Brain Training: Neurofeedback

Direction of SMR and Beta Change with Attention in Adults

Introduction. The aim of this study was to clarify the interpretation of sensory-motor rhythm (SMR; 13-15 Hz) and beta (16-20 Hz) changes with respect to attention states. Method. For this purpose, EEG was recorded from 11 participants during (a) a multiple object tracking task (MOT), which required externally directed attention; (b) the retention phase of a visuo-spatial memory task (VSM), which required internally directed attention and avoidance of sensory distraction; and (c) the waiting intervals between trials, which constituted a no-task-imposed control condition. The 2 active tasks were consecutively presented at 2 difficulty levels (i.e., easy and hard). Two analyses of variance were conducted on EEG log spectral amplitudes in the alpha (8-12 Hz), SMR, and beta bands from F3, F4, C3, C4 and P3, P4. Results. The first 15 analysis compared the MOT to the VSM by difficulty levels and revealed a significant task effect (p < .0005) but no effect of difficulty. The results showed that externally directed attention (MOT) resulted in lower values than internally directed attention (VSM) in all three bands. The second analysis averaged the difficulty levels together and added the no-task-imposed reference condition. The results again showed a significant task effect that did not interact with site, hemisphere, or, more important, band. Post hoc tests revealed that both MOT and VSM produced significantly smaller means than the no-task-imposed condition. This pattern of log-amplitude means and the lack of task interaction with any other factor indicate that task-induced attention reduces EEG power in the same proportion across the 3 bands and the 6 channels studied. Conclusions. These results contradict a frequent interpretation concerning the relationship between the brain's aptitude to increase low beta in neurofeedback programs and improved sustain attention capacities.

Another kind of 'BOLD Response': answering multiple-choice questions via online decoded single-trial brain signals

The term 'locked-in'syndrome (LIS) describes a medical condition in which persons concerned are severely paralyzed and at the same time fully conscious and awake. The resulting anarthria makes it impossible for these patients to naturally communicate, which results in diagnostic as well as serious practical and ethical problems. Therefore, developing alternative, muscle-independent communication means is of prime importance. Such communication means can be realized via brain-computer interfaces (BCIs) circumventing the muscular system by using brain signals associated with preserved cognitive, sensory, and emotional brain functions. Primarily, BCIs based on electrophysiological measures have been developed and applied with remarkable success. Recently, also blood flow-based neuroimaging methods, such as functional magnetic resonance imaging (fMRI) and functional near-infrared spectroscopy (fNIRS), have been explored in this context. After reviewing recent literature on the development of especially hemodynamically based BCIs, we introduce a highly reliable and easy-to-apply communication procedure that enables untrained participants to motor-independently and relatively effortlessly answer multiple-choice questions based on intentionally generated single-trial fMRI signals that can be decoded online. Our technique takes advantage of the participants' capability to voluntarily influence certain spatio-temporal aspects of the blood oxygenation level-dependent (BOLD) signal: source location (by using different mental tasks), signal onset and offset. We show that healthy participants are capable of hemodynamically encoding at least four distinct information units on a single-trial level without extensive pretraining and with little effort. Moreover, real-time data analysis based on simple multi-filter correlations allows for automated answer decoding with a high accuracy (94.9%) demonstrating the robustness of the presented method. Following our 'proof of concept', the next step will involve clinical trials with LIS patients, undertaken in close collaboration with their relatives and caretakers in order to elaborate individually tailored communication protocols. As our procedure can be easily transferred to MRI-equipped clinical sites, it may constitute a simple and effective possibility for online detection of residual consciousness and for LIS patients to communicate basic thoughts and needs in case no other alternative communication means are available (yet)--especially in the acute phase of the LIS. Future research may focus on further increasing the efficiency and accuracy of fMRI-based BCIs by implementing sophisticated data analysis methods (e.g., multivariate and independent component analysis) and neurofeedback training techniques. Finally, the presented BCI approach could be transferred to portable fNIRS systems as only this would enable hemodynamically based communication in daily life situations.

QEEG Correlates of Auditory-Visual Entrainment Treatment Efficacy of Refractory Depression

Introduction. It is well established that the number of people diagnosed and suffering from depression is on the increase. Many of these patients are not responsive to first-line pharmacological intervention or simply cannot use medications for other reasons. As such, there has been a growing need for nonmedication approaches to treatment. The purpose of this study was to examine the use of auditory-visual EEG entrainment (AVE) at a 14 Hz (beta) frequency to decrease symptoms of depression with corresponding changes in neurophysiology. Method. Sixteen participants ranged in age from 20 to 67 years and were screened utilizing the Beck Depression Inventory-II (BDI-II) and broken into two groups of 8 (simulated, AVE treatment groups), with a cross-over design. Both groups were given the BDI-II and QEEG testing at baseline, 4 weeks following either AVE or simulated treatment, and then again after an additional 4 weeks and a switch in treatment in the cross-over design. Results. Results revealed significant reduction of depression only after the 4 weeks on AVE therapy of the BDI-II scores (p > .01). QEEG scores adjusted for normal age deviations demonstrate significant EEG change scores over time in cortical regions associated with mood regulation. Conclusion. The findings indicate that AVE therapy may be aviable nonmedication therapeutic intervention.

Comprehensive Neurofeedback Bibliography: 2007 Update

A previous comprehensive bibliography of neurofeedback outcome studies was published by the author in 2001. Since that time there have been many new publications as the field of neurofeedback continues maturing, and a few older references were discovered. Therefore a new update of references under categories for various clinical conditions is provided.

First, Do No Harm: Adverse Effects and the Need for Practice Standards in Neurofeedback

Adverse and iatrogenic effects associated with psychotherapy have been substantiated in research for more than 40 years. Controlled research also exists in the field of neurofeedback (electroencephalographic biofeedback) that documents that negative effects can occur from inappropriate training. This article presents accumulating evidence, taken directly from acknowledgments by neurofeedback practitioners of the existence of both transient side effects and of more serious adverse reactions that have occurred. Unlicensed and unqualified practitioners pose a risk to the public and to the integrity and future of the profession. It is vitally important that both professionals and professional societies emphasize standards of practice and that the public be protected from individuals seeking to use neurofeedback to work with medical, psychiatric, and psychological conditions for which they are not qualified and licensed to work. Some in the field propose pursuing biofeedback or psychophysiology licensure as a means to establish standards of practice and address ethical concerns. This is a reasonable option to consider, although it may take many years to implement in various states. In the meantime it is vitally important that individuals offering neurofeedback services for clinical diagnostic conditions be licensed to lawfully provide services for such conditions

Neurofeedback Overtraining and the Vulnerable Patient

Neurofeedback overtraining in vulnerable patients can cause transient, site specific functional decline that may be distressing to the patient and trainer. Susceptible patients can be identified before training with a checklist, and overtraining then avoided by close observation of training response. Procedures are described and a possible mechanism is offered.

