1. EEG Operant Conditioning as a treatment for Autistic disorders Robert Coben, PhD Associate Fellow, EEG Biofeedback (BCIA) Diplomat, qEEG Certification Board Massapequa Park, New York Presented at Autism One 2008

2. 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.

3. White matter anomalies in Autism

4. 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)

5. fMRI connectivity

6. EEG Connectivity

8. What is EEG operant conditioning (biofeedback)?

9. Case Example: Mu NF

11. Case Example: Topographical changes

12. EEG biofeedback: Efficacy in ADHD

13. 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 <.0001

14. 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.

15. 1 st 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.

17. 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

18. 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

19. EEG connectivity changes

20. 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

21. Autistic Spectrum Disorder: A Controlled Study of EEG Coherence Training focused on Social Skill Deficits Robert Coben, PhD Presented at 2007 ISNR Conference San Diego, California

22. Facial/Emotional Processing

25. Facial/Emotional Processing deficits in Autism

27. 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).

28. 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. H 1 : NF (coherence training) can improve visual processing and social skills. H 2 : Improvements in visual processing would predict enhancements in social skills. H 3 : EEG analyses will show associated improvements in the neural substrate responsible.

29. 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

30. Subjects Skewness =.185 Kurtosis = -1.192 Skewness =.275 Kurtosis =.304 ExperimentalControlspvalue Age9.5, 2.3810.13, 2.720.39 Gender21 male21 male1.0 Race23 caucasian23 caucasian1.0 Handedness24 right handed22 right handed0.30 Medications0.16, 0.370.16, 0.371.0 ATEC31.00, 9.1631.16, 6.360.94 Social Skills 70.3, 7.3969.96, 6.330.86 Visual-Perception-1.63, 1.13-1.52, 1.070.73

31. Neurofeedback Protocol Design – Sites of Coherence training

32. Neurofeedback Protocol Design

33. Results

36. 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%

37. Results

40. Do the changes last?