ATTENTION (ADHD)

ADHD Assessment and Diagnosis

1. Psychosocial Assessment

We will explore variables related to psychosocial history, developmental milestones, family history and dynamics, educational/occupational history, and social-emotional well- being to gain a comprehensive understanding of the variables contributing to your ADHD symptoms.

2. Symptom Evaluation

We use valid and reliable questionnaires and interviewing to assess for common ADHD symptoms, as well as differentiate between ADHD and other diagnoses. This process also helps us understand the severity of your symptoms, their impact on your life, and how to best support you.

Many children with ADHD struggle with inattention, impulsivity, and hyperactivity. These symptoms can impact academic performance, social interactions, and daily activities.

Children with ADHD may have difficulty focusing on tasks, completing assignments, or following instructions. They might also interrupt conversations, fidget, or have trouble regulating their emotions.


Adults with ADHD often experience challenges with focus, organization, and emotional regulation. They may struggle to prioritize tasks, manage time effectively, and maintain a consistent work flow.

In addition, adults with ADHD may experience difficulty with impulsivity, such as making rash decisions or engaging in risky behaviors. They may also have trouble regulating their emotions, leading to frustration, anger, or anxiety.

3. Neurocognitive Testing

We use valid and reliable neurocognitive testing to identify cognitive strengths and weaknesses. Our neurocognitive testing assesses a variety of neurocognitive domains related to ADHD, including:

  • Simple Attention
  • Complex Attention
  • Sustained Attention
  • Executive Function
  • Cognitive Flexibility
  • Working Memory
  • Verbal & Visual Memory
  • Processing Speed & Reaction Time
  • Motor & Psychomotor Speed
  • NeuroCognition Index

4. Functional Neuroimaging

We utilize a combination of non-invasive functional imaging modalities, including EEG, QEEG, and swLORETA, to assess brainwave patterns underlying symptomatology and guide personalized recommendations based on your individual brain phenotype.

Electroencephalography (EEG) and quantitative EEG (QEEG) are non-invasive neuroimaging techniques that measure brain electrical activity. They help us assess brain function, including attention, impulsivity, and executive function, as well as differentiate from other mental health and/or learning challenges.

Source-localized electroencephalography (sLORETA) is a neuroimaging technique that uses EEG data to localize the source of brain activity in specific regions. It helps us understand the underlying neural roots of symptoms and specific areas of dysfunction.

This neuroimaging can also assist with determining the most effective treatment interventions, including which medications and/or supplements could be beneficial, as well as neurotherapy protocols and other interventions designed to improve functioning within regions showing impairment.


EEG image of patient with ADHD

Identifying ADHD Subtypes

ADHD evaluation process number 1

Inattentive Type

Characterized primarily by difficulty with focus, concentration, organization, and completing tasks.

ADHD evaluation process number 2

Hyperactive-Impulsive Type

Marked by excessive restlessness, impulsivity, difficulty sitting still, and interrupting others.

ADHD evaluation process number 3

Combined Type

This subtype includes significant symptoms of both inattention and hyperactivity-impulsivity.

image of two boys with different ADHD symptoms

Brain Patterns Associated With ADHD

image of swLoretta brain scans showing ADHD symptoms

There are a variety of structural abnormalities, functional brainwave patterns, and physiological imbalances that have been observed in individuals diagnosed with ADHD. Different “phenotypes” (i.e., observable traits or characteristics) of ADHD exhibit distinct patterns of brain activity and physiological metrics, as well as distinct symptoms and challenges. Each distinct pattern requires a distinct treatment path, so determining your phenotype can lead to more optimal outcomes.

Each person’s individual phenotype may involve any variety of contributing factors, underscoring the need for precise, individualized assessments and interventions. Common patterns include:

