EMG BIOFEEDBACK TRAINING: EFFECT ON BEHAVIOR OF

CHILDREN WITH ACTIVITY-LEVEL PROBLEMS

THESIS

Presented to the Graduate Council of the

North Texas State University in Partial

Fulfillment of the Requirements

For the Degree of

MASTER OF SCIENCE

By

David L. Henry, B. A,

Denton, Texas

May, 1977

.0-%

:6-7 1

4 ON 44

Henry, David L., EMG Biofeedback Training: Effect on

Behavior of Children with Activity-Level Problems. Master

of Science (Clinical Psychology), May, 1977, 66 pp., 3 tables,

5 figures, references, 52 titles.

The relationships between muscle-tension level, motoric-

activity level, and academic performance in the laboratory

setting are investigated. Three participants were rein-

forced for reducing and increasing their tension levels,

alternately, while engaged in a simulated academic task, and

the effects of each on the rate of acitivty and academic

performance were measured. Measures were also obtained on

the rate of activity and occurrence of problem behavior in

the subject's homes. Significant treatment differences

were found which support a direct relationship between

tension and activity level so that a decrease in EMG level

was associated with a decrease in motoric activity, and an

increase in EMG level was associated with an increase in

motoric activity. The efficacy of using EMG biofeedback

to train relaxation in children with activity-level problems

to control their symptoms is supported, especially where

such a technique can be used in a specific task-oriented

situation.

TABLE OF CONTENTS

Page

LIST OF TABLES

Thesis

Introduction

Method .

SubjectApparatusProcedure

Results . . .

Subject 1Subject 2Subject 3

Discussion

Subject 1Subject 2Subject 3Summary

Appendix

References

iv

.1

. . . . . . . 9 . . . . . . . 9 . . . 12

. . . . . , . . 21

. ... 29

50

........ 60

Iii

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LIST O TABLES

Table Page

1. Time-Series Analysis for Subject 1 . . . 41

2. Time-Series Analysis Subject 2 . . 44

3. Time-Series Analysis for Subject 3 . . . . . 47

iv

EMG BIOFEEDBACK TRAINING: EFFECT ON BEHAVIOR OF

CHILDREN WITH ACTIVITY-LEVEL PROBLEMS

Hyperactivity is a clinical condition characterized by

excessive movement, unpredictable behavior, unawareness of

consequences, inability to focus or concentrate on a

particular task, and poor academic performance (Stewart,

Pitts, Craig, & Dieruf, 1966). It has been estimated by

researchers and teachers that one in 25 children exhibit

symptoms of hyperactivity (Sroufe & Stewart, 1973).

Burks (1960) states that the hyperactive syndrome has

an organic basis and he lists seven primary symptoms seen

in most hyperactive children. These are a short attention

span, restlessness and overactivity, poor perceptual and

conceptual abilities, defective memory, and poor muscular

coordination. In addition, such children often show many

secondary or emotional symptoms, and when older may display

such antisocial tendencies as lying, stealing, vandalism,

fire setting, and cruelty to animals. Burks presents

evidence from several areas of investigation which support

an organic view of hyperactivity. He found that from 50% to

75% of children so diagnosed produce abnormal electro-

encephalograph (EEG) tracings. He postulates that these

children have a cortical impairment, and that those who

produce normal brain wave patterns may have a subcottical

1

2

defect which the EEG cannot reflect. His research showed

that hyperactive children fuse at lower frequencies than

do normals on the Flicker Fusion Test and have difficulty

seeing the aftereffect on the Archimedes Spiral, two tests

purported to measure cerebral efficiency and adaptability.

In checking the developmental histories of his sample,

Burks found that some type of birth trauma which could

cause brain impairment had occurred much more frequently

than in the normal population.

Stewart et al. (1966) and Denhoff, Davids, and Hawkins

(1971) note there is a high incidence of hyperactivity in

children with no history of disease or birth trauma.

Morrison and Stewart (1973) suggest that minimal brain

dysfunction is the cause of hyperactivity, and because

the syndrome is six times more prevalent among males, propose

that such a dysfunction is transmitted genetically.

The most commonly recommended treatment for hyper-

activity is the use of stimulant drugs and it is estimated

that about 200,000 children in the United States are currently

receiving amphetamines to control their overactivity

(Krippner, Silverman, Cavallo, & Healy, 1973).. Bradley (1937)

was among the first to report the use of drugs in treating

children with an "organic behavior syndrome." He found

by administering benzedrine that about 50% of the children

showed dramatic improvement in both school performance and

emotional response. The remainder of the subjects showed

little or no improvement and a small percentage showed

3

increased hyperactivity and aggressiveness. Conners and

Eisenberg (1963) and Denhoff et al. (1971) reported similar

results using methylphenidate (Ritalin) and dextroampheta-

mine, respectively. Using global ratings by parents,

teachers, and clinicians, Conners (1971) has shown that

stimulant drugs are effective with some children in

reducing overactivity and increasing attention span both

at home and at school, with a resultant improvement in

school achievement and social behavior. Comly (1971)

reports that teachers' ratings of children receiving stimu-

lant drugs indicate that improvements occurred in the areas

of listening ability, excitability, forgetfulness, and peer

relationships. Using actometer devices which are a direct

measure of motoric activity, several authors have shown

that stimulant drugs control excess activity in the

laboratory and applied settings (Hollis & St. Omer, 1972;

Sprague, Barnes, & Werry, 1970; Sykes, Douglas, Weiss, &

Minde, 1971L).

Stimulant drugs appear to be less effective in the

decrease of irritability, explosiveness, and other aspects

of emotionality (Weiss, Werry, Minde , Douglas, & Sykes, 1968;

Denhoff et al., 1971). Werry, Weiss, Douglas, and Martin

(1966) found that chlorpromazine decreased overactivity but

did not improve distractability,aggressiveness, or excita-

bility. Zrull (1963) found that children treated with

stimulants tended to become more fearful as their symptoms

improved, and postulated that the symptoms may be releases

4

for anxiety, whether the basis for the anxiety is psycho-

logical, physiological, or both. He noted that central

nervous system stimulants may be effective in treating a

child's symptoms at one time but not at other times, and

often have very different effects oxr children with identical

diagnoses. There is a growing ethical concern for the .

morality and wisdom implied in administering medication to

children (Fish, 1971; Hentoff, 1L970; Koegh, 1971; Ladd, 1970).

Because the often-implied objective behind the use of

drugs for the hyperactive child is that of enabling him to

profit academically, it is surprising that few data directly

support this belief. Most studies have measured the effect

on medication on component skills or learning, for example,

attention, concentration, and discrimination. Drug effects

on general intelligence test performance have been tested

(Conners & Rothschild, 1968; Epstein, Lasagna, Conners, &

Rodriquez, 1968; Knights & Hinton, 1968). Sprague et al.

(1970) measured childrens' responses of "same" or "different"

to pairs of visual stimuli presented on a screen. Conners,

Eisenberg, and Sharpe (1964) studied the effects of Ritalin

on paired-associate learning and Porteus Maze performance

in children with hyperactive symptoms. Others concentrated

their efforts on the effects of drugs on the attention of

hyperactive children to various tasks (Conners, Eisenberg, &

Barcai, 1967; Sprague & Toppe, 1966). These laboratory

studies investigated the effects of drugs on component

5

skills related to learning, but they did not measure academic

performance in the classroom.

Sulzbacher (1972) analyzed the effects of drugs on

behavior of hyperactive children in the classroom. Measures

of correct solutions and error rates were taken in arith-

metic, writing, and reading on three subjects. In addition,

measures were taken on the childrens' rates of talk outs and

out-of-seat behavior. His conclusion was that stimulants

"can effectively modify disruptive behavior without adversely

effecting academic performance in the classroom." Drug

effects on actual academic tasks were highly variable,

however.

Teachniques employing principles of behavior modification

have also been successfully used to control symptoms of

hyperactivity. Patterson (1965) used candy and pennies

to reinforce the on-task behavior of a hyperactive child in

a classroom setting. The child was reinforced at 10-second

intervals if attending to his assigned task. Prior to

conditioning, the boy spent 25% of his time making inatten-

tive or disruptive responses. After 10 days of training,

inappropriate behavior occurred only 5% of the time.

