Light and Sound Neurotherapy for ADHD and Learning Problems

February 8, 2016

Ed Pigott, Ph.D., Greg Alter, Ph.D.  &  Dennis Marikis, Ph.D.

Licensed Psychologists & Principals, NeuroAdvantage, LLC

All Rights Reserved, 2008

Neuropsychological research has established that people with Attention Deficit Hyperactivity Disorder (ADHD) have impairments in the functioning of their frontal cortex.  These impairments make it difficult for them to sustain attention and inhibit impulsive behaviors as well as negatively affect their executive functioning skills including verbal learning, working memory, planning, and complex problem solving (e.g., Barkley et al, 1992; Barkley, 1997; Pennington & Ozonoff, 1996; Seidman et al, 1998).  It is also common for people with ADHD to have learning disabilities as well as being at heightened risk for other conditions including depression, anxiety, and oppositional defiant disorders among other problems in living (e.g., Barkley et al, 1989; Hunt et al, 1994; Seidman et al, 1997).

Neurological Findings

Using an electroencephalographic (EEG) machine, Jasper and associates (1938) documented that children with significant behavioral problems had excessive slow theta (4 to 7 Hz) brainwaves compared to normal children.  Numerous subsequent researchers (e.g., Lubar, 1991) have documented that people with ADHD have high levels of theta, and diminished high alpha and low beta (12 to 16 Hz), waves in their frontal cortex compared to people without ADHD.  Studying a matched group of 25 boys with and without ADHD, Mann and associates (1992) found that the ADHD boys’ frontal theta waves increased in strength while performing mental tasks suggesting that their frontal lobes became more sluggish when cognitively challenged.

Scientists using neuro-imaging technologies provide further support that it is the under-arousal of the frontal cortex that gives rise to ADHD symptoms.  Using single photon emission computed tomography (SPECT), Amen and Carmichael (1997) found that ADHD children and adolescents had decreased metabolism and blood flow in their frontal lobes compared to youth with other diagnoses.  Similar SPECT findings for people with ADHD and/or learning disabilities have been made by other researchers (e.g., Lou et al, 1984; Seig et al, 1995).

Zametkin and associates (1990; 1993) using positron emission tomography (PET) also found that both adolescents and adults with ADHD had decreased metabolism in their frontal lobes.  Interestingly, these researchers found that their ADHD subjects’ metabolism decreased further during mental tasks paralleling Mann et al (1992) EEG findings that ADHD boys’ frontal lobes become less activated when cognitively challenged.  Unless the cognitive task is highly arousing (e.g., playing video games) and/or intrinsically rewarding, people with ADHD quickly lose interest and their minds become more sluggish with increased theta waves and decreased metabolism and blood flow in their frontal cortex.

Neurological Basis for Light and Sound Neurotherapy (LSN)

Over 70 years of research document the ease with which our brainwaves synchronize to repetitive light stimulation (e.g., Adrian & Matthews, 1934; Barlow, 1960; Frederick et al, 1999; Inouye et al, 1979; Kinney et al, 1972; Lesser et al, 1986; Nogawa et al, 1976; Pigeau & Frame, 1992; Toman, 1941; Townsend et al, 1975; Van der Tweel & Verduyn, 1965; Walter & Walter, 1949).  Neher (1961) found that this same synchronization effect occurred to rhythmic sound stimulation.

In 1999, Budzynski and associates took this research a step further with a group of academically struggling college students.  Their study found that multiple light stimulation sessions not only had a synchronization effect but that these changes persisted while performing cognitive tasks and resulted in a significant improvement in the subjects’ grade point average in the quarter following treatment termination while no such changes were found in control subjects.

Using a variety of neuro-imaging measurement tools, researchers have discovered that light and/or sound stimulation increases brain metabolism and cerebral blood flow (e.g., Aaslid, 1987; Diehl et al, 1998; Fox & Raichle, 1985; Fox et al, 1988; Kato et al, 1996; Phelps & Kuhl, 1981; Sappey-Marinier et al, 1992).

