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Evaluation and Remediation of Attentional Deficits

Susan F. Othmer and Siegfried Othmer, Ph.D.
December, 1992

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INTRODUCTION
Clinical findings are presented for the use of T.O.V.A. (T.M.) for assessment and of EEG biofeedback training for remediation of attentional deficits. Our complete clinical history with the T.O.V.A. and with ADHD children is reviewed. Subjects ranged in age from 5 to 17.

The T.O.V.A. (Test of Variables of Attention) is a relatively new tool for assessing attention deficits in children and adults. It is a continuous performance test (CPT) which in the course of twenty- two minutes teases out shortcomings in attention mechanisms. The data can be used to extract measures of inattention, impulsivity, reaction time, and variability of reaction time. The test is most commonly used to test children on stimulant medication such as Ritalin (R), so that the right dosage can be determined. It is preferred in this application because of an absence of practice effect. We are finding it particularly useful to test the efficacy of EEG biofeedback. The test is computerized, and computer-scored, so human bias is taken out of the picture with respect to both the testing and the scoring.

EEG training was conducted with our standard Attention Deficit Hyperactivity Disorder (ADHD) protocols of augmentation in either the sensorimotor rhythm (SMR, 12-15 Hz) spectral band, or the low beta (15-18 Hz) spectral band, concurrently with inhibition of excessive activity in the 4-7 Hz band and the 22-30 Hz band. This is a modification of the Lubar protocol for ADHD. Electrode placement was typically at sensorimotor cortex (Cz, C3, and C4 according to the International 10-20 system). Neurocybernetics instrumentation was used. In this instrument, the raw and filtered EEG signals are continuously displayed to the therapist. Thresholds can be updated without interruption of the training so that learning rate can be optimized. Data are provided to the client in the form of a video game which provides for a high update rate and continuous rather than discrete feedback signals. The highest signal-to-noise ratio is assured by the use of bandpass filtering techniques (as opposed to Fourier transform methods), and minimum signal delay is promoted by using soft rolloffs. Training sessions consisted of thirty minutes on the instrument.

CLINICAL FINDINGS
Figure 1 shows the impulsivity data for all of the ADHD children who have received both tests and retests (typically after twenty and forty sessions [second retest]) in our office to date. Scores are given in multiples of one standard deviation. Increasing positive score indicates worse performance. A change of half a standard deviation is deemed to be significant. We observe that this criterion is met for 9 of the 13 children. Nine children scored worse than +1 standard deviation at the outset, and of these, 7 scored better than +1 after the training. Since every child benefited in terms of impulsivity, it is clear that the systematic effect of the training overwhelmed any random variation in test results. More detailed treatment of the cases showing the largest impulsivity scores follows.

Figure 1

Figure 1. Impulsivity data for entire cohort of ADHD children evaluated with the T.O.V.A. to date. Scores are in multiples of one standard deviation. Increasing positive score means worse performance.