Several authors (Kinsely, 1970; Patterson, Jones,

Whittier, & Wright, 1965; Pihl, 1967; Twardosz & Sajivaj, 1972)

have reinforced behavior incompatible with hyperactive

responses, such as sitting still, and found that hyperactivity

and distractibility were decreased.

6

Ayllon, Layman, and Kandel (1975) reported a study which

compares the effects of stimulant drugs to behavior modifi-

cation techniques on classroom behavior and academic

performance. While on medication the subjects were observed

in a classroom for 18 days to establish a baseline for

correct math and reading responses, which occurred at a

negligible level for all subjects, and for occurrence of

hyperactive responses, which occurred nearly 20% of the time.

Medication was then withdrawn over a weekend and the rate of

hyperactive responses increased to 80%. A slight improve-

ment was found in math and reading responses. The class

time was divided so that half was spent on mathematics and

half on reading. The children were then reinforced for

correct mathematics responses while reading went unreinforced.

Hyperactive responses were reduced to 20% during mathematics

and mathematics performance improved from 12% to 85%

correct responses. Hyperactive responses remained at 80%

during reading and reading performance showed no improve-

ment. Correct reading responses were then reinforced and

similar improvement was obtained. Behavioral methods were

as effective as drugs in controlling hyperactivity in this

population with the additional effect of improved academic

performance. The problem of obtaining a transfer of effects

from the training situation to other areas was very apparent.

Investigators have sought to overcome the problem of

generalization by teaching parents to be behavior modifiers.

Ferman dnd Feighner (1973) videotaped parental interactions

7

so that parents could be aware of chronic maladaptive

behaviors which they reinforced in their children. They

were then taught to modify their own and their child's

behavior with encouraging results. Wiltz and Gordon (1974)

placed the entire family in an experimental apartment

equipped with one-way mirrors, video tape equipment, and

hidden microphones. The family lived in the setting for

five days, were observed carefully, and suggestions were

made for correcting maladaptive behavior. Hyperactive,

destructive, noncompliant, and other inapprorpiate responses

made by the child were quickly extinguished with this method.

Once back in their home, the parents continued the procedures

and remained in contact with the authors by telephone.

Appropriate behavior generalized to the home setting and

the parents continued to make progress in changing other

behavior in their children.

Effective behavior modification techniques are costly

in terms of equipment and manpower, On the other hand,

with techniques such as Jacobson's (1938) progressive

relaxation exercises or conditioning of relaxation with

biofeedback equipment, it would be possible to teach the

child to control his own impulses and behavior. If as

Zrull (1968) suggested, anxiety underlies hyperactive

syiptomatology, or if hyperactive children are overly tense,

as Lupin, Braud, Braud, and Duer (1974) suggested, such

techniques for desensitizing the tension or anxiety would

be beneficial. Wolpe (1958) postulated that anxiety is

8

incompatible with relaxation. Therefore, if a child can

be taught to relax in anxiety-producing situations such as

the classroom, the tension or anxiety would subside and the

symptoms would be alleviated. Lupin et al. (1974) suggested

that medication can reduce overactivity without reducing

the tension which would explain why hyperactive children

on medication remain excitable, irritable, explosive,

aggressive, and have a low tolerance of frustration.

Lupin et al. (1974) reported a study using the relaxation

exercises developed by Jacobson (1938) in the treatment of

13 hyperactive boys and their parents. Their treatment

program was carried out in the subjects' homes with the aid

of tape-recorded instructions. There were six tapes for

the children and six tapes for the parents. The parents'

tapes consisted of instructions in behavior modification,

instructions on teaching the child to do the relaxation

exercises, adult exercises, and three tapes using visual

imagery to enhance the feeling of relaxation. The visual

imagery tapes used desensitization techniques to enable the

parents to respond to their children with less anxiety. The

childrens' tapes consisted of one tape describing the relaxa-

tion exercises, four tapes which incorporated visual imagery

and sound effects, and one tape on the value of positive

attitudes. Both parents and children were instructed to

use the tapes daily for a 3-month period. At the end of

the treatment, a significant improvement was found between

pre and postbehavioral ratings done by parents. Teachers'

9

observations in a classroom setting revealed that inappro-

priate behaviors occurred much less frequently after

treatment, and scores on three Wechsler Intelligence Scale

for Children (WISC) subtests showed significant improvement.

However, children who used the tapes most frequently showed

the most improvement on parent ratings but not on other

measures, which suggests a placebo effect.

Biofeedback is a recently developed technique which

has been used successfully in treating tension-related

problems of adults, such as tension and migraine headaches

(Blanchard & Young, 1974; Budzynski, 1973; Sargent, Green, &

Walter, 1973). Through the use of electronic devices, the

subjects' physiological processes can be made known to

them via some external stimulus. This allows them to attend

to their internal states and ultimately bring them under

voluntary control. The biofeedback process incorporates

two major principles of operant conditioning--the immediate

knowledge of results and the gradual shaping of responses

(Budzynski & Stoyva, 1969). Essentially, it is a technique

of behavior modification going on under the skin. Biofeed-

back training has been useful in training adults to gain

control over a variety of physiological activities such as

heartrate, blood pressure, muscle tension, and brain wave

patterns.

Biofeedback is currently being explored as a treatment

for hyperactivity. Nall (1973) used alpha-brain-wave-feed-

back training with hyperactive children with limited success.

10

However, total training time was short (6 hours) and no

attempt was made to facilitate generalization from the

training situation to the child's normal environment.

Braud, Lupin, and Braud (1974) reported a pilot study

done with a hyperactive boy using electromyograph (EMG)

biofeedback to reduce his tension, Using the frontalis

muscle as an index of muscular tension, the EMG monitoring

system would sound a tone when tension levels occurred above

a predetermined threshold. The subject was simply told to

sit still and keep the tone off. He was given 24 minutes

of training twice weekly for 3 weeks, and then once weekly

for 5 weeks. Muscle tension declined greatly both within

and between sessions, and many psychosomatic symptoms were

eliminated. The subject was not encouraged to practice the

technique at home or elsewhere, so the improvements in his

behavior did not last. He was,,however, able to reduce his

tension level effectively and immediately after a 7-month

period.

Connoly,, Besserman, and Kirschvink (1974) used EMG

biofeedback to reduce the overactivity of six children in

an uncontrolled pilot study. All but one of the subjects were

taking Ritalin to control activity levels. Each subject

received two biofeedback-training sessions a week for 4 con-

secutive weeks. During these training sessions, the children

were reinforced for reductions in frontalis muscle tension

below an established level. Significant improvement was seen

on two subtests of the WISC and on parent and teacher ratings.

11

Braud (1975) conducted a controlled study comparing

normal children with hyperactive children in three treat-

ment groups. One group received home relaxation training

via taped exercises, one group received home training plus

EMG biofeedback, and one group received no treatment. Both

treatment groups were found to do better than the nontreat-

ment group on several measures, but no difference was

reported between the relaxation-only and relaxation-plus-

biofeedback groups. It was noted that EMG biofeedback

produced quicker and greater drops in tension levels, at

least in the forehead region.

There is a need for a treatment that will control

activity-level problems without impairing academic perfor-

mance. Allyon et al. (1975) suggest that the continued use

of drugs to control hyperactivity may result in students who

are compliant, yet academically incompetant. Behavioral

procedures can be used to reduce overactivity and improve

academic performance, but they are costly in terms of man-

power and equipment, and it is difficult to generalize the

effects from the specific settings in which they are trained

to other environmental situations. Relaxation training

and EMG-biofeedback training offer the possibility of a

treatment that will not only control hyperactivity without

impairing academic performance, but will also be more

easily generalizable to the total environment. Once control

over tension level is mastered, the child can be taught that

he can control his tension in any situation by applying the

12

skills he has learned. As in the drug studies, the effects

of reduced tension levels on global behavior ratings and

the component skills of learning have been measured, but

no studies were found which measured the effects on academic

performance.

This study was designed to determine if it would be

feasible to use EMG biofeedback in conjunction with reinforce-

ment techniques to train muscle relaxation and tension,

alternatively, in children With activity-level problems

while they engaged in an academic task. Time spent on task,

motoric activity, and mathematics effort were monitored

to assess the effects of reduced and increased tension

levels on the children' academic performance. Measures

were also taken in the childrens' homes to determine to

what extent responses trained in the simulated academic

situation would generalize to and produce changes in their

activity levels and behavior.