  • Brainwave Imbalances: Excesses or deficiencies of brainwave frequencies within particular regions of the brain, such as excess theta within the frontal lobe, can lead to a wide array of cognitive and emotional symptoms.
  • Structural Brain Abnormalities: Differences in grey and white matter volume in key brain regions related to cognitive function and emotional regulation, such as decreased cortical thickness within the prefrontal cortex, hippocampus, basal ganglia, or anterior cingulate cortex.
  • Brain Network Dysfunction: Dysregulation within and between neural networks, such as the default mode, salience, and central executive networks.
  • Altered Connectivity Patterns: Increased or decreased communication between regions, such as cortico-striatal-thalamic or fronto-parietal circuitry, can lead to inefficiencies and functional deficits.
  • Cerebellar Dysfunction: Issues with brain coordination can affect focus, processing speed, and stability within the nervous system.
  • Metabolic Issues: Impaired generation, utilization, and regulation of energy and other resources needed for neural functions.
  • Mitochondrial Dysfunction: Impaired ability to produce sufficient energy (ATP) needed for normal cognitive and behavioral processes.
  • Inflammation: Brain inflammation can disrupt normal neuronal function and communication.
  • Neurotransmitter Imbalances: Imbalances of neurotransmitters, such as dopamine and serotonin, can contribute to difficulties regulating attention, motivation, mood, and energy.
  • Impaired Methylation: Impairments in methylation processes can impact gene expression, neurotransmitter production, and overall brain function.
  • Gastrointestinal Imbalances: GI imbalances, such as dysbiosis, excess intestinal permeability, food sensitivities, and mucosal immunity can impair neurotransmitter production, increase inflammation, and lead to nutrient deficiencies.
  • Nutrient Deficiencies: Particular nutrients, such as Omega-3 Fatty Acids, play an important role in brain development, dopamine synthesis, and numerous biochemical reactions in the brain.

Alternative Sources of ADHD Symptoms

ADHD presents a wide range of symptoms, making it essential to differentiate it from other conditions that may share similar features. A thorough evaluation is crucial to identify the underlying causes and develop an appropriate treatment plan.

Examples of Conditions with Overlapping Symptoms:

  • Anxiety Disorders: Generalized anxiety disorder and social anxiety can manifest as restlessness, difficulty concentrating, and emotional dysregulation, all of which can hinder task focus.
  • Learning Disabilities: Dyslexia and dysgraphia impact academic performance and can lead to challenges with attention and focus.
  • Sensory Processing Challenges: These can impair the ability to process information or cause sensory overload, diverting attention from cognitive tasks.
  • Traumatic/Excessive Stress: Excessive stress can disrupt the limbic system, resulting in dissociation, emotional dysregulation, difficulty sitting still, and/or impulsiveness.
  • Concussion: Concussions, which often go undiagnosed, can result in cognitive impairments, including difficulties with attention, memory, and processing speed, which may resemble ADHD symptoms.
  • Oppositional Defiant Disorder (ODD) and Conduct Disorder: These conditions may share behavioral symptoms with ADHD.
  • Sleep Disorders: Sleep disturbances can lead to attention issues and cognitive difficulties.
  • Autoimmune Reactions (PANS/PANDAS): Autoimmune disruptions affect dopamine and norepinephrine pathways, leading to mood instability and inattention.
  • Adrenal Fatigue/Burnout: Adrenal fatigue and burnout can manifest symptoms similar to ADHD due to the overlap in cognitive, emotional, and physical symptoms.
  • Paroxysmal Non-Epileptic Seizure Activity: Abnormal neuronal firing can cause momentary "blackouts" or attention lapses.

A comprehensive evaluation is necessary to distinguish ADHD from these conditions, taking into account their unique characteristics and underlying factors.

Personalized Treatment Recommendations

ADHD evaluation process number 1

Neurotherapy & Coaching

We offer a variety of neurotherapy interventions, such as neurofeedback, neurostimulation, and photobiomodulation, to improve the functioning of brain regions contributing to ADHD symptoms. We also provide psychotherapy and coaching to help clients develop skills and strategies to improve attention, emotional regulation, and daily functioning.

ADHD evaluation process number 1

Neurocognitive Skills Training

We provide advanced neurocognitive training exercises to strengthen areas of cognitive functioning that could use some support and improve overall cognitive functioning. We also offer ongoing support and coaching to help you navigate your ADHD diagnosis, as well as provide resources and strategies to help you thrive.

ADHD evaluation process number 1

Medication & Supplementation

NeuroGrove does not prescribe medication for ADHD; however, our assessments can be useful for your prescriber to determine which medication may be the best fit for you. We can also provide personalized recommendations for natural interventions, such as supplementation and neuropeptide therapy.

ADHD evaluation process number 1

Diet & Lifestyle Modifications

We can work with you to identify dietary and lifestyle changes that can support your ADHD management, such as improving sleep hygiene, managing stress, and improving organization. Our naturopathic and functional medicine team specializes in providing personalized recommendations to support your brain wellness.

patient and ND discussing a treatment plan for adult ADHD.

