EEG Operant Conditioning as a Treatment for Autistic Disorders by Robert Coben
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EEG Operant Conditioning as a treatment for Autistic disorders
Robert Coben, PhD Associate Fellow, EEG Biofeedback (BCIA) Diplomat, qEEG Certification Board Massapequa Park, New York Presented at Autism One 2008
CNS changes in early development
• Autistic disorders are viewed as problems of early childhood Neuroinflammation impacting multiple systems including the CNS. • This inflammation interferes with normal development of neural connectivities in the developing brains of these children.
White matter anomalies in Autism
Connectivity in Autism
• MRI reductions in white matter (McAlonan et al., 2004) • fMRI underconnnectivity in anterior-posterior connections (Cherkassky et al., 2006) • fMRI hyperconnectivity across middle frontal regions (Mizuno et al., 2006). • Theory of hyperconnected frontal cortices along with frontal to other hypoconnectivity (Courchesne & Pierce, 2005). • Less white matter concentration in the genu, rostrum, splenium (Chung et al., 2004) • Cell columns are more numerous, smaller and less compact in frontal and temporal regions (Casanova et al, 2002) • Diminished connectivity in language areas during
fMRI connectivity
EEG Connectivity
What is EEG operant conditioning (biofeedback)?
Case Example: Mu NF
20 18 16 14 12 10 8 6 4 2 0 1 2 3 4 5 6 7 8 9 1 2.8 3 2.9 10-12 19-23 7-15 3.5 3.4 3.3 3.2 3.1
Case Example: Mu NF
Case Example: Topographical changes
EEG biofeedback: Efficacy in ADHD
EEG biofeedback: Efficacy in ADHD
• DeBeus (2006)
• Attention Training with ADHD Children: A DoubleBlind Placebo-Controlled Study • N = 60, with crossover • Attention Scores:
• Effectiveness of Intervention; P = .0004 9 8 7 6 5 4 3 2 1 0
Monastra, Monastra, George (2002)
• Treatment Effect; P = .0004 • Parent Ratings:
• Effectiveness of Intervention; P = .0002
EEGBF Ritalin
• Treatment Effect; P < .0001
PRE
POST
F/U
Empirical Evidence?
• Most of the work in this area has been based on case studies and case series. • Two published controlled studies. • Others in development. • No Randomized Controlled Trial (yet). • Must be evaluated in context and compared to other forms of intervention.
1 Pilot Study
st
• Jarusiewicz (2002) – Only research based on group data. 12 of 20 participants completed at least 20 sessions (20 – 69, mean = 36). Results showed 26% improvement/reduction in ATEC symptoms vs. 3% reduction for control group. Protocols began at C4 (57%) and were individualized based on symptoms. C4 with F7 was used for 75% and the others included F3-F4 and/or T3-T4.
Methods
• 37 ASD children compared with 12 WLC • Matched for age, gender, race, handedness, medications, symptom severity • EEGBF was assessment guided based on EEG connectivity et al. • EEGBF done twice weekly for 10 weeks • Pre-post parent judgment, rating scales, NP and QEEG
25 20 15 10 5 0 Autism PDD-nos CDD Aspergers
Findings
• 89% reported success • No reports of worsening • 40% reduction in autistic symptoms (ATEC) • Significant changes in symptoms, NP findings and EEG connectivity • Reduced neural hyperconnectivity • Tx response not
EEG connectivity changes
The relative efficacy of connectivity guided and symptom based EEG biofeedback for Autistic disorders
• Compared findings from Jarusiewicz (2002) to Coben & Padolsky’s (2007) approach • Matched subjects for severity of symptoms and equated the sample sizes • Both are effective, but tx guided by EEG connectivity
50 45 40 35 30 25 20 15 10 5 0
Sens/Cogn Health/Behavior Total
3 2.5 2
Jarusiewicz Coben/Padolsky
1.5 1 0.5 0
Jarusiewicz Coben/Padolsky
speech
social
cognitive
behavior
Spectrum Disorder: A Controlled Study of EEG Coherence Training focused on Social Skill Robert Coben, PhD Deficits
Presented at 2007 ISNR Conference San Diego, California
Facial/Emotional Processing
Facial/Emotional Processing
Facial/Emotional Processing
Facial/Emotional Processing deficits in Autism
Facial/Emotional Processing deficits in Autism
Efficacy of Social Skills Training
• Rao, Beidel, & Murray (2007) recently reviewed research related to social skills training in autistic disorders and concluded that empirical support is minimal at this time. • Bellini et al. (2007) have also reviewed social skills training programs. They calculated PND (% of non-overlapping data points). Mean intervention effects were 70% (questionable) and generalization 53%
Theory and Hypotheses
• Social skill deficits in ASD are, at least partially, related to the neural substrate of visual/facial/emotional processing. • Altering this neural substrate should then lead to improvements in social skills. • H1: NF (coherence training) can improve visual processing and social skills. • H2: Improvements in visual processing would predict enhancements in social skills. • H3: EEG analyses will show associated improvements in the neural substrate responsible.
