Discourse on the development of EEG diagnostics and biofeedback for attention-deficit/hyperactivity disorders

This article presents a review of work that my colleagues and I have been doing during the past 15 years developing a rationale for the diagnosis of attention-deficit/hyperactivity disorder (ADHD) and treatment of ADHD employing EEG biofeedback techniques. The article first briefly reviews the history of research and theory for understanding ADHD and then deals with the development of EEG and event-related potential (ERP) assessment paradigms and treatment protocols for this disorder, including our work and that of others who have replicated our results. Illustrative material from our current research and child case studies is included. Suggestions for future experimental and clinical work in this area are presented and theoretical issues involving the understanding of the neurophysiological and neurological basis of ADHD are discussed.     

A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities

Eighteen children with ADD/ADHD, some of whom were also LD, ranging in ages from 5 through 15 were randomly assigned to one of two conditions. The experimental condition consisted of 40 45-minute sessions of training in enhancing beta activity and suppressing theta activity, spaced over 6 months. The control condition, waiting list group, received no EEG biofeedback. No other psychological treatment or medication was administered to any subjects. All subjects were measured at pretreatment and at posttreatment on an IQ test and parent behavior rating scales for inattention, hyperactivity, and aggressive/defiant (oppositional) behaviors. At posttreatment the experimental group demonstrated a significant increase (mean of 9 points) on the K-Bit IQ Composite as compared to the control group (p<.05). The experimental group also significantly reduced inattentive behaviors as rated by parents (p<.05). The significant improvements in intellectual functioning and attentive behaviors might be explained as a result of the attentional enhancement affected by EEG biofeedback training. Further research utilizing improved data collection and analysis, more stringent control groups, and larger sample sizes are needed to support and replicate these findings.This research was supported by an equipment grant by Autogenics Systems. Portions of this paper were presented at the annual convention of the Association of Applied Psychophysiology and Biofeedback, March, 1993 in Los Angeles and at the annual meeting of the Biofeedback Society of California, November, 1992 in Monterey, California. The authors gratefully acknowledge Todd Fischer and Paul Clopton for their valuable assistance in statistical analysis for this article.     

Electroencephalographic Biofeedback in the Treatment of Attention-Deficit/Hyperactivity Disorder

Historically, pharmacological treatments for attention-deficit/hyperactivity disorder (ADHD) have been considered to be the only type of interventions effective for reducing the core symptoms of this condition. However, during the past three decades, a series of case and controlled group studies examining the effects of EEG biofeedback have reported improved attention and behavioral control, increased cortical activation on quantitative electroencephalographic examination, and gains on tests of intelligence and academic achievement in response to this type of treatment. This review paper critically examines the empirical evidence, applying the efficacy guidelines jointly established by the Association for Applied Psychophysiology and Biofeedback (AAPB) and the International Society for Neuronal Regulation (ISNR). On the basis of these scientific principles, EEG biofeedback was determined to be “probably efficacious” for the treatment of ADHD. Although significant clinical improvement was reported in approximately 75% of the patients in each of the published research studies, additional randomized, controlled group studies are needed in order to provide a better estimate of the percentage of patients with ADHD who will demonstrate such gains in clinical practice.     

Analysis of the physiological stress profile: The interrupted time-series design

Most research employing physiological stress profiling procedures has relied upon statistical analyses that are flawed in two ways: (a) These analyses typically average the physiological levels observed across a series of observations during any one phase of the profile, thereby ignoring rate of change as a relevant parameter, and (b) the problem of autocorrelation, or the natural correlation of time-series observations of the same physiologic activity, is unaddressed. We hope to introduce the biofeedback field to the technique of interrupted time-series analysis, which effectively deals with these two flaws. Interrupted time-series analysis additionally permits statistical conclusions based upon the stress profile of a single individual, thereby providing an objective basis for decisions concerning the effectiveness of training or the timing of changes in training for a single client. We describe the application of the technique to the analysis of a stress profile of a subject diagnosed as hypertensive.The authors gratefully acknowledge the assistance provided by Judith Green, Mark Lewis, Robert Shellenberger, and John Turner of the Aims Biofeedback Institute, Greeley, Colorado, in conducting this research.     

