In an in-school trial, students with ADHD were randomized to neurofeedback, cognitive behavioral therapy (CBT), or control groups.19 Six months post-intervention, students in the neurofeedback group had significant gains (attention ES = 0.34; executive function ES = 0.25; hyperactivity/impulsivity ES = 0.23; BRIEF [Brief Rating Inventory for Executive Function] ES = 0.31) compared with those in the CBT and control groups. These effect sizes may have been lower because the study did not use QEEG to identify the best protocol. However, at 6 months the patients who had received neurofeedback maintained the same medication dosage, but those in the CBT and the control groups had statistically significant increases in medications (9 mg, P = .002; and 13 mg, P ≤.001, respectively).
Monastra and colleagues9 used QEEG to randomize participants on medication to experimental and control groups. When the medication was removed at the end of treatment, only the participants who had completed neurofeedback were able to sustain their improvements in attention and impulsivity.
In autism studies that used the TBR protocol, significant gains were seen in nonverbal stereotypic behaviors, communication, communication skills, and social interaction.20-22 These changes were noted at 6-month, 1-year, and 2-year follow-up, respectively.
Coben and colleagues23 used multivariate coherence neurofeedback in their study (improving connections between areas in the brain during neurofeedback). Improvements in attention/executive function, visual-motor skills, language, and parent rating scales were maintained at a 10-month follow-up.
Becerra and colleagues24 described positive behavioral changes and a spurt of EEG maturation with theta-alpha neurofeedback training (done 2 years earlier) in 5 learning-disabled children. After 2 years, EEG maturation continued in the children who had received neurofeedback training as well as positive behavioral changes and remission of learning disability symptoms compared with controls.
In a study by Leins and colleagues,16 children were randomly assigned to 33 sessions of either SCP or TBR neurofeedback. Group assignment and assessment were blinded. There was a significant increase in full-scale and performance IQ as well as improvement in variables of attention. Changes in attention were medium to high for the SCP group (ES = .77-1.19) and medium (ES = .66) for the TBR group. Changes in IQ were medium in the SCP group (ES = 0.54) and medium to high in the TRB group (0.62-0.82); 6-month follow-up scores were not significantly different from end-of-treatment scores.
To guide neurofeedback treatments in dyslexia, Coben and colleagues25 identified hypocoherences in the left temporal lobe using pretreatment QEEG analysis. QEEG determined where hypocoherences occurred in the areas of the brain associated with dyslexia. After 20 neurofeedback sessions, the reading level in children with dyslexia increased by an average of 1.2 years. A long-term follow-up study is needed to determine if these results have been sustained.
Understanding QEEG and LORETA
In the early 1990s, 3-dimensional (3-D) locations of surface (scalp) EEG were used to identify abnormalities deep within the brain.26,27 Imaging modalities, including positron emission tomography, single-photon emission computed tomography, and functional MRI (fMRI), were co-registered to create a common anatomic atlas. The advent of EEG tomography (tEEG) provides coregistration of 2 imaging modalities that have similar spatial localization characteristics: fMRI measures blood flow and QEEG adds a high temporal resolution of changes in the electrical sources in the brain that are associated with changes in blood flow.28,29
Dr. Simkin is Clinical Assistant Professor, Department of Psychiatry, Emory University School of Medicine, Atlanta, GA. Dr. Lubar is Professor Emeritus, Department of Psychology, University of Tennessee, Knoxville, TN; and Affiliate Scientist for the Center of Complex Systems and Brain Sciences, Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, FL.
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