Method

Subjects

Advertisements were placed in area newspapers asking

for the research participation of children between the ages

of 5 and 12 who exhibited symptoms of hyperactivity. Appli-

cants were screened with an EMG to determine whether they

maintained high tension levels while at rest for 4 minutes,

and while responding to problems on a mathematics placement

examination. Three children were accepted as suitable sub-

jects for the study.

13

Subject 1 was a 10-year-old male in the fourth grade.

He had been diagnosed as hyperkinetic by several physicians,

and began receiving Ritalin when he entered school. Prior

to the start of the study, he received 20 mg of Ritalin per

day. Medication was withdrawn with the physician's approval

several days before the screening session. The subject was

extremely small in size, emotionally immature, and a problem

both in school and at home, Because of his overactivity and

poor academic performancehe was placed in a special educa-

tion class for half of each school day. He exhibited such

hyperactive symptoms as low tolerance of frustration,

irritability, impulsive actions, frequent fighting, and

temper tantrums. His parents felt that medication was

inadequate in controlling his behavior problems. During

screening, he maintained an average frontalis muscular

activity level of 8,85 micro-volts root mean squared {uV RMS)

while at rest, and 8.03 uV RMS while responding to the

placement test. The nonhyperactive children screened

were found to maintain tension levels between 2.3 and 3.9

uV RMS.

Subject 2 was a 6-year-old female in the first grade.

She presented mild behavioral problems at school, but was a

superior student academically. At home, she tended to be

overactive and agressive towards her playmates. She was

somewhat disobedient, showed a low tolerance of frustra-

tion, fought, and displayed temper tantrums frequently.

During screening, she was found to produce an average

14

frontalis muscular activity level of 14.30 uV RMS while

at rest, and 8.65 uV RMS while responding to the placement

exam.

Subject 3 was a 9-year-old in the third grade. She

was extremely fidgety and highly distractible during the

screening session. Her parents and teachers felt that

she was overactive to the point where she presented problems

for them at home and in school. Her activity level and an

apparent lack of motivation academically resulted in her

placement in a special class for half of each school day.

Besides being overactive and distractible, she appeared

somewhat overemotional, exhibited great fluctuations in mood

from time to time, and was often uncooperative. During

screening, she was found to produce an average frontalis

muscular activity level of 10,40 uV RMS while at rest and

10.02 uV RMS while responding to the placement test.

Apparatus

The Bio-Feedback Technology (BFT) EMG 401 system was

used to promote effective training of control over tension

levels. The BFT EMG 401 system provided instrumentation

for muscle tension detection, information feedback, and

data collection. The system consisted of two instruments--

the feedback myograph (BFT EMG 401) and the time period

integrator (BFT TPI 215). The feedback myograph sensed

muscle-produced electrical activity through three silver-

chloride electrodes (6.5 mm in diameter) which were placed

25 mm above the eyebrows, and spaced 102 mm apart on the

15

subject's forehead. The EMG 401 amplified the detected

signal and provided both audio-information feedback to the

subject, and an electrical signal which was recorded by the

TPI 215. Auditory feedback was provided to the subject

via headphones or a speaker so that a tone varied in pitch

in direct proportion to the degree of forehead muscle

tension present--the higher the pitch of the tone, the higher

the EMG level of muscle tension present. The feedback

myograph was powered by low voltage, rechargeable batteries

and was electrically shielded for effective research use

in a normal office setting.

The TPI received the amplified EMG signal, averaged it

over a selected time period of 10 to 120 seconds, and

provided a digital readout in uV RMS. It had a noise

threshold feature which allowed both the detection of inter-

nal equipment noise and the cancellation of the effect of

that noise on the EMG uV RMS readings. It was 125 V AC

powered and for the safety of the participant was electri-

cally isolated by optical circuitry.

An actometer was used to provide a direct measure of

activity. The actometer was a modified automatic winding

calendar wristwatch which provided a direct drive from

the pendulum of the self-winding mechanism to the hands of

the watch. It was worn like a wristwatch fastened by a

watchband on the dominant wrist or ankle, Any movement of

the arm or leg produced a movement of the hands on the watch

and the degree of the movement was proportional to the extent

16

of the motion of the limb. Results were in actometer units

which is a rate measure defined as the number of activity

minutes per hour of elapsed time divided by 100. The

actometer has been shown to be a highly reliable instrument

and validity has been high when activity measures were

correlated with oxygen consumption (Schulman & Reismen,

1959).

A Biofeedback Training Release form concerning informed

consent was signed by the parent or guardian of all partici-

pants in the study (see Appendix A). A written rationale

of the training procedure and description of the equipment

was also given to each parent (see Appendix B). Lupin's

Child Behavior Rating Scale was used to provide a measure

of each subject's home behavior (see Appendix C). Ratings

from "0", for no occurrence, to "4", for frequent occurrence,

were obtained daily on 11 problem behaviors,

A programmed mathematics course (Sullivan, 1970)

consisting of 37 levels of mathematics workbooks, a place-

ment test, and a teacher's manual was used to provide a

measure of the subject's academic performance. A stop-

watch was used to record the cumulative time spent on

task during each mathematics session,

Procedure

At the start of every session, the EMG batteries were

checked for proper voltage level and the noise calibration

was made. The subject's forehead was prepared for electrode

contact by scrubbing the skin with an abrasive cleanser

17

(Brasivol) and swabbing it with alcohol. The function and

safety of the EMG system was explained .to the partici-

pant. Three electrodes held in place by a rubber headband

and treated with electrode cream were placed on the child's

forehead. He was then seated at a desk which was situated

away from electrical and ground sources as a general safety

precaution, and was asked to touch a ground screw on the

EMG unit to remove static electricity. Electrode resistance

was checked to insure that both active electrodes were below

20,000 ohms and approximately similar in resistance. The

child's tension level was monitored and recorded for two

120-second intervals while he remained inactive.

The initial baseline period (Phase 1) lasted five

sessions. While seated at a school desk in a fully

illuminated room, attached to the EMG system, and equipped

with an actometer on the dominant ankle, the child was

encouraged to work mathematics problems from an appropriate

level of the programmed mathematics course for 20 minutes.

The experimenter recorded the subject's tension level at

120-second intervals. On-task behavior was defined as

looking towards the workbook, writing answers in the work-

book, or asking problem-related questions of the experimenter.

The experimenter explained generally how problems were to be

worked, and encouraged the child to remain on task. The

child was not given answers to the problems, nor forced to

work. At the end of 20 minutes, the workbook was collected,

the actometer was removed and read, and the problems were

18

graded. The number of problems correctly answered was

used as the measure of mathematics performance. In addition,

the subject's activity was measured in his home for 1 hour

each evening by placing the actometer on the dominant

wrist. After being equipped with the actometer, the child

was allowed to resume his normal activities.

The biofeedback-assisted relaxation-training (Phase 2)

began on the sixth session. With the child reclined on a

cot and the lights turned off, the audio-feedback system

was explained. He was requested to relax, close his eyes,

and keep the tone's pitch as low as possible. The child

was told that he would receive tokens for reducing his

tension level. At the end of the session, he could trade

these for candy or toys. The headphones were placed on the

child and a 20-minute-biofeedback session was begun. To

facilitate the transfer of the training to a normal working

situation, the response of relaxation was shaped through

several positions. For the first 4 minutes, the subject

lay on the cot with his eyes closed. For the second 4

minutes, he lay with his eyes open. During the third

4 minutes, he was seated in a reclining chair with his

eyes closed, and for the fourth 4 minutes, the child sat in

the recliner with his eyes open. In the last 4 minutes,

the child sat at a school desk with his eyes closed. Ten

120-second interval EMG readings were taken, and at each

interval the child would receive verbal praise and one token

for meeting the following criteria; a reduction of 1.0 uV RMS

19

when the previous reading was 10.0 uV RMS or above, a

reduction of 0.5 uV RMS when the previous reading was

between 6.0 and 9.9 uV RMS, a reduction of 0.2 uV RMS when

the previous reading was between 3.1 and 5.9 uV RMS, or any

reading of 3.0 uV RMS or lower.

