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Unlocking ADHD: How to Manage Time, Find Your Focus and Master Your Life

ADHD is a cognitive disorder that can cause impulsive and hyperactive behaviors. People with ADHD have a different way of processing brain activity, affecting their memory, attention span, and self-control. 

In this video, professor of psychology Dr. Neera Pant presents Dr. Upasana Gala to elaborate on the neurophysiology and neurochemistry of this condition, dispel the myths surrounding it, and discuss neurofeedback as a life-changing ADHD treatment. Moreover, she shares some lifestyle productivity hacks that can benefit both ADHD and neurotypical individuals. 

 

Dr. Neera Pant: Let me welcome the guest of honor right now, Dr. Upasana Gala.

Dr. Gala is the founder and CEO of Evolved Brain Training, a neurofeedback-based institute that focuses on using non-invasive brain training techniques to maximize the brain’s true potential. Earning a doctorate in neuroscience from the diverse Baylor College of Medicine, she has spent over a decade trying to unravel the way neurochemical and neurophysiological changes in the brain affects the way we interact with the world. The passion and curiosity for the subjects have led her to make the brain her full-time vocation.

Dr. Gala is one of the few women in STEM discipline in the UAE, working on promoting and auctioning future-forward technology to help individuals and businesses reassess the way they think and perform. Her goal is to share her teachings, encourage others to tap into, and expand their brains capabilities, and dispel any myths surrounding our most complex organ.

Over to you Dr. Gala.

Dr. Upasana Gala:  Thank you so much for that very nice introduction. And I am very excited to talk to you guys about my favorite topic – the brain. And specifically, we are going to talk about ADHD (Attention Deficit Hyperactivity Disorder), and a new way to tackle it and non-invasive ways to treat it.

So let me just share my presentation.

So what do we think about ADHD?

You know all of us at some point or the other have lost our keys or we’ve zoned out while talking to a friend, or walked into a room and forget why we walked in there. So it may feel like “oh we all experienced some kind of ADHD symptoms once in a while.”

But once in a while is different. What happens in people with ADHD is that these symptoms are so strong and so detrimental that they actually affect the quality of their life in a much more permanent way. And they come in different presentations. Not every ADHD person has the same presentation. Some of them may be inattentive only, so that means you know they’re unable to be persistent on a particular task, they may get distracted easily, or they tend to zone out, lose interest. And the other is the hyperactive-impulsive kind so, in that, you could be fidgety, you can be restless, even excessive talking. Or you could have a combination of both.

And it is really a growing concern these days. According to the CDC, 11% of children have today been diagnosed with ADHD, and it is rising. In the last 20 years, there’s been a 50% rise in ADHD among children, which can also be because of better diagnosis. And it is found to be more common in boys than girls. But recently, we know that it’s not. It may not necessarily be that boys get it more, but in this presentation, that boys can be different than girls and easier to diagnose. And most of these children that grow up with ADHD – quarter of them as adults, they continue to have symptoms. Many of them, they are better able to manage it because they have lived with ADHD for so long, but it never really completely goes away.

And apart from ADHD, people with ADHD also there’s a lot of comorbid disorders. So for example, if you take Oppositional Defiant Disorder, 50% of children with ADHD are also known to have oppositional defiant disorder. Or 25% of them have mood dysregulation disorder. And even things like anxiety and depression, they are more common in ADHD people rather than in the general population. So having ADHD can also make it more susceptible to these other disorders.

And I feel like there are so many myths these days surrounding ADHD. Right? Some people think that “oh it’s just bad behavior,” they’re not motivated,” “they’re not disciplined.” But they don’t care enough. Or you know it’s because of bad parenting, or sometimes people think that “oh if you get good grades, you cannot have ADHD.” But that’s actually not true. And same with “oh you’re not hyperactive so I don’t think you have ADHD.” And the biggest myth of all is that medication is the only way to treat ADHD. All of these things are myths because ADHD is not a voluntary behavior. It’s not because you’re not interested or you don’t care enough. There’s actual structural neurophysiological and neurochemical changes in the brains of people with ADHD, which is why they have all of these symptoms.

And so if you take a look at the brain of an ADHD person, you see that their prefrontal cortex, especially, is extremely impaired. And this prefrontal cortex is important for a lot of executive higher executive functions in people so that’s attention, planning, self-control – all of the inhibitory controls. And if you look at brain imaging studies, you see that the prefrontal cortex of people with ADHD is actually decreased in volume, so it’s even smaller. And not only that – it also has decreased activity in the prefrontal cortex. And if you look at SPECT scans, you see that they have decreased blood flow to the prefrontal region as well especially in the right frontal area. And there’s also some other areas like the basal ganglia and thalamus that are reduced in activation.