Growth and development of biofeedback: A bibliographic update

Computerized literature searching techniques were used to examine publication patterns in the worldwide biofeedback literature. Searches were completed in the United States and in Japan for the years 1985 through 1987. The results were used to update the results of an earlier study (Hatch & Riley, 1985) that covered the years from 1964 through 1984. Publication growth curves were generated for several media, including scientific journal articles, books, doctoral dissertations, and popular magazine articles. Although publication of information about biofeedback remains active worldwide, there has been a declining trend in effect for the past several years. The American database grossly underestimated the number of Japanese biofeedback articles, and it is likely that the literatures of other countries outside of North America were similarly underestimated. Possible explanations for the various trends noted are discussed.These results were presented in part at the Twentieth Annual Meeting of the Association for Applied Psychophysiology and Biofeedback. We gratefully acknowledge the assistance of Margaret Cyr-Provost in preparing the data for analysis.     

Good news—Bad press: Applied psychophysiology in cardiovascular disorders

Dysregulation in blood pressure control can occur as a result of psychological stress in either the hypertensive or hypotensive direction. Applied psychophysiological techniques incorporating biofeedback and relaxation have been shown to be efficacious in controlled studies of hypertensive patients. Electromyograph, thermal, skin conductance and direct blood pressure feedback have been utilized alone or in combination with relaxation, blood pressure monitoring, and medication. Prediction models are proposed to define what type of hypertensive is most likely to respond with significant blood pressure decrease. Neurocardiogenic syncope is a cardiovascular disorder which manifests itself as lightheadedness, dizziness, syncope, and often migraine-type headache. Preliminary indications suggest that biofeedback-assisted relaxation may also prove beneficial to patients with this syndrome.This paper was presented as a presidential address at the 27th Annual Meeting of the Association for Applied Psychophysiology and Biofeedback, Albuquerque, NM, March, 1996. I wish to thank my present and past collaborators who contributed their thoughts and enthusiams to my program of research in applied psychophysiology of cardiovascular disorders. They are G. Argueta Bernal, Ph.D., Ilona Jurek, M.D., M. Woerner, M.Ed. R. Ph., J.T. Higgins, Jr., M.D., T. Fine, M.A. LPCC, S.W. Utz, RN, Ph.D., Gerard Roberts, M.D., Blair Grubb, M.D., Michael Weaver, RN, Ph.D.     

Self-regulation of response patterning

This paper develops the basic premise that learning to self-regulate a pattern of responses can have different consequences from those observed when controlling individual functions alone. It is suggested that the self-regulation of patterns of responses can be a particularly sensitive and effective procedure for(a) uncovering biological linkages and constraints between responses in the intact human,(b) investigating how multiphysiological systems combine to produce unique subjective experiences and effects on performance, and(c) enhancing the clinical effectiveness of biofeedback procedures by training patients to integrate and coordinate voluntarily specific patterns of cognitive, autonomic, and motor responses. These hypotheses are illustrated by basic research involving biofeedback training for patterns of blood pressure, heart rate and EEG activity, related experiments on the cognitive self-regulation of patterns of physiological responses using affective imagery and meditation procedures, and case studies of patients treated with biofeedback. The concept of electronic biofeedback as an unnatural act is presented with the goal of placing self-regulation within a more biobehavioral perspective emphasizing the natural patterning of physiological processes.Presidential address read at the Biofeedback Research Society meeting on February 18, 1974 at Colorado Springs, Colorado. I would like to express my gratitude to my former teachers and colleagues, whose thinking and data have helped shape the theme presented in this paper. They are, in alphabetical order: Professors Joseph Campos, Andrew Crider, Harold Johnson, Peter Lang, David Shapiro, and Bernard Tursky. I would also like to thank my graduate students, notably Terry Bergman, Richard Davidson, Paul Fair, Daniel Goleman, Jim Hassett, and Marilyn Neyers for their important contributions to the research program.A portion of the recent data reported here was supported by the Advanced Research Projects Agency of the Department of Defense and monitored by the Office of Naval Research under Contract N00011-70-C-0350 to the San Diego State University Foundation.     

