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QEEG and Neurofeedback in the Treatment of ADHD
Dr. Neil Rutterford PhD CPsychol AFBPsS MIoD07825 [email protected]@drrutterford
www.lanc.uk.com@ADHD_LANC
LANC Facebook Page01403 240002
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Outline• Setting the Scene• Quantitative Electroencephalogram (QEEG)• Neurofeedback• Summary• Issues• Back to the Scene
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Setting the Scene
• ADHD – Symptoms– Diagnosis– Treatment– Implications/Outcome
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QEEG
Joe Kamiya Barry Sterman Richard Caton
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QEEG
1928 – Hans Berger “EEG – window on the mind”
First EEG measurements by Berger around 1928.
Example of EEG recordings by Berger
Recognized importance of quantification and objectivity in the evaluation of EEG
Theorized abnormalities in the EEG would reflect clinical disorders
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QEEG
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QEEG
– The functional significance of different frequency bands is not well understood.
– However, in general:• alpha decreases during mental activity
• beta also decreases during mental activity but relatively less than alpha which makes it seem that there is an increase in beta
• theta increases during focused attention at midline frontal sites, however, is abnormally high in ADHD
• delta appears with drowsiness and sleep
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QEEG
– QEEG is "a method of quantifying EEG that provides a precise, reproducible estimate of the deviation of an individual record from normal. This computer analysis makes it possible to detect and quantify abnormal brain organization, to give a quantitative definition of the severity of brain disease, and to identify subgroups of pathophysiological abnormalities within groups of patients with similar clinical symptoms” (John, 1990).
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QEEG
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QEEG
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QEEG
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QEEG
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QEEG Literature
• Chabot and Serfontein (1996) reported children with AD/HD had an increase in theta, primarily in the frontal regions and at the frontal midline.
• Clarke et al. (1998) carried out the first study of EEG differences between children with different DSM-IV types, comparing 20 AD/HD combined type, 20 AD/HD inattentive type and 20 control subjects. The AD/HD groups had increased theta, and reductions in alpha and beta.
• In a follow-up study with larger independent subject groups Clarke et al. (2001) found increased theta but also decreased Beta in combined AD/HD and decreased Alpha in inattentive AD/HD.
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QEEG
• Aim– To add further support to suggestion that
QEEGs can differentiate between subtypes of ADHD.
• Hypotheses– Combined ADHD group will demonstrate
increased theta and decreased beta– Inattentive ADHD group will demonstrate
increased theta and decreased alpha
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QEEG
• N = 120, age 6-16 years, mean age = 12.7, males = 92, females = 28
• QEEG performed as part of a diagnostic assessment
• 85 combined, 35 inattentive
• Data compared to Neuroguide normative database (Thatcher, 1998)
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QEEG Data
• Mean topographic brainmaps for combined ADHD
Theta Beta
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QEEG Data
• Mean topographic brainmaps for inattentive ADHD
Theta Alpha
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QEEG• Other parameters are important• Coherence is a reflection of the degree of
communication or shared activity between different areas of the brain and refers to more or less cortical differentiation.
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QEEG• Other parameters are important• Phase refers to the velocity or speed of the
transmission of signals between different brain areas and measures the time delay of signal transmission.
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Neurofeedback 1958,63 – Joseph Kamiya and alpha training
Recognition of certain brainwave states - alpha
Self regulated production of alpha
“Anxiety Change Through Electroencephalographic Alpha Feedback Seen Only in High Anxiety Subjects”
James V. Hardt and Joe Kamiya Science, Vol. 201, pp. 79-81, 7 July 1978
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Neurofeedback 70s – Barry Sterman and sensorimotor rhythm
(SMR training, 12-15 Hz)
“Neurofeedback treatment of epilepsy: from basic rationale to practical application.”
Tobias Egner & M Barry Sterman. Expert Rev. Neurotherapeutics 6(2), 247-257, 2005)
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Services – Neurofeedback
Neurofeedback
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NeurofeedbackNeurofeedback
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Neurofeedback
Let’s demonstrate!
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Neurofeedback Literature
• Lubar and Shouse (1976) first reported calming of hyperkinesia after SMR enhancement
• Monastra et al. (2002) reported comparable effects to medication.
• Arns et al. (2009) meta analysis. Found large effect size for inattention and impulsivity, medium effect size for hyperactivity.
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Neurofeedback
• Aim– Assess efficacy of QEEG driven
neurofeedback with ADHD pts.
• Hypothesis– Both ADHD groups will demonstrate EEG
change after neurofeedback
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Neurofeedback
• N = 60, age 6-16 years, mean age = 13.6, males = 52, females = 8
• 42 combined, 18 inattentive • Neurofeedback performed on a clinical
basis.• Protocols derived from individual QEEG
profile.• Mean number of sessions (approx. 30
minutes) = 46
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Neurofeedback Data• Mean topographic brainmaps for combined ADHD
Pre
Post
Theta Beta
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Neurofeedback Data• Mean topographic brainmaps for inattentive ADHD
Pre
Post
Theta Alpha
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Summary
• QEEG data supports different activity profiles between sub groups of ADHD
• Neurofeedback effective in both groups
• There are issues!
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Issues
• All aspects done within a clinical setting• No comparison group • Comorbidities• Other EEG data e.g. phase and coherence• Neurofeedback not done in isolation (Arns et al.
(2009) report no difference in neurofeedback effects between meds and non-med groups)
• Does EEG change reflect behavioural change?
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Back to the Scene
• ADHD– Symptoms– Diagnosis– Treatment – Implications/Outcome
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LANC Services
• Clinic Sessions– Regular, 45mins – 1 hour, £100 per session
• Distance Training– Regular, home or school or workplace,
technician, £50 each week plus £25 session review
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For Your Information
• International Society for Neurofeedback and Research (ISNR)
• Biofeedback Certification International Alliance (BCIA)
• Society of Applied Neuroscience (SAN)
• Biofeedback Federation of Europe (BFE)
• EEG Spectrum
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Thank You
Dr. Neil Rutterford PhD CPsychol AFBPsS MIoD
07825 [email protected]@drrutterfordwww.lanc.uk.com