So if you look at, so this is an FMRI study, so on the top is a neurotypical brain, so I don’t like to use the word “normal” because there is no such thing as a normal brain. So I use “neurotypical,” which is more common because it’s a more typical type of the brain that we see in the population. And then, there’s neurodivergent brains – one of which is an ADHD brain. So at the top is the neurotypical brain and at the bottom is the ADHD brain. And you can see, there is reduced activation here in the inhibition networks. So if you look at the bottom, there’s not that much activation. And also there’s reduced activation in the basal ganglia. We know that their prefrontal cortex is highly impaired. And because of that, they have a lot of dysfunction in their core executive functions.

So what are some of the core executive functions that the prefrontal cortex is responsible for?

One of them is the inhibition functions. This inhibits your impulses, so your core immediately urge. So if somebody cuts you off in traffic, what stops you from immediately, like honking the horn or blurting out something inappropriate? It’s because your inhibition network goes into play and stops you from doing that. And this inhibition function is also important to ignore distractions. So if you are a neurotypical person, and you’re listening to somebody give a talk, and someone next to you drops a pencil, you’re able to just ignore that distraction and focus on the person that you’re supposed to be listening to. Whereas for an ADHD brain, it just becomes impossible to ignore that. Their brain will make them want to look at the pencil, see what the other person did with it, and then maybe, come back and then look out the window and come back again. It’s because they’re unable to inhibit this urge to look at other distractions.

Then we have issues with working memory. Working memory is the ability of your brain to hold temporary information and it is different from short-term memory, in the sense that you don’t just have to hold the information. But you actually have to extract the right stuff out from that information, and use it to manipulate the next step of the task. So when you have a multi-step task to do, you need to have good working memory so you’re doing the right thing in order.

And the other issue people with dysfunction and executive functions have is cognitive problems with cognitive flexibility. The cognitive flexibility is important for problem solving and having a different perspective. So people with dysfunction in this area have a difficult time breaking out of their patterns and also to think of things from another person’s perspective, they find it really hard.

We’ll go a little bit into detail about each of these.

Inhibitory functions – how can it present in people?

I already mentioned about the distractibility. You know it’s not easy to ignore distractions, but it can also cause anger and other mood issues because again it is your immediate reaction or overreaction. And if you don’t have the inhibitory control to help you with it, you’re going to have some kind of mood disorders or more dysregulation issues. And it can also cause discipline problems. So if your boss is telling you to do something or your teacher certainly do something and you just don’t want to do it and you can’t think ahead, you can’t think of the consequences and so it comes out as a discipline problem. But it’s actually a problem with inhibitory control.

And working memory. So working memory you know, as I mentioned, you need to be able to hold information and then use it for other things. It’s really important for mental math. If you even want to do simple addition and subtraction, you need to be able to remember the carryover to use it to come up with your answer. And that’s why people with ADHD have trouble with mental math because of issues with working memory. And also a lot of forgetfulness kind of issues especially with like a multi-step or multi-list. For example, if you tell an ADHD person, you have to go to the market and bring eggs and bread and milk. They’ll go to the market, they’ll spend two hours there, and come back with like peanut butter and jelly, and totally forget about the eggs and the milk. That’s because of issues with working memory. And again because of these kinds of issues, it can affect your grades or your professional performance in life.

Problems with cognitive flexibility. So cognitive flexibility helps to break patterns like I mentioned. And if you notice that also is important for switching tasks. So if you look at some ADHD people, when they are really focused on something, it’s something they’re really enjoying or really into it. You can yell and scream in their face, and they will still not even pay attention to you. And that can sometimes also stop you from thinking outside the box because you become so set in your ways. And it can also affect interpersonal issues. Because imagine, you’re having an argument with somebody and you’re just unable to think of things from their perspective or put yourself in their shoes, then you’re gonna have a lot of interpersonal issues because you’re unable to break that pattern that you’re set with and it’s not easy for you to think differently.

So that’s why people with ADHD can have issues with all of these problems. Because of the cortex executive dysfunction.

And all these core executive functions – working memory, inhibition control as well as cognitive flexibility – they are all very interdependent and linked. So you need working memory in order to have good inhibition control. Because you need to know what you need to. You need to have a plan in mind to know what information is relevant and what needs to be ignored. And similarly, you need good inhibition for working memory. Because if you need to remember something or focus on something, you need to be able to ignore the internal and external distractions to be able to achieve that goal. Both of these need to be working together and helping each other. And both of these together are important for cognitive flexibility. So if you want to change a certain task or start a new routine, you need to be able to able to remember the previous tasks in your working memory so you know what to manipulate, and then you need to be able to inhibit your urge to continue doing the whole thing, and be able to be flexible.

So all these three executive functions together are responsible for reasoning, problem solving, and planning. Which is why people with ADHD often have trouble with this. So they have a really difficult time planning ahead. So if they know they have an exam tomorrow, but they’re playing a video game right now, it’s really hard for them to not continue playing the video game because they cannot think of what happens when tomorrow comes it’s going to be a problem and their brain just cannot comprehend that because it’s not happening right away and it’s difficult for them to plan ahead.

