EEG Spectrum International - Attentional Deficits, Specific Learning Disabilities and Associated Conduct Problems

EEG Biofeedback Training for Attention Deficit Disorder, Specific Learning Disabilities, and Associated Conduct Problems

EXPERIMENTAL METHOD
Given our operating hypothesis of a general applicability of the technique of beta/SMR training, it was appropriate to give the present work a broad, inclusive cast, as opposed to a narrow focus. The constraints of a clinical setting in terms of availability of subjects also militate against a narrow focus. Children of ages 6 to 16 were accepted into the study if they were referred for academic problems, attentional deficits, hyperactivity, or conduct problems. Eighteen children were accepted into the study. Of these, three only received about six training sessions and terminated the training for personal reasons which did not relate to consequences of the training. The results of the remaining fifteen are presented in the following.

The training protocol employed 15-18 Hz augmentation training, with concurrent inhibition of excessive 4-7 Hz and 22-30 Hz amplitudes. The present work may therefore be considered as a study in beta training, for comparison with Tansey's 14-Hz reinforcement, and with Lubar's use of a similar protocol with different electrode placement.

Electrode placement in the present study was bipolar, at sensorimotor cortex, along the Rolandic fissure. Placement was C1-C5, or C2-C6, per the International 10-20 system. An ear ground electrode on the same side being trained was also used. Training was performed on the dominant hemisphere, unless there were hemispheric differences in the EEG, in which case the side showing the larger or more deviant EEG was trained. Verbal reporting from the client, family, and teachers was used to adjust the training protocol throughout. By way of comparison, Lubar employs a frontal-temporal placement, whereas Tansey uses a large-area electrode at Cz in a monopolar configuration with an ear reference and ear ground. Our choice of electrode placement was largely historically rooted in the early work of Sterman and Lubar.

Instrumentation was by Neurocybernetics. A two-channel EEG amplifier from Mendocino Microcomputers was used. The signal was digitally processed in a PC. The primary EEG trace and the three filtered waveforms are continuously displayed to the therapist in a scrolling or chart recorder type of display. This information is used by the therapist to provide guidance, coaching, and motivation to the client, and helps the client to begin to associate certain mental states with what is observed in the EEG and in the feedback display. The feedback signal is derived digitally in the PC, and is presented to the client via a second computer, which displays a video game in which the brightness and speed of a pacman-like object is governed by the beta amplitude relative to a pre-set threshold. If the theta or high-beta (i.e., 22-30 Hz) thresholds are exceeded, the object goes dark and stops. Binary auditory feedback is provided as well.

The training proceeded in sessions of thirty minutes on the instrument (45-minute contact hour), after an initial intake session of an hour and a half, in which the history was taken, baseline EEG records were obtained for both hemispheres, and a training session was conducted. The academic testing was accomplished in a two to three-hour session on another day. At each training session, the last six-minute segment of the EEG record was stored on the client disc, along with an updated history of thresholds and other performance data from every session. A chart recorder output of representative EEG data was also obtained at each training session.

Academic and cognitive skills testing encompassed the full WISC-R, the PPVT, the WRAT, Benton VRT, and the Tapping Sub test of the Harris Tests of Lateral Dominance. The selection was made partly on the basis of the broad familiarity with these tests among educators, psychologists, and educational therapists, who will serve as the primary referral source for this type of training in the foreseeable future.

The subject population had the following characteristics: Of the fifteen subjects, fourteen had been diagnosed as having attention deficit disorder. Of these, seven had prominent symptoms of hyperactivity, and of these, two were on medication for the condition. Seven subjects were identified as having specific learning disabilities; of these, four were identified with dyslexia. Six of the subjects were characterized by oppositional/defiant disorder, and two by conduct disorder. Five of the children reported chronic headaches. And thirteen of the group reported various sleep disorders, including two cases of sleep anxiety (inability to fall asleep in one's own bed or room), four cases of sleep walking and sleep talking, and three cases of nocturnal enuresis. Mood disorders were common as well, with three cases of chronic anxiety, and four of childhood depression or dysthymia. One subject exhibited obvious motor tics.

Training was conducted for an average of 35 sessions, at a rate of 2-3 sessions per week. One subject was in ongoing educational therapy and two were in ongoing psychotherapy.