielded a personal call from the National Institutes of Health that expressed interest in his work. Another result has been opportunity for economically disadvantaged North Carolina families, for whom a treatment like neurofeedback would otherwise be unaffordable. For these families, whose options can be limited by requirements for medical insurance and prescription co-pays, Keith established an on-campus clinic aimed at providing what has until now eluded them: a chance not only to treat their children, but potentially to cure them. Collaborating on these families' behalf have been Rich Ogle, professor and chair, and Kate Nooner, associate professor, of the UNCW Department of Psychology.

By Benjamin Rachlin '15M