When the above sequence was completed, the subject was

seated at the desk with his eyes open, ready to begin the 20-

minute-mathematics session. The procedure was the same as

that followed in Phase 1 except that biofeedback was provided

through a speaker, and reinforcement of gains in relaxation

was continued in accordance with the above criteria. This

sequence was adhered to until tension levels stabilized at

or below 4.0 uV RMS during the first 20 mintues of training

and remained below 4.0 uV RMS during the mathematics

session. At this time, the first 20 minutes of training

was discontinued. When EMG levels remained at or below

4.0 uV RMS during the mathematics session, the biofeedback

was faded out over a 4-day period. On the 1st day,

biofeedback was discontinued during the last 6 minutes of the

mathematics session. On the 2nd day, it was discontinued

for the last 12 minutes of the session. On the 3rd day,

it was discontinued for the last 18 minutes of the session,

and on the 4th day, no biofeedback was provided. Reinforce-

ment according to relaxation criteria continued, When EMG

levels remained at or below 4.0 uV RMS for 3 consecutive

days without biofeedback, this phase ended.

20

The second baseline (Phase 3)consisted of the last

three sessions of the Phase 2 procedure, plus two sessions.

The child continued to receive reinforcement for meeting

the relaxation criteria, but no biofeedback was given. The

procedures used in Phase 1 were otherwise followed. Home

activity measures were obtained each day from this point

until the end of the program.

The biofeedback-assisted tension-training (Phase 4)

began after Phase 3. The subject sat at a desk with his

eyes open. He was asked to tense his muscles and to keep

the feedback tone as high as possible by whatever tactics

he could find, as long as these did not include gross

facial distortions which produced high readings that were

less reflective of entire body tension. The session lasted

for 20 minutes during which 10 EMG readings were taken at

120-second intervals. The subject received verbal praise

and one token for an increase of 1.0 uV RMS above the pre-

vious reading, or for any reading above 30.0 uV RMS, At

the end of this period, a 20-minute-mathematics session began.

The procedure followed while working mathematics remained

the same as during Phase 2 except that the child was rein-

forced for increases in tension according to the criteria

used during the tension-training period. When EMG readings

stabilized at or above 30.0 uV RMS during the 20 minutes

of tension training, and remained above that level while

working mathematics, the tension-training period was dis-

continued. Biofeedback and reinforcement were continued

21

during the mathematics session.. If EMG readings remained

above 30.0 uV RMS, the biofeedback was faded out over a

4-day period as in Phase 2. Reinforcement according to

tension criteria continued. When tension levels remained

above 30.0 uV RMS for 3 consecutive days without biofeedback,

this phase ended.

The third baseline (Phase 5) consisted of the last

three sessions of the Phase 4 procedure, plus two sessions.

The child continued to receive reinforcement for meeting

the tension criteria, but no feedback was given. The

procedures used in Phase 1 were otherwise followed.

A second biofeedback-assisted-relaxation phase (Phase 6)

began on the first session following Phase 5. Procedures

used during Phase 2 were followed exactly. The program

ended after the third session in which EMG tension levels

remained at or below 4.0 uV RMS without biofeedback. Home

activity measures and behavior ratings by parents were

continued during this phase.

Results

Subjects 1, 2, and 3 received a total of 48, 43, and

45 sessions, respectively. Sessions occurred daily,

Monday through Friday, over a 2k4-month period. The number

of sessions during Phases 2 and 4 were individualized,

whereas Phases 1, 3, and 5 consisted of five sessions each.

During Phase 2, Subjects 1, 2, and 3 reached the procedural

criteria in 18, 13, and 16 sessions, respectively. During

Phase 4, all subjects reached the procedural criteria in nine

sessions.

22

The data for each of the three subjects on seven

variables across three baseline and intervention periods

were subjected to a time-series analysis (Bower & Glass,

1974; Glass, Willson, & Gottman, 1975). One-tailed t tests

were used to decide whether there was any significant change

in levels between a given phase and the phase that followed.

A full summary of the data for each subject including the

model identification, level of the data at each phase,

amount of change in that level between phases, t value

for the change, error variance, and degrees of freedom for

the test are presented in Tables 1, 2, and 3 for Subjects 1,

2 and 3 respectively.

Subject 1

The first subject's presession frontalis EMG data (see

AppendiX D) were identified as following a first-order

moving-averages model. This model is identified by the

series of numbers 0, 0, 1. These refer to the order of

autoregression, the order of differencing, and the order

of moving averages, respectively. The level of the series

at Phase 1 was estimated to be 16.37 uV RMS. The inter-,

vention effect between Phase 1 and 2 was -10.33 uV RMS

which was significant, t (21) :--5.95, p< .0005. The

effect between Phase 2 and 3 was -0.65 uV RMS which was not

significant. The intervention effect between Phase 3 and4

was 8.32 uV RMS which was significant, t (12) = 2.46,

p < .025. Between Phase 4 and 5, the change in level

was -5.24 uV PMS which approached significance, t (12) = -1.40,

23

p< '.10. A significant change in level of -3.78 uV RMS

was found between Phase 5 and 6, t (9) = -3.28, p< .005.

The frontalis EMG readings during the mathematics

session (see Appendix E) followed a first-order autoregres-

sive model (1, 0, 0) for the analysis. The initial level

of the data was estimated to be 25.77 uV RMS. Between

Phase 1 and 2,a significant change of -22.75 uV RMS occurred,

t (21):= -6.63, p< .0005. The change in level between Phase

2 and 3 was 0.57 uV RMS which was not significant. Between

Phase 3 and 4, a significant increase in level of 40.17 uV

RMS was found, T (12) = 9.09, p < .0005. Between Phase 4

and 5, a decrease in level of 13.87 uV RMS was significant,

t (12) = -2.86, p,< .01. From Phase 5 to 6, a significant

change in level of -26.21 uV RMS occurred, t (9) = -8.92,

p< .005.

The percentage of time spent on task during the mathe-

matics session (see Appendix F) assumed the model 1, 0, 1.

At Phase 1, the subject spent an estimated 74% of his time

on task. An increase in level of 21% occurred between

Phase 1 and 2 which was significant, t (21) = 5.83, p < .0005.

A nonsignificant drop of 1% was found from Phase 2 to 3.

Between Phase 3 and 4, a drop of 8% was found to be signif-

icant, t (21) = -2.19, p < .025. From Phase 4 to 5, a

nonsignificant change of 1 % was found. From Phase 5 to 6,

a significant increase in level of 4% was obtained, t (9) =

5.35, p < .0005.

24

The mathematics session actometer data (see Appendix G)

assumed a model 0, 0, 1 for the analysis. An activity rate

of 11.94 was estimated as the level at Phase 1. From

Phase I to 2, a significant decrease in rate of 11.01 was

found, t (21) = -6.60, p <,.0005. From Phase 2 to 3, a

decrease in rate of 0.46 was not significant. A nonsignif-

icant increase of 0.19 was found between Phase 3 and 4.

A nonsignificant decrease of 1.20 occurred between Phase 4

and 5. The level at Phase 5 was 0.55 and a decrease of

0.36 to Phase 6 was significant, t (9) = -2.54, p< .0005.

The behavior rating data (see Appendix H) followed a

0, 0, 1 model and at Phase 1 the level was estimated to

be 25. No significant change in level occurred from Phase

I to 5. From Phase 5 to 6, however, a significant decrease

in level of 3 was found, t (9) = -2.54, p< .025.

The academic performance measure, number of mathematics

problems answered correctly, was highly variabled. Conse-

quently, an appropriate model was not clearly identified.

A significant change in the level of this variable did not

occur between any successive phase of the program for this

subject.

The home activity data were Identified as following

a 0, 0, 1 model. The level at Phase 1 was 105.60, and

a decrease in level to Phase 3 of 40.82 was significant,

t (8) = -8.61, p< .0005. The changes in level of

14.94 from Phase 3 to 4, and of 13.99 from Phase 4 to 5

25

were not significant. From Phase 5 to 6, a drop in rate of

30.38 was significant, t (9) = -2.90, p < .01.

Subject 2

This subject's presession frontalis EMG data (see

Appendix D) assumed a 0, 0, 1 model for the data analysis,

and the level at Phase 1 was estimated to be 11.70 uV RMS.