Summarizing across these studies, neuroscientists have documented that light and sound stimulation:

  • Strengthens those brainwave patterns that synchronize with the frequency of the flashing light and/or rhythmic sound and that these changes persist while performing mental tasks; and
  • Increases brain metabolism and cerebral blood flow.

These findings provide a strong theoretical foundation to understand why LSN is an effective treatment for ADHD and learning problems.  LSN treatment has an activating effect on the brain that persists following treatment termination.

LSN Treatment for ADHD and Learning Problems

Eleven studies involving over 500 people have been conducted using light and sound stimulation to correct the under-arousal of the frontal cortex that is found in people with ADHD and learning disabilities.  These studies document LSN’s effectiveness for many symptoms common in people with ADHD and/or learning disabilities.  Summarizing across studies, researchers found that LSN treatment:

  • Increased sustained attention;
  • Decreased hyperactivity;
  • Improved impulse control;
  • Decreased anxiety and depression;
  • Improved essential learning skills including:
  • Auditory memory
  • Mental processing speed
  • Verbal and non-verbal IQ
  • Improved academic performance;
  • Generated improvements equal, or superior, to stimulant medication; and
  • Maintained the treatment gains made in IQ and ability to sustain attention for up to 16-months following treatment termination.

Review of Studies:

Carter and Russell (1993; 1994)

Carter and Russell (1993) were the first researchers to evaluate LSN for ADHD and/or learning problems.  The subjects were 14 boys in a private school and 12 boys in a public school.  The boys were between eight and twelve years old and diagnosed with learning disabilities.  The private school boys had 40 LSN sessions while the public school boys had only 18 LSN sessions.  The LSN sessions consisted of two minutes of 10 Hz light and sound stimulation, one minute of no stimulation, followed by two minutes of 18 Hz stimulation completing the cycle.  Each session consisted of five such cycles and lasted 25 minutes.  All sessions were conducted in school.

The results for the two groups were evaluated separately due to the private school boys receiving 22 more LSN training sessions.  Both groups were assessed one week prior to starting their LSN sessions and one week after having completed treatment.  While both groups showed improvement, the private school boys did considerably better with a significant eight point improvement in IQ as measured by the Raven IQ test as well significant improvements in reading, spelling, and auditory memory functioning.  The public school boys showed significant improvement in only IQ (5.5 points) and spelling.  The private school boys also showed greater gains in behavior with significant improvement on 9 scales of the Burk Teacher’s Behavior Index verses improvement on only 6 scales by the public school boys.

Carter and Russell followed up on these promising results with a series of federally funded studies on EEG-assisted LSN (Carter & Russell, 1994; Russell, 1997; Russell & Carter, 1997).  In the 1994 study, Carter and Russell randomly assigned 40 learning disabled boys into three experimental groups: 20 into the LSN therapy group, 10 into a attention-only placebo group, and 10 into a no treatment control group.  The LSN group’s verbal IQ showed a significant increase of 4.3 points after 20 sessions and 9.2 points after completing 40 LSN training sessions.  This progressive improvement supported Carter and Russell’s 1993 finding that the number of LSN sessions is positively correlated with increased treatment effectiveness.

In contrast, the placebo group and no treatment control groups showed no improvement in verbal IQ as measured by the Peabody Picture Vocabulary Test (PPVT).  The LSN group also showed significant improvement in their ability to sustain attention and inhibit impulsive behaviors as measured by the teacher-completed Attention Deficit Disorders Evaluation Scale (ADDES) but no improvement on its hyperactivity scale.  There were no changes for the placebo and no treatment control groups on any of the ADDES scales.

Russell and Carter (1997a; 1997b; 1997c; 1997d)

In 1997, Russell and Carter reported on four different studies.  The first was a 16-month follow-up to their 1994 study.  In this study, they found that the verbal IQ gains, and enhanced ability to sustain attention, were maintained for 16 months following LSN treatment termination while the improvements in their ability to inhibit impulsive behaviors did not last.

