This paper summarizes data from a review of neurofeedback (NFB) training with 150 clients with Asperger's Syndrome (AS) and 9 clients with Autistic Spectrum Disorder (ASD) seen over a 15 year period (1993-2008) in a clinical setting. The main objective was to investigate whether electroncephalographic (EEG) biofeedback, also called neurofeedback (NFB), made a significant difference in clients diagnosed with AS. An earlier paper (Thompson et al. 2009) reviews the symptoms of AS, highlights research findings and theories concerning this disorder, discusses QEEG patterns in AS (both single and 19-channel), and details a hypothesis, based on functional neuroanatomy, concerning how NFB, often paired with biofeedback (BFB), might produce a change in symptoms. A further aim of the current report is to provide practitioners with a detailed description of the method used to address some of the key symptoms of AS in order to encourage further research and clinical work to refine the use of NFB plus BFB in the treatment of AS. All charts were included for review where there was a diagnosis of AS or ASD and pre- and post-training testing results were available for one or more of the standardized tests used. Clients received 40-60 sessions of NFB, which was combined with training in metacognitive strategies and, for most older adolescent and adult clients, with BFB of respiration, electrodermal response, and, more recently, heart rate variability. For the majority of clients, feedback was contingent on decreasing slow wave activity (usually 3-7 Hz), decreasing beta spindling if it was present (usually between 23 and 35 Hz), and increasing fast wave activity termed sensorimotor rhythm (SMR) (12-15 or 13-15 Hz depending on assessment findings). The most common initial montage was referential placement at the vertex (CZ) for children and at FCz (midway between FZ and CZ) for adults, referenced to the right ear. Metacognitive strategies relevant to social understanding, spatial reasoning, reading comprehension, and math were taught when the feedback indicated that the client was relaxed, calm, and focused. Significant improvements were found on measures of attention (T.O.V.A. and IVA), core symptoms (Australian Scale for Asperger's Syndrome, Conners' Global Index, SNAP version of the DSM-IV criteria for ADHD, and the ADD-Q), achievement (Wide Range Achievement Test), and intelligence (Wechsler Intelligence Scales). The average gain for the Full Scale IQ score was 9 points. A decrease in relevant EEG ratios was also observed. The ratios measured were (4-8 Hz)(2)/(13-21 Hz)(2), (4-8 Hz)/(16-20 Hz), and (3-7 Hz)/(12-15 Hz). The positive outcomes of decreased symptoms of Asperger's and ADHD (including a decrease in difficulties with attention, anxiety, aprosodias, and social functioning) plus improved academic and intellectual functioning, provide preliminary support for the use of neurofeedback as a helpful component of effective intervention in people with AS.
This paper reviews the symptoms of Asperger's Syndrome (AS), a disorder along the autism continuum, and highlights research findings with an emphasis on brain differences. Existing theories concerning AS are described, including theory of mind (Hill and Frith in Phil Trans Royal Soc Lond, Bull 358:281-289, 2003), mirror neuron system (Ramachandran and Oberman in Sci Am 295(5):62-69, 2006), and Porges' (Ann N Y Acad Sci 1008:31-47, 2003, The neurobiology of autism, Johns Hopkins University Press, Baltimore, 2004) polyvagal theory. (A second paper, Outcomes using EEG Biofeedback Training in Clients with Asperger's Syndrome, summarizes clinical outcomes obtained with more than 150 clients.) Patterns seen with QEEG assessment are then presented. Single channel assessment at the vertex (CZ) reveals patterns similar to those found in Attention-Deficit/Hyperactivity Disorder. Using 19-channel data, significant differences (z-scores > 2) were found in the amplitude of both slow waves (excess theta and/or alpha) and fast waves (beta) at various locations. Differences from the norm were most often found in mirror neuron areas (frontal, temporal and temporal-parietal). There were also differences in coherence patterns, as compared to a normative database (Neuroguide). Low Resolution Electromagnetic Tomography Analysis (Pascual-Marqui et al. in Methods Find Exp Clin Pharmacol 24C:91-95, 2002) suggested the source of the abnormal activity was most often the anterior cingulate. Other areas involved included the amygdala, uncus, insula, hippocampal gyrus, parahippocampal gyrus, fusiform gyrus, and the orbito-frontal and/or ventromedial areas of the prefrontal cortex. Correspondence between symptoms and the functions of the areas found to have abnormalities is evident and those observations are used to develop a rationale for using EEG biofeedback, called neurofeedback (NFB), intervention. NFB training is targeted to improve symptoms that include difficulty reading and mirroring emotions, poor attention to the outside world, poor self-regulation skills, and anxiety. Porges' polyvagal theory is used to emphasize the need to integrate NFB with biofeedback (BFB), particularly heart rate variability training. We term this emerging understanding the Systems Theory of Neural Synergy. The name underscores the fact that NFB and BFB influence dynamic circuits and emphasizes that, no matter where we enter the nervous system with an intervention, it will seek its own new balance and equilibrium.
