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www. lanc. uk. com @ADHD_LANC Facebook Page 01403 240002 reception@lanc. uk. com QEEG and Neurofeedback in the Treatment of ADHD Dr. Neil Rutterford Ph. D CPsychol AFBPs. S MIo. D 07825 632340 dr. rutterford@lanc. uk. com @drrutterford

Outline • • • Setting the Scene Quantitative Electroencephalogram (QEEG) Neurofeedback Summary Issues Back to the Scene

Setting the Scene • ADHD – Symptoms – Diagnosis – Treatment – Implications/Outcome

QEEG Richard Caton Joe Kamiya Barry Sterman

QEEG 1928 – Hans Berger “EEG – window on the First EEG measurements by Example of EEG recordings by mind” Berger around 1928. Berger Recognized importance of quantification and objectivity in the evaluation of EEG Theorized abnormalities in the EEG would reflect clinical disorders

QEEG

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

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).

QEEG

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.

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

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)

QEEG Data • Mean topographic brainmaps for combined ADHD Theta Beta

QEEG Data • Mean topographic brainmaps for inattentive ADHD Theta Alpha

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.

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.

Neurofeedback 1958, 63 – Joseph Kamiya and alpha training “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 Recognition of certain brainwave states - alpha Self regulated production of alpha

Neurofeedback 70 s – 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)

Neurofeedback

Neurofeedback Let’s demonstrate!

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.

Neurofeedback • Aim – Assess efficacy of QEEG driven neurofeedback with ADHD pts. • Hypothesis – Both ADHD groups will demonstrate EEG change after neurofeedback

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

Neurofeedback Data • Mean topographic brainmaps for combined ADHD Pre Post Theta Beta

Neurofeedback Data • Mean topographic brainmaps for inattentive ADHD Pre Post Theta Alpha

Summary • QEEG data supports different activity profiles between sub groups of ADHD • Neurofeedback effective in both groups • There are issues!

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?

Back to the Scene • ADHD – Symptoms – Diagnosis – Treatment – Implications/Outcome

LANC Services • Clinic Sessions – Regular, 45 mins – 1 hour, £ 100 per session • Distance Training – Regular, home or school or workplace, technician, £ 50 each week plus £ 25 session review

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

Thank You Dr. Neil Rutterford Ph. D CPsychol AFBPs. S MIo. D 07825 632340 dr. rutterford@lanc. uk. com @drrutterford www. lanc. uk. com