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

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 Joe Kamiya Barry Sterman Richard Caton

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. –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

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 Theta Beta

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

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 Kamiya Science, 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 – Neurofeedback Neurofeedback

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 Theta Beta

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

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