A change in level at Phase 2 of -6.98 uV RMS was significant,

t (16):= -4.59, p< '.0005. The decrease in level at Phase 3

of 1.52 uV RMS was not significant. From Phase 3 to 4 a

significant increase of 7.41 uV RMS was found, t (12) = 10.91,

p < .0005. The level at Phase 5 decreased by 5.50 uV RMS

which was significant, t (12) = -6.08, p < .0005. The

decrease of 0.72 uV RMS in Phase 6 was not significant.

The frontalis EMG data for the mathematics session

(see Appendix E) followed a 0, 0, 1 model. At Phase 1, the

level was estimated at 7.20 uV RMS, and the decrease of

3.32 uV RMS in Phase 2 was significant, t (16) = -3.10,

p < .0005. The change in level from Phase 2 to 3 of -1.02 uV

RMS was not significant. A significant increase of 38.21 uV

RMS occurred from Phase 3 to 4, t (12) = 18.16, p < .0005.

A decrease from Phase 4 to 5 of 12.07 uV RMS was significant,

t (12) = -4.96, p< '.0005. From Phase 5 to 6, the level

decreased by 31.64 uV RMS which was significant, t (9) =

-13.71, p < .0005.

A 0, 0, 2 model was used to analyze the percentage of

time spent on task (see Appendix F). At Phase 1, the level

26

was 75% and an increase of 20% in Phase 2 was significant,

t (16) = 4.76, p< .0005. From Phase 2 to 3, an increase in

level of 4% was not significant. A decrease in level from

Phase 3 to 4 of 19% was found to be significant, t (12)

-14.68, p< .0005. From Phase 4 to 5, the level increased

by 10% which was significant, t (12) = 4.74, p< .0005.

Another increase in level of 16% between Phase 5 and 6 was

also significant, t (9) = 3,99, p K .0025.

The mathematics-session actometer rates (see Appendix G)

assumed a 0, 0, 1 model. At Phase 1, the level was estimated

to be 1.13 and a decrease in level of 0..77 in Phase 2 was

significant, t (16) =-3,37, p< .0025. Between Phase 2 and

3, the change of -0.08 was not significant. The level

increased by 5.53 from Phase 3 to 4 which was significant,

t (12) = 2.30, p< .025. A drop in level of 5.11 from

Phase 4 to 5 was not significant. At Phase 5, the level

was estimated at 5.14, and a decrease in level of 4.82 at

Phase 6 was significant, t (9) = 4,14, p< .0025.

The behavior rating data (see Appendix H) were analyzed

using a 1, 0, 1 model. The level at Phase 1 was 26, and

a decrease of 9 in Phase 2 was significant, t (16) = -3.62,

p< .0025. No significant differences were obtained between

Phase 2 and 5. The level at Phase 5 was 15, and a decrease

of 5 in Phase 6 was significant, t (9) = -3.39, p< .005.

The number of problems worked correctly by this subject

were highly variable, but were analyzed using a 0, 0, 1

model. At Phase 1, the level was 78. No significant change

27

was found from Phase 1 to 3. From Phase 3 to 4, a decrease

in level of 34 was significant, t (12) = -7.93, p < .0005.

No significant differences were found from Phase 4 to 6.

The home actometer data followed a 1, 0, 1 model.

The level at Phase 1 was estimated to be 68.64, and an

increase in Phase 3 of 11.58 was significant, t (8) = 2.51,

p< .025. From Phase 3 to 4, a significant change of 33.81

occurred, t (12) = 2.68, p< .01. No significant change

occurred from Phase 4 to 6.

Subject 3

The presession frontalis EMG data (see Appendix D)

were analyzed with a 0, 0, 1 model. At Phase 1, the level

was estimated to be 12.16 uV RMS, A change of -4.36 uV RMS

in Phase 2 approached significance, t (19) = -1.54, p< .10.

A decrease of 3.43 uV RMS in Phase 3 was not significant.

The level increased in Phase 4 by 7.54 uV RMS which was

significant, t (12) = 3.56, p< .0025. A nonsignificant

decrease of 1.22 uV RMS occurred between Phase 4 and 5.

From Phase 5 to 6, a decrease of 6.61 uV RMS was highly

significant, t (9) = -9.13, p< .0005.

The mathematics session frontalis EMG data (see Appendix

E) followed a 0, 0, 2 model. The level at Phase I was

7.34 uV RMS. The level decreased by 2.76 uV RMS in Phase 2

which was significant, t (19) =-3.33, p< .0025. A

further decrease of 1.32 uV RMS in Phase 3 was not signif-

icant. From Phase 3 to 4, the Level increased significantly

by 34.47 uV RMS, t (12) 32.04, p< .0005. From Phase 4 to

28

5, the level decreased significantly by 11.58 uV RMS,

t (12) = -8.00, p < .0005. A further decrease of 22.94 uV

RMS from Phase 5 to 6 was significant, t (9) = -29.13,

p < .0005.

A 0, 0, 1 model was used to analyze the percentage

of time spent on task (see Appendix F). At Phase 1, the

level was 92%, and no significant change was evidenced

until Phase 4. in Phase 4, the level decreased by 18%,

which was significant, t (12) = -6.32, p< .0005. From

Phase 4 to 5, an increase in level of 5% was significant,

t (12) = 2.36, p< .025. The level again increased signif-

icantly by 11% from Phase 5 to 6, t (9) = 6.21, p< .0005.

The mathematics-session actometer data (see Appendix G)

were identified as follQwing a 1, 0, 1 model. No significant

change in level occurred from Phase 1 to 3. At Phase 3,

the level was 1.36 and an increase in rate of 38.02 in

Phase 4 was significant, t (12) = 5.74, p < .0005. No

significant change occurred from Phase 4 to 6.

The behavior rating data (see Appendix H) followed a

0, 0, 1 model. At Phase 1, the level was 19, and a decrease

of two in Phase 2 was significant, t (19) = -5.36, 2< .0005.

From Phase 2 to 4, no change occurred. The level decreased

by five in Phase 5 which was significant, t (12) = -1.89,

p< '.05. A further significant decrease of three occurred

in Phase 6, t (9) = -2.71, p,< .025.

The number of problems worked correctly were analyzed

with a 0, 1, 1 model. No significant change in level occurred

29

in any phase. Again, variability in the data made model

identification procedures inadequate.

The home actometer data assumed a 1, 0, 1 model. No

significant change was found from Phase I to 3. At Phase 3,

the level was estimated at 90.52 and a significant

increase in Phase 4 of 34.29 was found, t (12) = 2.56,

p < .025. From Phase 4 to 5, a significant decrease in

rate of 43.63 occurred, t (12) = -2.94, p .01. From

Phase 5 to 6, a significant increase of 35.45 was found,

t (9) 4.81, p< .0005.

Discussion

The measures of academic performance and home activity

were highly variable, and stable baselines were not attained.

They appeared to be influenced in an uncontrolled manner

by outside variables. The number of mathematics problems

correctly worked proved to be an unstable measure of academic

performance due to the variability in the difficulty level

in the problems presented (Ross, 1976). Because the level

of difficulty was generally increasing, improvements in

academic performance were difficult to obtain; if a subject

worked at the same rate each day, his mathematics performance

would appear to continually decrease. In order to use

mathematics problems correctly worked as a measure of

academic performance that reflected deficits or improvements

from day to day, the mathematics problems would need to be

of the same type, format, and order of difficulty throughout

30

the study. Such an approach would not closely approximate

the typical classroom situation, however.

The home actometer measures also appeared to be invalid

due to uncontrolled variation in the children's activities.

The trends in the weather tended to allow the children to

play outside more often as the study progressed which

produced increases in activity in most cases. Changes in

types of activity, choice of playmates, and location of

activity all produced much uncontrolled variation. It would

be necessary to standardize the location and activity of

children when measuring motoric activity to get an accurate

measure, and logistically this was beyond the capability of

this study. Both academic performance and home actometer

measures were judged to be invalid and are not considered

in the remainder of the discussion.

The Lupin's Child Behavior Rating Scale appeared to

be valid for measuring gross changes in a child's behavior,

and was concluded to be relevant in terms of consumer

attitudes of the parents. Since there was no reference

point against which to compare behaviors, apparently parents

rate their child according to his past few days' behavior.

