Mendi for ADHD?

Dr. Danish and his team at Philadelphia Integrative Psychiatry want to find new ways to help people with ADHD. They're curious about a device called "Mendi" that's designed for ADHD treatment. Mendi uses a technology called functional near-infrared spectroscopy (fNIRS) neurofeedback. Basically, it measures changes in blood flow and oxygen levels in the brain while people do different tasks. Then, it tries to help patients with ADHD improve their focus based on that data.

It specifically targets the prefrontal cortex, which is essential for functions like focus and working memory. The fNIRS sensor provides signals processed by special algorithms, offering simple visual feedback during neurofeedback training. However, Dr. Danish remains cautious about these claims until further research confirms their accuracy and this blog looks at the nuances of true neurofeedback, this version of neurofeedback, and the potential efficacy of each for ADHD.

What is traditional neurofeedback?

Traditional neurofeedback is a well-known technique used to manage conditions like ADHD. Unlike Mendi’s fNIRS-based approach, traditional neurofeedback primarily relies on electroencephalography (EEG). During a neurofeedback session, patients engage in tasks while their brain activity is monitored using EEG leads. When the patient’s brain exhibits desired patterns (such as increased focus), they receive positive feedback (e.g., visual cues or sounds). Over time, this reinforcement aims to strengthen specific neural pathways associated with improved attention and self-regulation.

In simpler terms, the idea is that as a patient with ADHD focuses on a task, such as a simple video game, the device senses improved blood flow to the prefrontal cortex. Conversely, when the patient's focus wanes, the device detects a decrease in blood flow and signals the patient to refocus. This process is intended to strengthen neural pathways that promote focus, similar to the mechanisms involved in mindfulness practices. In fact, Dr. Danish often describes neurofeedback to his patients as a form of reinforced mindfulness.

However, the efficacy of traditional neurofeedback remains a topic of debate, and its benefits may not extend uniformly to all aspects of a patient’s life. While Dr. Danish has seen the benefit of neurofeedback for some patients, he has also seen it not work as well for others (but without negatives/ side effects). He emphasizes the need for thorough research to validate the claims of newer technologies like neurofeedback (and Mendi, but more on that below) and to understand their comparative effectiveness.

What is the Technology Behind Mendi?

Mendi utilizes functional near-infrared spectroscopy (fNIRS), which is an optical brain monitoring technique that estimates cortical hemodynamic activity (aka blood flow) in response to neural activity. Specifically, it uses near-infrared light to measure changes in the concentration of oxygenated and deoxygenated hemoglobin, primarily near the cortical surface, making it a safe and non-invasive method for measuring superficial blood flow changes.

Using information about blood flow changes to the superficial aspects of small parts of the frontal cortex, Mendi aims to improve focus during a specific task (like playing a basic video game). If blood flow decreases, Mendi assumes focus has waned. To help the user refocus, it adjusts different sensory cues (like sound, touch, and visual changes in the game).

Some Questions Still Remain

Dr. Danish expresses some hesitation regarding Mendi's claims until further research is conducted. While neurofeedback is a well-known technique, the specific application of fNIRS in this context is less precise and may not yield the same level of brain activity accuracy as traditional neurofeedback methods.

Additionally, Dr. Danish is cautious about the potential increase in screen time for patients who already grapple with the negative emotional and social impacts of excessive screen use. Although there may be positives, such as reinforcing mindfulness practices, the overall efficacy and safety of Mendi for ADHD treatment remain to be thoroughly validated through larger, more comprehensive studies.

Screen time in children and teens, especially those with ADHD, has been linked to negative mental health outcomes. Read more here about research research.

Lastly, and most importantly, even neurofeedback itself has questionable outcomes in treating ADHD. That said, Dr. Danish wants to reiterate that, at least for some, Mendi might be a favorable approach to improving mindfulness, focus, and other aspects of ADHD and overall executive functioning. To that end, here are some studies on both traditional neurofeedback and fNIRS related neurofeedback as they pertain to various cognitive conditions, including ADHD.