Diabetic ulcers: The effect of thermal biofeedback-mediated relaxation training on healing

The present study was a preliminary investigation into the effect of thermal biofeedback-mediated relaxation training on healing of diabetic ulcers. Subjects were three males who had nonhealing diabetic ulcers of the toe, ankle, and leg, respectively. Treatment consisted of thermal biofeedback training at the ulcer site, handwarming training (in two of the three subjects), and home relaxation practice. Two subjects showed significant healing. Thermal biofeedback-mediated relaxation training may be a useful adjunct to traditional treatments for diabetic foot ulcers.The authors wish to acknowledge the assistance of Drs. Naomi Alazraki, Kathryn Morton, Louis Larsen, and Mr. Barry Burkinshaw of the Salt Lake VA Medical Center, without whom this study could not have been performed. The first author would also like to thank Dr. Edward Taub for his invaluable advice and support.     

EEG Biofeedback for Treatment of Psychogenic Non-Epileptic Seizures (PNES) in Multiple Sclerosis: A Case Report

Applied Psychophysiology and Biofeedback - The objective of the present study was to evaluate the effectiveness of EEG biofeedback for treatment of psychogenic non-epileptic seizures (PNES) in a...     

The effects of stimulant therapy,EEG biofeedback,and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder

One hundred children, ages 6–19, who were diagnosed with attention-deficit/hyperactivity disorder (ADHD), either inattentive or combined types, participated in a study examining the effects of Ritalin, EEG biofeedback, and parenting style on the primary symptoms of ADHD. All of the patients participated in a 1-year, multimodal, outpatient program that included Ritalin, parent counseling, and academic support at school (either a 504 Plan or an IEP). Fifty-one of the participants also received EEG biofeedback therapy. Posttreatment assessments were conducted both with and without stimulant therapy. Significant improvement was noted on the Test of Variables of Attention (TOVA; L. M. Greenberg, 1996) and the Attention Deficit Disorders Evaluation Scale (ADDES; S. B. McCarney, 1995) when participants were tested while using Ritalin. However, only those who had received EEG biofeedback sustained these gains when tested without Ritalin. The results of a Quantitative Electroencephalographic Scanning Process (QEEG-Scan; V. J. Monastra et al., 1999) revealed significant reduction in cortical slowing only in patients who had received EEG biofeedback. Behavioral measures indicated that parenting style exerted a significant moderating effect on the expression of behavioral symptoms at home but not at school.     

Biofeedback in medicine: who,when, why and how?

Biofeedback is a mind-body technique in which individuals learn how to modify their physiology for the purpose of improving physical, mental, emotional and spiritual health. Much like physical therapy, biofeedback training requires active participation on the part of patients and often regular practice between training sessions. Clinical biofeedback may be used to manage disease symptoms as well as to improve overall health and wellness through stress management training. Research has shown that biofeedback interventions are efficacious in treating a variety of medical conditions, and many Americans are turning to biofeedback and other less traditional therapies for their routine healthcare.Clinical biofeedback training is growing increasingly popular in the USA, as many people are seeking out relatively new approaches to healthcare. This article provides an overview of clinical biofeedback training, outlines two models of training, details research which has established how effective biofeedback is in patients with a given disease, and describes who should be referred for biofeedback training.     

