Facilitating Neurofeedback in Children with Autism and Intellectual Impairments Using TAGteach

Individuals with autism and intellectual impairments tend to be excluded from research due to their difficulties with methodological compliance. This study focuses on using Teaching with Acoustic Guidance—TAGteach—to behaviorally prepare children with autism and a IQ?≤?80 to participate in a study on neurofeedback training (NFT). Seven children (ages 6–8) learned the prerequisite skills identified in a task analysis in an average of 5 h of TAGteach training, indicating that this is a feasible method of preparing intellectually-impaired children with autism to participate in NFT and task-dependent electroencephalography measures. TAGteach may thus have the potential to augment this population’s ability to participate in less accessible treatments and behavioral neuroscientific studies.     

Psychopathology in Children with Intellectual Disability: Risk Markers and Correlates

The purpose of this literature review was to summarize studies examining risk factors, markers, and correlates of psychopathology in youngsters with intellectual disability. A total of 26 studies met inclusion criteria and were reviewed. Due to the limitations of research methods (i.e., not establishing precedence), no risk factors were identified. The majority of variables examined were risk markers (i.e., age, sex, level of functioning). The most consistent age finding was that hyperactivity and/or conduct disorder symptoms were negatively associated with age. Sex effects were equivocal but suggested that boys had more disruptive behavior problems than girls. Specific patterns emerged in regard to level of functioning. Those with milder delays were more likely to have disruptive and emotional disorders. Conversely, those with more severe delay had higher rates of stereotypy, self-injury, and social isolation and were less likely to show symptom improvement over time. This review also identified correlates of emotional and problem behavior such as parent psychopathology and stress and dysfunctional home environment. Parallels were drawn with the general child psychopathology field and further research directions were discussed.     

Methylphenidate and Play Skills in Children with Intellectual Disability and ADHD

Attention-deficit/hyperactivity disorder (ADHD) affects 9–12% of individuals with intellectual disability (ID). Although psychostimulant medication is often the primary treatment modality, little is known regarding the effects of such agents on social interactions and play in this population. Additionally, the role of ADHD symptoms in social and play deficits (beyond that accounted for by ID alone) is not well understood. The first aim of this study was to examine differences in play skills between children with ADHD and ID and non-ADHD/ID controls. The second aim was to determine what, if any, changes in social/play behavior would occur with the use of the stimulant, methylphenidate, among the participants with ADHD/ID. It was hypothesized that the ADHD/ID group would display significantly greater activity level, “rough” play, and more aggression than matched controls. Additionally, it was hypothesized that these deficits would evidence statistically significant improvement with pharmacologic treatment. This study replicates prior work conducted by the authors.     

Neurofeedback Associated with Neurocognitive-Rehabilitation Training on Children with Attention-Deficit/Hyperactivity Disorder (ADHD)

Neurofeedback is a computer-based behavior training gaining increasing interest in the treatment of children with attention-deficit hyperactivity disorder (ADHD), but is not a complete therapy for these patients. To meet the need for a more integrative approach, this study used neurofeedback with cognitive rehabilitation therapy as a more comprehensive approach for children with ADHD. Thirty children (females) were selected randomly from visitors of 5 clinics in Tehran city. Subjects were placed into 2 experimental groups and 1 control group. Groups were matched based on age, gender and socioeconomic status. One experimental group solely received neurofeedback in 10 sessions, the other experimental group received neurofeedback with cognitive rehabilitation therapy, and the control group left therapy received no therapy or left in the initial stages of therapy. Integrated visual and auditory test (IVA) was used pre-test and post-test to measure attention and impulsivity in children with ADHD, in addition to Neurocognitive Joyful Attentive Training Intervention (NEJATI). Data was analyzed using dependent T-test and analysis of covariance (ANCOVA). There are meaningful differences between all groups in attention and impulsivity factors. The group who received neurofeedback with cognitive rehabilitation therapy showed more improvement in attention and impulsivity factors compared to the group who received only neurofeedback and the control group with no treatment. There was also a significant difference between the solely neurofeedback group and control group in the attention factor. Neurofeedback is a facilitator therapy to improve the attention factor in children with ADHD, but is not a complete therapy due to its lack of support in performance factors. A complementary therapy such as cognitive rehabilitation therapy that focuses more on performance factors would be a more effective therapy as it leads to more positive effects on impulsivity and hyperactivity.     