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

Though it had already been shown in the 1970s that neurofeedback improves attention, academic performance and social behavior in 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 present long 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 influence Theta- 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 assessments turned out to be stable. Yet another significant reduction of number of problems and significant improvement in attention was observed. 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 compliment to traditional treatments. The stability of changes might be explained by normalizing of brain functions that are responsible for inhibitory control, impulsivity and hyperactivity.

Neurofeedback by neural correlates of auditory selective attention as possible application for tinnitus therapies

More and more people are suffering from tinnitus. There are many treatments for tinnitus that have been claimed based on different causes. Unfortunately, until now none of the existing treatments has been found to be effective in general. Here, we would like to suggest a treatment to tinnitus based on neurofeedback using neural correlates of auditory selective evoked potentials (ASEPs). We have shown that the wavelet phase synchronization of auditory late responses (ALR) single sweeps allows for a direct online monitoring of phase locked auditory attention. The results show that after a simple training, subjects learned to control their attention to the auditory modality. To improve the ability in the attention control system is an objective of many tinnitus treatments, so that the perception of the patients towards the tinnitus noise can be reduced to a minimum. It is concluded that our proposed neurofeedback system by wavelet phase synchronization measure might be used in a clinical treatment of tinnitus patients and it is possible to extent to other therapeutic based control systems.

Comment on “Neurofeedback Overtraining and the Vulnerable Patient”

Instead of looking at impediments to neurofeedback treatment successes as indicative of client vulnerabilities, understanding client sensitivity, hardiness, reactivity, and behavioral suppression, the therapist can better predict the course of treatment, provide an enhanced basis for continuous informed consent, and reframe self-perceived deficits as validation of patient talents. A self-report questionnaire is appended.

The Impact of Neurotherapy on College Students' Cognitive Abilities and Emotions

Background. In past research, several case studies and five controlled-group studies explored the effect of electroencephalographic (EEG) biofeedback on intelligence, attention, and behavior in children diagnosed with attention deficit hyperactivity disorder, but no studies have explored the effects of EEG biofeedback in nonclinical adults on measures of response control, mood, emotional intelligence, and self-efficacy. Method. Sixteen nonclinical college students were randomly assigned to receive Beta/Sensory Motor Rhythm EEG biofeedback to increase 12 to 15 Hz activity while inhibiting 4 to 7 Hz and 22 to 36 Hz activity. A control group received placebo EEG biofeedback. All participants completed pre- and postmeasures assessing intelligence scores, attention, impulse control, mood, emotional intelligence, and self-efficacy to assess the effect of EEG biofeedback. Results. Results showed significant improvements in response control but no improvements in attention. Measures of intelligence and emotional functioning did not change after EEG biofeedback. Conclusions. This study indicates that response control may improve in a few as 20 EEG biofeedback sessions. Implications and shortcomings discussed.

Positive behavioral and electrophysiological changes following neurofeedback training in children with autism

Two electrophysiological studies tested the hypothesis that operant conditioning of mu rhythms via neurofeedback training can renormalize mu suppression, an index of mirror neuron activity, and improve behavior in children diagnosed with autism spectrum disorders (ASD). In Study 1, eight high-functioning ASD participants were assigned to placebo or experimental groups before 10 weeks of training of the mu frequency band (8-13 Hz). Following training, experimental participants showed decreased mu power and coherence, increased sustained attention ability, and improved scores on subscales of the ATEC compared to the placebo group. Both groups showed improvement in imitation ability. In Study 2, 19 high-functioning ASD children underwent a similar procedure with verified diagnoses, a modified double-blind protocol, and training of the high mu band (10-13 Hz). The results showed decreases in amplitude but increases in phase coherence in mu rhythms and normalization of mu rhythm suppression in experimental participants compared to placebo. Furthermore, like Study 1, participants showed improvements in sustained attention and in ATEC scores but no improvements in imitation following training. This suggests that training of the mu rhythm can be effective in producing changes in EEG and behavior in high-functioning ASD children, but does not affect imitation behavior per se

Comparison of Discrete-Trial-Based SMR and SCP Training and the Interrelationship Between SCP and SMR Networks: Implications for Brain–Computer Interfaces and Neurofeedback

Background. Operant conditioning of one's slow cortical potential (SCP) or sensorimotor rhythm (SMR) can be used to control epilepsy or to manipulate external devices, as applied in BCI (Brain-Computer Interface). A commonly accepted view that both SCP and SMR are reflections of central arousal suggests a functional relationship between SCP and SMR networks. Method. The operant conditioning of SCP or SMR was tested with a single electroencephalographic (EEG) channel wireless biofeedback system. A series of trainings taught 19 participants to control SCP or SMR over vertex during 20 neurofeedback sessions. Each session consisted of 96 trials to decrease cortical arousal (SCP positivity/SMR enhancement) and 64 trials to increase cortical arousal (SCP negativity/SMR suppression). In each trial, participants were required to exceed an individual threshold level of the feedback parameter relative to a 500-msec prefeedback baseline and to hold this level for 2 sec (SCP) or 0.5 sec (SMR) to obtain reinforcement. Results. Ten of the 19 participants achieved control over their EEG. In the SCP-trained group, 4 of 9 participants increased the differentiation between their SCP responses on positivity-required versus negativity-required trials. SMR suppression and enhancement was achieved by 3 and 4 of the 10 SMR-trained participants. The SMR-trained responders did not show differentiation in their SMR responses, but did show a differentiation in their SCP response—while trained on SMR. Conclusions. The results showed the proposed method was successful to teach control of SCP or SMR. Bidirectional control was very difficult to achieve with the present SMR training procedure. SCP positivity and SMR enhancement were easier to learn. The results suggest that SMR training modulates excitability thresholds in the striatal-thalamocortical motor loop, whereas changes in the loop's excitability thresholds by SCP training do not affect the thalamic bursting that underlies the SMR.

