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Research and publications

Effectiveness of EEG-Biofeedback on Attentiveness, Working Memory and Quantitative Electroencephalography on Reading Disorder.

ElnazMosanezhad-Jeddi 2013

Cognitive factors are the important correlates of reading disorder and their impairments are established in children with reading disorder. Neurofeedback as an intervention has been reported to be useful in improvement of cognitive deficits. The present study aimed to determine the effectiveness of this treatment on attentiveness and working memory and related electroencephalographic (EEG) changes in children with reading disorder.

In this single subject study, six children with reading disorder aged 8-10 years old completed twenty 30-minunt sessions of treatment. Continuous performance task, the digit span subscale of the 3(rd) edition of Wechsler Intelligence Scale for Children (WISC-III) and quantitative electroencephalography were used to evaluate the changes at pre and post-treatment. The data were evaluated by visual inspection of the graph, the mean percentage improvement and signal detection measures.

The results showed improvements in attention and working memory.

These significant changes in coherence are possible indications of the connectivity between frontal and posterior association and integration between sensory and motor areas that explain the improvements in attention and working memory.

Improvements in spelling after QEEG-based neurofeedback in dyslexia: a randomized controlled treatment study.

Marinus H. M. Breteler Æ Martijn Arn 2009

Phonological theories of dyslexia assume a specific deficit in representation, storage and recall of phonemes. Various brain imaging techniques, including qEEG, point to the importance of a range of areas, predominantly the left hemispheric temporal areas. This study attempted to reduce reading and spelling deficits in children who are dyslexic by means of neurofeedback training based on neurophysiological differences between the participants and gender and age matched controls. Nineteen children were randomized into an experimental group receiving qEEG based neurofeedback (n = 10) and a control group (n = 9). Both groups also received remedial teaching. The experimental group improved considerably in spelling (Cohen's d = 3). No improvement was found in reading. An indepth study of the changes in the qEEG power and coherence protocols evidenced no fronto-central changes, which is in line with the absence of reading improvements. A significant increase of alpha coherence was found, which may be an indication that attentional processes account for the improvement in spelling. Consideration of subtypes of dyslexia may refine the results of future studies.

The effectiveness of neurofeedback training on EEG coherence and neuropsychological functions in children with reading disability

Nazari MA 2012

Neurofeedback training (NFT) is an effective intervention in regulating electroencephalogram (EEG) abnormalities leading to improvements in behavioral deficits, which exist in children with reading disabilities. This single-subject study explores our evaluation of the improvements in the reading ability and phonological awareness deficit, as well as the changes in the EEG in children with reading disabilities as a result of NFT. Participants were 6 children, aged between 8 and 10 years, who completed twenty 30-minute sessions of NFT and follow-up measurement sessions 2 months subsequent to the completion of the training sessions. The results showed significant improvement in reading and phonological awareness skills. Furthermore, EEG analysis did not show notable changes in the power of the targeted bands (delta, theta, and beta), rather there was normalization of coherence of the theta band at T3-T4, delta band at Cz-Fz, and beta band at Cz-Fz, Cz-Pz, and Cz-C4. These significant changes in coherence possibly indicate integration of sensory and motor areas that explains the improvements in reading skills and phonological awareness.

Efficacy of neurofeedback treatment in ADHD: The effects on attention, impulsivity and hyperactivity: A meta analysis.

In order to study thetreatment of the children with attention deficit hyperactivity disorder (ADHD), the integrated visual and auditory continuousperformance test (IVA-CPT) was clinically applied to evaluate the effectiveness of electroencephalogram (EEG) biofeedback training. Of all the 60 children with ADHD aged more than 6 years, the effective rate of EEG biofeedback training was 91.6% after40 sessions of EEG biofeedback training. Before and after treatment by EEG biofeedback training, the overall indexes of IVA were significantly improved among predominately inattentive, hyperactive, and combined subtype of children with ADHD (P<0.001). Itwas suggested that EEG biofeedback training was an effective and vital treatment on children with ADHD.