Thus, there would appear to be no comparison of rates

between subjects, and slight daily changes within subjects

may not have been detected. Parent raters were not informed

as to which phase of treatment was occurring, but they may

have determined this to some extent by asking their children.

Thus, an expectancy bias cannot be ruled out. However,

31

expectancy during tension training may have been in the

wrong direction since "treatment" was ongoing. If that

were the case, expectancy bias could be assessed.

Because no reliability measures were established for

the on-task measures, they may have been subject to experi-

menter bias. The experimenter, knowing which phase of

treatment was occurring, would be subject to any expectancy

type of bias. However, both the responses of starting and

stopping the stopwatch, and the definitions of the behavior

being measured were simple. Therefore, the contamination

of the data from such bias may have been minimal. Kirby

and Shields (1972) used an identical on-task measurement

procedure with two raters, and obtained 98% agreement.

Subject 1

This subject exhibited desirable behavioral changes

concomitant with relaxation training. Changes occurred in

both the academic and the home settings.. Tension training

produced no significant lasting changes in his behavior,

however. As tension levels during mathematics decreased in

Phase 2, so did presession tension levels, and activity

levels during mathematics. He increased time spent on task

from 74% to 95%. These effects were maintained in Phase 3

with contingent reinforcement. As Lupin et al. (1974)

predicted, when tension levels drop, so do activity levels.

However, an improvement in behavior ratings by the parent

did not occur during this phase.

32

In Phase 4, presession tension levels increased along

with tension levels during mathematics. However, at Phase 1

the presession level was 16.37 uV RMS, and the increase in

Phase 4 was only to 12.51 uV RMS, below his initial

baseline. On-task behavior showed a significant reduction,

but remained well above baseline level. However, no change

in mathematics session activity level or home behavior

occurred. In Phase 5 both mathematics session and presession

tension levels dropped. The drop in mathematics session

tension was significant, and the drop in presession tension

approached significance. The percentage of time spent on

task, activity levels during mathematics, and behavior

ratings at home did not vary concomitantly with these

reductions in muscle-tension levels.

Results for Phase 6 were similar to those obtained in

Phase 2, and in addition, there was a significant drop in

occurrence of problem behaviors at home. For this subject,

relaxation training produced desirable changes in daily

tension levels, as seen in the decreases in the presession

and mathematics-session EMG readings, in academic performance,

as seen in the increase of percentage of time spent on task,

in activity levels in academic and home settings, and in

home behavior. Tension training may have aided the subject

to better distinguish between states of tension and relaxa-

tion, which would enhance his ability to control those states.

Tension training was associated with a significant reduction

33

in percentage of time spent on task in the laboratory

setting, however, no behavioral changes were effected in

the home situation.

Subject 2

As this subject learned to relax in Phase 2, presession

tension dropped significantly, on-task behavior increased

from 75% to 92%, activity level in the academic setting

decreased to nearly zero, and she exhibited a drop in the

occurrence of problem behaviors at home. In the academic

setting, the expected changes in her behavior occurred.

This subject reported that she practiced relaxation

techniques at home and in school after Phase 2 ended.

During Phase 3, tension levels in both presessions and

mathematics sessions remained low without the benefit of

biofeedback. The changes in percentage of time spent on

task, mathematics-session activity level, and problem

behavior at home were also maintained during this phase.

In Phase 4, as mathematics-session tension levels

increased, so did presession levels, but these remained

below the initial baseline level. This subject was parti-

cularly opposed to the tension requirements, and began to

show problem behaviors in the academic setting such as

crying, temper tantrums, and refusal to work. Time spent

on task declined significantly, and she exhibited increased

activity levels during the sessions. Behavior ratings at

home were highly variable, and no significant change occurred.

34

When tension training was ended in Phase 5, mathe-

matics-session tension level dropped significantly to just

above the reinforcement criterion level. Presession tension

showed a dramatic and significant drop back to the low

levels reached in Phase 3. Concomitant with these changes

percentage of time spent on task increased gradually, but

significantly, and mathematics-session activity levels

evidenced a strong trend toward improvement. The occurrence

of problem behaviors at home did not change significantly.

In Phase 6, mathematics-session tension levels were

reduced to below the levels reached in Phase 3. Presession

levels dropped to an extremely low point and remained there.

Percentage of time spent on task increased to 98% and mathe-

matics-session activity was significantly reduced. The

rate of problem behaviors at home dropped significantly, and

she ceased to be a problem in the laboratory setting.

Relaxation training reduced this subject's normal

tension levels, as seen by the decrease in presession EMG

readings. Desirable changes occurred in behavior at home

and in the academic setting. Tension training produced

the expected undesirable changes in behavior in the academic

setting--higher activity level, poor work performance,

tantrums, and other maladaptive and uncooperative responses.

Little effect was seen in home behavior coincident with

tension training.

35

Subject 3

Subject 3 was slow to respond to the relaxation training.

In Phase 2, mathematics-session tension levels dropped

significantly. Although there was a similar trend in

presession tension levels, the reduction approached, but

did not attain significance, At this point, she had not

learned to relax well enough for the effect to generalize

to other settings. There were no significant changes in

behavior in the laboratory setting, although on-task

behavior evidenced a desirable trend after an initial

reduction. Behavior ratings by the parents, although

variable, showed a significant decrease in the occurrence

of problem behavior during this period.

During Phase 3, presession tension levels remained low

suggesting that the relaxation training was slowly taking

effect. The improvements in behavior at home were maintained,

and time spent on task remained high.

This subject was the only one whose presession tension

levels increased to a higher point during Phase 4 than

were manifested in the initial baseline. A concomitant

drop in on-task behavior, and a dramatic increase in mathe-

matics'session activity resulted. However, there was no

significant change in home behavior.

In Phase 5, mathematics-session tension level dropped

significantly, and presession tension decreased to baseline

level. Mathematics-session activity level did not change

36

appreciably. On-task behavior increased, and the occur-

rence of problem behaviors at home decreased.

The second relaxation-training phase produced greater

gains in relaxation than attained previously. The subject's

presession readings dropped significantly, on-task behavior

greatly increased, and home behavior ratings showed improve-

ment. Although it did not attain a significant change in

level, activity during the mathematics session evidenced a

strong declining trend and variability reduced appreciably.

This subject was somewhat slow in responding to

relaxation training, and it was not until the second

training phase that the effects of reduced tension were

reflected in her behavior. She was quick to show behavioral

deficits following tension training, especially in the area

of overactivity. In the laboratory setting, when tension

level increased,activity level became very high--and as

tension was reduced,activity steadily decreased. Indeed,

tension and activity levels appeared to co-vary in this

subject. Little emotional change was noted following either

relaxation or tension training.

Summary

Combined results of all subjects indicate that EMG

biofeedback in conjunction with contingent reinforcement

was an effective procedure to either raise or lower EMG

levels of children engaged in an academic task. Such

training has typically been done with the participant

reclined and inactive. A review of the literature revealed

37

no studies in which relaxation was trained while a parti-

cipant was engaged in a task requiring motoric activity.

By training relaxation in an academic setting, the changes

in behavior occur where they are most needed, and with this

procedure no transfer of training is necessary.

The effects of EMG-biofeedback training while engaged

in an academic task (see Appendix E) were maintained by

contingent reinforcement for both tension reduction and

tension induction after biofeedback was withdrawn. While

working mathematics problems, it was found that high tension

levels were associated with high activity levels and

decreased academic performance. Low tension levels were

associated with low activity levels and increased academic

performance, as indicated by mathematics-session actometer-

rate data and percentage of time-spent-on-task data.

.The effects of EMG-biofeedback training to reduce

muscle tension in the laboratory setting transferred in

such a manner as to influence the ENG recordings taken

during the initial portion of subsequent sessions (see

Appendix D). This transfer of training was maintained by

reinforcement after biofeedback was withdrawn. However,

tension-induction training did not evidence this transfer

of training. Ratherthe EMG readings during the initial

portion of subsequent sessions returned to the levels

established during the initial baseline. Apparently,

tension induction did nothing more than negate effects of

prior relaxation training. Furthermore, when biofeedback

38

for tension induction was discontinued, the presession EMG

levels began to drop back to the levels reached during

tension-reduction training.