Can the Brain be Trained? Comparing the Literature on the Use of EEG Biofeedback/Neurofeedback as an Alternative or Complementary Therapy for Attention Deficit Hyperactivity Disorder (ADHD)

Psychologists, social workers, and school counselors are increasingly adding neurofeedback (NFT), a controversial alternative or complementary therapy to their treatment plans for patients with Attention Deficit Hyperactivity Disorder. NFT involves training the patient in self-regulation of brain wave patterns, employing a standard diagnostic tool, the EEG, in an interactive operant conditioning mode not often used by neurologists or psychiatrists. Some NFT therapists claim in their books that they have sufficient expertise to advise parents against the use of Ritalin™ and amphetamines, which are part of the conventional multimodal therapy strongly endorsed in a wide variety of clinical publications. In return, some of the leading conventional physicians and Ph.D. researchers in the field of ADHD have traditionally ignored or disparaged the literature of NFT as being insufficiently scientific and appearing largely in obscure journals or books published outside the mainstream medical presses. While most librarians are unlikely to have sufficient scientific or clinical credentials to pass judgment, one way or another, on NFT as a treatment for ADHD, an examination of the credentials of authors, their books, book reviews, journals, and the publishers in which opponents and proponents make their case is entirely within our purview, and such an analysis is provided.

EEG Neurofeedback Treatment of Patients with Down Syndrome

Down syndrome is the most common identifiable cause of intellectual disability, accounting for almost one third of cases and approximately 1 in 800 births. Neurofeedback (NF) is an operant conditioning method for retraining brain wave (EEG) patterns. An increasing number of clinicians use operant conditioning of EEG activity as a method of helping children with Attention Deficit Hyperactivity and Generalized Learning Disability (ADHD/ADD or GLDO). Some Down syndrome children display symptoms of ADHD/ADD, GLDO or both. We believed that NF may have potential in helping children with Down syndrome. Methodology: Eight children with Down Syndrome (ages 6-14) were evaluated through questionnaire, parent interview, and pre- and post-treatment quantitative EEG's. All eight children were seen by the first author and by the special educator at the baseline, and at the 20th, 40th and 60th treatment sessions. Pre-treatment QEEGs were analyzed using the NxLink normative database and generally showed excess delta and theta EEG patterns. None of the subjects were able to speak more than one word sentences and they had very limited vocabulary (between 5-10 words). They usually pointed a finger to communicate and were not able to engage in basic conversation. All children displayed very poor attention and concentration, poor memory, impulsivity, behavior problems, in some cases balance problems. The purpose of this preliminary study was to evaluate whether QEEG guided, bipolar montage NF training is effective in developing speech, improving attention and concentration, improving learning, decreasing behavioral problems or impulsivity, and alleviating balance problems in Down Syndrome children. All subjects were medication-free during treatment. NF training was conducted using Lexicor Biolex software with electrode placement guided by QEEG findings, seeking to normalize abnormal QEEG patterns. Training continued until the subjects demonstrated improvement and there were significant improvements in the reports of parents, or until a total of 60 treatment sessions were provided. Scores derived from a combination of questionnaire and parental ratings were obtained pre- and post-treatment in the areas of memory, speech and language, attention, behavior, and balance. Results. One subject dropped out after eight sessions. All seven children who completed NF training showed significant (p < .02) improvement in all areas evaluated based on the questionnaire and parent interviewing, and changes were found in QEEGs. Further study with a control group and additional outcome measures is warranted. © by The Haworth Press, Inc. All rights reserved.

Neurofeedback for treating tinnitus

Many individuals with tinnitus have abnormal oscillatory brain activity. Led by this finding, we have developed a way to normalize such pathological activity by neurofeedback techniques (Weisz et al. (2005). PLoS Med., 2: e153). This is achieved mainly through enhancement of tau activity, i.e., oscillatory activity produced in perisylvian regions within the alpha frequency range (8-12 Hz) and concomitant reduction in delta power range (0.5-4 Hz). This activity is recorded from electrodes placed on the frontal scalp. We have found that modification of the tau-to-delta ratio significantly reduces tinnitus intensity. Participants who successfully modified their oscillatory pattern profited from the treatment to the extent that the tinnitus sensation became completely abolished. Overall, this neurofeedback training was significantly superiorin reducing tinnitus-related distress than frequency discrimination training.

Place of electroencephalograpic biofeedback for attention-deficit/hyperactivity disorder.

Neurofeedback in fibromyalgia syndrome

EEG Biofeedback (Neurofeedback-NFB) is a learning strategy that enables people to alter their brainwaves. In the present case study, we applied a NFB protocol on three patients with Fibromyalgia Syndrome (FMS). The existing symptoms and clinical conditions of the patients attributed to FMS, Visual Analog Scale for pain and fatigue, Hamilton Depression and Anxiety Inventory Scales, Beck Depression and Anxiety Inventory Scales, and SF-36 were recorded before and after NFB training. Most of the symptoms were decreased after ten sessions. There was also improvement in all of the scales after the treatment. The results of the present study may suggest NFB training as a novel treatment method in FMS.

Annotation: Neurofeedback – train your brain to train behaviour

Background:  Neurofeedback (NF) is a form of behavioural training aimed at developing skills for self-regulation of brain activity. Within the past decade, several NF studies have been published that tend to overcome the methodological shortcomings of earlier studies. This annotation describes the methodical basis of NF and reviews the evidence base for its clinical efficacy and effectiveness in neuropsychiatric disorders. Methods:  In NF training, self-regulation of specific aspects of electrical brain activity is acquired by means of immediate feedback and positive reinforcement. In frequency training, activity in different EEG frequency bands has to be decreased or increased. Training of slow cortical potentials (SCPs) addresses the regulation of cortical excitability. Results:  NF studies revealed paradigm-specific effects on, e.g., attention and memory processes and performance improvements in real-life conditions, in healthy subjects as well as in patients. In several studies it was shown that children with attention-deficit hyperactivity disorder (ADHD) improved behavioural and cognitive variables after frequency (e.g., theta/beta) training or SCP training. Neurophysiological effects could also be measured. However, specific and unspecific training effects could not be disentangled in these studies. For drug-resistant patients with epilepsy, significant and long-lasting decreases of seizure frequency and intensity through SCP training were documented in a series of studies. For other child psychiatric disorders (e.g., tic disorders, anxiety, and autism) only preliminary investigations are available. Conclusions:  There is growing evidence for NF as a valuable treatment module in neuropsychiatric disorders. Further, controlled studies are necessary to establish clinical efficacy and effectiveness and to learn more about the mechanisms underlying successful training.