Essentially, ADHD is like having a Ferrari for an engine. You have all these amazing ideas, great energy a lot of a lot of stuff going on, but then you have bicycle brakes. So you’re just going to crash and burn. But if you have the right tools and you can understand what’s going on in your ADHD brain and you can help manage it, then you can come out as a manager.

How can we help these ADHD things?

So first of all to understand what’s happening in an ADHD brain, we want to know how people diagnose ADHD today. Today’s ways to do that.

One of the most common things is the behavior checklist, which is the Conners rating scale. It is a simple evaluation method. It’s a bunch of questionnaire and then you ask either the teacher fills it or the parent fills it or the self if they are an adult, but the limitation with this is that the symptoms can be subjective. So it also causes issues with like studies because it’s hard to know what you think is inattentive if that’s the same or the other person thinks. So it’s difficult to have an objective view of that.

The other assessment is continuous performance test. This test measures your sustained attention, measures your impulse control as well as your response speed. It helps to understand a lot of information about the executive functioning. But the limitations with that is there are some issues with the validity of tasks that the standardization. It’s still not a bad test though.

Then there is the DSM-V. The checklist that is in the DSM-V, which is really good because it standardizes all the diagnosis and treatment. However, there’s a wide array of symptoms and checklists. So there is a big risk of misdiagnosis or over-diagnosis if you go by this big array of this.

But lately we have a brain mapping technology (qEEG), which is really cool because it helps identify specific areas of the brain and the brain waves that are not functioning optimally. I think it’s really cool technology, but the limitation of that is that it is new-ish, so it isn’t used as much. But once it is used more widespread, we will have better controls and better standards. And I think it will be a gamechanger.

So the rest of the talk I am going to talk about the electrophysiology of ADHD and how we can use EEG to both assess as well as treat ADHD.

Just to understand briefly what are the different electrical activities in the brain? What are the different kinds of brain waves?

We have the delta brain waves, which have the frequency band of one to four hertz, which means they make a cycle one to four times within a second. They are the slowest brain waves. It’s when you are sleeping or drowsy, you’re going to have a high delta activity in your brain.

Then we have the theta brain waves, which is from four to eight hertz. And the theta brain waves is often like the brain wave between conscious and unconscious. So if you’re driving down a normal route and you zone out daydreaming, that’s when your brain is in theta state.

The alpha state is 8 to 13 hertz. It’s the more relaxed awareness. So if you’re just relaxing at the beach or you just finished making a presentation and now you’re sitting down, that’s when your brain is in alpha state.

And then you have the beta state, which is your alert awake conscious state. It’s 13 hertz to around 30, and then you have high beta from 30 to 40. So right now, you and I, we’re all in beta state, hopefully if nobody is in theta and spawning out. So the beta brain state is generally what your most common brain state would be whenever you’re doing something actively and consciously.

Now that we understand the different brain waves, let’s see what happens.

What does an ADHD person’s qEEG map look like?

So here is a neurotypical brain, which is normalized. So the zero is like that’s the normal levels of the different brain wave activities. The entire qEEG map from 1 to 60 hertz. And then, this is the ADHD brain. You can clearly see there’s a lot of dysregulation. Some areas in the front, especially, highly more activity. In the bottom, less activity. And overall doesn’t look exactly like this state. So this is the total qEEG, but now we split it up into the different brain waves – the delta, theta, alpha, and beta. And see the difference between the neurotypical and the ADHD brain.

So two things that I specifically want you to look at, is the theta. So the colors range from blue is the lowest and red is the highest. So you can see here, in the normal brain, there is much more theta activity because it’s closer to green in the prefrontal cortex rather than the neurotypical brain. So you can see they have extremely high levels of theta in the prefrontal cortex. And if you look at beta, there is much lower beta because there’s much more blue here, whereas it’s more purple over here. So there’s much less beta in the ADHD brain compared to the neurotypical brain. So what we see is they have the more theta, but less beta.

And brain mapping. Now that we know that there’s such a typical presentation of all these different brain waves, it would be interesting, you know, we can use brain mapping as a diagnostic purpose because you get a lot of information from QEEG. You get to see the amplitude, the frequency as well as the relationship between different areas of the cortex that we are looking at. And it also helps you quantify the amount and distribution and ratio of the various brain waves.

So not just how much theta there is, how much beta there is, but also the ratios. The theta to beta ratio, the SMR ratio – all this kind of stuff. And what that helps with so because not every ADHD person will have the same amount of theta or the same amount of low beta. It helps you give more specific information about each ADHD brain. And because we get such specific information about each ADHD brain, we can come up with specific solutions for that ADHD brain. And the best thing about it is that, it is a completely non-invasive reading of the brain activity, so you don’t even have to go into a machine. You don’t have to ingest anything. None of that. You just attach your sensors on the head, and it’s painless and non-invasive. And it’s already been used for a lot of different typical presentations for other disorders like depression, anxiety, migraine. So it’s a really cool way to diagnose ADHD and maybe a little bit more objective rather than the subjective behavior checklist.

