Training the brain to be alert


A programme has been designed to help adults with ADHD increase their levels of alertness, writes CLAIRE O'CONNELL

IT’S NOT often that I find myself arranging playing cards into suits and sorting coins against the clock on a weekday morning. Or counting beeps playing through headphones while simultaneously scanning a document for spelling mistakes.

All the while, PhD student Simona Salomone from Trinity College Dublin’s Institute of Neuroscience is charting my progress.

Next we go right down to the basement, where I’m wired up to an EEG machine – it’s painless but not exactly glamorous – and Salomone records electrical activity in my brain while I carry out simple but repetitive tasks on a computer in the darkened room.

Why am I doing this? It’s all in the name of scientific research – I’m taking part in a study on adult attention deficit hyperactivity disorder, or ADHD, as part of the control group.

I’m happy to donate some brain time to the cause, but I’m also intrigued by the wider study.

The research is looking at the effects of a programme designed to help adults with ADHD increase their own levels of alertness.

Adults with ADHD tend to have problems relating to inattention, so the idea behind the approach is to make participants more aware of instances when they are alert, then teach them to use a catchword and tricks such as sitting up straight and taking deep breaths to recreate a more alert brain state.

“It is a psycho-educational intervention,” explains Salomone, who works on the project with Dr Redmond O’Connell, Dr Jessica Bramham and Prof Ian Robertson. “And we are using biofeedback as a tool to help us train people.”

The biofeedback element uses small electrodes placed on the finger to measure galvanic skin response (GSR), which increases when a person is more alert.

By watching their GSR status change on a laptop screen, the person can become more aware of their alertness, explains Salomone.

“We play a sudden loud sound in the room, and after they hear the sound they will be able to see the bump on the GSR status on the screen – this reflects increased alertness,” she says.

“The next step is to learn how to increase it yourself, so we teach them to say a word to try to reproduce the peak in the GSR response, and they learn to do that quite quickly – after five to six attempts they are able to produce peaks.”

Ultimately, a goal of the programme is that participants use the technique to increase their alertness in everyday tasks that need it.

“If you are reading and you feel your attention is going down, you say your word out loud or even just in your mind and you can refocus on what you are doing, keep going,” says Salomone.

“They have to practise several times using the biofeedback device before starting to apply the technique in everyday situations – that is how the programme is structured.”

So what’s the science behind it?

“Alertness is linked to a number of chemical messengers, one of which is noradrenaline, which is a fight or flight chemical,” explains Ian Robertson, professor of psychology at Trinity.

“In people with adult ADHD, their brain is chronically short of noradrenaline and they get restless and bored easily because the brain, a lot of the time, has a less than optimal level of alertness.”

For about two decades Prof Robertson has been researching how people with different types of disorders of the brain can take relatively simple steps to control their level of alertness when they need to increase it.

He originally developed the method, which boosts alertness through actions – such as saying a catchphrase, sitting up and taking deep breaths – with people who had a particular type of stroke, and then later in people with age-related forgetfulness.

Now they have developed a partly home-based programme for adults with ADHD, explains Robertson.

“We train them to gain control over their level of alertness. Using deep breaths, a catchphrase and sitting up – all of these increase the activity in the frontal lobes of the brain and increase noradrenaline levels,” he says.

“These simple changes alter the brain state, so you are essentially teaching people to give themselves the equivalent of a short-acting pill that has no side effects.”

The study, which is funded by the Health Research Board, has already included more than 20 adults with ADHD, some of whom trained on the programme and some who did not.

Each participant does the suite of tasks before and after the period it takes to do the training, whether they trained or not – the tasks are not diagnostic but they can give some insight into attention, explains Salomone.

Meanwhile, I’m one of about 25 control participants who do the tasks but have not been diagnosed with ADHD.

And while it’s too early to give any definitive findings from the data coming out of the project, both Salomone and Robertson describe the preliminary results as promising.