Effects of Neurofeedback Training on Inhibitory Capacities in ADHD Children: A Single-Blind,Randomized, Placebo-Controlled Study

Introduction. Studies performed during the last decades suggest that neurofeedback (NF) training can effectively reduce symptomatology in children with Attention deficit hyperactivity disorder (ADHD). Yet questions remain concerning specific effects of NF training in ADHD children, because these studies did not use a randomized, placebo-controlled approach. To address this issue, such an approach was used in the present study to measure the impact of NF training on inhibitory capacities.

Method. Nine ADHD children (with no comorbidity), aged 8 to 13 years, were randomly assigned to either an experimental group (n = 5) or a placebo group (n = 4). For both groups, training protocols comprised 40 one-hr sessions (20 meetings of 2 sessions each). Sensorimotor rhythm/Theta training was used in the experimental group. Prerecorded sessions of the first author's EEG activity were used in the placebo group. Pre- and posttraining assessments consisted of the Conner's Parent Rating Scales (CPRS–R) and neuropsychological tests. A multiple case study strategy was applied for data analysis using a Reliable Change Index when applicable.

Results. One experimental participant was a dropout, and one placebo participant had to be discontinued due to adverse effects. The latter participant accepted to undergo posttraining evaluations; hence an Intention-to-Treat analysis was performed on this participant's data. Remaining participants showed significant improvements on the CPRS–R. Improvements were measured on the Variability measure of the CPT–II consistently across the placebo group and on the Inhibition Condition of the Stroop Task for all but one placebo participant. The same trend was found for the Inhibition/Switching Condition (Stroop Task) across the experimental group (n = 4).

Conclusion. The small sample size precludes from evaluating specific neurofeedback effects. Still, the presence of placebo responses suggests that other factors, such as motivation or expectations, might contribute to the outcome of NF training in children with ADHD.     

Intellectual Disability Modifies Gender Effects on Disruptive Behaviors

In typically developing children, boys are more commonly diagnosed than girls with disruptive behavior disorders, namely, attention-deficit/hyperactivity disorder, conduct disorder, and oppositional defiant disorder. For children with intellectual disability (ID), the evidence for this gender effect is less clear. In this report we examine gender effects on disruptive behavior in the Australian Child to Adult Development Study, a cohort of children and adolescents with ID, assessed in 4 waves. Items from the Developmental Behaviour Checklist were selected for their similarity to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (American Psychiatric Association, 1994 American Psychiatric Association. 1994. Diagnostic and statistical manual of mental disorders, 4th, Washington, DC: Author.  [Google Scholar]) criteria and their frequency compared for boys and girls after taking age and severity of ID into account, both individually and as a composite score. On 14 items, there were no significant gender differences. On 3 items, boys had significantly higher scores than girls, whereas for 1 item, girls scored higher. The extent of these differences was smaller than that reported in typically developing children. On a composite scale of all items, there was no significant effect of gender. We discuss possible explanations for the lesser effect of gender in children with ID.     

Psychopathology in Children and Adolescents with Autism Compared to Young People with Intellectual Disability

Autism is a neurodevelopmental disorder with a specific pattern of behavioural, communication and social problems. Additional mental health problems are often poorly understood and undetected. This study investigates the level and pattern of emotional and behavioural problems in young people with autism compared with children with intellectual disability (ID). Subjects were 381 young people with autism and a representative group of 581 Australian young people with ID aged 4–18 years. Parents/carers provided details of the emotional and behavioural problems of their child using the Developmental Behaviour Checklist (DBC-P). Young people with autism were found to suffer from significantly higher levels of psychopathology than young people with ID. The implications of this finding are discussed.     