So what do they see when they look at the different ADHD symptoms? What happens in the brain base?  

If you look at the people with distractibility issues, their brain mapping shows abnormalities in the beta and high data frequency. So generally, they show reduced data and reduced high beta.

Then, if you look at the people with hyperactivity and impulsivity disorder symptoms, then you see for them low SMR activity. SMR is a sensory-motor rhythm in the sensory-motor cortex.

And then people with a combined ADHD, you see both unusually high theta in the front so in the frontal cortex, and higher theta than beta activity. Not only do they have a lot of theta, too little beta, but their theta-beta ratio is really high because of this.

Can we use the same EEG technology to treat it, now that we know that we can use it to diagnose it? One way we can do that is using EEG neurofeedback.  

So how does EEG neurofeedback work?

Neurofeedback means “biofeedback for the brain.” An analogy that I often use, imagine you’re walking in front of a mirror, but your hair is messed up. Now when you look in the mirror, you get that information about your hair being messed up, so you fix it. Right? So that is exactly what we do with the brain. We show the brain its own activity in real time. And when the brain sees what it’s doing wrong, it can essentially self-correct and self-regulate. Because our brains have a self-regulating mechanism, but only if they know what they’re doing wrong.

So the way it works is that we hook up a person to EEG sensors. We extract information about the brain activity. And we translate that information onto a screen that they’re watching, and give them immediate audio and visual feedback that helps them change their brainwave patterns.

How would this work for an ADHD person?

So you have an ADHD person here, they’re hooked up to their sensor. And every time their brain does something desired, which in this case, is focused better. So every time their brain focuses, the video output they’re watching, the screen becomes full screen, it will be clear, and the sound will be good. But if they get distracted or bored or get restless, then the screen will start getting smaller, blurrier, and sound will be more muffled.

Now the big screen and the good sound, they are a positive reward for the brain. Here, the brain likes it. So then the brain does more of that desired activity, and then it gets more positive reward, and so it does more. That’s how it gets into this loop. The more it focuses, the more of what it gets, which makes it want to focus more. And then eventually, when you do this kind of training several times, then this new way of being more focused becomes the brain’s natural new habit. It’s based on the principle of operant conditioning. So even when they stop doing the sessions, six months later, a year later, this becomes a new brainwave pattern and they find it easy to focus, regardless of whether they do more sessions or not.

What are the commonly used protocols for ADHD?

There are three main protocols.

The theta beta training, which because as we know it is two people have more theta less data. Theta beta training essentially what they’re doing is you are reducing their theta activity and increasing their beta.

For SMR training, it’s between 12 to 15 hertz. And people with ADHD have low SMR activity. Lower SMR activity means less inhibition of motor activities. Less inhibition means more restless, more hyperactive, more fidgety.

And SCP regulation. These are very slow brain waves, less than one hertz, and what happens in ADHD people is that they have dysregulated SCP. So it’s not like they have more or so SCP (slow cortical potential) and it doesn’t mean that they have more or less dysregulation of slow cortical potentials.

How do we do the theta/beta training?

So we do it in the central and frontal region. As I mentioned, these people have higher theta than beta. The training goal – decrease theta, increase beta. And the expected result is the ADHD people will be more alert and more focused while still being relaxed. They’re not hyperactive, but they’re alert and focused, and not zooming out.

And then the other is the SMR activity. Since ADHD people have reduced SMR, the training goal is to increase the power of SMR. And their expected result is to see a reduction in the hyperactivity and impulsivity syndromes.

Here is a fairly recent study from 2015, where they do a two-phase study. In the first phase, they do 15 sessions of SMR training and decreasing theta. And then phase two, they do 15 more sessions where they decrease theta as well as increase beta. And then they look at three things – the inattention, the hyperactivity, and impulsivity, and then the combined scores. You can see after phase one the significant decrease in inattention, and then a little further decrease after phase two. And for hyperactivity and impulsivity, there’s a greater decrease from phase two. But combined overall, you can see that there is a significant improvement in both the attention and hyperactivity and impulsivity with this combined SMR and theta/beta training protocol.

Then the next is the slow cortical potential training, which is the other common way to treat people with ADHD. And SCPs are based on electrical activity in the brain, usually really low ones; they’re very slow brainwaves. The SCPs go from surface negative to surface positive, and they are event-related, so they have to be generated. And they happen over the sensory-motor cortex. So what happens in a negative SCP? It reflects increased excitation, and the negative shift allows for increased attention and initiation of goal-directed behavior. So you have a goal you want to achieve and then you plan all your actions around it to achieve that goal.

