Poor functioning at frontal pole sites is associated with many disorders such as schizophrenia, autism, learning disorders, attention

deficit disorder (ADD), and anxiety disorders. Training often incl udes both right hemi sphere (RH) and LH, for example, training 20 min in the LH could be followed by 10 min in the RH. One session is typically 30-40 min long. It is important to rememberthat HEG hypoperfusion rel ates to EEG hypoacti vation (EEG slowing). It happens when specific areas of the brain are lacking in oxygen-rich blood. In EEG slOWing, slow waves have ampli tudes that are much greater than fast waves. For example, slow-wave dominance is indicated when theta (4-8 Hz) amplitudes are at least 2.5 times greater than beta ( 13-21 Hz) amplitudes at Fpz. Training clients with fast -wave dominance is usually contraindicated, it may cause them to feel wired or on edge. Large numbers of those diagnosed with attention deficit hyperactivity disorder (ADHD) have been studied with QEEG. Their brain wave patterns were found to be discreetly different than those of the normal population. Dr. Joel Lubar, at the University of Tennessee, analyzed QEEG data for over 109 volunteers with ADHD and I I controls. He concluded, "Excessive theta activity and lack of beta activity are the primaty neurological landmarks of ADHD" ( 1995, p. 505, italics added). Furthermore, "during academic challenges, there were significant increases in slow (4-8 Hertz) theta activity along the midline and in the frontal regions and decreased beta activity, especially along the midline posteriorly" (p. 502). The pattern of too much theta and too little beta is characteristic of the inattentive type of ADHD. He also catalogued other subtypes of ADHD that have distinctive EEG patterns. Lubar's review of the literature revealed the following, --- key --reward beta and inhibit theta Joel Lubar, a leader and early pioneer, trains most ADD/ADHD children along the cingulate. Other clinicians, including Margaret Ayers, Mary J. Sabo, and the Othmers, have been known to train along the sensorimotor cortex to treat this disorder. Hershel Toomim often trains directly on the prefrontal lobes at Fp I , Fp2, and Fpz (which is part of the anterior cingulate cortex). Knowledge of this disorder and its treatment are primary to most neurofeedback practices. Figure 5.9 explains why many clinicians train to inhibit theta at Cz, Fz, C3, or C4 for children with ADHD

Rewarding SMR in the RH is a common practice, whereas rewarding 15-18 or 16-20 Hz beta in the LH is a common practice. BetalSMR protocols are often applied along the sensorimotor strip, C3, C4, or Cz. Hence, the expression "C3lbeta training" implies that 15- 18 Hz beta is uptrained while theta (EEG slowing) is downtrained. The expression "C4/SMR" implies that 12- 15 Hz (SMR) is uptrained while theta (EEG slowing) is downtrained (Othmer, Othmer, & Kaiser, 1999, p. 285). However, either beta or SMR uptraining may be used at Cz. Usually, beta is uptrained at Cz for more alertness, whereas SMR is uptrained at Cz to remit impulsivity or hyperactivity, in both cases slow-wave and high-beta (20-30 Hz) inhibition is added to the protocol. Similar training concepts have been applied with bipolar (sequential) montages at C3-to-T3 and C3-to-Cz or C4-to-T4 and C4-to-Cz sets. BetalSMR protocols are not limited to single

channel protocols. C3lbeta and C4/SMR may be trained simultaneously with a two-channel protocol using a referential montage as suggested by Brown and Brown (2000). Regardless of the method chosen, all protocols should be based on concrete EEG or quantitative EEG data.