EEG Operant Conditioning as a treatment for Autistic disorders

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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

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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.

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White matter anomalies in Autism
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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)

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fMRI connectivity
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EEG Connectivity
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What is EEG operant conditioning (biofeedback)?
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Case Example Mu NF
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Case Example Mu NF
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Case Example Topographical changes
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EEG biofeedback Efficacy in ADHD
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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 lt .0001

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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.

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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.

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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

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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

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EEG connectivity changes
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The relative efficacy of connectivity guided and
symptom based EEG biofeedback for Autistic
disorders

• Compared findings from Jarusiewicz (2002) to
  Coben Padolskys (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

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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

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Facial/Emotional Processing
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Facial/Emotional Processing
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Facial/Emotional Processing
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Facial/Emotional Processing deficits in Autism
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Facial/Emotional Processing deficits in Autism
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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).

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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.

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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

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Subjects
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
Skewness .185 Kurtosis -1.192
Skewness .275 Kurtosis .304
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Neurofeedback Protocol Design Sites of
Coherence training
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Neurofeedback Protocol Design
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Results
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Results
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Results
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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

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Results
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Results
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Results
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Do the changes last?