All in the Head

Psychologist John Kline, an EEG expert and professor at the University of South Alabama in Mobile, said studies over the past decade have been marred by poor research design or compromised by other factors, such as the use of multiple treatments simultaneously and a lack of randomization.

"The literature that ties brain wave changes to treatment outcomes is really tentative," Kline said.

A study published in 2001 by psychologist Jeffrey Lohr of the University of Arkansas in Fayetteville echoed Kline. "Despite 20 years of research on neurofeedback," Lohr and his co-authors concluded, "it appears that nearly all of the experimental tests published in peer-reviewed journals are surprisingly weak."

To Lilienfeld, the rationale for the use of neurofeedback for ADHD is "not completely implausible." But, he added, "there's a danger in confusing correlation with causation." In Lilienfeld's view, brain wave abnormalities may not be the cause of attention problems. "Changing brain wave patterns may have no effect," he said.

"What's disturbing about neurofeedback," he added, "is how widely promoted it is in the face of mixed evidence."

Other experts say neurofeedback works for ADHD. A small study by Joel F. Lubar at the University of Tennessee published in 1995 found improvements in behavioral ratings by parents of 23 children who underwent a summer program of intensive neurofeedback.

Stokes said she isn't swayed by the skepticism of critics.

"I don't care about that," she said. Maybe, Stokes added, the improvement parents report "is due to the counseling I give or the toy I give [children] at the end of the sessions. I'm more outcome-based. I'm a clinician and I want them to get better."

That was Margit Paulding's goal for her 6-year-old son, who has undergone more than 60 sessions in the past six months at Stokes's center. Paulding said she hoped to wean her little boy off a high dose of Concerta, a stimulant his pediatrician prescribed to treat his severe case of ADHD.

"Until we started this, he was getting worse, even on the meds," Paulding said recently, as her son stared at the computer screen in Stokes's office, playing what he calls "brain games."

"Almost immediately we saw a decrease in hyperactivity, and we got feedback from other people who didn't know he was doing this treatment that he was better," Paulding said.

"We were spending every penny and then some on this," she noted, adding that she and her husband decided the financial sacrifice was justified by his improvement. Her husband's parents, she said, were so impressed by what they saw that they now pay for the sessions.