The positive shift – it indicates reduction of cortical excitation, and it happens when resources are consumed to perform the task. What happens in an ADHD brain is that their brain has less of that negative shift. They don’t have that attention and energy to follow a goal and do it. Their SCP gets kind of stuck in the positive shift. With the SCP training, what we’re trying to do is improve the regulation of cortical excitability. And the expected result is to have increased attention and initiation of goal-directed behavior.

This is a very recent meta-analysis from 2020 of all the commonly used protocols for ADHD training. Look at the efficacy score. The efficacy score of 0.4 to 0.6 is considered medium efficacy, and 0.6 and above is considered high efficacy. And this is the SCP training – slow cortical potential, you can see it already has very high efficacy, and the gray is after finishing the training of either 20 or 30 sessions. It’s different for all of them because it’s a meta-analysis. And the black is a follow-up after six months of no more training. So they’ve already finished their sessions, and then for six months, they don’t do any training and then they see the efficacy. And you can see that the results sustain.

And then this is a combined SCP as well as TBR training, already again a very high efficacy at the end of training, and then it sustains. For TBR, there’s a medium efficacy at the end of training. But interestingly, you see that at a follow-up, without any more sessions, they somehow strengthen their efficacy. Their brains got better because they had that training, even though they were not doing any more sessions. And finally SMR, you can see that it was a medium efficacy at the end of training and at the follow-up, it sustained as well. These are all the different protocols that are used so far.

There is another new, just maybe like a decade or so – Infra-low Frequency Training. These are even slower than the slow cortical potential. Less than 0.5 and even less than 0.1 hertz. In fact, even less than like 0.1 millihertz. They involve training the very slowest of brain waves. And the computer settings encourage and reward specific components of the EEG in this very slow brainwave region. And in fact, Intra-low Frequency is what I do in my center. And Intra-low Frequency is one of the very few EEG training where you can actually see changes in session. Within the session, you can see people be more focused or more relaxed. And even though we’re training the very slow brain waves, you see a change in all the other brain frequencies. In the theta and the alpha and the beta, all of these are also changed when we work on the Intra-low Frequency. And the best thing about it is that clients can see it immediately during session or within one or two sessions, we start seeing the changes.

This is data from my own center, and we’ve taken information from 35 clients, male and female mix. And this is based on their own self reporting of their symptoms and the symptoms we use for analysis were distractibility, poor concentration, poor sustained attention, impulsivity, and hyperactivity. And the orange is after 10 sessions, so halfway through their training. And the grays after 20 sessions. And you can see there’s a 40 to 50% reduction for both male and female and overall total.

And then we also use continuous performance tests to measure the inattention and impulsivity scores. And again you can see more than 50% reduction in the inattention score as well as in the impulsivity score. They’re making fewer omission errors and fewer commission errors, which are indicative of attention and impulsivity respectively.

And the long-term effects. Here, if you look at the red and the black is what we’re comparing. The red is the sham neurofeedback and the black is the neurofeedback group. And this is post, so after the training, and then this is the follow-up six to twelve months after they finish training. And you can see continued, sustained effects. This is inattention, this is impulsivity, again sustained results, and then this is hyperactivity.

And then there are many other ways people also do – something called “Cognitive Training for ADHD.” This graph is comparing neurofeedback to control as well as cognitive training. The black line is neurofeedback, the dashed is the cognitive training. You can see compared to cognitive training, the neurofeedback has a much greater increase in the effects, so better efficacy. And after six-month follow-up, you still continue to see those results. And similarly, this is attention and this is impulsivity, and you can see that the neurofeedback has a reduction in the impulsivity. And six-month follow-up, you continue to see those effects. The long-term effects of EEG are really great, and it shows that you don’t have to continue training the person.

What are currently the common solutions people use for treatment outside of neurofeedback?

The number one treatment that any psychiatrist, anyone, will give you right now is medications – pharmacological solutions. And these are either stimulants like methylphenidate or amphetamines, or non-stimulants like atomoxetine.

And the way they work is that the stimulants increase the dopamine and norepinephrine. So dopamine is your reward molecule. It seeks and searches for reward, and then motivates you to go to the action required to achieve that reward. And people with ADHD are known to have decreased levels of dopamine. And that’s why you know sometimes for neurotypical people, just the reward of completing a task is enough to motivate us to finish a task. Whereas for people with ADHD, just completing a task doesn’t give them enough of that dopamine. But if they’re doing something they really enjoy, like playing a video game, they can do it for hours because that achieves their threshold of dopamine. But for regular tasks, they don’t have enough dopamine. That’s why these stimulants target those. And the norepinephrine is the molecule that allows you to focus on the task at hand without getting distracted.

And then the non-stimulant inhibits the reuptake of norepinephrine. Once norepinephrine has been released in the synaptic cleft, it will let it stay there and not uptake it. So it allows ADHD people to be able to focus for longer.

