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
 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.
White matter anomalies in
Autism
 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
fMRI connectivity
EEG Connectivity
 What is EEG operant
conditioning (biofeedback)?
 Case Example: Mu NF
20 3.5
18
3.4
16
14 3.3
12 10-12
3.2
10 19-23
8 7-15 3.1
6
3
4
2 2.9
0
1 2 3 4 5 6 7 8 9 1 2.8
Case Example: Mu NF
Case Example: Topographical
changes
EEG biofeedback: Efficacy in
ADHD
 EEG biofeedback: Efficacy in
ADHD
• DeBeus (2006) Monastra, Monastra,
• Attention Training with George (2002)
ADHD Children: A Double-
Blind Placebo-Controlled 9
Study 8
• N = 60, with crossover 7
• Attention Scores: 6
• Effectiveness of Intervention; P = 5
EEGBF
.0004 4
Ritalin
• Treatment Effect; P = .0004 3
• Parent Ratings: 2
• Effectiveness of Intervention; P = 1
.0002 0
• Treatment Effect; P < .0001 PRE POST F/U
 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.
 1 Pilot Study
st

• 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.
 Methods
• 37 ASD children
compared with 12 WLC 25

• Matched for age, gender,

race, handedness, 20

medications, symptom
Autism
severity 15
PDD-nos
• EEGBF was assessment CDD
10
guided based on EEG Aspergers
connectivity et al.
5
• EEGBF done twice
weekly for 10 weeks
0
• Pre-post parent
judgment, rating scales,
NP and QEEG
 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
EEG connectivity changes
 The relative efficacy of connectivity guided and
symptom based EEG biofeedback for Autistic
disorders
• Compared
findings
from 50
3
Jarusiewicz 45
(2002) to
Coben & 40 2.5
Padolsky’s
(2007) 35
approach 2
30
• Matched Jarusiewicz
subjects for 25 Jarusiewicz
severity of
Coben/Padolsky 1.5 Coben/Padolsky
symptoms 20
and 15
equated the 1
sample 10
sizes 0.5
• Both are 5
effective, 0
but tx Sens/Cogn Health/Behavior Total
0
guided by
speech social cognitive behavior

EEG
connectivity
 Spectrum
Disorder: A
Controlled
Study of EEG
Coherence
Training focused
on Social Skill
Robert
Deficits Coben, PhD
Presented at 2007 ISNR Conference
San Diego, California
Facial/Emotional Processing
Facial/Emotional Processing
Facial/Emotional Processing
Facial/Emotional Processing
deficits in Autism
Facial/Emotional Processing
deficits in Autism
 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%
 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.
 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
 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 Skewness = .275

Kurtosis = -1.192 Kurtosis = .304
 Neurofeedback Protocol
Design – Sites of Coherence
training
Neurofeedback Protocol
Design
 Results
ANOVA

Sum of
S q u a re s df M e a n S q u a re F S ig .
ATEC change B e tw e e n G r o u p s 7 1 4 .4 2 0 1 7 1 4 .4 2 0 7 .7 8 8 .0 0 8
W it h in G r o u p s 4 4 0 3 . 2 0 0 48 9 1 .7 3 3
T o ta l 5 1 1 7 .6 2 0 49
S o c S k ills c h a n g e B e tw e e n G r o u p s 1 8 1 .4 5 1 1 1 8 1 .4 5 1 4 .6 2 5 .0 3 7
W it h in G r o u p s 1 8 8 3 . 2 5 4 48 3 9 .2 3 4
T o ta l 2 0 6 4 .7 0 5 49
V is u a lP r o c e s s c h a n g e B e t w e e n G r o u p s 6 .6 9 0 1 6 .6 9 0 1 5 .9 6 7 .0 0 0
W it h in G r o u p s 2 0 .1 1 3 48 .4 1 9
T o ta l 2 6 .8 0 3 49
Results
Results
 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%
Results
Results
Results
Do the changes last?