Hyphomicrobia and the oxidation of manganesse in aquatic ecosystems

Biogenic manganese deposits from freshwater pipelines in many parts of the world have been examined chemically and microbiologically. For chemical analysis to indicate the nature of the deposit the sampling procedure must ensure that the biogenic deposit is not contaminated by abiogenic material. Hyphomicrobium is abundant in manganese deposits from world-wide location but it is not the only manganese-oxidizing bacterium. The difficulties of assessing the relative importance of hyphomicrobia and other manganese bacteria, and of formulating satisfactory culture media, are discussed.Examination of accredited deposits and laboratory cultures suggests that some hyphomicrobia preferentially oxidize manganese rather than iron.I gratefully acknowledge all those persons and institutions who supplied samples of manganese deposits, and in particular The Hydro-Electric Commission, Tasmania; The Snowy Mountains Authority; Northern Electricity Authority of Queensland; Miss I. J. Powling, State Rivers and Water Supply Commission, Victoria; Melbourne and Metropolitan Board of Works; Mr. G. E. Hollis, New Zealand Electricity Department; Mr. J. Henderson, North-West Gloucestershire Water Boards, and Mrs. K. Ormerod, Norsk Institut for Vannforskning. I thank Mrs. P. M. Scarborough, Mr. R. Buckney for technical assistance, and the Australian Research Grants Committee for a grant.     

Ontogeny of maternal behavior and brood pheromone in crayfish

Summary Third stage crayfish were maze tested to determine their preference for paired stimulus solutions of females in various breeding stages and of males. Formerly unattractive female crayfish begin to produce a brooding attractant when they deposit eggs (Fig. 1). The attractant become maximally effective when the eggs hatch (Fig. 2). Behavioral changes occur as larvae develop into the fourth stage and result in both a reduced larval attraction to any mother's stimulus (Figs. 3, 4) and a tendency to become solitary. At the same time the mother's attractant becomes less potent (Fig. 5). The mother receives feedback from her developing brood which maintains her behavior and attractive stimulus (Fig. 8). In the absence of this feedback, the mother's behavior changes to include larval predation in some species (Fig. 4, 6, 7) and her stimulus is no longer attractive (Figs. 8, 9).I gratefully acknowledge the help received from my graduate committee: Drs. Albert Carlson, Ronald R. Hoy, Emil W. Menzel and Charles Walcott. I also thank Mr. Kenneth Lantz of the District 6 Office of the Louisiana Department of Fisheries and Wildlife for providing laboratory space and assistance during my study in Louisiana. Funded by U.S. National Science Foundation Grant G.U. 3850.     

A Reminiscence

Leslie Orgel and Francis Crick with Gobind Khorana in Madison, Wisconsin (December 1965). I first met Leslie at the Endicott House (MIT) in February 1964. Leslie was then spending a period of time at MIT and the occasion was a party for him. During our conversation, Leslie talked about starting some experimental work. He seemed to be particularly interested in polyphosphates and the chemical activation of small molecules (building blocks).Shortly after his move to the Salk Institute in the Fall of 1964 I visited him in January 1965. He already had a lab going. I remember meeting Jim Ferris, in particular, and John Sulston sometime later. That particular time was exciting for my research as well. We had the first results on the Genetic Code using the chemical-biochemical approach that my lab had developed. Francis Crick was also at the Salk Institute during the time of my visit. Both Leslie and Francis were very excited by my results and they began to ask a lot of questions and gave me a whole lot of suggestions about further experiments. In fact, my thinking and planning of things that we were doing were so scrutinized and clarified during these discussions that, it seemed to me, my own group had only to turn out all the experiments that were needed. These interactions with Francis and Leslie continued intensively throughout that year and later. In fact, both Leslie and Francis accepted my invitation to Madison in December 1965 for more discussions.Since those early days of the Salk Institute, I have made numerous visits over the years to Leslie and his research group. It has always been very exciting to learn about the many discoveries bearing on chemical evolution that have unfolded from Leslie's research group. In addition, I have always benefitted from the insightful comments that Leslie invariably provided on my own research. I look forward to our continued interactions and friendship in the future.Leslie, A Happy Birthday!     