Neurofeedback for Children with ADHD: A Comparison of SCP and Theta/Beta Protocols

Behavioral and cognitive improvements in children with ADHD have been consistently reported after neurofeedback-treatment. However, neurofeedback has not been commonly accepted as a treatment for ADHD. This study addresses previous methodological shortcomings while comparing a neurofeedback-training of Theta-Beta frequencies and training of slow cortical potentials (SCPs). The study aimed at answering (a) whether patients were able to demonstrate learning of cortical self-regulation, (b) if treatment leads to an improvement in cognition and behavior and (c) if the two experimental groups differ in cognitive and behavioral outcome variables. SCP participants were trained to produce positive and negative SCP-shifts while the Theta/Beta participants were trained to suppress Theta (4–8 Hz) while increasing Beta (12–20 Hz). Participants were blind to group assignment. Assessment included potentially confounding variables. Each group was comprised of 19 children with ADHD (aged 8–13 years). The treatment procedure consisted of three phases of 10 sessions each. Both groups were able to intentionally regulate cortical activity and improved in attention and IQ. Parents and teachers reported significant behavioral and cognitive improvements. Clinical effects for both groups remained stable six months after treatment. Groups did not differ in behavioural or cognitive outcome.

Changes in EEG Spectrograms, Event-Related Potentials and Event-Related Desynchronization Induced by Relative Beta Training in ADHD Children

Background. During the last three decades EEG-based biofeedback (neurofeedback) was used as an alternative treatment for reducing symptoms of ADHD. The goal of this study was to objectively assess the efficacy of biofeedback training by comparing spectrograms, ERPs and ERDs, measured before and after 20 sessions of neurotherapy in a group of ADHD children. Method. Electroencephalogram (EEG), Event related potentials (ERPs) and event related synchronisation/desynchronisation (ERD/ERS) were recorded and computed in auditory GO/NOGO task before and after 15-22 sessions of EEG biofeedback. Eighty-six ADHD children participated in the study. Each session consisted of 30 min of relative beta training. The patients were divided into two groups (good performers and poor performers) depending on their ability to elevate beta activity during sessions. Results. Amplitude of late positive components of evoked potentials in response to NOGOstimuli increased, and event-related synchronisation in alpha frequency band measured at central areas decreased after the whole set of sessions of neurofeedback training in the group of good performers but did not change for the poor performers group. Evoked potential differences between post- and pre-treatment conditions for good performers were distributed over frontal-central areas, reflecting activation of frontal cortical areas associated with beta training. Conclusion. Relative beta training with electrodes located above the frontal areas was associated with an increase of the late positive NOGO component. This activation likely indicates recovery of normal functioning of the executive system

Assessment-guided neurofeedback for autistic spectrum disorder

Research reviewing the epidemiology of Autism (Medical Research Council, 2001) indicated that approximately 60 per 10,000 children (1/166) are diagnosed with Autistic Spectrum Disorder (ASD). Jarusiewicz (2002) published the only controlled study documenting the effectiveness of neurofeedback for Autism based on one outcome measure. The present study extended these findings with a larger sample size, broader range of assessments, and physiological measures of brain functioning. Methods. Assessment-guided neurofeedback was conducted in 20 sessions for 37 patients with ASD. The experimental and control groups were matched for age, gender, race, handedness, other treatments, and severity of ASD. Results. Improved ratings of ASD symptoms reflected an 89% success rate. Statistical analyses revealed significant improvement in Autistics who received Neurofeedback compared to a wait list control group. Other major findings included a 40% reduction in core ASD symptomatology (indicated by ATEC Total Scores), and 76% of the experimental group had decreased hyperconnectivity. Reduced cerebral hyperconnectivity was associated with positive clinical outcomes in this population. In all cases of reported improvement in ASD symptomatology, positive treatment outcomes were confirmed by neuropsychological and neurophysiological assessment. Conclusions. Evidence from multiple measures has demonstrated that neurofeedback can be an effective treatment for ASD. In this population, a crucial factor in explaining improved clinical outcomes in the experimental group may be the use of assessment-guided neurofeedback to reduce cerebral hyperconnectivity. Implications of these findings are discussed.

Neurofeedback Treatment of Two Children with Learning, Attention, Mood, Social, and Developmental Deficits

Background. Neurofeedback is biofeedback training of EEG activity through an operant conditioning process by which the individual is trained to increase or inhibit the brain's production of electrical activity in specific frequency ranges. Studies have demonstrated efficacy with a variety of disorders, including attention deficit hyperactivity disorder (ADHD), learning problems, and autistic features. This paper describes the application of neurofeedback in a clinical setting with two complex children who manifested multiple diagnoses, including learning disabilities (LD), ADHD, social deficits, mood disorders, and pervasive developmental disorder (PDD). Both boys had adjusted poorly to school, family, and peers. Methods. Subjects were referred to the author's clinical practice. They received individualized protocols based on their symptoms and functional impairments. They were administered semi-weekly 20-minute sessions of one-channel neurofeedback training for approximately six months. In both cases symptoms were identified and tracked with a parent rating scale and one case, with the Symptom Assessment-45 Questionnaire (SA-45) also. Results. Each boy improved in all tracked symptoms without adverse effects. One improved on most measures of the SA-45 with no deterioration on any measure. Functional improvements in academic functioning, home behavior, and peer relationships were indicated. Conclusions. Neurofeed back was a successful treatment for these two multi-symptomatic and diagnosed boys, whose improvements surpassed the gainsmade with previous therapies. The advantages of neurofeedback include the relative absence of observable adverse effects, the lack of reliance on medication with its possible side effects and noncompliance, and the possibility of long-term gains without continued intervention.

Self-regulation of Slow Cortical Potentials: A New Treatment for Children With Attention-Deficit/Hyperactivity Disorder

OBJECTIVE. We investigated the effects of self-regulation of slow cortical potentials for children with attention-deficit/hyperactivity disorder. Slow cortical potentials are slow event-related direct-current shifts of the electroencephalogram. Slow cortical potential shifts in the electrical negative direction reflect the depolarization of large cortical cell assemblies, reducing their excitation threshold. This training aims at regulation of cortical excitation thresholds considered to be impaired in children with attention-deficit/hyperactivity disorder. Electroencephalographic data from the training and the 6-month follow-up are reported, as are changes in behavior and cognition. METHOD. Twenty-three children with attention-deficit/hyperactivity disorder aged between 8 and 13 years received 30 sessions of self-regulation training of slow cortical potentials in 3 phases of 10 sessions each. Increasing and decreasing slow cortical potentials at central brain regions was fed back visually and auditorily. Transfer trials without feedback were intermixed with feedback trials to allow generalization to everyday-life situations. In addition to the neurofeedback sessions, children exercised during the third training phase to apply the self-regulation strategy while doing their homework. RESULTS. For the first time, electroencephalographic data during the course of slow cortical potential neurofeedback are reported. Measurement before and after the trials showed that children with attention-deficit/hyperactivity disorder learn to regulate negative slow cortical potentials. After training, significant improvement in behavior, attention, and IQ score was observed. The behavior ratings included Diagnostic and Statistical Manual of Mental Disorders criteria, number of problems, and social behavior at school and were conducted by parents and teachers. The cognitive variables were assessed with the Wechsler Intelligence Scale for Children and with a computerized test battery that measures several components of attention. All changes proved to be stable at 6 months' follow-up after the end of training. Clinical outcome was predicted by the ability to produce negative potential shifts in transfer sessions without feedback. CONCLUSIONS. According to the guidelines of the efficacy of treatments, the evidence of the efficacy of slow cortical potential feedback found in this study reaches level 2: “possibly efficacious.” In the absence of a control group, no causal relationship between observed improvements and the ability to regulate brain activity can be made. However, it could be shown for the first time that good performance in self-regulation predicts clinical outcome. “Good performance” was defined as the ability to produce negative potential shifts in trials without feedback, because it is known that the ability to self-regulate without feedback is impaired in children and adults with attention problems. Additional research should focus on the control of unspecific effects, medication, and subtypes to confirm the assumption that slow cortical potential feedback is a viable treatment option for attention-deficit/hyperactivity disorder. Regulation of slow cortical potentials may involve similar neurobiological pathways as medical treatment. It is suggested that regulation of frontocentral negative slow cortical potentials affects the cholinergic-dopaminergic balance and allows children to adapt to task requirements more flexibly.