Implicit Neurofeedback Training of Feature-Based Attention Promotes Biased Sensory Processing during Integrative Decision-Making

Complex perceptual decisions, in which information must be integrated across multiple sources of evidence, are ubiquitous but are not well understood. Such decisions rely on sensory processing of each individual source of evidence, and are therefore vulnerable to bias if sensory processing resources are disproportionately allocated among visual inputs. To investigate this, we developed an implicit neurofeedback protocol embedded within a complex decision-making task to bias sensory processing in favor of one source of evidence over another. Human participants of both sexes (N = 30) were asked to report the average motion direction across two fields of oriented moving bars. Bars of different orientations flickered at different frequencies, thus inducing steady-state visual evoked potentials. Unbeknownst to participants, neurofeedback was implemented to implicitly reward attention to a specific “trained” orientation (rather than any particular motion direction). As attentional selectivity for this orientation increased, the motion coherence of both fields of bars increased, making the task easier without altering the relative reliability of the two sources of evidence. Critically, these neurofeedback trials were alternated with “test” trials in which motion coherence was not contingent on attentional selectivity, allowing us to assess the training efficacy. The protocol successfully biased sensory processing, resulting in earlier and stronger encoding of the trained evidence source. In turn, this evidence was weighted more heavily in behavioral and neural representations of the integrated average, although the two sources of evidence were always matched in reliability. These results demonstrate how biases in sensory processing can impact integrative decision-making processes.SIGNIFICANCE STATEMENT Many everyday decisions require active integration of different sources of sensory information, such as deciding when it is safe to cross a road, yet little is known about how the brain prioritizes sensory sources in the service of adaptive behavior, or whether such decisions can be altered through learning. Here we addressed these questions using a novel behavioral protocol that provided observers with real-time feedback of their own brain activity patterns in which sensory processing was implicitly biased toward a subset of the available information. We show that, while such biases are a normal and adaptive mechanism for humans to process complex visual information, they can also contribute to suboptimal decision-making.     

Neurofeedback Treatment of Two Children with Learning,Attention, Mood,Social, and Developmental Deficits

ABSTRACT

Background. Neurofeedback is biofeedback training of EEG activity through an operant conditioning process by which the individual is trained to increase or inhibit the brain's production of electrical activity in specific frequency ranges. Studies have demonstrated efficacy with a variety of disorders, including attention deficit hyperactivity disorder (ADHD), learning problems, and autistic features. This paper describes the application of neurofeedback in a clinical setting with two complex children who manifested multiple diagnoses, including learning disabilities (LD), ADHD, social deficits, mood disorders, and pervasive developmental disorder (PDD). Both boys had adjusted poorly to school, family, and peers.

Methods. Subjects were referred to the author's clinical practice. They received individualized protocols based on their symptoms and functional impairments. They were administered semi-weekly 20-minute sessions of one-channel neurofeedback training for approximately six months. In both cases symptoms were identified and tracked with a parent rating scale and one case, with the Symptom Assessment-45 Questionnaire (SA-45) also.

Results. Each boy improved in all tracked symptoms without adverse effects. One improved on most measures of the SA-45 with no deterioration on any measure. Functional improvements in academic functioning, home behavior, and peer relationships were indicated.

Conclusions. Neurofeedback was a successful treatment for these two multi-symptomatic and diagnosed boys, whose improvements surpassed the gains made with previous therapies. The advantages of neurofeedback include the relative absence of observable adverse effects, the lack of reliance on medication with its possible side effects and noncompliance, and the possibility of long-term gains without continued intervention.     

Performance Enhancement Training Effects on Attention

Abstract

The purpose of this case study was to evaluate the effects of alpha-increase biofeedback training on human attention. A healthy twenty-three year old male college student had undergone twenty-three sessions of alpha- increase biofeedback (8–13 Hz) at PZ electrode site for a period of eleven weeks. Pre-and Post- visual TOVA CPT test was administered to assess the changes in reaction times and their variability. QEEG evaluation was conducted prior as well as upon the completion of the study. The results of the TOVA test clearly indicate an improvement in individual's reaction time and the reaction time variability. Statistical analysis showed that before and after QEEG evaluations were within normal limits.     

