|Introduction to Neurofeedback and Learning Disabilities|
|Savannah: Learning Disability, 15yF
SS: ADHD and Learning Disabilities, 8yF
M: Learning & Communication Disorders, 18yM
JCT: Learning Disabilities & Depression, 14yM
KL: Learning disabilities, Gifted, 12yF
|Conversations With Neil’s Brain : The Neural Nature of Thought and Language
WH Calvin, GA Ojemann
|Attention, Memory, and Executive Function
G. Reid Lyon, Norman A. Krasnegor (Eds)
Introduction to Neurofeedback and Learning Disabilities
EEG Biofeedback (also known as neurofeedback) is gradually becoming known and recognized for its utility in remediating Attention Deficit Disorder. Less well known is its emerging application to specific learning disabilities. This is surprising for several reasons. First of all, more children are affected by specific learning disabilities than are diagnosed with ADHD, so EEG biofeedback could potentially have a much larger impact there. Secondly, there is no claim that stimulant or anti-depressant medication is terribly helpful with learning disabilities, so that EEG biofeedback does not challenge and compete with an already accepted treatment. Thirdly, there is no claim that specific learning disabilities are “medical conditions.” To be sure, they certainly have a physiological foundation. However, they cannot be addressed by the usual remedies in the arsenal of the medical practitioner. Hence treatment with EEG training for learning disabilities does not get caught up in the third-party payer maelstrom or in the diagnostic ambiguity of whether something does or does not “qualify” as a bona fide learning disability. Finally, it is surprising because there is probably as much early research backing EEG biofeedback for learning disabilities as there is for Attention Deficit Disorder. The latter application has been criticized for a lack of robust research under controlled conditions. Ironically, part of the reason is that the early research was not exclusively focused on attention problems, but rather on learning disabilities as well.
Perhaps for this reason, much of the early work with EEG biofeedback in connection with attention and learning problems emphasized assessment of academic skills rather than behavioral measures. These had the advantage of being very objective, but at the same time they did not meet the expectations of researchers who had a focus on ADHD. These researchers have ever since called attention to a dearth of behavioral data, despite their notorious subjectivity.
The first significant study of both attention and learning problems using EEG biofeedback was performed by Joel and Judith Lubar (Lubar, 1984). The study reported on six children who had undergone the training. The motivation was that seizure disorders, ADHD, and specific learning disabilities were often characterized by elevated low-frequency (less than 10Hz) activity in the EEG (Lubar et al, 1985). Such elevated activity could be seen as disruptive to the ongoing mental activities, possibly either causing or exacerbating learning disorders. It had already been shown to be possible to control seizure susceptibility and hyperactivity with EEG training that attempted to “train down” the low frequency activity at the same time that certain higher-frequency activity is promoted (12-18 Hz) (Sterman, 1978). Could the same training impinge on learning disorders as well? The results of this initial study were highly promising in this regard, although they were compromised by the fact that five of the children were receiving other special academic support as well during the period of the study.
Moreover, the Lubars were not alone. Tansey and Bruner published a single case study of a child with both attention and learning problems in the same timeframe (Tansey, 1983). In this case, both conventional biofeedback and EEG biofeedback were used, so the interpretation of the results remained ambiguous. Tansey published a study of four children in 1985 in which the focus was learning disorders rather than attentional deficits, and this was the first of many studies in which improvements in IQ score were documented for EEG training. In a follow-up study using 24 subjects with learning disorders (Tansey 1990), an average improvement in Wechsler full-scale IQ score of 19 points was demonstrated, which was quite impressive. The improvements in performance IQ (deemed to reflect more right hemisphere function) was +19 points, and the improvement in verbal IQ (deemed to reflect left hemisphere function) was +16 points. Of the 24 children in the study, 11 had been diagnosed as neurologically impaired, 11 were judged perceptually impaired, and only two were diagnosed with ADD.
Our own clinical study for replication purposes took place in 1990-1991, and also emphasized academic skills assessments over behavioral measures (Othmer, 1991). In a study of 15 subjects, an average WISC-R improvement of 23 points was found (with independent testing). The improvement ranged from 7 points to 35. Thus every study participant improved his IQ score, and most did so significantly. Academic skills were also assessed with the Wide Range Achievement Test (WRAT), and on this test there was more of a divergence in outcomes than was the case for the IQ test. Only ten of the 15 children were evaluated with the WRAT. In the reading test, only one child scored below grade level at the outset. That child improved more than three grade levels with the training, and reached age-appropriate norms. Five other children significantly advanced their reading performance above grade level, in rank order by +5.6 years, + 4.5 years, +4.2 years, +3.5 years, and +2 years. Since only one child was reading below grade level initially, not much can be discerned from this about reading disabilities. On the other hand, the striking gains experienced by some children does indicate that the training had an effect on some of the mechanisms underpinning the reading process. It may be argued that the training moved them closer to their native reading ability.