Method
• 50 patients diagnosed with Autistic Spectrum Disorder • All underwent Neuropsychological (focus on visual processing) testing, ratings of social skill deficits, and QEEG Assessment prior to intervention • All underwent follow-up Neuropsychological, rating scale and QEEG assessment following intervention • Two groups were studied – 25 patients received 20 sessions of QEEG Connectivity guided EEG
Subjects
Experimental Age Gender Race Handedness Medications ATEC Social Skills Visual-Perception 9.5, 2.38 21 male 23 caucasian 24 right handed 0.16, 0.37 31.00, 9.16 70.3, 7.39 -1.63, 1.13 Controls 10.13, 2.72 21 male 23 caucasian 22 right handed 0.16, 0.37 31.16, 6.36 69.96, 6.33 -1.52, 1.07 pvalue 0.39 1.0 1.0 0.30 1.0 0.94 0.86 0.73
Skewness = .185 Kurtosis = -1.192
Skewness = .275 Kurtosis = .304
Neurofeedback Protocol Design – Sites of Coherence training
Neurofeedback Protocol Design
Results
ANOVA Sum of S q u a re s B e tw e e n G r o u p s 7 1 4 .4 2 0 W it h in G r o u p s 4 4 0 3 . 2 0 0 T o ta l S o c S k ills c h a n g e 5 1 1 7 .6 2 0 B e tw e e n G r o u p s 1 8 1 .4 5 1 W it h in G r o u p s 1 8 8 3 . 2 5 4 T o ta l V is u a lP r o c e s s c h a n g e B e t w e e n G r o u p s W it h in G r o u p s T o ta l 2 0 6 4 .7 0 5 6 .6 9 0 2 0 .1 1 3 2 6 .8 0 3 df M e a n S q u a re 1 7 1 4 .4 2 0 48 9 1 .7 3 3 49 1 48 49 1 48 49 6 .6 9 0 .4 1 9 1 5 .9 6 7 .0 0 0 1 8 1 .4 5 1 3 9 .2 3 4 4 .6 2 5 .0 3 7 F 7 .7 8 8 S ig . .0 0 8
ATEC change
Results
Results
Results
• Social Skills change Effect Size = 0.61 • One study found social skills training to have an ES of 0.33 • ATEC change Effect Size = 0.79 • Medium to Large • PND (% of nonoverlapping data points) = 88% • Social skills training has mean PND = 70% and generalization = 53%
Results
Results
Results
Do the changes last?
EEG Operant Conditioning as a treatment for Autistic disorders
Robert Coben, PhD Associate Fellow, EEG Biofeedback (BCIA) Diplomat, qEEG Certification Board Massapequa Park, New York Presented at Autism One 2008
CNS changes in early development
• Autistic disorders are viewed as problems of early childhood Neuroinflammation impacting multiple systems including the CNS. • This inflammation interferes with normal development of neural connectivities in the developing brains of these children.
White matter anomalies in Autism
Connectivity in Autism
• MRI reductions in white matter (McAlonan et al., 2004) • fMRI underconnnectivity in anterior-posterior connections (Cherkassky et al., 2006) • fMRI hyperconnectivity across middle frontal regions (Mizuno et al., 2006). • Theory of hyperconnected frontal cortices along with frontal to other hypoconnectivity (Courchesne & Pierce, 2005). • Less white matter concentration in the genu, rostrum, splenium (Chung et al., 2004) • Cell columns are more numerous, smaller and less compact in frontal and temporal regions (Casanova et al, 2002) • Diminished connectivity in language areas during
fMRI connectivity
EEG Connectivity
What is EEG operant conditioning (biofeedback)?
Case Example: Mu NF
20 18 16 14 12 10 8 6 4 2 0 1 2 3 4 5 6 7 8 9 1 2.8 3 2.9 10-12 19-23 7-15 3.5 3.4 3.3 3.2 3.1
Case Example: Mu NF
Case Example: Topographical changes
EEG biofeedback: Efficacy in ADHD
EEG biofeedback: Efficacy in ADHD
• DeBeus (2006)
• Attention Training with ADHD Children: A DoubleBlind Placebo-Controlled Study • N = 60, with crossover • Attention Scores:
• Effectiveness of Intervention; P = .0004 9 8 7 6 5 4 3 2 1 0
Monastra, Monastra, George (2002)
• Treatment Effect; P = .0004 • Parent Ratings:
• Effectiveness of Intervention; P = .0002
EEGBF Ritalin
• Treatment Effect; P < .0001
PRE
POST
F/U
Empirical Evidence?
• Most of the work in this area has been based on case studies and case series. • Two published controlled studies. • Others in development. • No Randomized Controlled Trial (yet). • Must be evaluated in context and compared to other forms of intervention.