The second study was a replication study with learning disabled boys but distinguished between those with Attention Deficit Disorder but without hyperactivity (ADD) and those with ADHD.  Due to school conflicts, the LSN treatment groups were only able to complete 25 LSN sessions verses the 40 sessions in the prior studies.  Despite having only 25 LSN sessions, both the ADD and ADHD treatment groups showed significant improvements in verbal (PPVT) and non-verbal (Raven) IQ.  These gains in verbal and non-verbal IQ were maintained for nine months following LSN treatment termination (Russell, 1997). There were no similar changes in the ADD and ADHD boys randomly assigned to the control groups.

The third study was a replication study with learning disabled girls conducted by an independent researcher working at a different university.  This study found significant increases in verbal (PPVT) and non-verbal (Raven) IQ for the girls in the LSN treatment group while there were no similar changes in the girls randomly assigned to the control group.

The final study reported by Russell and Carter compared the effectiveness of LSN, Ritalin, and LSN combined with Ritalin medication for learning disabled boys with ADD/ADHD.  Boys were referred into the study after a pediatric evaluation confirmed the diagnosis and the pediatrician decided that a trial on Ritalin was warranted.  The parents were then informed about the study.  Only the boys of those parents who agreed to have their son randomly assigned to any of the treatment conditions were included in the study.  There were five boys randomly assigned to each condition (i.e., 5 ADD/ADHD boys in the LSN only group; 5 ADD/ADHD boys in the Ritalin only group; and 5 ADD/ADHD boys in the combined group.) with a total of fifteen boys in the study.  Treatment lasted for eight weeks.

A problem in this study was the small number of boys in each group making it hard to reach statistical significance on observed differences in performance. Despite this difficulty, the LSN only group significantly improved (p < .001) their performance on the Raven IQ test from 105.9 to 115.0 while there was a less though still significant change (p < .05) on the Raven for the Ritalin only group.  All though there were no statistically significant changes on the PPVT, each of the five boys in the Ritalin only group declined in their PPVT IQ scores while each of the 10 boys in the LSN only group and the combined LSN/Ritalin group improved in their PPVT IQ scores.

Patrick (1996)

Patrick (1996) studied the effectiveness of 15 EEG-assisted light stimulation sessions with 25 ADHD children 14 of whom were taking stimulant medication.  The medicated children did not take their medication at least 8 hours prior to testing or light stimulation treatment sessions and medication dosages were not changed throughout the study.  The sessions lasted 40 minutes with the light stimulation varying between 12 and 14 Hz.

All of the children were first assessed for their ability to sustain attention, inhibit impulsive behaviors, and scholastic achievement using the following instruments:

  • Sustained attention was measured by the Wechsler Intelligence Scale for Children Third Revision (WISC-3) freedom from distractibility scale; Test of Variables of Attention (TOVA—a computerized continuous performance test) errors of omission scale; and Achenbach Child Behavior Checklist (CBCL) attention problem profile scale.
  • Impulsivity was measured by the WISC-3 processing speed scale and TOVA errors of commission scale.
  • Scholastic achievement was measured by the Wechsler Individual Achievement Test (WIAT) and Raven IQ test (Raven).

Following the initial assessment, the children were randomly assigned into either the treatment group or waitlist control group.  All children were re-administered the instruments after the treatment group completed their 15 EEG-assisted light stimulation sessions.  The waitlist control children then received 15 stimulation sessions and were then re-assessed.  The children were also re-administered the WIAT three months after treatment termination to assess the durability of any scholastic achievement gains.

The waitlist control group showed no significant changes on any measure.  In contrast, 15 EEG-assisted light stimulation sessions resulted in significant improvements on the following measures:

  • Improved ability to sustain attention as measured by the WISC-3 freedom from distractibility scale and both the parent and youth versions of the CBCL’s attention problem profile scale.
  • Decreased impulsivity as measured by the WISC-3 processing speed scale and TOVA errors of commission scale.
  • Enhanced scholastic achievement as measured by the WIAT.  The improved WIAT results were maintained three months following treatment termination.

There was no significant improvement on either the Raven IQ test or the TOVA errors of omission scale.  The lack of improvement on these two measures may be due to the limited amount of time spent in the stimulation sessions.  Patrick’s subjects spent only 600 minutes in training verses the 1,000 minutes of LSN training in the Carter and Russell studies.  In two of their studies, Carter and Russell demonstrated a clear link between the amount of LSN training and the size of the treatment effect.

