1. Vernice Si Toh, MBPsS
Asia Pacific Neurofeedback/ Biofeedback Conferences Penang, Malaysia 2016
2. Vernice Si Toh
• Psychologist @ Spectrum of Life
• MSc Clinical Child Psychology
– Anglia Ruskin University, Cambridge
• Member of PSIMA
(Membership No. 318/15)
• Graduate member of BPS
(Membership number: 410461)
• Division of Neuropsychology
• Division of Educational and Child Psychology
• International Affiliate of APA
(Membership No. 03495674)
• Division 40: Clinical Neuropsychology
4. Worldwide
prevalence
rate: 5.29%
2007 2008
Prevalence rate
among school
age in the US:
3 – 7%
Prevalence
rate in
Malaysia:
1.61%
2011
96 over 2,766
cases in
Malaysia
201287 ADHD cases
over 2,239
cases in
Malaysia
Cormier, 2008
Gomez & Hafetz, 2011
Polanczyk, de Lima, Horta, Biederman, & Rohde, 2007
United Nations Children’s Fund, 2014
5.
6.
7.
8.
9. • Lubar & Shouse, 1976
– Result shown hyperactivity and distractibility of the child improved.
• Shouse & Lubar 1978
– Effectiveness of EEG biofeedback in combination with drugs are more
effective than drugs alone.
• Shouse & Lubar 1979
– Larger open label study
– Findings similar as above. Effect sustained even after medication being
withdrawn.
• Lubar, Swartwood, Swartwood, & O’ Donnell, 1995:
– 19 children (8 – 19 years old) with ADHD
– 40 sessions
– Findings: 1) improved attention, 2) reduced impulsivity and hyperactivity
behaviors.
10. • Fuchs, Birbaumer, Lutzenberger, Gruzelier, & Kaiser, 2003;
Hodgson, Hutchinson, & Linley, 2014; Monastra, Monastra &
George, 2002; Rossiter, 2004; Rossiter & La Vaque, 1995
– Findings: comparable effect, especially on attentiveness and
impulsivity
11. • Six-month follow up
– Meisel, Servera, Garcia-Banda, Cardo, & Moreno, 2014
• Neurofeedback training VS pharmacological intervention
• Significant academic performance detected in NFB group
– Gevensleben et al., 2010; Leins et al., 2007
• Behavioural improvements maintained after neurofeedback training
• Two years follow up
– Gani, Birbaumer, & Strehl, 2008: Effect is able to uphold
• Ten years follow up
– Tansey, 1993: long term symptom reduction
12. • Meta-Analysis of Neurofeedback in ADHD
(Journal of Clinical EEG & Neuroscience, July,
2009)
– Most of the studies are of theta/beta training or slow cortical potential
training.
– Large ES for inattention and impulsivity and a medium ES for
hyperactivity
17. • Restless and fidgety
• Talks excessively and blurted out answers
• Interrupt or intrude on others
• Loses temper and impatient
• Argues with adults and refused to comply
• Poor attention span, easily distracted and avoid tasks that require
sustained mental effort
• Forgetful and often loses things necessary for tasks or activities
18. Month Sessions Protocols
January S1 F3 Beta + F4 SMR
P3-P4 SMRFebruary S2 – 3
March S4 – 7
April S8 – 10
May S11 – 13
June -
July S14
Total 14
20. Presenting Symptoms Improvements
• Restless and fidgety • Able to sit still for longer period
of time
• Talks excessively and blurted out
answers
• Able to control, talk lesser during
session
• Interrupt or intrude on others • Will still interrupt but will wait
for her turns when guided
• Loses temper and impatient • More patient and tantrum
reduce
• Argues with adults and refused to
comply
• Obey to instructions better
• Poor attention span, easily distracted
and avoid tasks that require
sustained mental effort
• Attention span prolonged,
putting effort during session e.g.
neurofeedback session
• Forgetful and often loses things
necessary for tasks or activities
• Memory improved
21. CLIENT B
GENDER Male
AGE 9
ADHD subtypes combined
CALIS Parents reported anxiety, self-reported
non-anxious
22. • Restless and fidgety
• Talks excessively and blurted out answers
• Interrupt or intrude on others
• Loses temper and impatient
• Argues with adults and refused to comply
• Poor attention span, easily distracted and has difficulty sustaining
attention
• Often loses things necessary for tasks or activities
• Blame others for his mistakes or misbehaviors
• Tell lies to get what he wants or to avoid punishment
• Purposely annoyed others as well as being touchy and easily annoyed
by others
23. Month Sessions Protocols
December S1 – 3 F3 B + C3 SMR
Pz alpha2
February S4 F3 + C3 SMR
C4-P4 SMRS5 – 7
March S8 – 9
April S10 – 12
May S13
Total 13
27. Presenting Symptoms Improvements
• Restless and fidgety • Can sit still during session for longer time
• Talks excessively and blurted out answers • Able to control and talk lesser during
sessions
• Interrupt or intrude on others • Slight improvement
• Loses temper and impatient • Tantrums reduced and able to wait during
setup
• Argues with adults and refused to comply • Still required training
• Poor attention span, easily distracted • Attention span prolonged, parents reported
to sit longer while watching movie at home
• Often loses things necessary for tasks or
activities
• Still required training
• Blame others for his mistakes or
misbehaviors
• Still required training
• Tell lies to get what he wants or to avoid
punishment
• Still required training
• Purposely annoyed others as well as being
touchy and easily annoyed by others
• Slight improvement
28. CLIENT C
GENDER Male
AGE 7
ADHD subtypes Hyperactive – impulsive with
Oppositional defiant behaviour
CALIS Parent report and self reported
to have anxiousness
29. • Restless and fidgety
• Talks excessively and blurted out answers
• Interrupt or intrude on others