These findings are consistent with the data on the

occurrence of behavior problems in the home. Tension

reduction was associated with a concomitant reduction of

problem behaviors, whereas tension induction was not

accompanied by a change in the rate of problem behavior at

home. That tension induction showed less transfer than

tension reduction may have been due to the fact that the

subjects received a larger number of tension-reduction

trials than tension-induction trials,

Tension-induction training may have facilitated

relaxation training particularly with respect to the

latency of the onset of relaxation, and also possibly with

respect to the level of relaxation attained. Tension-

induction training may have aided the participant in

discriminating between states of tension and relaxation.

However, this improvement in relaxation during the final

phase may have resulted from the additional relaxation

training trials.

The changes in activity level, as indicated by the

mathematics-session actometer-rate data, and in academic

performance, as indicated by the percentage of time-spent-

on task data, were generally significant and in the predicted

direction.

39

Individual exceptions to these findings were present.

However, it is hypothesized that most of these exceptions

could be accounted for by a failure to extend a particular

experimental phase to the extent that is desirable in a

small N research design. In other cases, it may be that the

amount of uncontrolled variation was too great for parti-

cular effects to be validly assessed.

It should be noted that these findings were obtained

with children exhibiting both high activity levels and high

EMG levels, and may not hold for children exhibiting low

EMG levels. The results lend support to the efficacy of

using EMG-biofeedback training in conjunction with contingent

reinforcement of reductions in EMG-tension levels to reduce

overactivity, increase attention to an academic task, and

reduce problem behavior.

Further research using this procedure with extended

baseline and interventionperiods, a more controlled home

activity situation, and a uniform academic task would

illuminate the relationships between tension level, activity,

level, academic performance, and problem behavior. The

tendency of effects trained in the laboratory to transfer

to other settings could be more adequately measured. Future

researchers should withdraw contingent reinforcement to

determine if the effects of relaxation would be maintained.

It would be interesting to train problem students to relax

in a real classroom and measure the effects on behavior

there. Finally,if the effects of relaxation training on a

40

group of hyperactive children not receiving stimulant drugs

and a group of hyperactive children receiving the drugs were

compared, the information would be invaluable in assessment

of the possibility of using relaxation training as an alter-

native to drug treatment in the control of activity-level

problems.

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50

Appendix ABiofeedback Training Release Form

I, , understand the general

procedure regarding the use of biofeedback training, and

am satisfied with the explanation given to me concerning the

function and safety of the equipment. I voluntarily agreed

to participate.

is currently in reasonably good

health, and is not being treated for any medical disorder

which would prohibit the use of biofeedback training.

Yes No

I, the undersigned, agree to hold North Texas State

University and/or their authorized representatives harmless

from liability for any injuries or damages resulting from

the intentional or unintentional use or misuse and/or

negligent use or misuse of any procedures included herein.

I understand that the data collected will be used

primarily for the participant's benefit and strict anonymity

will be adhered to if the data is utilized for other purposes

such as the advancement of knowledge in this area.

Participant Date

Parent or Guardian Witness

51

Appendix B

Rational of Biofeedback Training

Electromyograph biofeedback has been used effectively

in the treatment of tension related problems with adults,

and recently, has been used in conjunction with reinforce-

ment techniques to alleviate some symptoms of hyperactive

children. Several authors have suggest that a child's

activity level is related to his tension levels, and that

hyperactive children are also overly tense. Overactivity

is a means for them to allevaite some of their tension.

High tension also results in poor concentration on tasks and

many other problem behaviors.

The goal of this program is to make the child aware of

his tension level through biofeedback, and then to reinforce

him for raising and lowering that level when asked to do

so. In this way, the child can be taught to control his

tension level. The BFT EMG 401 system will be used to sense

electrical activity prodcued by muscles in the forehead

region, and to transpose this activity into a tone which

is fed back to the participant. The pitch of this varies

in proportion to the level of muscle activity present, and

this gives the participant information on this tension level.

The participant is sheilded from any electrical current by

optical isolation circuitry, so the equipment can in no

way result in electrical shock.

Though this procedure is experimental and no promises of

improvement can be made, it is believed that as the child

Appendix B--Continued 52

learns to control his tension level, he will also learn

to control his activity level, with a resultant improvement

in his behavioral and academic performance. Learning self-

control should also enhance the child's self-image allowing

him to react more positively and with less anxiety to other

persons and in new situations.

53

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010

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55

Appendix D

Subj ect 1

I--I --- --- I It

Sujel

- % - - - 1

0

Subject 3

1 -4-----+ ---+I t- ----'

2 6 10 14 18 22 26 30 34 38 42 46

Sessions

Figure 1. Mean presession frontalis EMG levels for eachsubject.

56

Appendix E

Subject I

J4.4-~i-4-9 IT~ TTh

I'

-.ISubject 2

1~ -~k I

44-

ptt--4- - -----

tn AzzL. 7K11111Ii

-atI I I 1I L .~ .4 --- T-t-tlT -7

Subject 3

II

~ti~L~i --II - -- -- 'IIL It - - V -~

- "- -t- - -I- - -i - -+C

J1,

44111

L- -I--..

- ----- +t-- 1--

JItIEL10 14 18 22 26 30 34 38 42 46

Sessions

Figure 2. Mean mathematics frontalis EMG levels for each

subject.

7

i-iL':

In

CoI

co

(N

2 6

I

I

iI

.................. ...... ..

II I

u if--

I --- I I I I I I I I If I Io"Wo "mm- mom..-"

I t

®rww m

57

Appendix F

Subject 2

~F R--

C - -- ------ New

Subject 3

cc.o -

0-oI IF l

N MA~

6 10 14 18 22 26Li L 3L30 34 38 42 46

Sessions

Figure 3. Percentof time on-task during mathematics sessionfor each subject.

0)0o

C)

0l

Subject 1

7: III~III -~ liii--- -

- -" - - -1- - - - - - - - - - -

- - - - - I- -I

(d

0

N

-I

~i~L[i~IJI~ I L 2-1 L L1 V

21LVLJ I tJi.

I_

IL

58

Appendix G

Subject 1

Ell1

7jI

Subject 2

--- ------ --- --

I7 L u

["v'ljI'

{II

1 4 18 2

~1~~

K:1I.I-

L.

viVMN"

-4 -44--K-- --

bject 3

2 26 3034 38 42 46

Sessions.

Figure 4. Actometer rate during mathematics session for eachsubject.

(CNH-

00

I

H-

2'

Q)4-)

a)

04JFU

N

C)-I~: ~I

- I--1

Kz~-Y--t'ci' - -

2 6

...........i r

i

f--, 4- I-LL-V--4I

r - -

L

Appendix H

Subject 1

p L-

tz-iElz IzzzEmif-

zz: - 7:-?11pzEl i' - _ _ S

N\'I

subject

V9

JilL

IIIVKI~~~~~~ v F I ? A iI .f. . L~4I -+4 -* -

N I

'-u-I-I-I

A

I-II-uI

ilIMKI

4 & .. L

. .6. _ - a6 10 14 18 22

uL _

ect 3

26 30 34 38

7-.'

F- - - n

421 -6

42 46

Sessions

Figure 5. Daily sum of Lupin Child Behavior Behavior RatingScale for each subject.

59

0l

I)

0c:

L 1 .... _ F

4-)

0

rd

0

0(Y)

Q()

cq

I

------------

; I --I -4 rt--A ii -

-.1. to No a of 9- -

r-

"...I N- !, .. i At

2

1

IIIa

60

References

Ayllon, T.,, Layman, D., & Kandel, H. A behavioral-

educational alternative to drug control of hyperactive

children. Journal of Applied Behavioral Analysis,

1975, 8(2), 137-147.

Blanchard, E. B., & Young, L. D. Clinical applications of

biofeedback training: A review of evidence, Archives

of General Psychiatry, 1974, 30, 573-589.

Bower, C. & Glass, G. V. CORREL and TSX. Computer programs,

copyright June, 1974.

Bradley, C. The behavior of children receiving benzedrine.

American Journal of Psychiatry, 1937, 94, 577-585.

Braud, L. W. The effects of EMG biofeedback and progressive

relaxation upon hyperactivity and its behavioral concomi-

tants. Presented at the 22nd Annual Convention of the

Southwestern Psychological Association, April, 1975,

Houston, Texas.