The Effectiveness of Neurofeedback and Stimulant Drugs in Treating AD/HD: Part II. Replication

Thomas Rossiter 2004

This study replicated T. R. Rossiter and T. J. La Vaque (1995) with a larger sample, expanded age range, and improved statistical analysis. Thirty-one AD/HD patients who chose stimulant drug (MED) treatment were matched with 31 patients who chose a neurofeedback (EEG) treatment program. EEG patients received either office (n = 14) or home (n = 17) neurofeedback. Stimulants for MED patients were titrated using the Test of Variables of Attention (TOVA). EEG (effect size [ES] = 1.01–1.71) and MED (ES = 0.80–1.80) groups showed statistically and clinically significant improvement on TOVA measures of attention, impulse control, processing speed, and variability in attention. The EEG group demonstrated statistically and clinically significant improvement on behavioral measures (Behavior Assessment System for Children, ES = 1.16–1.78, and Brown Attention Deficit Disorder Scales, ES = 1.59). TOVA gain scores for the EEG and MED groups were not significantly different. More importantly, confidence interval and nonequivalence null hypothesis testing confirmed that the neurofeedback program produced patient outcomes equivalent to those obtained with stimulant drugs. An effectiveness research design places some limitations on the conclusions that can be drawn.

EEG Biofeedback in the Schools: The Use of EEG Biofeedback to Treat ADHD in a School Setting

William D. Boyd Ph.D. 2008

Six middle school students diagnosed with attention deficit/hyperactivity disorder were selected for sensorimotor rhythm (SMR) training with EEG biofeedback. The subjects were evaluated following a 72-hour drug-free period with the WISC-III Digit Span subtest and the Test of Variables of Attention (TOVA). Five of the subjects received 20 sessions of EEG biofeedback and one of the subjects received nine sessions of EEG biofeedback. The subjects were evaluated again following a 72-hour drug-free period. Five of the six subjects improved on their combined Digit Span, TOVA Inattention, and TOVA Impulsivity scores. These results supported previous findings that EEG biofeedback can be effective in the treatment of attention deficit/hyperactivity disorder. More importantly, this study demonstrated that EEG biofeedback could be used in an actual school setting. Recommendations for implementing an EEG biofeedbmk program in the schools were provided.

Individual alpha neurofeedback training effect on short term memory

Memory performance has been reported to be associated with electroencephalogram (EEG) alpha activity. This study aimed to improve short term memory performance by individual alpha neurofeedback training (NFT). With appropriate protocol designed for NFT, the experimental results showed that the participants were able to learn to increase the relative amplitude in individual alpha band during NFT and short term memory performance was significantly enhanced by 20 sessions of NFT. More importantly, further analysis revealed that the improvement of short term memory was positively correlated with the increase of the relative amplitude in the individual upper alpha band during training. In addition, effective strategies for individual alpha training varied among individuals and the most successful mental strategies were related to positive thinking.

Is neurofeedback an efficacious treatment for ADHD? A randomised controlled clinical trial

Background:  For children with attention deficit/hyperactivity disorder (ADHD), a reduction of inattention, impulsivity and hyperactivity by neurofeedback (NF) has been reported in several studies. But so far, unspecific training effects have not been adequately controlled for and/or studies do not provide sufficient statistical power. To overcome these methodological shortcomings we evaluated the clinical efficacy of neurofeedback in children with ADHD in a multisite randomised controlled study using a computerised attention skills training as a control condition.

Methods:  102 children with ADHD, aged 8 to 12 years, participated in the study. Children performed either 36 sessions of NF training or a computerised attention skills training within two blocks of about four weeks each (randomised group assignment). The combined NF treatment consisted of one block of theta/beta training and one block of slow cortical potential (SCP) training. Pre-training, intermediate and post-training assessment encompassed several behaviour rating scales (e.g., the German ADHD rating scale, FBB-HKS) completed by parents and teachers. Evaluation (‘placebo’) scales were applied to control for parental expectations and satisfaction with the treatment.

Results:  For parent and teacher ratings, improvements in the NF group were superior to those of the control group. For the parent-rated FBB-HKS total score (primary outcome measure), the effect size was .60. Comparable effects were obtained for the two NF protocols (theta/beta training, SCP training). Parental attitude towards the treatment did not differ between NF and control group.

Conclusions:  Superiority of the combined NF training indicates clinical efficacy of NF in children with ADHD. Future studies should further address the specificity of effects and how to optimise the benefit of NF as treatment module for ADHD.

American Academy Of Pediatrics Lists Biofeedback As A Level 2 Psychosocial Intervention For ADHD Symptoms

“Advantages to QEEG-Neurotherapy are that it is noninvasive, self-regulated, and has no know side effects, or systematic or pharmacological interactions. It is effective across a wide range of conditions and age groups.”