Independent biofeedback self-regulation of EEG alpha and skin resistance

Skin resistance and EEG alpha were recorded concurrently during alpha biofeedback, in which the participant attempted to control alpha, and during skin resistance biofeedback, in which the participant attempted to control skin resistance. Alpha production changed significantly (p<0.001) during alpha biofeedback, indicating successful self-regulation of alpha, but did not change significantly during skin resistance biofeedback. Similarly, skin resistance changed significantly (p<.001) during skin resistance biofeedback but did not change significantly during alpha biofeedback. The results show independent control of alpha and skin resistance, and may reflect independent self-regulation of cognitive and somatic tension-relaxation systems.A longer version of this paper was presented at the meeting of the Biofeedback Society of America, Orlando, Florida, March 1977. Laurie Franconi, Tammy Johnson, and Dan Smith were invaluable during data collection. This research was supported in part by Grant #SMI76-04946 from the National Science Foundation to the author.     

Neurofeedback: An Alternative and Efficacious Treatment for Attention Deficit Hyperactivity Disorder

Current research has shown that neurofeedback, or EEG biofeedback as it is sometimes called, is a viable alternative treatment for Attention Deficit Hyperactivity Disorder (ADHD). The aim of this article is to illustrate current treatment modalities(s), compare them to neurofeedback, and present the benefits of utilizing this method of treatment to control and potentially alleviate the symptoms of ADHD. In addition, this article examines the prevalence rates and possible etiology of ADHD, the factors associated with ADHD and brain dysfunction, the current pharmacological treatments of ADHD, Ritalin, and the potential risks and side effects. Behavior modification and cognitive behavioral treatment for ADHD is discussed as well. Lastly, a brief history of the study of neurofeedback, treatment successes and clinical benefits, comparisons to medication, and limitations are presented.     

Biofeedback treatment of gastrointestinal disorders.

Biofeedback has had a greater impact on gastroenterology than on any other medical subspecialty. Biofeedback is the treatment of choice for many of the most common types of fecal incontinence, and preliminary studies suggest that it is likely to become a preferred method for treating patients with constipation related to inability to relax the striated pelvic floor muscles during defecation. This dysfunction may account for up to 50% of patients with chronic constipation. Thermal biofeedback forms part of a multicomponent behavioral treatment for irritable bowel syndrome that is reported to be effective, and other promising applications of biofeedback for gastrointestinal disorders are under investigation.     

Effects of biofeedback-assisted attention training in a college population

A program of stress management employing open-focus attention-training workshops was developed at Baruch College to bring the benefits of stress reduction to students. The purpose of the research reported here was to evaluate the results of the open-focus attention-training technique. Open-focus technique without biofeedback training was used for two semesters. Biofeedback training was incorporated in the third semester. In the first study, changes in grade point average (GPA), stress-related symptoms, and physiological measures were examined. The experimental subjects' stress data for this study was reported previously (Valdés, 1985). In the second study, changes in the same variables for experimental and control subjects were evaluated. Students in the control group showed decreased GPA, while those who participated in open-focus training showed a trend toward improved GPA. Stress-related symptoms associated with anxiety and management of emotional problems showed significant posttraining improvement, as did physiological measures in all of the biofeedback modalities in which the experimental subjects were specifically trained. The results support the hypothesis that the workshops were successful in reducing stress levels, and suggest that further controlled research be conducted to verify these findings, and to identify the most effective components of the training procedure.Portions of this report were presented at the Fifteenth Annual Meeting of the Biofeedback Society of America, Alburquerque, March 1984. Special thanks and acknowledgement are due to Dr. Manus Rabinowitz, professor of statistics and computer information systems; Ms. Angela Anselmo, M. S. Ed., of the Department of Compensatory Programs, and Mr. Eric Laner, a graduate assistant. Professor Rabinowitz was responsible for the study, development, and evaluation of statistical data, tests, and computer programs. Ms. Anselmo assisted in conducting the workshops.