HOW WE CAN HELP

At NeuroGrove, the first step of any treatment package is a comprehensive assessment that includes QEEG brain mapping, LORETA 3D neuroimaging, a psychophysiological assessment, neurocognitive testing, and a thorough discussion of symptoms, history, and goals. This allows us to assess for the brain patterns most commonly associated with ADHD as well as other variables that could be contributing to these imbalances.

child showing symptoms of ADHD in class

From there, both neurofeedback and neurostimulation can be used to adapt brainwave activity in the necessary directions (e.g., decrease theta in the frontal cortex), alter neurotransmitters, and improve communication between regions to help the brain achieve optimal functioning.

Pairing neurotherapy with other NeuroGrove services can further enhance the effectiveness of these interventions and support overall brain-body wellness. For example, peripheral biofeedback can be utilized to teach stress reduction skills, improve the ability to be still, and balance the nervous system.

Functional medicine and personalized nutrition can also be utilized to assess for chemical imbalances, digestive issues, or nutritional factors that could be exacerbating symptoms. We will then meet you/your child where you/they are with these services to help implement feasible and appropriate diet and lifestyle changes. Our integrative psychotherapy services can also support the implementation of such changes, as well as provide additional coping skills, strategies, and emotional support.

WHAT THE RESEARCH SAYS

To date, there have been over 130 studies examining the effectiveness of neurotherapy as an intervention for ADHD. Such extensive research has led to a better understanding of the cortical mechanisms related to ADHD as well as a large volume of evidence supporting the efficacy of using neurotherapy and integrative modalities to treat ADHD. Overall, the research suggests that neurotherapy can help to balance out the brain’s electrical activity and improve communication between various brain regions, which in turn reduces symptoms like distractibility, impulsivity, inattention, and hyperactivity. For a few examples:

In 2009, researchers completed a meta-analysis of studies on neurofeedback as a treatment for ADHD that measured changes with impulsivitiy, inattention, and hyperactivity (Arns, de Ridder, Strehl, Breteler, & Coenen). The outcomes showed that neurofeedback as a treatment for ADHD meets the qualifying criteria for the classification of “efficacious and specific”. Overall effect sizes were large for categories of inattention and impulsivity and medium for hyperactivity.

Another study (Mohagheghi et al., 2017) compared the efficacy of two different neurofeedback protocols (theta suppression/alpha enhancement vs. theta suppression/beta enhancement) in sixty children with ADHD aged 7-10 years old. Results showed that both protocols significantly alleviated general ADHD symptoms, as well as hyperactivity, inattention, and omission errors, although the alpha-enhancing protocol showed greater suppression of omission errors. These effects were also maintained at the 8-week follow-up assessment.

A study by Bazanova, Auer, and Sapina (2018) revealed the importance of personalized neurotherapy for ADHD, showing that an individualized neurofeedback training paired with EMG biofeedback produced superior clinical results when compared to a standardized protocol or individualized neurofeedback alone. The combined, individualized group also showed the most sustained changes in alpha brainwave activity at the 6-month follow-up.

A study by Levesque et al. (2006) showed improved functioning in regions related to attention, including the right anterior cingulate cortex, left caudate, and left substantia nigra during a task following neurofeedback training. Baumeister et al. (2016) also found significantly increased activation within an extensive inhibitory network (e.g. right anterior insula, right caudate, right dorsolateral prefrontal cortex, etc.) after neurofeeback training.

For more research studies on this topic, see our Research page.

References:

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.

Baumeister, S., Wolf, I., Holz, N., Boecker-Schlier, R., Adamo, N., Holtmann, M., … Brandeis, D. (2016). Neurofeedback training effects on inhibitory brain activation in ADHD: A matter of learning? Neuroscience. https://doi.org/10.1016/j.neuroscience.2016.09.025

Bazanova, O. M., Auer, T., & Sapina, E. A. (2018). On the efficiency of Individualized theta/beta ratio neurofeedback combined with forehead EMG training in ADHD children. Frontiers in Human Neuroscience, 12, 3. https://doi.org/10.3389/fnhum.2018.00003

Lévesque, J., Beauregard, M., & Mensour, B. (2006). Effect of neurofeedback training on the neural substrates of selective attention in children with attention-deficit/hyperactivity disorder: a functional magnetic resonance imaging study. Neuroscience Letters, 394(3), 216–221. https://doi.org/10.1016/j.neulet.2005.10.100

Mohagheghi, A., Amiri, S., Moghaddasi Bonab, N., Chalabianloo, G., Noorazar, S. G., Tabatabaei, S. M., & Farhang, S. (2017). A randomized trial comparing the efficacy of two neurofeedback protocols for treatment of clinical and cognitive symptoms of ADHD: Theta suppression/beta enhancement and theta suppression/alpha enhancement. BioMed Research International, 1–7. https://doi.org/10.1155/2017/3513281

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