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

0

2

4

6

8

10

12

14

16

18

20

1 2 3 4 5 6 7 8 9 1

10-12

19-23

7-15

2.8

2.9

3

3.1

3.2

3.3

3.4

3.5

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

1

2

3

4

5

6

7

8

9

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

0

5

10

15

20

25

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

0

5

10

15

20

25

30

35

40

45

50

Sens/Cogn Health/Behavior Total

Jarusiewicz

Coben/Padolsky

0

0.5

1

1.5

2

2.5

3

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

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

0

10

20

30

40

50

60

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

0

10

20

30

40

50

60

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?