These medications are great. But medications are like glasses, if you have bad eyesight and you wear glasses, yes, you will be able to see and read while you’re wearing the glasses. But as soon as you take off the glasses, you won’t be able to read again because these glasses are not fixing your eyesight. They’re only making it possible for you to read while you’re wearing them. The same thing happens with medications, they’re not a long-term solution. They’re not fixing or curing your ADHD. They’re just allowing you to manage the symptoms. And as soon as you get off the medication after a few months, your brain will go back to the basal levels of dopamine, norepinephrine, and you will again continue to have those symptoms. On top of that, there’s other negative side effects like sleep trouble, reduced appetite (especially in adolescence), there’s a lot of irritability, also changes with the blood pressure and heart rate. There’s a lot of negative side effects. But while you’re taking the medication, they really work. They really help you with your attention and impulsivity issues.

Does neurofeedback compare to the results of medications? That is an important question, right? Because if they do, then we can do something that is less invasive than medications.

Here, you see a study from 2013 where they compare children that are on methylphenidate and children that are going through neurofeedback. The dashed line is methylphenidate, and the dark blue is neurofeedback. And you can see, there is really no difference between the children that are on. And this is the ADHD total score – pre-treatment, post-treatment, a two-month follow-up, and a six-month follow-up. And they continue to have similar results. The six-month follow-up for the medication, they continue to take the medication. But for neurofeedback, they don’t do neurofeedback anymore. We see similar results, but without having to ingest anything, without any invasiveness, without any of the negative side effects of medication.

So neurofeedback is a safer option, more non-invasive, no medication is involved, and it treats the issue at its core. It’s giving you a long-term solution. It’s not just a Band-Aid, it’s not just the pair of glasses that like fixes it for a while – it is a long-term solution. And it uses your brain’s natural ability to regulate itself. It’s not some upside thing that is causing changes, it’s just your brain has the ability to self-regulate, you just need to let it know what it’s doing wrong.

Apart from neurofeedback, you know neurofeedback is a great non-invasive way if pharmacological medications don’t suit you, or you don’t want to be on them. But apart from that, if you really understand what is going on in your ADHD brain, there are other changes you can make in your lifestyle and micro hacks you can use in your daily life to help you with these issues as well. And regardless of whether you are taking medications or doing any counseling or doing your feedback, it’s always a good idea to supplement it with changes in your lifestyle and making micro-hacks.

What kind of micro-hacks can we do?

We know that three main issues people with you know people with ADHD have is problems with inhibitory control.

So how can you, in your daily life, help your brain within inhibitory control?

Number one thing – removing temptation. So there is something you’re trying to do, if you’re trying to lose weight and you’re trying to not eat fatty foods, rid of your house of fatty foods. It’s a simple technique that we all use, but it is especially important for people with ADHD because they have such little inhibitory controls. So add some friction towards the things that you don’t want to do. Add a little barrier towards it. That makes it less likely for you to be tempted.

And build self-discipline. But do this in like a small way. Don’t have super intimidating or overwhelming goals like “I’m going to finish my dissertation in two days.” That’s not going to happen.

Set clear goals, and be kind to yourself. Because planning is not one of the fortes of people with ADHD. It’s really important that you keep this in mind and put your plan to paper.

What can you do for inattention?

Have a dedicated space, whether it’s a dedicated workspace or school space. If you know your brain is prone to getting distracted easily, remove everything unnecessary from your workspace. Only have the things you’re going to need.

And use timers. Timers for working as well as timers for a break. Don’t use your phone because there’s a bunch of distractions on your phone. So buy an actual physical timer that you can set. You set a timer for one hour, and then in that one hour, you focus and finish your work and don’t take any breaks. And then you set a timer for 15 minutes, and that’s your time to take a break. And as soon as you hear the “ding”, you go back to work. So it’s a great way to buy these focus timers. They’re really cheap, but it’s a really great tool to help people with ADHD. Using timers in your daily life.

And also eliminate distractions. I’m going to especially talk about this one because it’s something that I struggle with myself. You know, the amount of time we spend on our phones and screens. These days, we don’t even, like the first thing that you do wake up in the morning, you look at your phone. The last thing that you do before you go to sleep is to look at your phone. We cannot wait in line for coffee without looking at our phone, or we cannot wait for our friend to show up for dinner without looking at our phone.  It’s our love affair. This phone screen is really a problem. So one of the things that you can do, very easy micro-hack, is to put all of your time-sucking apps, Instagram, Facebook, TikTok, whatever, put them inside a folder. And then put that folder on screen three – don’t put it on your homepage. Anytime you have a few seconds of nothing to do, you’re not immediately going to Instagram or immediately going to TikTok. It adds a little bit of friction to that, and helps to eliminate distractions. So very easy thing. As soon as we finish this talk, I want all of you guys to go do this one task. Honestly, it will make a big difference in your life.