Denise Malkowicz, Jolene Ross, James Caunt “Integrative Approaches to Brain Rehabilitation”, Chapter 12, Integrative Rehabilitation, in Integrative Psychiatry, Monti, D. & Beitman, B., (Editors), Weil Integrative Medicine Library, Oxford Press

EEG Biofeedback: A New Treatment Option For ADD/ADHD

Attention Deficit Disorder is commonly treated with stimulant medications such as Ritalin

(methylphenidate). However, this medication has short- term effects and numerous undesirable side effects including insomnia and loss of appetite. This study explores using EEG biofeedback, with its minimal side effects and long-term results, as an alternative to pharmacological treatments for ADD.

Follow-up study of learning disabled children treated with neurofeedback or placebo

Becerra J, Fernndez T, Harmony T, Caballero MI, Garcia F, Fernandez-Bouzas A, Santiago-Rodriguez E, Prado-Alcalá RA. (2006)

This report is a 2-year follow-up to a previous study describing positive behavioral changes and a spurt of EEG maturation with theta/alpha neurofeedback (NFB) training in a group of Learning Disabled (LD) children. In a control paired group, treated with placebo, behavioral changes were not observed and the smaller maturational EEG changes observed were easily explained by increased age. Two years later, the EEG maturational lag in Control Group children increased, reaching abnormally high thetaRelative Power values; the absence of positive behavioral changes continued and the neurological diagnosis remained LD. Incontrast, after 2 years EEG maturation did continue in children who belonged to the Experimental Group with previousneurofeedback training; this was accompanied by positive behavioral changes, which were reflected in remission of LDsymptoms.

Improvements in spelling after QEEG-basedneurofeedback in dyslexia: A randomized controlled treatment study.

Breteler, M. H. M., Arns, M., Peters, S., Giepmans, I., & Verhoeven, L. (2010)

Phonological theories of dyslexia assume a specific deficit in representation, storage and recall of phonemes. Various brainimaging techniques, including qEEG, point to the importance of a range of areas, predominantly the left hemispheric temporal areas. This study attempted to reduce reading and spelling deficits in children who are dyslexic by means of neurofeedback trainingbased on neurophysiological differences between the participants and gender and age matched controls. Nineteen children wererandomized into an experimental group receiving qEEG based neurofeedback (n = 10) and a control group (n = 9). Both groups also received remedial teaching. The experimental group improved considerably in spelling (Cohen’s d = 3). No improvement was foundin reading. An in-depth study of the changes in the qEEG power and coherence protocols evidenced no frontal- central changes, which is in line with the absence of reading improvements. A significant increase of alpha coherence was found, which may be anindication that attentional processes account for the improvement in spelling. Consideration of subtypes of dyslexia may refine theresults of future studies.

EEG biofeedback of low beta band components: Frequency-specific effects on variables of attention and event-related brain potentials.

Egner, T., & Gruzelier, J. H. (2004)

Objective: To test a common assumption underlying the clinical use of electroencephalographic (EEG) biofeedback training (neurofeedback), that the modulation ofdiscreet frequency bands is associated with frequency-specific effects. Specifically, the proposal was assessed that enhancement ofthe low beta components sensorimotor rhythm (SMR: 12 – 15 Hz) and beta1 (15 – 18 Hz) affect different aspects of attentionalprocessing. Methods: Subjects (n 1⁄4 25) were randomly allocated to training with either an SMR or beta1 protocol, or to a non- neurofeedback control group. Subjects were assessed prior and subsequent to the training process on two tests of sustained attention. The neurofeedback participants were also assessed on target P300 event-related potential (ERP) amplitudes in a traditional auditory oddball paradigm. Results: Protocol-specific effects were obtained in that SMR training was associated with increased perceptual sensitivity prime’ (d0 ), and reduced omission errors and reaction time variability. Beta1 training wasassociated with faster reaction times and increased target P300 amplitude whereas no changes were evident in the control group.Conclusions: Neurofeedback training of SMR and beta1 band components led to significant and protocol-specific effects in healthysubjects. The data can be interpreted as indicating a general attention-enhancing effect of SMR training, and an arousal-enhancing effect of beta1 training.

The Effects of Individual Upper Alpha Neurofeedback in ADHD: An Open-Label Pilot Study

C. Escolano 2014

Standardized neurofeedback (NF) protocols have been extensively evaluated in attention-deficit/hyperactivity disorder (ADHD). However, such protocols do not account for the large EEG heterogeneity in ADHD. Thus, individualized approaches have been suggested to improve the clinical outcome. In this direction, an open-label pilot study was designed to evaluate a NF protocol of relative upper alpha power enhancement in fronto-central sites. Upper alpha band was individually determined using the alpha peak frequency as an anchor point. 20 ADHD children underwent 18 training sessions. Clinical and neurophysiological variables were measured pre- and post-training. EEG was recorded pre- and post-training, and pre- and post-training trials within each session, in both eyes closed resting state and eyes open task-related activity. A power EEG analysis assessed long-term and within-session effects, in the trained parameter and in all the sensors in the (1–30) Hz spectral range. Learning curves over sessions were assessed as well. Parents rated a clinical improvement in children regarding inattention and hyperactivity/impulsivity. Neurophysiological tests showed an improvement in working memory, concentration and impulsivity (decreased number of commission errors in a continuous performance test). Relative and absolute upper alpha power showed long-term enhancement in task-related activity, and a positive learning curve over sessions. The analysis of within-session effects showed a power decrease (“rebound” effect) in task-related activity, with no significant effects during training trials. We conclude that the enhancement of the individual upper alpha power is effective in improving several measures of clinical outcome and cognitive performance in ADHD. This is the first NF study evaluating such a protocol in ADHD. A controlled evaluation seems warranted due to the positive results obtained in the current study.

Case study: Improvements in IQ score and maintenance of gains following EEG biofeedback with mildly developmentally delayed twins

Fleischman, M. J., & Othmer, S. (2005)

This study reports on the improvements in IQ scores and maintenance of the gains following EEG biofeedback with identical twin girls with mild developmental delay and symptoms suggestive of Attention Deficit Hyperactivity Disorder (ADHD). Full Scale IQ scores increased22 and 23 points after treatment and were maintained at three follow-up retests over a 52-month period. ADHD symptom checklists completed by their mother showed a similar pattern of improvement and maintenance of gains. The extent of improvement is supported by anecdotal reports of behavioral changes. The results are discussed in the context of other studies of EEG biofeedbackalso showing improved intelligence following EEG biofeedback.

Neurofeedback training as an educational intervention in a school setting: How the regulation of arousal states can lead to improved attention and behavior in children with special needs

Foks, M. (2005)

The current choice of treatment for the remediation of attentional and behavioral difficulties among primary school children withspecial educational needs (SEN) is, increasingly, pharmacological. If-neurofeedback can regulate brain arousal states and thereby improve attention, behavior and readiness to learn, there may be a case for incorporating it into the special needs provision ofmainstream primary schools, thus avoiding the use of potentially damaging stimulant medication as a means of controlling behavior and promoting inclusion. An experimental design was used, employing the TOVA test as a pre-/post-test measure ofattention and the TOVA rating scale as parental pre/post measure of behavior, plus qualitative feedback as a post-treatment measure of attention/behavior. Results indicate that neurofeedback may make an important impact on emotions and affect of the SEN individual, leading to improved behavior and improved attentional capability; quality time spent on a no-failure task of any kind on a one-to-one basis may be beneficial to children with SEN, affecting their personal belief system and behavior; incorporatingneurofeedback as part of the school-based special needs provision is feasible and practicable

Neurofeedback treatment for attentiondeficit/hyperactivity disorder in children: A comparison with methylphenidate. 

Fuchs, T., Birbaumer, N., Lutzenberger, W., Gruzelier, J. H., & Kaiser, J. (2003)

Clinical trials have suggested that neurofeedback may be efficient in treating attention-deficit/hyperactivity disorder (ADHD). We compared the effects of a 3-month electroencephalographic feedback program providing reinforcement contingent on the production of cortical sensorimotor rhythm (12–15 Hz) and beta1 activity (15–18 Hz) with stimulant medication.Participants were N = 34 children aged 8–12 years, 22 of which were assigned to the neurofeedback group and 12 to themethylphenidate group according to their parents' preference. Both neurofeedback and methylphenidate were associated withimprovements on all subscales of the Test of Variables of Attention, and on the speed and accuracy measures of the d2 AttentionEndurance Test. Furthermore, behaviors related to the disorder were rated as significantly reduced in both groups by both teachers and parents on the IOWA-Conners Behavior Rating Scale. These findings suggest that neurofeedback was efficient inimproving some of the behavioral concomitants of ADHD in children whose parents favored a non-pharmacological treatment.