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

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 increased 22 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 biofeedback also showing improved intelligence following EEG biofeedback.

Follow-Up Study of Learning-Disabled Children Treated with Neurofeedback or Placebo

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 theta Relative Power values; the absence of positive behavioral changes continued and the neurological diagnosis remained LD. In contrast, after 2 years EEG maturation did continue in children who belonged to the Experimental Group with previous neurofeedback training; this was accompanied by positive behavioral changes, which were reflected in remission of LD symptoms.

The Boys Totem Town Neurofeedback Project: A Pilot Study of EEG Biofeedback with Incarcerated Juvenile Felons

Seven male adolescents, ages 14 to 17 who were in a juvenile detention residential treatment program and diagnosed with the combined type of Attention Deficit Hyperactivity Disorder (ADHD-C) or with Conduct Disorder, participated in a study examining the effects of electroencephalographic (EEG) neurofeedback on sustained attention, response inhibition, executive functions, intellectual ability, and memory. All of the participants received 20 sessions of EEG biofeedback therapy in conjunction with treatment received in a residential program. Pre- and post-treatment measures were collected within one week of treatment, and data were analyzed using an adapted model of Jacobson and Truax's method of clinically significant change (Jacobson & Truax, 1991) which allows criterion scores to be set and 95 percent confidence intervals determined at the level of individual performance on the collected measures. Sixty-four percent experienced improved performance after EEG neurofeedback on one or more measures. Clinically significant and reliable improvements were observed on teacher ratings of the Global Executive Composite from the Behavior Rating Inventory of Executive Function (average improvement = .22 mean item raw score points; Gioia, Isquith, Guy, & Kenworthy, 2000). Normal range performance was enhanced on the Composite IQ measure of the Kaufman Brief Intelligence Test (average gain = 9 points; Kaufman & Kaufman, 1990), on the Omissions subscale from the Conners' Continuous Performance Test (average decrease = 13 errors; Conners, 1994) and on the four subtest screening measures from the Wide Range Assessment of Memory and Learning (Sheslow & Adams, 1990), with average gains ranging from 2.0 to 3.67 scaled score points across the four subtests. The results are consistent with previous findings, and suggest that the methodology used for data analysis is a useful tool to assess individual levels of change, and indicate that EEG biofeedback may be a useful adjunct in the treatment of juvenile offenders.

The neurophysiology of dyslexia: A selective review with implications for neurofeedback remediation and results of treatment in twelve consecutive patients

Dyslexia is a common and important problem in all industrial societies, with a prevalence rate of five to ten percent, for which no consistently effective treatment is available. Recent advances in imaging (morphometric MRI, functional MRI, PET, regional cerebral blood flow), as well as in neurophysiology (evoked potentials, QEEG, event-related desynchronization, coherence studies, magnetic source imaging, reading difference topography) have clarified our understanding of the normal circuitry involved in reading and differences seen in individuals who have trouble learning to read. These studies have important implications for the use of neurofeedback to help dyslexic individuals learn to read more easily. First, we obtain a QEEG and a reading difference topograph. We then train down any abnormalities that are significantly increased and train up any abnormalities that are significantly decreased. Increasing 16–18 Hz activity at T3 (left mid-temporal area) has also proved quite helpful in improving reading speed and comprehension. These combined approaches have been helpful in all cases of dyslexia we have treated, dramatically so in some cases. Each of the 12 individuals treated improved by at least two grade levels after 30 to 35 sessions.

EEG Spectral-Power and Coherence: LORETA Neurofeedback Training in the Anterior Cingulate Gyrus

Introduction. This study examines the EEG spectral power and coherence changes that occur as a result of LORETA neurofeedback (LNFB) training, which is a recently developed spatial-specific neurofeedback protocol in which it has been demonstrated that human beings can learn to change activity in their own anterior cingulate gyrus. We trained individuals to increase low-beta (14-18 Hz) activity in the cognitive division of the anterior cingulate gyrus (ACcd). Methods. This study was conducted with eight non-clinical students with a mean age of 22. The participants completed over 30 sessions of LNFB training. We utilized the WAIS-III for pre- and post-psychometric measures to assess the influence of this training protocol. Results. We selected training Sessions 5, 10, 15, 20, 25, and 30 for comparison to Session 1. There are significant increases in absolute power and coherence over sessions. There is significant increase in the working memory and processing speed subtest scores. Discussion. The anterior regions of the cortex increase in the low-beta frequency relative to the ACcd at significant levels. The superior prefrontal cortex and occipital regions increase in the higher beta frequencies, but not in the trained frequency. The improvements in the working memory and processing speed scores suggest that LNFB had an overall positive effect in attentional processes, working memory, and processing speed.

Neurofeedback with Juvenile Offenders: A Pilot Study in the Use of QEEG-Based and Analog-Based Remedial Neurofeedback Training

Introduction. Atypical EEG and neuropsychological indicators have been observed among offenders. Dangerous offenders treated with a combined program that included neurofeedback (EEG biofeedback) and galvanic skin response (GSR) biofeedback demonstrated reduction in recidivism (Quirk, 1995). This study was designed to further evaluate the EEG findings of youth offenders and to provide an initial report on the effectiveness of a task oriented analog/QEEG-based remedial neurofeedback training approach. Method. Five offenders with significant psychopathology were referred for treatment. The group was evaluated with attentional testing and analog/QEEG assessment prior to and following neurotherapy. Treatment consisted of 20 or 40 sessions of a task-activated, analog/QEEG-based approach. Another group of thirteen offenders were assessed with attentional testing and provided with neurotherapy following QEEG assessment. Results. For all of the youth trained, in the analog/QEEG group, pre- vs. post-audio and visual attention testing demonstrated significant improvement within 20 remedial sessions. Three of the five youth showed rapid advancement in a residential grading system. Staff observational ratings suggested behavioral improvement in the QEEG group who in general were in training for a longer period of time. Conclusion. EEG abnormalities and deficits in neuropsychological testing were found among offenders. Neurotherapy as an adjunctive treatment appears to hold promise for improvement in cognitive performance as well as recidivism. It is anticipated that different neurofeedback protocols may enhance outcomes.

