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EEG Operant Conditioning as a
treatment for Autistic disorders
Robert Coben, PhDAssociate Fellow, EEG Biofeedback (BCIA)
Diplomat, qEEG Certification BoardMassapequa 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 sentence comprehension (Just et al., 2004)
fMRI connectivity
EEG Connectivity
What is EEG operant conditioning (biofeedback)?
Case Example: Mu NF
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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 Double-Blind Placebo-Controlled Study
• N = 60, with crossover• Attention Scores:• Effectiveness of Intervention; P =
.0004
• Treatment Effect; P = .0004• Parent Ratings:• Effectiveness of Intervention; P =
.0002
• Treatment Effect; P < .00010
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PRE POST F/U
Monastra, Monastra, George (2002)
EEGBF
Ritalin
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.
1st Pilot Study
• 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
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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 predicted by age, medications, severity of symptoms
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 appears more effective
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Sens/Cogn Health/Behavior Total
Jarusiewicz
Coben/Padolsky
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speech social cognitive behavior
Jarusiewicz
Coben/Padolsky
Autistic Spectrum
Disorder: A Controlled
Study of EEG Coherence
Training focused on Social Skill
DeficitsRobert Coben, PhDPresented 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% (low).
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 coherence NF
–25 patients wait list controls
Subjects
Skewness = .185Kurtosis = -1.192
Skewness = .275Kurtosis = .304
Experimental Controls pvalue
Age 9.5, 2.38 10.13, 2.72 0.39
Gender 21 male 21 male 1.0
Race 23 caucasian 23 caucasian 1.0
Handedness 24 right handed 22 right handed 0.30
Medications 0.16, 0.37 0.16, 0.37 1.0
ATEC 31.00, 9.16 31.16, 6.36 0.94
Social Skills 70.3, 7.39 69.96, 6.33 0.86
Visual-Perception -1.63, 1.13 -1.52, 1.07 0.73
Neurofeedback Protocol Design – Sites of Coherence
training
Neurofeedback Protocol Design
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Results
ANOVA
714.420 1 714.420 7.788 .008
4403.200 48 91.733
5117.620 49
181.451 1 181.451 4.625 .037
1883.254 48 39.234
2064.705 49
6.690 1 6.690 15.967 .000
20.113 48 .419
26.803 49
Between Groups
W ith in G roups
Tota l
Between Groups
W ith in G roups
Tota l
Between Groups
W ith in G roups
Tota l
ATECchange
SocSkillschange
VisualProcesschange
Sum ofSquares df Mean Square F Sig.
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 non-
overlapping data points) = 88%
• Social skills training has mean PND = 70% and generalization = 53%
Results
Results
Results
Do the changes last?