Life Experiences of Mothers of Children with an Intellectual Disability: A Qualitative Study

ABSTRACT

Introduction: Mothers of intellectually disabled children face several psychological problems. Qualitative studies use a process that can reveal truthful perceptions and help mothers express their emotions about their unique and personal experiences. Method: This study used a qualitative research method design with a hermeneutic approach to examine the life experiences of mothers of children with intellectual disabilities in light of their caregiving experiences. Results: A phenomenological, hermeneutical analysis with an inductive approach was used. The categories of interest were determined to be “impact,” “care management,” “stigma,” “uncertainty,” “relations,” and “search for meaning.” Conclusions: Not all mothers perceive having an intellectually disabled child negatively. Some mothers may not experience any problems providing care to their children. Almost all mothers, however, have concerns for the future and experience significant changes in their family and social relationships.     

Theory of Mind, Socio-Emotional Problem-Solving, Socio-Emotional Regulation in Children with Intellectual Disability and in Typically Developing Children

This study has examined the link between social information processing (SIP) and socio-emotional regulation (SER) in 45 children with intellectual disability (ID) and 45 typically developing (TD) children, matched on their developmental age. A Coding Grid of SER, focusing on Emotional Expression, Social Behaviour and Behaviours towards Social Rules displayed by children in three dyadic contexts (neutral, competitive or cooperative) was applied. Correlational analyses highlighted specific “bi-directional” links between some abilities in SIP and in SER, presenting between-groups partial similarities and dissimilarities that allowed discussing the developmental delay versus difference hypotheses in ID children. Cluster cases analyses identified subgroups with variable patterns of links. In both groups, the SIP and some categories of SER varied depending on developmental age.     

Depression and Anxiety Symptoms in Children and Adolescents with Autism Spectrum Disorders without Intellectual Disability

Recent studies have shown that rates of depression and anxiety symptoms are elevated among individuals with autism spectrum disorders (ASDs) of various ages and IQs and that depression/anxiety symptoms are associated with higher IQ and fewer ASD symptoms. In this study which examined correlates of depression and anxiety symptoms in the full school-age range of children and adolescents (age 6-18) with ASDs and IQs ≥ 70 (n = 95), we also observed elevated rates of depression/anxiety symptoms, but we did not find higher IQ or fewer ASD symptoms among individuals with ASDs and depression or anxiety symptoms. These findings indicate an increased risk for depression/anxiety symptoms in children and adolescents with ASDs without intellectual disability, regardless of age, IQ, or ASD symptoms.     

The Effects of Humorous Literature on Emotion: A Pilot Project Comparing Children with Asperger's Syndrome Before and After Neurofeedback Training and Controls

This study examined neurofeedback training, reading humorous stories, and emotion in children diagnosed with Asperger's Syndrome (AS). In a pre-posttest design (before and after the story), positive and negative affect were compared between controls and two experimental groups of children with AS—those beginning training (<4 sessions) and those near completion of training (>40 sessions). Children with AS who had more than 40 sessions of neurofeedback responded the same way to the reading materials as the normally functioning controls with increases in positive affect and decreases in negative affect. Children with AS with less than 4 sessions of neurofeedback did not display this change.     

Self-Reported Health of People with Intellectual Disability

Abstract Self-reported health is an important outcome in the evaluation of health care but is largely ignored in favor of proxy-based reporting for people with an intellectual disability. This study briefly reviews the role of self-report in health assessment of people with intellectual disability and the challenges and recommendations that have emerged from the considerable body of research on interviewing and self-report. Limitations in current recommendations are addressed from the perspective of the cognition of self-report. The review describes conceptual directions for the reconciliation of the two contradictory themes in the treatment of self-report: the centrality given to personal perceptions and choices and the methodological concerns over the meaningfulness and validity of the self-reporting process.     

Psychopathology in Adults with Autism and Intellectual Disability

There have been few studies of psychopathology in adult with autism. This study examined psychiatric co-morbidity in 147 adults with intellectual disability (ID) and autism and 605 adults with ID but without autism. After controlling for the effects of gender, age, psychotropic medication and level of ID, people with autism and ID were no more likely to receive a psychiatric diagnosis than people with ID only. People with autism were less likely to receive a diagnosis of personality disorder. These findings cast doubts on the hypothesis that adults with ID and autism are more vulnerable to certain psychiatric disorders than non-autistic adults with ID.