Electroencephalographic biofeedback in the treatment of attention-deficit/hyperactivity disorder

Historically, pharmacological treatments for attentiondeficit/ hyperactivity disorder (ADHD) have been considered to be the only type of interventions effective for reducing the core symptoms of this condition. However, during the past three decades, a series of caseand controlled-group studies examining the effects of EEG biofeedback have reported improved attention and behavioral control, increased cortical activation on quantitative electroencephalographic examination, and gains on tests of intelligence and academic achievement in response to this type of treatment. This review paper critically examines the empirical evidence, applying the efficacy guidelines jointly established by the Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neuronal Regulation (ISNR). On the basis of these scientific principles, EEG biofeedback was determined to be "probably efficacious" for the treatment of ADHD. Although significant clinical improvement was reported in approximately 75% of the patients in each of the published research studies, additional randomized, controlled group studies are needed in order to provide a better estimate of the percentage of patients with ADHD who will demonstrate such gains in clinical practice

Emerging brain-based interventions for children and adolescents: overview and clinical perspective

Electroencephalogram biofeedback (EBF), repetitive transcranial magnetic stimulation (rTMS), and vagal nerve stimulation (VNS) are emerging interventions that attempt to directly impact brain function through neurostimulation and neurofeedback mechanisms. This article provides a brief overview of each of these techniques, summarizes the relevant research findings, and examines the implications of this research for practice standards based on the guidelines for recommending evidence based treatments as developed by the American Academy of Child and Adolescent Psychiatry for attention deficit hyperactivity disorder (ADHD). EBF meets the "Clinical Guidelines" standard for ADHD, seizure disorders, anxiety, depression, and traumatic brain injury. VNS meets this same standard for treatment of refractory epilepsy and meets the lower "Options" standard for several other disorders. rTMS meets the standard for "Clinical Guidelines" for bipolar disorder, unipolar disorder, and schizophrenia. Several conditions are discussed regarding the use of evidence based thinking related to these emerging interventions and future directions.

Neurofeedback Treatment of Depression and Anxiety

A robust body of research documents that there are biological predispositions that often exist for depression, anxiety, and obsessive-compulsive disorder. However, new research has shown that medication is only mildly more effective than placebo in the treatment of these problems. In treating these conditions, neurofeedback (EEG biofeedback) may offer an alternative to invasive treatments such as medication, ECT, and intense levels of transcrancial magnetic stimulation. This paper reviews the neurofeedback literature with these problems, finding particularly positive research support for the treatment of anxiety disorders. New findings on the neurofeedback treatment of depression are presented.

ERPs correlates of EEG relative beta training in ADHD children

Eighty-six children (ages 9–14) with attention deficit hyperactivity disorder (ADHD) participated in this study. Event-related potentials (ERPs) were recorded in auditory GO/NOGO task before and after 15–22 sessions of EEG biofeedback. Each session consisted of 20 min of enhancing the ratio of the EEG power in 15–18 Hz band to the EEG power in the rest of spectrum, and 7–10 min of enhancing of the ratio of the EEG power in 12–15 Hz to the EEG power in the rest of spectrum with C3-Fz electrodes' placements for the first protocol and C4-Pz for the second protocol. On the basis of quality of performance during training sessions, the patients were divided into two groups: good performers and bad performers. ERPs of good performers to GO and NOGO cues gained positive components evoked within 180–420 ms latency. At the same time, no statistically significant differences between pre- and post-training ERPs were observed for bad performers. The ERP differences between post- and pretreatment conditions for good performers were distributed over frontal–central areas and appear to reflect an activation of frontal cortical areas associated with beta training.

Critical validation studies of neurofeedback

Electroencephalographic biofeedback (neurotherapy) as a treatment for attention deficit hyperactivity disorder: rationale and empirical foundation

During the past three decades, electroencephalographic (EEG) biofeedback has emerged as a nonpharmacologic treatment for attention-deficit/hyperactivity disorder (ADHD). This intervention was derived from operant conditioning studies that demonstrated capacity for neurophysiologic training in humans and other mammals and targets atypical patterns of cortical activation that have been identified consistently in neuroimaging and quantitative EEG studies of patients diagnosed with ADHD. This article presents the rationale for EEG biofeedback and examines the empirical support for this treatment using efficacy guidelines established by the Association for Applied Psychophysiology and Biofeedback and the International Society for Neuronal Regulation. Based on these guidelines, EEG biofeedback is considered to be "probably efficacious" for the treatment of ADHD and merits consideration as a treatment for patients who are stimulant "nonresponders." Although research findings published to date indicate positive clinical response in approximately 75% of patients treated in controlled group studies, additional randomized, controlled trials are needed to provide a better estimate of the robustness of this treatment.

Electroencephalogram biofeedback for reading disability and traumatic brain injury

The application of electroencephalogram (EEG) biofeedback with reading disability and traumatic brain injury (TBI) is relatively recent. There are many studies regarding the effectiveness (improving attention and IQ scores) of EEG biofeedback in patients with attention deficit hyperactivity disorder, who are known to have a high rate of comorbidity for learning disabilities. This suggests the possibility that EEG biofeedback specifically aimed at remediating reading disability and TBI would be effective. This article provides strong initial support for this idea and provides reason to believe that assessment and training under task conditions are likely to be fruitful. Given the significance of these problems and the absence of very effective alternatives for remediation of these conditions, efforts to complete the needed research seem warranted. Clinical use of this intervention seems to be warranted with informed consent.

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

The current choice of treatment for the remediation of attentional and behavioural difficulties among primary school children with special educational needs (SEN) is, increasingly, pharmacological. If neurofeedback can regulate brain arousal states and thereby improve attention, behaviour and readiness to learn, there may be a case for incorporating it into the special needs provision of mainstream primary schools, thus avoiding the use of potentially damaging stimulant medication as a means of controlling behaviour and promoting inclusion. An experimental design was used, employing the TOVA test as a pre-/post-test measure of attention and the TOVA rating scale as parental pre/post measure of behaviour, plus qualitative feedback as a post-treatment measure of attention/behaviour. Results indicate that neurofeedback may make an important impact on emotions and affect of the SEN individual, leading to improved behaviour 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 behaviour; incorporating neurofeedback as part of the school-based special needs provision is feasible and practicable.