Heart rate variability (HRV) training and EEG Biofeedback are techniques used to improve neurological disorders in both clinical and optimal performance populations. HRV training uses combined respiration and heart rate biofeedback to achieve synchrony between the changes in breathing and heart rate. This specific signature of synchronization of breathing and heart rate changes appears to correlate with a relaxed state and cognitive clarity. HRV may provide a promising index for both physical and emotional stress. Improvements in mental processing (Thayer, Hansen, Saus-Rose, & Johnson, 2009) and emotional stability (Applehans & Lueken, 2006) have been demonstrated as a result of HRV training. A similar mental state is the target of EEG biofeedback training when parameters are set to increase sensorimotor rhythm (SMR). SMR is usually trained using the frequency band 12-15 Hz. These frequencies are called SMR only when they are produced across the sensorimotor strip (C3, Cz, C4). In other locations, 12-15 Hz is simply called beta. SMR production has been closely linked to a state of calm, relaxed focus (Sterman, 1996). This article proposes that HRV training may be associated with increased levels of SMR. Preliminary data have been collected for 40 clients. Twenty clients were athletes training to improve performance, and 20 clients were from a clinical population aiming to increase SMR as a part of their program. A 3-min sample of EEG baseline data was compared to a 3-min sample of EEG data collected during HRV training. Mean microvolt values were collected for SMR during both the baseline recording and during the HRV training. T-test results show that there was a statistically significant increase in SMR during HRV training as compared to baseline (p < .001). This suggests that increased HRV leads to increases in production of SMR.
The cognitive science of religions’ By-Product Theory contends that much religious thought and behavior can be explained in terms of the cultural activation of maturationally natural cognitive systems. Those systems address fundamental problems of human survival, encompassing such capacities as hazard precautions, agency detection, language processing, and theory of mind. Across cultures they typically arise effortlessly and unconsciously during early childhood. They are not taught and appear independent of general intelligence. Theory of mind (mentalizing) undergirds an instantaneous and automatic intuitive understanding of minds, mental representations, and their implications for agents’ actions. By-Product theorists hypothesize about a social cognition content bias, holding that mentalizing capacities inform participants’ implicit understanding of religious representations of agents with counter-intuitive properties. That hypothesis, in combination with Baron-Cohen’s account of Autistic Spectrum Disorder (ASD) in terms of diminished theory of mind capacities (what he calls “mind-blindness”), suggests an impaired religious understanding hypothesis. It proposes that people with ASD have substantial limitations in intuitive understanding of and creative inferences from such representations. Norenzayan argues for a mind-blind atheism hypothesis, which asserts that the truth of these first two hypotheses suggests that people with ASD have an increased probability, compared to the general population, of being atheists. Numerous empirical studies have explored these three hypotheses’ merits. After carefully pondering distinctions between intuitive versus reflective mentalizing and between explicit versus implicit measures and affective versus cognitive measures of mentalizing, the available empirical evidence provides substantial support for the first two hypotheses and non-trivial support for the third.
This article presents a case study to illustrate how children with attention-deficit/hyperactivity disorder (ADHD) can be assessed and successfully trained using neurofeedback. There is established efficacy for using neurofeedback to treat ADHD (Arns, De Ridder, Strehl, Breteler, & Coenen, 2009; Gani, Birbaumer, & Strehl, 2009; Gevensleben et al., 2009). Indeed, the American Academy of Pediatrics gave biofeedback Level 1 efficacy in its 2012 review (American Academy of Pediatrics, 2012), the same level of efficacy as is given to medications. The other condition that has sufficient randomized controlled studies to establish efficacy for electroencephalogram biofeedback is epilepsy (Tan et al., 2009). This case is presented to share techniques that will help clinicians conduct neurofeedback appropriately so that good results are obtained. The future of our field depends on every practitioner doing a quality job with excellent outcomes.
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