The Autism Society Event and Education Recordings Archive

Neurofeedback is a safe approach to evaluate, monitor and change activity in the brain. Brain-wave activity is altered through operant conditioning. Neurofeedback is an effective treatment for children with autism as it enables children to self-regulate their brain waves. Brain waves are amplified and processed by software that provides auditory and visual feedback via a game simulation on a computer monitor. The preliminary results of this study will show neurofeedback training produces measurable improvements in participation, attention, and social responsiveness. Introduction:

Neurofeedback training is an emerging intervention in which individuals learn to regulate their own brain waves through operant conditioning in order to improve their attention (Jarusiewicz, 2002).  Research on this treatment modality has focused on individuals with attention deficit hyperactive disorder (ADHD) and epilepsy (Heinrich et al., 2007).  However, research on the effects of neurofeedback in people with ASD has been more limited and a need for further research exists (Coben & Padolsky, 2007).  This pilot study will determine how neurofeedback training can improve variables of attention, arousal, and social responsiveness to promote learning and participation in purposeful activities in children with ASD.Research Design

            This single case study design, neurofeedback training was administered throughout the intervention process. The Test of Variables of Attention (TOVA), the Social Responsiveness Scale (SRS), and the Neurofeedback Assessment measured the variables of attention, social responsiveness, and arousal in children with ASD, respectively. A single case study design was most appropriate for this pilot study due to time constraints and difficulty obtaining a large sample of participants who qualified for the inclusion criteria.  Protocols used during neurofeedback training varied among participants; therefore, the participants can only be compared individually and not to other participants.  This study utilized an ABA research design as well by administering a pre-test and post-test, before and after the neurofeedback training.  Population

Eight children receiving services from The Thompson Center for Autism and Neurodevelopmental Disorders were the primary participants in this study.  The participants of this study included six children diagnosed with ASD between four and sixteen years of age.  Children participating in the study had a DSM-IV diagnosis of autistic disorder as determined by the Autism Diagnostic Interview-Revised (ADI-R) and the Autism Diagnostic Observation Schedule (ADOS). 

Children with a presence of sensory or motor deficits sufficient enough to interfere with training (e.g., visual impairment, auditory impairment, severe cerebral palsy) were excluded from the study.  Children with serious neurological disorders, Down syndrome, Fragile X syndrome, Tourette's syndrome, or fetal alcohol syndrome was excluded from the study.  Intelligent Quotient (IQ) must be greater than or equal to 50 and less than or equal to 130.  IQ was acquired by reviewing medical records.  Verbal mental age must be less than 36 months (to exclude participants unable to understand simple task instructions).
Assessments

The Test of Variables of Attention (TOVA) is a visual continuous performance test, developed by Lawrence M. Greenberg, M.D., for measuring attention in both adults and children. The TOVA is one of the longest continuous performance tests with duration of approximately 23 minutes and demonstrates good reliability and validity.  Normative data are available for the age range of the participants in our study to compare and show any impairment in variables of attention (Greenberg et al., 2007).  The TOVA was implemented as a pre-test during the first session in order to obtain baseline measures of variables of attention and then re-administered during the final session, following 20 treatment sessions, as a post-test to compare measures.

The Social Responsiveness Scale (SRS) is an assessment, developed by John Constantino, M.D., to identify the presence and severity of social impairment associated with ASD.  The SRS is a 65-item rating scale using a four point Likert-like scale that is completed by a parent or teacher of the participant in 20-30 minutes.  The SRS assesses social awareness, social cognition, social communication, social motivation, and autistic mannerisms of the participants.  This assessment demonstrates good reliability and validity (Constantino & Gruber, 2005). The SRS was implemented as a pre-test during the first session to provide baseline measures of social responsiveness and then re-administered following 20 neurofeedback training sessions as a post-test to compare measures.The Neurofeedback assessment, designed by Guy McCormack, PhD., will be used to assess the levels of arousal in children with ASD for this study.  The assessment uses a five point Likert-like scale to measure arousal in the children with ASD based on parental report and observation.  The Neurofeedback Assessment includes three subtests addressing sleep patterns, attention, and emotional/social behavior.  No reliability or validity data exists at this time for this instrument.
(3.5) Apparatus

            The NeuroCybernetics EEGer Training System was the software utilized to perform neurofeedback training.  Sensors were applied to the scalp of the child with conductive gel to record the electrical activity in the brain (Sichel, Fehmi, & Goldstein, 1995).  The neurofeedback training was used during each 15-20 minute session to provide each participant with immediate visual and auditory feedback to encourage optimal brainwave patterns while measuring brain activity.  “Neurofeedback training observes how the brain works from moment to moment.  While the children play the video games, their concentration and focus are rewarded by movements on the screen and special sounds” (Faddis, 2008).  If the child has difficulty maintaining attention, visual and auditory feedback will decrease.  While the child is engaging in neurofeedback training, another computer screen displays the brainwave activity being recorded (Faddis, 2008). If the frequency is low, then theta waves are inhibited to increase the frequency.  If the frequency is high, then hi-beta waves are inhibited to decrease the frequency.  Neurofeedback is a safe and non-invasive process.
Procedure

            A convenience sample was obtained by referrals from the Thompson Center for Autism and Neurodevelopmental Disorders at the University of Missouri-Columbia and consisted of six participants. Following completion of the TOVA, SRS, and Neurofeedback assessment, each participant then engaged in 20 neurofeedback training sessions. Participants were scheduled to complete two, 30 minute neurofeedback training sessions per week for a total of 20 sessions over a three-month period.  Participants completed neurofeedback training sessions on Wednesday and Friday mornings with Dr. McCormack and a research assistant at the Thompson Center.  Following the 20 neurofeedback training intervention sessions, each participant was re-evaluated using the TOVA, administered by Dr. McCormack, and parents of the participants completed the SRS and Neurofeedback Assessment instruments in order to obtain post-test data.  Following completion of the post-assessments, each participant and his parents voluntarily made the decision to continue neurofeedback training sessions if desired due to noted progress and improvement in behaviors associated with ASD. Data Analysis Method

The study compared the pre-test and post-test data from the TOVA, SRS, and Neurofeedback Assessment instruments for each individual participant.  The percentage change between the pre-test and post-test total raw scores was calculated by the following equation: ((y2-y1)/y1) x 100.  Percentage changes were calculated for the subtests of each assessment for each participant.

Learning Objectives: