EEG and HEG neurofeedback: Brainwave and cerebral blood flow training for the treatment of Autistic

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EEG and HEG neurofeedbackBrainwave and
cerebral blood flow training for the treatment of
Autistic Spectrum Disorders in the school setting

• Mark Darling
• B Soc Sc (Hons) (Psych), Assoc MAPS, MISNR
• Registered Psychologist

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What is EEG neurofeedback?

• A form of EEG (electroencephalogram) training
  that encourages improved self-regulation of brain
  wave (electrical) activity
• A learning technique (EEG operant conditioning)
• Training effects generalise across environments
• Continued vigilance is not required
• Also known as EEG biofeedback or neurotherapy

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How is EEG neurofeedback done?

• Sensors placed on a persons scalp measure their
  brains electrical signal, or EEG
• The signal is amplified and fed back in the form
  of a computer display that lets the trainee know
  when they are producing appropriate brainwave
  patterns and when they are not
• As the brain processes the information it adjusts
  its performance (neural plasticity)
• The brain begins to use its new-found skills

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How is EEG neurofeedback done?
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Neurofeedback therapist screen
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Neurofeedback client screen
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What is HEG neurofeedback?

• A method of increasing cerebral blood flow
• Two separate HEG (haemoencephalography) devices
  were developed in the mid-1990s
• Near infrared (nir) HEG (Hershel Toomim) trains
  the brain to increase red colour (oxygenated
  blood)
• Passive infrared (pir) HEG (Jeff Carmen) trains
  the brain to increase its core temperature
• Both methods produce increased activation of
  hypoperfused (underactive) areas of the brain

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How is HEG neurofeedback done?

• Both forms of HEG utilise a headband with
  built-in sensors for measuring blood flow
• nir HEG sensors measure reflected red and
  infrared light from brain tissue in order to
  calculate the degree of oxygenation (red colour)
• pir HEG employs an infrared thermometer to
  measure brain temperature under the sensor
• In both cases the signal is fed back in the form
  of a computer display that rewards increased
  blood flow in the area directly below the sensor

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How is HEG neurofeedback done?
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Possible areas of impact

• Modulation of levels of arousal
• Regulation of sleep/wake cycle
• Organisation of cognitive processes
• Normalisation of sensory processing
• Inhibition of inappropriate motor responses
• Management of mood and emotions
• Organisation of memory

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The history of neurofeedback

• Prof. M. Barry Sterman (1967) trained cats to
  increase SMR brainwave amplitudes by rewarding
  them with milk or chicken soup
• SMR amplitude increases were associated with a
  waking state that was completely devoid of motor
  activity (e.g., eating, grooming, playing)
• SMR-trained cats proved seizure-resistant when
  exposed to a convulsant (hydrazine)

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EEG-trained cats
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Human epilepsy research (1972)
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Review of epilepsy research

• Sterman (2000) conducted a meta-analysis of 30
  years of epilepsy research
• 82 showed clinical improvement
• 66 showed positive changes to the EEG
• There was an average of 70 symptom reduction
  (intensity and frequency)

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The history of neurofeedback

• Further areas of successful research include
• ADHD, learning difficulties, behaviour disorders
• Mood disorders such as depression, anxiety, anger
  management PTSD
• Traumatic brain injury, stroke, etc
• Alcoholism substance addiction
• HEG research is still in its infancy
• pir HEG historically used to treat migraines
• nir HEG used for a wider range of disorders

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Research indicators for potential HEG
effectiveness (National Library of Medicine, 2002)
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EEG neurofeedback for ASD

• Autism/Aspergers Syndrome a relatively recent
  area of investigation for neurofeedback
• Published peer-reviewed research limited to a
  single case study (Sichel, Fehmi, Goldstein,
  1995), a short series (Scolnick, 2005) and a
  pilot study (Jerusiewicz, 2002)
• However, the observation of clinicians worldwide
  is that autistic spectrum disorders respond
  favourably to neurofeedback training
• Much needed research is now under way

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ASD pilot study (Jerusiewicz, 2002)

• 20 children with ASD in experimental group
• 20 children with ASD in control group
• Experimental group completed an average of 36
  neurofeedback sessions
• Pre- and post-treatment scores on the Autism
  Treatment Evaluation Checklist (ATEC) were
  collected

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Pilot study results percentage of improvement on
ATEC
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Recent HEG research (Limsila Toomim, 2003)

• Largest HEG study to date
• 180 autistic children in Thailand
• After 40 sessions, the cohort's mean HEG readings
  (prefrontal activation) increased 53
• Of the 81 subjects who were studying in public
  school, 86 increased their GPA by more than 0.5
  (mean 0.94) points on a 4-point scale
• Only 4 decreased their GPA by more than 0.5
  points (mean 0.57)

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Recent EEG research (Coben Padolsky, 2006)

• 37 subjects with autism
• 20 EEG neurofeedback sessions
• Wait list control group (n12) matched for
  gender, age, race, handedness, IQ treatment
• 89 success rate
• 40 reduction of autistic symptoms on ATEC
• Significant improvements on neuropsychological
  tests of Attention, Language, Visual-Perception
  Executive Functioning
• QEEG infrared imaging demonstrated gains

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Recent EEG research (Coben Padolsky, 2006)
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Recent HEG research (Coben, 2006)

• 28 subjects with autism
• 20 nir or pir HEG sessions
• Wait list control group (n12) matched for
  gender, age, race, handedness, IQ treatment
• All subjects had previously completed 20 sessions
  of EEG neurofeedback
• All subjects had identified frontal system
  dysfunction based on neurobehavioral testing,
  neuropsychological testing, infrared imaging, and
  QEEG data

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Recent HEG research (Coben, 2006)

• 90 success rate
• 42 reduction in autistic symptoms on ATEC
• 43 reduction in social interaction deficits
• 47 reduction in communication deficits
• 44 reduction in sensory/cognitive deficits
• 39 reduction in behaviour deficits
• Statistically significant (p lt .05) improvements
  in neurobehavioural and neuropsychological
  functioning
• pir HEG more successful on some measures

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Recent EEG research (Coben Hudspeth, 2006)

• 14 ASD subjects with significant Mu rhythm
  (indicative of frontal dysfunction)
• 20 sessions of either bipolar interhemispheric or
  coherence EEG training
• Both groups improved significantly on QEEG,
  neurobehavioural and neuropsychological measures
• Only the coherence trained group demonstrated a
  reduction in the Mu rhythm

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Recent research (Coben, 2006)
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2004 Hervey Bay school-based neurofeedback pilot
project

• Special school setting
• Six children all ascertained as ASD Level 6
• All appropriate assessments were provided
• Teaching staff were trained as technicians to run
  neurofeedback sessions
• Full clinical/technical supervision was provided
• Neurofeedback sessions formed part of each
  childs Individual Education Profile (IEP)

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A snapshot of the results

• An average of 40 training sessions completed
• Reductions in autistic behaviour on the ATEC
  ranged from 2.2 to 47.8 (average 22)
• Improvements reported sleep, mood, speech,
  academics, attention, memory, social skills
  reductions in anger, aggression, seizures,
  hyperactivity, impulsivity
• Behaviour was monitored in the classroom at
  pre-determined windows of time for 28 sessions
• 64 reduction in classroom autistic behaviour

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A snapshot of the results
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A snapshot of the results

• Two functionally non-verbal children began
  speaking in short sentences
• One child with epilepsy ceased having seizures
  from the start of the program
• The other child with epilepsy had two seizures in
  the first month, then didnt have any more
  (normally 3-7 per month)
• The program won two awards and a 20,000 federal
  grant for the school to continue the
  neurofeedback program

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School Neurofeedback Project

• Initial half-day presentation at school
• 2 day EEG technician training for school staff
• All appropriate assessments provided
• Individually tailored neurofeedback protocols
  sent/received via e-mail adjusted as necessary
• Full technical support provided via phone/e-mail
• 2 year contracts signed in 2006 include free
  lease of neurofeedback equipment and five free
  assessments (value approx. 4500)

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Further information

• www.familychallenge.com.au
• www.markdarlingneurotherapy.com
• www.biocompresearch.org HEG neurofeedback
• www.eeginfo.com links to many EEG neurofeedback
  resources
• www.isnr.org neurofeedback bibliography
  online access to the Journal of Neurotherapy
• www.adhd.com.au Melbourne ADHD clinic using
  neurofeedback biomedical interventions

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Mark Darling B Soc Sc (Hons) (Psych), Assoc MAPS,
MISNR Registered Psychologist

• Family Challenge Psychology Clinic
• Suite 3 Mountain Creek Professional Centre
• Cnr Golf Links Karawatha Drives
• Mountain Creek QLD 4557

• Phone/Fax [phone]
• E-mail mark_at_familychallenge.com.au
• Web www.familychallenge.com.au