• Loses temper and impatient
• Argues with adults and refused to comply
• Poor attention span, easily distracted and has difficulty sustaining attention
• Often loses things necessary for tasks or activities
• Blame others for his mistakes or misbehaviors
• Tell lies to get what he wants or to avoid punishment
• Purposely annoyed others as well as being touchy and easily annoyed by
others
• Unable to follow instruction or complete schoolwork although he
understand
31. Presenting Symptoms Improvements
• Restless and fidgety • Able to stay in seat longer
• Talks excessively and blurted out answers • Still required training
• Interrupt or intrude on others • Will stay away as per told
• Loses temper and impatient • Still required training
• Argues with adults and refused to comply • Obey to instructions better
• Poor attention span, easily distracted and has
difficulty sustaining attention
• Improved attention span, still
required further training
• Often loses things necessary for tasks or activities • Comply better and listen to others
• Blame others for his mistakes or misbehaviors • Still required training
• Tell lies to get what he wants or to avoid
punishment
• Still required training
• Purposely annoyed others as well as being touchy
and easily annoyed by others
• Still required training
• Unable to follow instruction or complete
schoolwork although he understand
• Able to put in effort to read and
understand the instruction
33. • Restless and fidgety
• Did not want to talk/ speak very softly
• Finger biting
• Loses temper and impatient
• Longer adaptation time required
• Poor attention span, easily distracted and has difficulty sustaining attention
• Accompaniment of transitional objects or toys are required
• Accompaniment of parents are requested during sessions
• Keep mentioning she felt scared
• Refuses to follow instructions although she understands
• Refuses to comply with adults’ request
40. Presenting Symptoms Improvements
• Restless and fidgety • Less fidgety and able to sit still longer
during session
• Did not want to talk/ speak very softly • Speaks louder and clearer now
• Finger biting • Totally weaned off
• Loses temper and impatient • Tantrums reduced and more patient
• Longer adaptation time required • Able to adapt in shorter time
• Poor attention span, easily distracted and has
difficulty sustaining attention
• Attention approved a lot, even
feedback from school teacher
• Accompaniment of transitional objects or toys
are required
• No TOs or toys are seen
• Accompaniment of parents are requested during
sessions
• Able to attend session alone
• Keep mentioning she felt scared • No longer mentioning
• Refuses to follow instructions although she
understands
• Able to listen and follow instructions
better
• Refuses to comply with adults’ request • Comply with adults more
41.
42.
43.
44.
45.
46. References
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D. C.: American Psychiatric
Publishing Fifth edition.
American Psychological Association. (n.d.). Anxiety. Retrieved on November 30, 2013 from http://www.apa.org/topics/anxiety/
Appendix S2: Evidence-based child and adolescent psychosocial interventions. (2010) Pediatrics, 125(3), S128. doi: 10.1542/peds.2010-0788H
Arns, M., Heinrich, H., & Strehl, U. (2014). Evaluation of neurofeedback in ADHD: the long and winding
road. Biological Psychology, 95, 108 – 115. doi: 10.1016/j.biopsycho.2013.11.013
Arns. M., de Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: the effects on inattention,
impulsivity and hyperactivity: a meta-analysis. Clinical EEG and Neuroscience, 40(3), 180 – 189. doi: 10.1177/155005940904000311
Brain waves 1 [Online image]. (2014). Retrieved June 5, 2016 from
http://3yo5rd3wte5n2qyjm315n8zl.wpengine.netdna-cdn.com/wp-content/uploads/2014/04/brain-waves-1.jpg
Cormier, E. (2008). Attention deficit/hyperactivity disorder: a review and update. Journal of Pediatric Nursing, 23(5), 345 – 357.
doi: 10.1016/j.pedn.2008.01.003
Freepik [Online image]. (2015). Retrieved June 5, 2016 from http://www.freepik.com/free-vector/keep-it-working_797987.htm
Gomez, R., & Hafetz, N. DSM-IV ADHD: Prevalence based on parent and teacher ratings of Malaysian primary school children. Asian Journal of
Psychiatry, 4(1), 41 – 44. doi: 10.1016/j.ajp.2010.12.003
Lubar, J. F., & Shouse, M. N. (1976). EEG and behavioral changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR): a
preliminary report. Biofeedback Self Regulation, 1(3), 293-306. Retrieved September 30, 2015 from
http://www.neurofeedbackclinic.ca/journals/ADHD_ADD/adhd05.pdf
Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: a systematic review and
metaregression analysis. American Journal of Psychiatry, 164(6), 942 – 948. doi: 10.1176/appi.ajp.164.6.942
Shouse, M. N., & Lubar, J. F. (1978). Physiological basis of hyperkinesis treated with Methylphenidate. Pediatrics, 62(3), 343 – 351.
Shouse, M. N., & Lubar, J. F. (1979). Operant conditioning of EEG ryhthms and Ritalin in the treat of hyperkinesis. Biofeedback and Self-regulation,
4(4), 299 – 312. doi:10.1007/BF00998960
United Nations Children’s Fund (2014). Statistical data from the Ministry of Health. Children with Disabilities in Malaysia. Kuala Lumpur: UNICEF
Malaysia.
Wehmeier, P. M., Schacht, A., & Barkley, R. A. (2010). Social and emotional impairment in children and adolescents with ADHD and the impact on
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