Micheletti (1998)

Micheletti (1998) compared four groups of children 6 to 13 years old that were diagnosed with ADHD.  The groups were:

  • Self-selected control group (31 children)
  • LSN group (21 children)
  • Stimulant medication (Ritalin or Adderall) group (20 children)
  • Combined LSN and stimulant medication group (27 children)

The LSN sessions consisted of two minutes of 10 Hz light and sound stimulation, one minute of sound only stimulation, followed by two minutes of 18 Hz light and sound stimulation completing the cycle.  Each session consisted of four such cycles and lasted 20 minutes.  The first session was conducted in an office and included the child’s parents being trained how to use the LSN device.  The remaining 39 LSN sessions were supervised by the parents at home.

Testing was done just prior to treatment (pre), immediately following treatment termination (post) and four weeks after treatment had ended (post-post) by research assistants unaware of the treatment conditions.  The cognitive tests administered were:

  • The reading, spelling, and math sections of the Wide Range Achievement Test (WRAT);
  • Peabody Picture Vocabulary Test (PPVP); and
  • Raven’s Progressive Matrices IQ test (Raven).

The behavioral assessments administered were:

  • Attention Deficit Disorders Evaluation Scale (ADDES) completed by parents and
  • Intermediate Visual and Auditory Continuous Test (IVA), a computerized continuous performance test.

The children in the stimulant medication and combined LSN/medication groups did not take their medication at least eight hours prior to the initial (pre) testing assessment but took it as prescribed throughout the remainder of the study including the post-post assessment.  There were no statistically significant differences between groups on the cognitive and behavioral measures administered prior to initiating training.  This is important since there was no random assignment between groups.

Overall, Micheletti found that both the LSN, and combined LSN/medication, treatments superior to stimulant medication.  Cognitively, the LSN group showed significant improvement on the reading and spelling sections of the WRAT as well as on the Raven ((7.2 points).  Behaviorally, the LSN group showed significant improvement in their ability to sustain attention and decrease hyperactivity as measured by the ADDES.  The LSN group just missed having significant improvement on the IVA sustained attention scale (p<.058).  All of the LSN group’s cognitive and behavioral improvements were maintained one month after treatment termination.

The combined LSN/medication group also showed significant improvement in the reading and spelling sections of the WRAT as well as on the Raven (5.8 points).  Behaviorally, the combined group showed significant improvement in their ability to sustain attention and decrease hyperactivity as measured by the ADDES as well as demonstrated improved response control on the IVA.   All of the combined group’s cognitive and behavioral gains were maintained one month after terminating LSN treatment.

The stimulant medication group showed significant improvement only on the reading section of the WRAT and the Raven (4.5 points) with no significant improvement on any of the behavioral measures.  The self-selected comparison group showed no significant changes on any measure.

In addition to documenting LSN’s positive cognitive and behavioral effects for ADHD children when used either alone, or in combination with medication, this study found that parents could be trained to successfully implement LSN training with their children at home.

Budzynski and Associates (1999)

Budzynski and associates (1999) reported on two studies.  The first was a pilot study evaluating the effects of a single 15-minute 14 Hz light stimulation session on college students’ alpha waves (7 to 13 Hz).  This study was conducted based on multiple EEG studies documenting that people with high IQ’s and superior academic performance had faster peak (or dominant) alpha production than did people with lower IQ’s and poor academic performance (Anoukhin & Vogel, 1996; Jausovec, 1996; Vogt et al, 1998).

The relative strength of the pilot study subjects’ alpha waves were recorded prior to their light stimulation session; immediately following the session; and at five-minute increments for 20 minutes after the session ended.  The authors divided the alpha band (7 to 13 Hz) into three smaller ones:  A1 (7-9 Hz), A2 (9-11 Hz), and A3 (11-13 Hz) and then calculated the A3/A1 ratio to assess changes in peak alpha production.  Based on previous research, a ratio greater than 1 resulted in better than average performance while a ratio less than 1 was associated with poorer cognitive performance.