By contrast, in the arithmetic test of the WRAT, nine of the ten children scored in deficit at the outset. After training, five had shown significant improvement: +7.6 years, +2.7 years, +2.3 years, +2 years, and +1.6 years. Two more treaded water, with gains of one year (whereas the test-retest interval in the study was nine months). One child tested the same on the retest, and two, sad to say, actually scored worse (although one of these remained way above grade level, and could be considered a case of regression to the mean). It is noteworthy that in some children major improvements were observed, whereas in others there was negligible change. This discrepancy could even be seen within the same child. For example, the child whose deficit in math performance worsened actually soared in terms of reading!
It is tempting to suggest that the training protocol employed in this study fortuitously happened to be what certain children needed in order to break the relevant bottleneck in reading or arithmetic ability. These tasks, it is now known from imaging studies, require certain cortical regions to activate in a timely manner and to communicate with one another for overall task completion. A training protocol that uses a single electrode placement on the scalp may not reasonably be expected to address all possible shortcomings in terms of local activation and intra-cortical communication involved in such complex processes as reading and arithmetic computation.
And then there is dysgraphia. No one fails out of school because of an inability to draw, so this particular disability does not get much attention, except perhaps from those who do assessments on children. The inability to draw reflects more on right hemisphere skills, and on inter-hemispheric communication. Whereas this disability may be harmless in itself, it can be an indicator for other deficiencies in right hemisphere skills that could indeed be important. To assess drawing skills, children are asked to draw their family during the intake interview. We have seen many children improve with the training from the point at which they are drawing stick figures to where they acquire full-bodied relatives-all within the span of a few weeks, with some twenty to forty training sessions.
It is the lack of systematic, predictable success with learning disorders-more than perhaps any other reason-that has kept the professional community of EEG biofeedback practitioners from promoting this application more overtly. However, the very striking results that can be achieved with many children also place an obligation on us to make this information available. As long as the potential trainee is aware of the finite likelihood of success, he should certainly have the opportunity to train. Clinicians have an understandable reluctance to promote a technique where the outcome may be so highly variable, in addition to being unpredictable, particularly in a field that is still trying to gain recognition by the mainstream educational and medical communities.
For the future, things look very bright indeed. The new imaging studies give us indications for what protocols to try in order to improve the likelihood of success. For example, Shaywitz et al (1998) recently published a study on PET scans in dyslexic subjects. Regions of heightened oxygen uptake may reflect areas where reading is being bottlenecked in such subjects. It is relatively straight-forward to try a variety of training schemes involving the identified sites. The combination of functional imaging and EEG biofeedback may yield near-term breakthroughs in the remediation of various specific learning disabilities that have been relatively intractable to date.
Lubar, J.O., and Lubar, J.F. (1984).
Electroencephalographic biofeedback of SMR and beta for treatment of attention deficit disorders in a clinical setting.
Biofeedback and Self-Regulation, 9 (1), 1-23.
Lubar, J.O., Bianchini, K., Calhoun, W., Lambert, E., Brody, Z. and Shabsin, H. (1985)
Spectral analysis of EEG differences between children with and without learning disabilities.
Journal of Learning Disabilities, 18, 403-408.
Othmer, S., Othmer, S.F., and Marks, C. (1991).
EEG biofeedback training for attention deficit disorder, specific learning disabilities, and associated conduct problems.
Web-published, www.eegspectrum.com. Available as a Monograph from EEG Spectrum, Encino, CA.
Shaywitz SE, Shaywitz BA, Pugh KR, Fulbright RK, Constable RT, Mencl WE, Shankweiler DP, Liberman AM, Skudlarski P, Fletcher JM, Katz L, Marchione KE, Lacadie C, Gatenby C, Gore JC (1998)
Functional disruption in the organization of the brain for reading in dyslexia.
Proc Natl Acad Sci U S A 95(5), 2636-2641
Sterman, M.B. and MacDonald, L.R. (1978)
Effects of central cortical EEG feedback training on incidence of poorly controlled seizures.
Epilepsia, 19(3), 207-222.
Tansey, M., and Bruner, R. (1983)
EMG and EEG biofeedback training in the treatment of a 10 year old hyperactive boy with a developmental reading disorder.
Biofeedback and Self-Regulation, 4, 299-311.
Tansey, M. (1990)
Righting the rhythms of reason: EEG biofeedback training as a therapeutic modality in a clinical office setting.
Medical Psychotherapy, 3, 57-68.