Braud, L. W., Lupin, M. N., & Braud, W. G. The use of

EMG biofeedback in the control of hyperactivity.

Presented at the llth Annual Convention for Learning

Disabilities, February, 1974, Houston, Texas.

Budzynski, T. H. Biofeedback procedures in the clinic.

Seminars in Psychiatry, 1973, 5(4), 441-452.

Budzynski, T. H., & Stoyva, J. M. An instrument for

producing deep muscle relaxation by means of analog

information feedback. Journal of Applied Behavioral

Analysis, 1969, 2, 231-237.

61

Burks, H. The hyperkinetic child. Exceptional Child,

1960, 27, 18-26.

Comly, H. Cerebral stimulants for children with learning

disorders. Journal of Learning Disabilities, 1971,

4, 484-490.

Conners, K. C. Recent drug studies with hyperkinetic

children. Journal of Learning Disabilities, 1971,

4(9), 12-19.

Conners, K. C., & Eisenberg, L. The effects of methylpheni-

date on symptomatology and learning in disturbed children.

American Journal of Psychiatry, 1963, 120, 458-463.

Conners, K. C., Eisenberg, L., & Barcai, A. Effect of

dextroamphetamines in children: Studies on subject with

learning disabilities and school behavior problems.

Archives of General Psychiatry, 1967, 17, 478-485.

Conners, K. C., Eisenberg, L., & Sharpe, L. Effects of

methylphenidate (ritalin) on paired-associate learning

and porters maze performance in emotionally disturbed

children. Journal of Consulting Psychology, 1964, 28,

14-22.

Conners, K. C., & Rothschild, G. Drugs and learning in

children. In G. Helmuch (Ed.), Learning Disorders,

Vol. 3, Seattle: Special Child Publications, 1968.

Connoly, D. P., Besserman, R., & Kirschvink, J. Electromyo-

graphy biofeedback on hyperkinetic children, The Journal

of Biofeedback, 1974, 2. 24-30.

62

Denhoff, E., Davids, A., & Hawkins, R. Effects of dextro-

amphetamines on hyperkinetic children: A controlled

double blind study. Journal of Learning Disabilities,

1971, 4(9), 27-34.

Epstein, L., Lasagna, L., Conners, C., & Rodriquez, A.

Correlation of dextroamphetamine excretion and drug

response in hyperkinetic children. Journal of Nervous

and Mental Disease, 1968, 146, 136-146.

Ferman, S., & Feighner, A. Video feedback in treating

hyperkinetic children: A preliminary report. American

Journal of Psychiatry, 1973, 130(7), 792-796.

Fish, B. The "one child, one drug" myth of stimulants in

hyperkinesis: Importance of diagnostic categories in

evaluating treatment. Archives of General Psychiatry,

1971, 25, 193-203.

Glass, G. V., Willson, V. L., & Gottman, J. M. Design and

Analysis of Time-Series Experiments. Colorado Associated

University Press, Boulder, Colorado, 1975.

Hentoff, N. The drugged classroom. Evergreen Review,

December, 1970, 6-11.

Hollis, J., & St. Omer, V. Direct measurement of psycho-

pharmacologic response: Effects of chlorpromazine on

motor behavior of retarded children. American Journal

of Mental Deficiency, 1972, 76, 397-407.

Jacobson, E. Progressive Relaxation. Chicago: University

of Chicago Press, 1938.

63

Keogh, B. Hyperactivity and learning disorders: Review and

speculation. Exceptional Children, 1971, 38, 101-109.

Kinsley D. E. The effects of operant conditioning techni-

ques upon selected behavior of neurologically handicapped

children. Dissertation Abstracts, 1970, 30(9-A), 3792.

Kirby, F. D., & Shields, F. Modification of arithmetic

response rate and attending behiavor in a seventh grade

student. Journal of Applied Behavioral Analysis, 1972,

5, 79-84.

Knights, R., & Hinton, G. Minimal brain dysfunction:

Clinical and psychological test characteristics.

Academic Therapy, 1968, 4, 265-273.

Krippner, S., Silverman, R., Cavallo, M., & Healy,, A. A

study of hyperkinetic children receiving stimulant drugs.

Academic Therapy, 1973, 8, 261-269.

Ladd, E. Pills for classroom peace? Saturday Review,

November, 1970, 66-83.

Lupin, M., Braud, L. W., Braud, W. G,, & Duer, W. E. Effects

of relaxation upon hyperactivity using relaxation tapes

for children and parents. Presented at the llth Annual

Convention for Learning Disabilities, February, 1974,

Houston, Texas.

Morrison, J., & Stewart, M. Evidence for polygenetic inheri-

tance in the hyperactive child syndrome. American

Journal of Psychiatry, 130(7), 1973, 791-792.

Nall, A. Alpha training and the hyperkinetic child--Is it

effective? Academic Therapy, 1973, 9, 5-19.

64

Patterson, G. R. An application of conditioning techniques

to the control of a hyperactive child. In P. Ullman &

L. Krasner (Eds.), Case Studies in Behavior Modification,

New York: Holt, Rinehart, and Winston, 1965, 370-375.

Patterson, G. R., Jones, R., Whittier, J., & Wright, M.

A behavior modification technique for the hyperactive

child. Behavior Research and Therapy, 1965, 2, 217-226.

Pihl, R. D. Conditioning procedures with hyperactive

children. Neurology, 1967, 17, 421-423.

Ross, R. M. The effect of a free-time contingency of arith-

metic and problem behavior in the classroom. North

Texas State University Dissertation, August, 1976.

Sargent, J. D., Green E. E., & Walter, E. D. Preliminary

report on the use of autogenic feedback training in the

treatment of migrain and tension headaches. Psychosomatic

Medicine, 1973, 35, 129-135.

Schulman, J. L.,, & Resiman, J. M. An objective measure of

hyperactivity. American Journal of Mental Deficiency,

1959, 64, 455-456.

Sprague, R., Barnes, B., & Werry, J. Methylphenidate and

thoridazine: Learning, reaction time, activity, and

classroom behavior in disturbed children. American

Journal of Orthopsychiatry, 1970, 40, 615-628.

Sprague, R., & Toppe, L. Relationship between activity

level and delay of reinforcement. Experimental Child

Psychology, 1966, 3, 390-397.

65

Sroufe, L. A., & Stewart, M. A. Treating problem children

with stimulant drugs. The New England Journal of Medicine,

1973, 289(8), 407-412.

Stewart, M. A., Pitts, F. N., Craig, A. G., & Dieruf, W.

The hyperactive child syndrome. American Journal of

Orthopsychiatry, 1966, 36, 861-867.

Sullivan Mathematics Program. Palo Alto, California:

Behavioral Research Laboratories, 1970.

Sulzbacher, S. Behavior analysis of drug effects in the

classroom. In G. Semb (Ed.), Behavior Analysis and

Education. University of Kansas, 1972.

Sykes, D.,, Douglas, V., Weiss, G., & Minde, K. Attention

in hyperactive children and the effects of methylpheni-

date (ritalin). Journal of Child Psychology and

Psychiatry, 1971, 12, 129-139.

Twardosz, S., & Sajivaj, T. Multiple effects of a procedure

to increase sitting in a hyperactive retarded boy.

Journal of Applied Behavioral Analysis, 1972, 5, 73-78.

Weiss, G., Werry, J., Minde, K., Douglas, V., & Sykes, D.

Studies on the hyperactive child: The effects of dextro-

amphetamine and chlorpromazine on behavior and intel-

lectual functioning. Journal of Child Psychology and

Psychiatry, 1968, 9, 145-156.

Werry, J. S., Weiss, G., Douglas, V., & Martin, J. Studies

on the hyperactive child: The effects of chlorpromazine

upon behavior and learning ability. Journal of the

American Academy of Child Psychiatry, 1966, 5, 292-312.

66

Wiltz, N. A., & Gordon, S. B. Parental modification of

a child's behavior in an experimental residence. Journal

of Behavior Therapy and Experimental Psychiatry, 1974,

5 (1), 107-109.

Wolpe, J. Psychotherapy by Reciprocal Inhibition. Palo

Alto, California: Stanford University Press, 1958.

Zrull, J. P. Discussion of the effects of methylphenidate

on distrubed children. American Journal of Psychiatry,

1963, 120, 463-464.