Increasing Individual Upper Alpha Power by Neurofeedback Improves Cognitive Performance in Human Subjects

The hypothesis was tested of whether neurofeedback training (NFT)—applied in order to increase upper alpha but decrease theta power—is capable of increasing cognitive performance. A mental rotation task was performed before and after upper alpha and theta NFT. Only those subjects who were able to increase their upper alpha power (responders) performed better on mental rotations after NFT. Training success (extent of NFT-induced increase in upper alpha power) was positively correlated with the improvement in cognitive performance. Furthermore, the EEG of NFT responders showed a significant increase in reference upper alpha power (i.e. in a time interval preceding mental rotation). This is in line with studies showing that increased upper alpha power in a prestimulus (reference) interval is related to good cognitive performance.

Neurofeedback and the Brain

Neurofeedback is an emerging neuroscience-based clinical application, and understanding the underlying principles of neurofeedback allows the therapist to provide referrals or treatment, and provides clients with a framework for understanding the process. The brain’s electrical patterns are a form of behavior, modifiable through “operant conditioning,” with the excessive brain frequencies reduced, and those with a deficit are increased. The learning curve for EEG has been described (Hardt, 1975).

Neurofeedback: An Alternative and Efficacious Treatment for Attention Deficit Hyperactivity Disorder

Current research has shown that neurofeedback, or EEG biofeedback as it is sometimes called, is a viable alternative treatment for Attention Deficit Hyperactivity Disorder (ADHD). The aim of this article is to illustrate current treatment modalities(s), compare them to neurofeedback, and present the benefits of utilizing this method of treatment to control and potentially alleviate the symptoms of ADHD. In addition, this article examines the prevalence rates and possible etiology of ADHD, the factors associated with ADHD and brain dysfunction, the current pharmacological treatments of ADHD, Ritalin, and the potential risks and side effects. Behavior modification and cognitive behavioral treatment for ADHD is discussed as well. Lastly, a brief history of the study of neurofeedback, treatment successes and clinical benefits, comparisons to medication, and limitations are presented.

Intentional Increase of Cerebral Blood Oxygenation Using Hemoencephalography (HEG): An Efficient Brain Exercise Therapy

Intentional enhancement of regional cerebral blood oxygenation (rCBO2) in specific cerebral locations was studied as a brain exercise. A review of literature showed the effect of brain exercise on brain physiology. Hemoencephalography (HEG), a graphic analog of brain blood flow of oxygenated hemoglobin indicated by non-invasive infrared spectroscopy, was used to guide intentionally increasing rCBO2. A musical note and visual graphic keyed to changes in cortical blood oxygenation was provided to the participant. A primary aim of this study was to demonstrate the capacity of subjects with brain disorders to increase oxygenation of selected brain tissue using HEG and test the hypothesis that multiple repetitions of these brain exercises improved sustained attention measured with a continuous performance test. The impulsivity score for subjects in the exercise group was in the normal range after 10 sessions. In a small set of subjects, low arousal SPECT images showed increased vascularity after 30 half-hour sessions of intentional enhancement of local blood oxygenation.

Effects of electroencephalogram biofeedback with Asperger's syndrome

This article reports the pilot study of electroencephalogram (EEG) biofeedback to improve focusing and decrease anxiety in 10 adolescent boys diagnosed with Asperger's syndrome attending a therapeutic day school. Five of the boys dropped out of the study before 12 sessions were completed. The analysis of pre- and post-intervention quantitative EEGs for the five students who completed the study showed a trend to "normalization", but did not reach statistical significance. All five boys who completed 24 sessions showed improved behavior as rated by parents and teachers, but other factors, such as maturation could not be ruled out as causes of the improvement. The challenges facing this research and proposals for further exploration are outlined.

Interhemispheric EEG Training

Early clinical experience in this field with what has been commonly called beta/SMR training, as opposed to alpha/theta, primarily involved training on the central (sensorimotor) strip. Our initial EEG training beginning in 1988 followed the work of Margaret Ayers, Barry Sterman, Joel Lubar and Michael Tansey by training either beta (nominally 15-18 Hz) or SMR (nominally 12-15 Hz) left, right or center on the central strip. Our experience with training left and right hemispheres separately with different reward frequencies actually led us to resist interhemispheric training for some time. Even though we were aware of the work of Quirk and Von Hilsheimer with C3-C4 SMR, we could not see how two hemispheres that needed to train at different frequencies could be trained together effectively with one reward frequency. Over time we developed the approach of balancing left-side beta and right-side SMR training for each individual in every session. It was clear that left-side training was more effective and more comfortable with a slightly higher frequency reward than that for right-side training. There emerged an identification of left-side deficits with under-activation and right-side deficits with overarousal. Since there was also an arousal shift for the entire physiology as we rewarded higher (beta) or lower (SMR) frequencies, we found that we needed to balance left-side activation with right-side calming for each individualaccordingtoarousallevel,symptomsandsensitivitytotraining.

Neurofeedback with anxiety and affective disorders

A robust body of neurophysiologic research is reviewed on functional brain abnormalities associated with depression, anxiety, and obsessive-compulsive disorder. A review of more recent research finds that pharmacologic treatment may not be as effective as previously believed. A more recent neuroscience technology, electroencephalographic (EEG) biofeedback (neurofeedback), seems to hold promise as a methodology for retraining abnormal brain wave patterns. It has been associated with minimal side effects and is less invasive than other methods for addressing biologic brain disorders. Literature is reviewed on the use of neurofeedback with anxiety disorders, including posttraumatic stress disorder and obsessive-compulsive disorder, and with depression. Case examples are provided.

