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QEEG and Neurofeedback in the Treatment of ADHD

www.lanc.uk.com @ADHD_LANC LANC Facebook Page 01403 240002 reception@lanc.uk.com. QEEG and Neurofeedback in the Treatment of ADHD. Dr. Neil Rutterford PhD CPsychol AFBPsS MIoD. 07825 632340 dr.rutterford@lanc.uk.com @drrutterford. Outline. Setting the Scene

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QEEG and Neurofeedback in the Treatment of ADHD

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  1. www.lanc.uk.com @ADHD_LANC LANC Facebook Page 01403 240002 reception@lanc.uk.com QEEG and Neurofeedback in the Treatment of ADHD Dr. Neil Rutterford PhD CPsychol AFBPsS MIoD 07825 632340 dr.rutterford@lanc.uk.com @drrutterford

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

  3. Setting the Scene • ADHD • Symptoms • Diagnosis • Treatment • Implications/Outcome

  4. QEEG Richard Caton Joe Kamiya Barry Sterman

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

  6. QEEG

  7. 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

  8. 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).

  9. QEEG

  10. QEEG

  11. QEEG

  12. QEEG

  13. 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.

  14. 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

  15. 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)

  16. QEEG Data • Mean topographic brainmaps for combined ADHD Beta Theta

  17. QEEG Data • Mean topographic brainmaps for inattentive ADHD Alpha Theta

  18. 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.

  19. 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.

  20. Neurofeedback 1958,63 – Joseph Kamiya and alpha training • Recognition of certain brainwave states - alpha • Self regulated production of alpha “Anxiety Change Through Electroencephalographic Alpha Feedback Seen Only in High Anxiety Subjects” James V. Hardt and Joe KamiyaScience, Vol. 201, pp. 79-81, 7 July 1978

  21. Neurofeedback • 70s – 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)

  22. Services – NeurofeedbackNeurofeedback

  23. Neurofeedback

  24. Neurofeedback Let’s demonstrate!

  25. 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.

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

  27. 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

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

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

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

  31. 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?

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

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

  34. 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

  35. Thank You Dr. Neil Rutterford PhD CPsychol AFBPsS MIoD 07825 632340 dr.rutterford@lanc.uk.com @drrutterford www.lanc.uk.com

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