What can you do for hyperactivity?

Physical exercise. Physical exercise is a great way to get rid of that excess energy in people with ADHD. Not only that physical exercise has a lot of other benefits for your brain, it increases the level of dopamine, serotonin, norepinephrine in your brain. And we already know dopamine is important for motivation, norepinephrine is important for focus, and serotonin is important for mood regulation. Because a lot of people with ADHD also have more dysregulation issues so they suddenly become really upset or really hyper really emotional, and having good amounts of serotonin helps them with that. Having the added benefit of motivation, focus as well as mood regulation and being happier, you will also be able to get rid of the hyperactivity a little bit. You don’t need much – even minutes a day is enough, but the consistency is what is important.

Use fidget spinners. The fidget spinners are actually made for people with ADHD to help them get rid of this excess energy. And you can even, while you’re doing that, you can focus on something because it like rids you of the need to do something else. It’s an easy way to eliminate distraction.

Don’t forget to take rest. Because people with ADHD really put so much on their plate, they have a hard time saying “no” to everything – this and that and all these other things. And then they forget to take rest and downtime, and it can really affect their overall mood and natural health. So don’t forget to take rest. Put rest on your calendar. Put it as a thing that you need to do.

For working memory, working memory, as I mentioned, is what’s important to hold information in mind for multi-step things.

Because it’s difficult for people with ADHD, it’s a really good idea to break your goal into many goals so that you don’t forget a specific step.

And reduce multitasking, which is very tempting for people with ADHD because they want to do everything. They want to do this and that and that everything at the same time, but it really isn’t productive. You can have multiple tasks set up, but use that focus timer to allow you to give one hour of dedicated time to one task, and then another maybe 20 minutes to another task or 30 minutes on the test. But when you’re doing one task, really dedicated to that task.

And use checklists because you are going to forget something – that’s just how an ADHD brain is. So using a checklist is a great way to help your brain with the working memory issue.

And that’s all that I have. If we are unable to answer any of your questions now, you can follow me at Evolve Brain Training and ask me more questions. And thank you so much.

Dr. Pant: Thank you. I am going to take up the questions one by one.

Did you have any information about QEEG mapping being done in India?

Dr. Gala: I am not sure. I know that they do it in the, I don’t know actually but I know that you can. I don’t know if they do QEEG mapping, but they definitely do the EEG training. So maybe some of those centers might also have QEEG mapping. It’s actually very expensive right now – that’s another limitation to that. The QEEG mapping is really expensive, and I think especially in India, that might be the reason that they’re not doing it more frequently. But if you find an EEG training center and ask them, they might have it but they may not want to advertise it because it costs them a lot of money as well.

Dr. Pant: Yeah, okay. The next question, can QEEG mapping be done on autistic people?

Dr. Gala: Yeah, absolutely. It can be done on anyone who can sit still for 10 minutes. We can do it for them so we can. We’ve even done it for children three years old, nine years old. We can do it for anyone.

Dr. Pant: All right. This is a related question, can people have both autism and ADHD? And if so, in this case, would the protocols for this treatment be the same?

Dr. Gala: No. The protocols will be different. In fact, yes and a person can have both autism and ADHD and other comorbid disorders as well. But that’s the thing about neurofeedback protocols. They are different for everybody, so even for 10 different people with ADHD symptoms, there will be a different protocol for all of them. And that’s actually one of the problems because it’s hard to do really good studies. Because if you look at pharmacological studies, they give everybody the same dosage. Right? And then, that is like the control and the standardized treatment. But from neurofeedback, there’s no such thing as a standardized treatment. That’s why it’s been really hard to get like good research published because no two people are going to have the same training protocol. And then it’s hard to talk about the differences between the different protocols. But the results are there it’s just hard to put it in like a knee into the bow. But yeah, it would be a different protocol.

Dr. Pant: Okay. Does the prolonged exposure to these waves have adverse effects on the people?

Dr. Gala: You are not exposing yourself to any waves. The sensors are only measuring your brain waves. You have the ECG it’s just measuring your heart rate – that’s exactly what the EEG is doing. It’s measuring your brain waves. It’s not putting any information into your brain. It is not putting any waves or any magnetic or any radiation or anything inside your brain. It’s only measuring, so there is nothing. It’s completely non-invasive.

Dr. Pant: Okay. Does ADHD affect the IQ and do these people have high IQ?

Dr. Gala: No. There’s no real correlation to ADHD and IQ. There are some ADHD people with a very high IQ. They’re really smart. They’re really good at managing the symptoms and doing. And then there are some people that are not; it’s just like the general population. There’s no correlation between ADHD and IQ.

Dr. Pant: Okay. Does mindfulness meditation work by altering brain waves in ADHD patients or by increasing control over inhibitory mechanisms?

Dr. Gala: Both.

Dr. Pant: Both. Okay.

Dr. Gala: Meditation is more the alpha and theta state. And the more you meditate, the more you increase your alpha levels and the theta levels. But also meditation, what it does is it strengthens your prefrontal cortex. And strengthening the prefrontal cortex means strengthening your inhibitory networks. So if your amygdala is sending you a flight or flight mode, the prefrontal cortex needs to tell you, like the landlord, so we’re not going to do this, we’re going to wait, we’re going to make rational decisions. And regular mindfulness meditation allows you to have a stronger group of recordings so it gets better and at the same time it also changes.

Dr. Pant: Okay. Does frequent snapping of hands or arms indicate ADHD in children?

Dr. Gala: Yes. It can be, but it can also be autistic stimming. So you need to look at other things, what the kid is doing, to know if it’s an ADHD issue or some other issue. But yes, they can also have that presentation.

Dr. Pant: Okay. So a similar question, I have observed some people having habits of shaking their legs while talking during social interactions or interviews, does this indicate some lack of control? How to control this? Is it nervousness or ADHD or you know is it related to ADHD?

Dr. Gala: I cannot know, unless I do a consultation with them. It could be nervousness, it could be restlessness, it could be a general physical restlessness that they have because of ADHD. Or only because of hyperactivity, or only nervous situations, they become that way and it’s coming out this is a presentation of that. There’s no way to tell just from like never meeting the person and talking to them. And looking at their brain.

Dr. Pant: Right. I do have a question for you, I just wanted to, with the present pandemic that we are having right now, how is it impacting people with ADHD?

Dr. Gala: I feel like you know because they have to do a lot of things online, right? And it’s really hard for people, even a lot of the kids that come to me, even for adults or even for people that don’t have ADHD, it’s hard to stay focused. It’s an online thing, right? So yes, kids are really struggling, and even adults who have to do a lot of meetings online. There are so many distractions online, so the whole online situation is really exacerbating the symptoms of ADHD. And then they’re spending so much screen time and you know all of everything that goes along with it, it affects their sleep quality, affects everything. And worse, sleep makes ADHD symptoms worse as well.

Dr. Pant: All right. The other thing I wanted to ask you was, when you said you are using those non-invasive treatments at the studies that you say the treatment goes on for six months and you’ve mapped them after a year, how long is that? Do you have a longitudinal study kind of a thing?

Dr. Gala: The longest one is six to twelve months. I personally don’t have my own, but one of the studies that I presented, they have a 12-month follow-up in that.

Dr. Pant: Yeah. That’s the longest?

Dr. Gala: Yeah. One year is the longest that I have seen. I don’t know, but I’m keeping my own notes and I will follow up with my clients. Actually, most of my clients, they’ve never really stopped. Even after they finish their 20 sessions or 30 sessions or whatever they need, they did get on a maintenance program. So they do like one session a month or they do one session whenever they feel like they need something because it’s essentially like going to the gym. It’s a brain gym. And there’s no risk of over-training or anything like that because you can always improve. You can always have better focus. You can always have better motivation, so I myself have done more than 100 sessions on myself because why should I not do it, right? There is no harm in continuing to do more sessions, but it’s not necessary. But you can continue to see more and more progress if you continue to do more sessions.

Dr. Pant: All right. So this is probably the last question that I take, it says, “Are there any ways we can help children with both ADHD and autism during these difficult times? Any specific activities you could suggest?”

Dr. Gala: Activities? You mean like.

Dr. Pant: Something that they could do to handle this pandemic maybe, the stress of the pandemic.

Dr. Gala: Yeah. I mean, there’s lots of like little you know I like playing this game because it helps with cognitive flexibility – so you pick up a pen and then you come up with 10 different uses for this pen. Apart from using it for writing, what else can I use it for? I can use it for playing drums. I can use it to tie my hair. I can use it to mix something, whatever. And it allows the brain to have more synaptic connections because it’s thinking more, being more creative, using the right side of the brain, improving abstract thinking. It’s a really cool exercise, and you can do it with lots of different objects in your house. And it’s a good game to play with kids as well, and it helps improve their cognitive flexibility.

Dr. Pant: Okay. Thank you so much. Thank you Dr. Gala for those invaluable inputs about the brain and the focus on ADHD. Thank you for elaborating on the neurophysiology and neurochemistry of the disease. It was indeed fascinating to learn about this revolutionary, medication-free, neurofeedback therapy as well as the daily micro-hacks that you’ve just told us to do. You’ve given us amazing insights about neurofeedback and I’m sure it has motivated a large number of participants to try this non-invasive way of addressing stress-related issues. Thank you again so much. It was indeed very interesting. Thank you so much.

Dr. Gala: Thank you so much for having me, and you were all great audience with really nice questions. Thank you.

Dr. Pant: Thank you.

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