The Effectiveness of Neurofeedback and Stimulant Drugs in Treating AD/HD: Part I. Review of Methodological Issues

The paper examines major criticisms of AD/HD (Attention Deficit/Hyperactivity Disorder) neurofeedback research using T. R. Rossiter and T. J. La Vaque (1995) as an exemplar and discusses relevant aspects of research methodology. J. Lohr, S. Meunier, L. Parker, and J. P. Kline (2001), D. A. Waschbusch and G. P. Hill (2001), and J. P. Kline, C. N. Brann, and B. R. Loney (2002) criticized Rossiter and La Vaque for (1) using an active treatment control; (2) nonrandom assignment of patients; (3) provision of collateral treatments; (4) using nonstandardized and invalid assessment instruments; (5) providing artifact contaminated EEG feedback; and (6) conducting multiple non-alpha protected t tests. The criticisms, except those related to statistical analysis, are invalid or are not supported as presented by the authors. They are based on the critics' unsubstantiated opinions; require redefining Rossiter and La Vaque as an efficacy rather than an effectiveness study; or reflect a lack of familiarity with the research literature. However, there are broader issues to be considered. Specifically, what research methodology is appropriate for studies evaluating the effectiveness of neurofeedback and who should make that determination? The uncritical acceptance and implementation of models developed for psychotherapy, pharmacology, or medical research is premature and ill-advised. Neurofeedback researchers should develop models that are appropriate to the technology, treatment paradigms, and goals of neurofeedback outcome studies. They need to explain the rationale for their research methodology and defend their choices.

Neurofeedback Training with Virtual Reality for Inattention and Impulsiveness

In this research, the effectiveness of neurofeedback, along with virtual reality (VR), in reducing the level of inattention and impulsiveness was investigated. Twenty-eight male participants, aged 14–18, with social problems, took part in this study. They were separated into three groups: a control group, a VR group, and a non-VR group. The VR and non-VR groups underwent eight sessions of neurofeedback training over 2 weeks, while the control group just waited during the same period. The VR group used a head-mounted display (HMD) and a head tracker, which let them look around the virtual world. Conversely, the non-VR group used only a computer monitor with a fixed viewpoint. All participants performed a continuous performance task (CPT) before and after the complete training session. The results showed that both the VR and non-VR groups achieved better scores in the CPT after the training session, while the control group showed no significant difference. Compared with the other groups, the VR group presented a tendency to get better results, suggesting that immersive VR is applicable to neurofeedback for the rehabilitation of inattention and impulsiveness.

Changes in frontal brain asymmetry associated with premenstrual dysphoric disorder: A single case study

Background. In a pilot study, Baehr (2001) reports changes in frontal cortical alpha asymmetry during the luteal phase of the menstrual cycle were documented in five depressed women who also experienced Premenstrual Dysphoric Disorder (PMDD). In this paper detailed data is presented for one of these subjects and two comparison subjects who were part of the first study. The goal was two-fold: (a) to study how patterns of mood changes during the luteal phase of the menstrual cycle correlated with changes in frontal alpha brainwave asymmetry, and (b) to determine whether treatment strategies, tailored to ameliorate symptoms, would be reflected in brainwave changes. Method. Neurofeedback, medical interventions, and prospective charting were collected over a period of six months for one patient. These data were compared with data collected for two monthly cycles from two non-PMDD comparison subjects. Results. The patient responded well to the neurofeedback protocol for depression and was normalizing her scores by the second week in treatment except for setbacks which occurred during the luteal phase of her menstrual cycle. Extreme mood changes correlated with changes in brainwave asymmetry during this period. A combination of neurofeedback and medication worked to stabilize her mood swings and asymmetry scores. Conclusion. This case study demonstrated how brainwave changes in frontal alpha asymmetry occurred during the luteal phase of the menstrual cycle in a woman who suffered from PMDD. Two comparison subjects, who were undergoing similar treatment for depression but did not suffer from PMDD, had stable alpha asymmetry scores during the entire menstrual cycle. Anomalies in serotonergic and/or gabergic function in the luteal phases of PMDD are pinpointed as possible underlying factors in this disorder.

Neurofeedback as a Treatment for ADHD: A Methodological Review with Implications for Future Research

Attention deficit/hyperactivity disorder (ADHD) represents one of the most common psychiatric disorders in childhood, resulting in serious impairment across a variety of domains. Research showing that a high proportion of children with ADHD exhibit a dysfunctional electroencephalogram (EEG), relative to aged matched peers, provides a rationale for the use of neurofeedback as an intervention. The aim of neurofeedback training is to redress any EEG abnormality, resulting in a concomitant improvement in the behaviour and/or cognitive performance of these children. This review focused on studies using neurofeedback to treat children with ADHD, with particular emphasis on the methodological aspects of neurofeedback training. Specifically, the review examined the modality of feedback provided, the different training parameters and their underlying rationale, and the particular montages used. In addition, the review also focused on the duration, frequency and total number of training sessions required to obtain a positive effect in terms of a change in the individual's EEG, behaviour and/or cognitive performance. Finally, the long-term effects of neurofeedback and the potential negative side effects were reviewed. Throughout, the review provides a number of directions for future research.

The effectiveness of neurofeedback and stimulant drugs in treating AD/HD: Part II. Replication

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.

Neurofeedback for Elementary Students with Identified Learning Problems

Introduction. The goal of this research was to ascertain whether basic reading, reading comprehension, the reading composite, and IQ scores could be improved using neurofeedback. Pre-test and post-test reading and cognitive assessments were administered to sixth, seventh and eighth graders identified as having learning problems. Control and experimental groups were chosen at random. With the exception of three students, every student in the control and experimental group had previously been diagnosed with Specific Learning Disabilities or as Other Health Impaired according to State and Federal guidelines for special education services. The three students were medically diagnosed as having ADHD and were on a 504 Accommodation Plan. Method. The research began in late August 2001 with securing administrative and parental permissions. Student participation began during the last week in September and lasted through the last week in April. A day was set aside to administer QEEGs (also called "brain maps") to the students in the experimental group. Protocols were developed by following the brain maps and by using clinical judgment after staffing the students with their teachers on a regular basis; their psychoeducational evaluations were also used to plan the protocols. Following the statistics on the biofeedback machines also influenced protocol decisions. Neurofeedback training was provided to the participants of the experimental group only. Both the experimental group and the control group had their Individualized Educational Plans (IEP) or 504 Plans plus their general curriculum plans. Neurofeedback training lasted approximately 30 to 45 minutes within each one-hour time block. The sessions were conducted weekly for the seven-month period. Some students received more sessions than others because of absences, field trips, testing and other natural rhythms of home and school life. The average number of sessions per student was 28. Results. Neurofeedback was more effective in improving scores on reading tests than no neurofeedback training. There were significant interactions between neurofeedback and time on basic reading. Wilks' lambda (Λ) = .69, F(1, 23) = 10.32, p < .01, on reading comprehension, Λ = .75, F(1, 23) = 7.62, p = .01, and on reading composite scores, Λ = .65, F(1, 23) = 12.59, p < .01. Neurofeedback training was more effective in improving both the Verbal and Full Scale IQ scores than no neurofeedback training. There was a significant interaction between neurofeedback and time on Verbal IQ, Λ = .62, F(1, 21) = 12.71, p < .01, and on Full Scale IQ, Λ = .56, F(1, 21) = 16.50, p [removed]