Long term effects after feedback of slow cortical potentials and of theta-beta amplitudesin children with attention-deficit/hyperactivity disorder (ADHD)

Gani C, Birbaumer N & Strehl U. (2008)

Though it had already been shown in the 1970s that neurofeedback improves attention, academic performance and social behaviorin children with ADHD, it has not been considered as a standard therapy so far. This is mainly due to the small number of controlled studies fulfilling methodological standards - especially long-term data was not available so far. We are the first to presentlong term data of children undergoing neurofeedback training. 47 patients in the age of 8 – 12 years were randomly assigned to two different training groups. One group was trained to self-regulate slow cortical potentials (SCP), the other group tried to influenceTheta- and Beta-amplitudes. Follow-up evaluation was carried out 6 months and more than 2 years after the last training session. Eleven children of the SCP group and 12 CHildren of the Theta/Beta group took part in three booster sessions. Parents rated behavioral symptoms as well as frequency and impact of problems. Attention was measured with the Testbatterie zur Aufmerksamkeitsprüfung (TAP). All improvements in behavior and attention that had been observed at previous assessmentsturned out to be stable. Yet another significant reduction of number of problems and significant improvement in attention wasobserved. EEG-self regulation skills were preserved. In each group, half of the children no longer met ADHD criteria.Neurofeedback appears to be an alternative or complement to traditional treatments. The stability of changes might be explained by normalizing of brain functions that are responsible for inhibitory control, impulsivity and hyperactivity.

The usage of neurofeedback with children with ADHD: Themethod and its evaluation. 

Gevensleben H, Moll GH, Rothenberger A, Heinrich H. (2011)

Neurofeedback is a computer-based behavior training, which is gaining increasing interest in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). This article gives an introduction to neurofeedback and summarizes the state of research, discussing inter alia methodical aspects (e. g., requirements to a control training). Evaluation studies conducted so far indicate clinical efficacy. Forexample, neurofeedback training was superior to a computerized attention training in a randomized controlled trial (medium effect size). Follow-up investigations suggest that treatment effects remain stable (at least six months). At the clinical level, comparable improvements could be obtained for the neurofeedback protocols theta/beta training and training of slow corticalpotentials. Neurophysiological findings document different mechanisms of theta/beta training and slow cortical potential training Future studies should further elucidate the specificity of training effects related to the kind of training and certain disorders and address how to optimize and individualize neurofeedbacktraining.

Neurofeedback Training Induces Changes in White and Gray Matter

The main objective of this structural magnetic resonance imaging (MRI) study was to investigate, using diffusion tensor imaging, whether a neurofeedback training (NFT) protocol designed to improve sustained attention might induce structural changes in white matter (WM) pathways, purportedly implicated in this cognitive ability. Another goal was to examine whether gray matter (GM) volume (GMV) might be altered following NFT in frontal and parietal cortical areas connected by these WM fiber pathways. Healthy university students were randomly assigned to an experimental group (EXP), a sham group, or a control group. Participants in the EXP group were trained to enhance the amplitude of their β1 waves at F4 and P4. Measures of attentional performance and MRI data were acquired one week before (Time 1) and one week after (Time 2) NFT. Higher scores on visual and auditory sustained attention were noted in the EXP group at Time 2 (relative to Time 1). As for structural MRI data, increased fractional anisotropy was measured in WM pathways implicated in sustained attention, and GMV increases were detected in cerebral structures involved in this type of attention. After 50 years of research in the field of neurofeedback, our study constitutes the first empirical demonstration that NFT can lead to microstructural changes in white and gray matter.

What is neurofeedback?

EEG biofeedback (neurofeedback) originated in the late 1960s as a method for retraining brainwave patterns through operant conditioning. Since that time asizable body of research has accumulated on the effectiveness of neurofeedback in the treatment of uncontrolled epilepsy, ADD/ADHD, anxiety, alcoholism, posttraumatic stress disorder, and mild head injuries. Studies also provide encouraging indications that neurofeedback offers a treatment alternative for use with learning disabilities, stroke, depression, fibromyalgia,autism, insomnia, tinnitus, headaches, problems with physical balance, and for the enhancement of peak performance. At a time when an increasing number of people are concerned with negative effects from relying solely on medication treatments,neurofeedback may offer an additional treatment alternative for many conditions. This article assists the reader to understand how neurofeedback works, how assessment allows neurofeedback to be individualized, and briefly reviews evidence for theneurofeedback treatment of many conditions. The public is cautioned that in selecting a practitioner for the treatment of the kindsof medical, psychiatric and psychological conditions cited above, a practitioner should be licensed for independent practice in theirstate or province and should ideally also be certified by a legitimately recognized body