1 Pilot Study
st
• Jarusiewicz (2002) – Only research based on group data. 12 of 20 participants completed at least 20 sessions (20 – 69, mean = 36). Results showed 26% improvement/reduction in ATEC symptoms vs. 3% reduction for control group. Protocols began at C4 (57%) and were individualized based on symptoms. C4 with F7 was used for 75% and the others included F3-F4 and/or T3-T4.
Methods
• 37 ASD children compared with 12 WLC • Matched for age, gender, race, handedness, medications, symptom severity • EEGBF was assessment guided based on EEG connectivity et al. • EEGBF done twice weekly for 10 weeks • Pre-post parent judgment, rating scales, NP and QEEG
25 20 15 10 5 0 Autism PDD-nos CDD Aspergers
Findings
• 89% reported success • No reports of worsening • 40% reduction in autistic symptoms (ATEC) • Significant changes in symptoms, NP findings and EEG connectivity • Reduced neural hyperconnectivity • Tx response not
EEG connectivity changes
The relative efficacy of connectivity guided and symptom based EEG biofeedback for Autistic disorders
• Compared findings from Jarusiewicz (2002) to Coben & Padolsky’s (2007) approach • Matched subjects for severity of symptoms and equated the sample sizes • Both are effective, but tx guided by EEG connectivity
50 45 40 35 30 25 20 15 10 5 0
Sens/Cogn Health/Behavior Total
3 2.5 2
Jarusiewicz Coben/Padolsky
1.5 1 0.5 0
Jarusiewicz Coben/Padolsky
speech
social
cognitive
behavior
Spectrum Disorder: A Controlled Study of EEG Coherence Training focused on Social Skill Robert Coben, PhD Deficits
Presented at 2007 ISNR Conference San Diego, California
Facial/Emotional Processing
Facial/Emotional Processing
Facial/Emotional Processing
Facial/Emotional Processing deficits in Autism
Facial/Emotional Processing deficits in Autism
Efficacy of Social Skills Training
• Rao, Beidel, & Murray (2007) recently reviewed research related to social skills training in autistic disorders and concluded that empirical support is minimal at this time. • Bellini et al. (2007) have also reviewed social skills training programs. They calculated PND (% of non-overlapping data points). Mean intervention effects were 70% (questionable) and generalization 53%
Theory and Hypotheses
• Social skill deficits in ASD are, at least partially, related to the neural substrate of visual/facial/emotional processing. • Altering this neural substrate should then lead to improvements in social skills. • H1: NF (coherence training) can improve visual processing and social skills. • H2: Improvements in visual processing would predict enhancements in social skills. • H3: EEG analyses will show associated improvements in the neural substrate responsible.
Method
• 50 patients diagnosed with Autistic Spectrum Disorder • All underwent Neuropsychological (focus on visual processing) testing, ratings of social skill deficits, and QEEG Assessment prior to intervention • All underwent follow-up Neuropsychological, rating scale and QEEG assessment following intervention • Two groups were studied – 25 patients received 20 sessions of QEEG Connectivity guided EEG
Subjects
Experimental Age Gender Race Handedness Medications ATEC Social Skills Visual-Perception 9.5, 2.38 21 male 23 caucasian 24 right handed 0.16, 0.37 31.00, 9.16 70.3, 7.39 -1.63, 1.13 Controls 10.13, 2.72 21 male 23 caucasian 22 right handed 0.16, 0.37 31.16, 6.36 69.96, 6.33 -1.52, 1.07 pvalue 0.39 1.0 1.0 0.30 1.0 0.94 0.86 0.73
Skewness = .185 Kurtosis = -1.192
Skewness = .275 Kurtosis = .304
Neurofeedback Protocol Design – Sites of Coherence training
Neurofeedback Protocol Design
Results
ANOVA Sum of S q u a re s B e tw e e n G r o u p s 7 1 4 .4 2 0 W it h in G r o u p s 4 4 0 3 . 2 0 0 T o ta l S o c S k ills c h a n g e 5 1 1 7 .6 2 0 B e tw e e n G r o u p s 1 8 1 .4 5 1 W it h in G r o u p s 1 8 8 3 . 2 5 4 T o ta l V is u a lP r o c e s s c h a n g e B e t w e e n G r o u p s W it h in G r o u p s T o ta l 2 0 6 4 .7 0 5 6 .6 9 0 2 0 .1 1 3 2 6 .8 0 3 df M e a n S q u a re 1 7 1 4 .4 2 0 48 9 1 .7 3 3 49 1 48 49 1 48 49 6 .6 9 0 .4 1 9 1 5 .9 6 7 .0 0 0 1 8 1 .4 5 1 3 9 .2 3 4 4 .6 2 5 .0 3 7 F 7 .7 8 8 S ig . .0 0 8
ATEC change
Results
Results
Results
• Social Skills change Effect Size = 0.61 • One study found social skills training to have an ES of 0.33 • ATEC change Effect Size = 0.79 • Medium to Large • PND (% of nonoverlapping data points) = 88% • Social skills training has mean PND = 70% and generalization = 53%
Results
Results
Results
Do the changes last?