The pilot study found that the alpha ratio increased from .9 prior to the 14 Hz light stimulation session to 1.12 immediately following the session.  The alpha ratio continued to increase in the subsequent assessments with a ratio of 1.28 after 20 minutes.  The mean peak alpha frequency was also assessed.  It increased from 9.78 Hz prior to the light stimulation session to 9.91 Hz immediately following the session.  The mean peak alpha frequency also continued to increase at each subsequent five-minute increment and was 10.38 Hz after 20 minutes.  Unfortunately, the authors did not continue to monitor the subjects’ alpha waves for a longer period of time to assess where it would top out at and the durability of the single light stimulation session’s effect.

The second study evaluated the effects of 30 light stimulation sessions with the light frequency alternating every minute between 14 Hz and 22 Hz for 15 minutes.  The treated subjects were the first 8 college students seeking academic counseling at the start of the winter quarter.  The comparison group was the next group of 8 students seeking academic counseling.

Both groups of subjects’ EEGs were collected while the students completed a variety of mental tasks prior to initiating treatment.  All subjects’ EEGs were reassessed while performing the same mental tasks after the treated subjects had completed their 30 light stimulation sessions.  The two groups fall and spring grade point averages (GPA) were also compared to see if the light stimulation group showed improvement in the quarter following treatment termination.

The treated students GPA significantly increased between the fall and spring quarters by an average of .7 points (see graph).  In contrast, the comparison group’s GPA decreased by an average of .2 points despite having received academic counseling.  The treated students also showed a significant increase in both their A3/A1 alpha ratio and peak alpha frequency while completing mental tasks while there were no such changes in the comparison group.

This study is important because it documents how 30 15-minute light stimulation sessions (only 450 minutes of training) alternating at 14 and 22 Hz were able to significantly increase faster peak alpha production while completing mental tasks thereby making the college students’ brains less sluggish when cognitively challenged.  It is this underlying neurological change that likely caused these students to improve their GPA by an average of .7 points in the quarter following treatment termination while there were no similar improvements in the control subjects following their academic counseling.

Joyce & Siever (2000)

Joyce and Siever (2000) evaluated the effectiveness of 35 LSN training sessions with 34 elementary school students in special education classes from two different schools.  The subjects were all diagnosed with having ADHD, behavioral/emotional disorders, and/or learning disabilities.  All of the subjects were administered the TOVA—a computerized continuous performance test that measures the ability to sustain attention, inhibit impulsive responding, and reaction times—prior to initiating LSN training (Pre) and after completing the 35 LSN sessions (Post).  Twenty subjects in one school were in classes that followed a reading program that used the computer-administered Standardized Test for the Assessment of Reading (STAR) to monitor reading progress.  In addition to the TOVA, these subjects’ pre/post STAR assessments were included and compared to a control group, as an additional measure for evaluating the effectiveness of the LSN intervention.

The LSN device was networked such that up to 10 subjects could be treated at a time with the same LSN program though still allowing the students individually to control the sound volume and light intensity. All LSN training sessions took place at school.  Due to the diagnostic mix of subjects and the high incidence of co-morbid depression and anxiety disorders in this population, the first eight LSN sessions were 20 minutes long and relaxation focused with the light and sound stimulation set in the low alpha range.

The remaining 27 sessions were learning focused and took advantage of the LSN device’s ability to differentially stimulate the subjects’ right and left visual fields thereby differentially impacting the right and left hemisphere of the subjects’ brains.  These sessions lasted 22-minutes and the device was programmed to provide 12 Hz right hemisphere, and 18 Hz left hemisphere, light and sound stimulation.

Following 35 LSN training sessions, the subjects demonstrated significant improvement in their ability to sustain attention, inhibit impulsive responding, and reaction times as measured by the TOVA.  The TOVA is standardized such that the “normal” range falls between a score of 85 and 115.  At the conclusion of training, the students’ average score on each of these measures were within the normal range (see graph).

The subjects in the reading program also demonstrated significant improvement in their reading scores compared to the control group.

