2008 FNAN Award to Robert Coben and Ilean Podolsky for Article on the Efficacy of Neurofeedback in the Treatment of Autism
Each year, the Foundation for Neurofeedback and Applied Neuroscience awards a $1,000 prize to the authors of what it considers to be the article that represents the most important contribution to the advancement of the field of neurofeedback during the past year.
The recipients of this year’s award are Robert Coben, PhD, and Ilean Podolsky, PhD, for their article “Assessment-Guided Neurofeedback for Autistic Spectrum Disorder,” which appeared in Volume 11, Number 1 of the Journal of NeurotherapyThe article described the use of neurofeedback training to address the symptoms of 37 children who fell within the autistic spectrum of disorders.
After 20 sessions of neurofeedback, 89% of the children showed significant improvement in their symptoms, including a 40% reduction in their core autistic spectrum disorder (ASD) scores as indicated on the Autism Treatment Evaluation Checklist (ATEC).
People who suffer from autism spectrum disorders are characterized by impaired ability to take part in social interaction and communication, along with impaired imaginative development. These symptoms tend to begin to manifest themselves before the age of three. In 2001, the Medical Research Council estimated in 2001 that 60 out of every 10,000 children fell within the autistic spectrum.
The severity of ASD symptoms can range from relatively mild to extremely severe. As a result, some individuals who fall within the autism spectrum are able to function at a high level, while others are seriously disabled. Recent research has tended to look at ASDs as being a range of related neurodevelopmental disorders that includes Asperger’s Disorder, Pervasive Developmental Disorder - Not Otherwise Specified, Childhood Disintegrative Disorder, and Rett’s Disorder, as well as Autism.
No single approach has been shown to be fully effective in the treatment of autism spectrum disorders. Most parents of ASD children tend to opt for more than one modality of treatment.
Neurofeedback – also known as neurotherapy or EEG biofeedback – is a noninvasive technology that makes it possible for an individual to learn to change his or her cognitive functioning, affective state or overall performance level by learning to voluntarily vary the patterns of electrical activity within his or her brain. Electrodes are placed on the head of the person who is to be trained. These electrodes allow the clinician who oversees the training to monitor the electroencephalographic (EEG) activity in selected areas of the trainee’s brain. The trainee is then rewarded for making patterns of brainwave activity at particular frequencies thought to be most appropriate to the task at hand. The reward process is usually accomplished through a combination of audio and visual feedback, most commonly presented to the trainee in the form of changes in a video game watched by the trainee.
Earlier studies had previously indicated that neurofeedback might prove to be helpful in addressing the symptoms associated with autism.
Normal brain functioning requires an ongoing level of connectivity between various areas of the brain. But either too much or too little connectivity between certain regions of the brain may prove to be counterproductive. Studies of brain functioning have shown certain patterns of both hyper (too much) and hypo (too little) connectivity in the brains of people suffering from autism spectrum disorders.
Coben and Podolsky studied 37 ASD children (31 males and 6 females) who ranged in age from less than four years to more than 14. Based on quantitative electroencephalogram (qEEG) data collected before the start of neurofeedback, they noted that the autistic spectrum children tended to have too much (hyper) connectivity across the left and right frontal and temporal areas of their brains. (A qEEG graphs patterns of electrical activity in the brain’s cortex based on the readings from multiple sensors placed on the scalp.)
The children received 20 sessions of neurofeedback training designed to reinforce decreased connectivity between the hyperconnected areas. A second qEEG was undertaken at the completion of training. The children were also rated on a variety of neurobehavioral rating scales before and after the training. These measures included the ATEC scale, the Gilliam Autism Rating Scale (GADS), the Behavior Rating of Executive Function (BRIEF) and the Personality Inventory for Children (PIC-2). They also received a neurological evaluation of their executive, attentional, visual-perceptual and language functioning. At the end of the study, the parents of the children were asked to rate the efficacy of the neurofeedback training, and changes in brain activity were measured using a special infrared camera.
Subsequent to the neurofeedback training, 84% of the subjects showed improvement in their ASD symptoms. There was a 40% overall reduction in their core symptoms based on the Autism Treatment Evaluation Checklist. In all cases where symptoms improved, the researchers also saw corresponding neuropsychological and neurophysiological changes. Highly significant improvement was seen in measures of attention, executive function, and visual perception. There were also significant increases in the subjects’ language skills. Infrared imaging showed an enhancement of metabolic activity in the subjects’ brains after training.
The Foundation for Neurofeedback and Applied Neuroscience (FNAN) is a nonprofit, tax-exempt corporation, based in California, dedicated to encouraging research into the mechanisms underlying neurofeedback and its clinical applications. It seeks to foster meaningful scientific research by providing technical assistance and other support to individuals seeking to extend the horizons of the field. FNAN awards its prize for the best neurofeedback article on an annual basis.
Commenting on the autism study, Dr. Harold Burke, Chief Scientist of EEG Spectrum International, noted that one of the most important contributions of the study was the use of multiple, sophisticated assessment techniques that may often allow a fuller, more comprehensive “picture” of the client. In addition, he noted that their findings of improved coherence by the use of neurofeedback represents a relatively new and potentially exciting protocol for treating not only clients within the autism spectrum but also clients with other mental difficulties.