Study Results

Neurofeedback and Brain Self-Regulation

The article explores neurofeedback, a biofeedback method providing real-time neural activity feedback to enhance brain self-regulation. Neurofeedback can induce lasting neural changes linked to behavioral improvements, involving brain regions like the thalamus and prefrontal cortex. Despite mixed clinical trial results, it remains a promising tool for enhancing neuroplasticity and brain function.

Positive Results for Neuropsychiatric Disorders

The article highlights the use of fNIRS in neurofeedback, showing potential improvements in brain function and symptom reduction across various neuropsychiatric conditions. For example, fNIRS-neurofeedback improved inhibitory control in impulsive adults and reduced social anxiety symptoms. Overall, fNIRS-neurofeedback shows promise in enhancing cognitive performance and treating neuropsychiatric disorders.

fNIRS-neurofeedback for ADHD

A systematic review of 22 studies found that fNIRS-neurofeedback shows promise in improving inhibitory control and reducing ADHD symptoms. Children with ADHD showed significant improvements comparable to other treatments, and adults also indicated potential benefits. The review supports fNIRS-neurofeedback as a feasible method to enhance executive functions in ADHD patients.

Hemoencephalography (HEG) as a subtype of neurofeedback (NF)

The study investigated training hemodynamic responses using NIRS during neurofeedback sessions, focusing on motor imagery of swallowing. Participants successfully modulated hemoglobin levels, suggesting NIRS-based neurofeedback could treat swallowing disorders. This method shows potential for improving quality of life for individuals with dysphagia by enhancing voluntary brain signal control.

Results for Executive Function

The article reviews methods to enhance executive functions (EFs) through behavioral training and neuromodulation techniques like neurofeedback. Behavioral cognitive training and neurocognitive modulation of specific brain regions can significantly improve task switching, memory updating, and response inhibition. These approaches show potential for generalizing training gains across cognitive domains, enhancing learning, emotional control, and mental health.

For more on this topic and related subjects, please look at these blogs:

Screen time in children and teens, especially those with ADHD, has been linked to negative mental health outcomes. Read more here about research research.
Discover the transformative impact of the Few Foods Diet on ADHD symptoms by exploring the Oligoantigenic Diet study, a fascinating approach to dietary intervention. Explore more.
Unveil the unexpected advantages of Saffron in ADHD treatment, highlighting its potential as a natural remedy. Learn more.
Learn about the advantages of executive function coaching for individuals with ADHD, offering strategies to improve organization, planning, and time management. Find out here.
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Uncover the extensive benefits of Omega 3 Fatty Acids, not just for general health but also for their positive effects on ADHD symptoms. Read more.
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Learn about the pros and cons of stimulants for ADHD here. Learn more.
Delve into the realm of Non-Stimulant ADHD management with our comprehensive guide on non-stimulant treatment options, offering effective strategies beyond traditional stimulant medications. Explore here.
Area Private Schools with Extra Supports for ADHD: Explore our list of regional private schools along with their general mission statements, partly based on first-hand accounts from students and their parents. Read more.
Summer Camps for Children with ADHD: Check out our list of local and national summer camps designed for children with ADHD. Find out more.
Gain a richer insight into the critical role of neuropsychological and psychoeducational evaluations in understanding cognitive and learning challenges through our in-depth analysis. Read more.
Dive into our extensive guide for a thorough exploration of the various school accommodations designed to support students with ADHD, enhancing their educational experience. Find out more.

References:

Mendi for ADHD

Neurofeedback and Brain Self-Regulation

Positive Results for Neuropsychiatric Disorders

fNIRS-neurofeedback for ADHD

Hemoencephalography (HEG) as a subtype of neurofeedback (NF)

Results for Executive Function

Acamprosate for Alcohol Use Disorder

Neurofeedback: A Guide to Mental Health Improvement

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