Joyce (2001)

Joyce (2001) built on his prior study in a demonstration project funded by the Minnesota Department of Education.  The subjects were 204 students from seven public schools in 1st through 11th grades with a history of impulsivity, distractibility, and learning problems.  The LSN training followed the same protocol that Joyce and Siever (2000) used in the prior study.  The subjects averaged 30 LSN sessions over three months.

The Behavioral Dimensions Scale (BDS) and Slosson-R reading test were administered to all subjects prior to initiating LSN training (Pre) and after terminating treatment (Post).  The subjects showed significant improvement in anxiousness, depression, hyperactivity, and inattention as measured by the BDS in which higher scores signifies better functioning on these scales (see graph).  The subjects also showed significant improvement in reading as measured by the Slosson-R reading test averaging an eight month gain in grade-equivalent reading scores following three months of LSN training.

The Joyce studies are important in that they demonstrate the ability to simultaneously provide LSN treatment to up to 10 ADHD and/or learning disabled students and still get substantial improvements in their ability to sustain attention and inhibit impulsive behaviors as well as reduce their levels of anxiety, depression, and hyperactivity based on teacher ratings.  These behavioral gains were in addition to the students’ significant improvements in reading.

Summary

These eleven studies document LSN’s effectiveness for many symptoms common in people with ADHD and/or learning disabilities.  Significant improvements found included:

  • Increased sustained attention;
  • Decreased hyperactivity;
  • Improved impulse control;
  • Improved essential learning skills including:
    • Auditory memory
    • Mental processing speed
    • Verbal and non-verbal IQ
  • Improved academic performance; and
  • Decreased anxiety and depression.

To evaluate effectiveness, six studies used random assignment procedures including one that had a placebo therapy group in which the subjects received the same amount of attention as did the LSN group.  Three additional studies used control groups to compare LSN’s effectiveness but did not include random assignment procedures due to study constraints (e.g., parents in the Micheletti study were unwilling to have their children randomly assigned between the four different groups).  The remaining two studies simply compared subjects’ initial assessments to those following LSN treatment termination.

LSN’s effectiveness appears durable based on the five studies that included follow-up assessments.  Micheletti (1998) found that ADHD students’ improvements in reading, spelling, non-verbal IQ, sustained attention, and decreased hyperactivity were maintained one month following LSN treatment termination.  Patrick (1996) found that students’ improvements in scholastic achievement scores were maintained for three months following treatment termination.  Budzynski and associates (1999) found that light stimulation training improved college students’ GPA by an average of .7 points in the quarter following treatment termination while there were no similar improvements in the control subjects following their academic counseling.  Russell (1997) found that the gains in both ADD and ADHD boys’ verbal and non-verbal IQ were maintained for nine months following LSN treatment termination.  Russell and Carter (1997) found that gains in verbal IQ, and enhanced ability to sustain attention, were maintained for 16 months following LSN treatment termination while the improvements in the ADHD students’ ability to inhibit impulsive behaviors were not maintained during follow-up.

Overall, these five studies found that LSN’s treatment effects were durable despite the lack of intermittent booster sessions which are common in actual LSN clinical practice.  This is in contrast to the well-documented fact that stimulants fail to produce sustained positive effects for people with ADHD once the medication is discontinued (Swanson et al, 1993).

Two studies found that LSN’s treatment effects were equal or superior to stimulant medication, the most common treatment for ADHD (Russell & Carter, 1997;Micheletti, 1998).  While preliminary, this is an important finding that deserves further research.  People with ADHD need access to effective alternatives to stimulant medication.  Though pervasively prescribed, a number of researchers (e.g., Nash, 2000; Swanson et al, 1993; Volkow et al, 1996) have documented problems with stimulant medications that limit their usefulness including:

  • Failure to produce desired results in 25 to 40% of people taking the medication;
  • High rates of negative side effects including tics, weight loss, headaches, stomach aches, insomnia, anxiety, and increased heart beat and blood pressure among others;
  • Lack of sustained positive effects once medication is discontinued; and
  • The unknown risks of long-term use.

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