Results

Experiment Conditions

Initially, my project consisted of analyzing many patient’s data to assess improvement. However, confidentiality laws and my limited exposure with patients did not allow me to do so. But fortunately, Scottsdale Neurofeedback Institute measures the effectiveness of the treatments themselves. They retest patient with the three tests stated above and so far have a success rate of 94%. The patients are often retested after around 25 EEG Neurofeedback therapy sessions, and contribute to the Institute’s success rate if their scores increase on the whole. To complete the experiment requirement the Senior Research Project, I selected 3 patients whom I have been training. After their retest, I compared their numbers to those from before. While I realize that this is not a very large sample size by any definition, these tests are completely objective methods of tracking progress. I then concluded how much these patients have improved (by standard deviations). I was only able to use the TOVA test for attention because ADHD is the only quantifiable result I could measure. While it is impossible to retest for depression without a brainmap, many patients use their own observation to assess improvement. Many feel much more positive about their daily activities, so do not need a retest. Due to the limited amount of data I was exposed to, my project became centered on whether neurofeedback therapy can help cure ADHD in an individual’s brain. 

I will now describe each patient individually and assess their test scores.While patients take all three aforementioned tests for a diagnosis, my three patients only retested with the TOVA and the Connors. I will primarily be using the TOVA for my analysis, as the Connor’s test involves subjective rating scales. I used the following method of analysis to determine improvement:
As seen below, each patient is described anonymously. The iQ as well as test scores are listed for both the diagnosis test (initial) and the retest (final). If a section score of the TOVA is less than 20 points away from the patient’s iQ, that score is considered a poor score and that section is noted as a problem. The different sections of the TOVA test are the ommsion and commission errors/scores, the response time score, and the variability score. Both the response time and variability score assess attention and reaction time, and the higher the score is, the better the patient performance. The TOVA omission errors / commission errors represent how many questions the patient failed to answer and got wrong (out of the questions they did answer). The omission score/commission score is a representation of how normal those errors are compared to others their age. A low score signifies poor performance while a higher one is considered more normal. If the scores change by 15 points, that is considered 1 standard deviation change. The change by standard deviation is listed in the last column of the table. So, to summarize, if any of the scores increase (or number of errors decrease) significantly, improvement can be assumed. Lastly, the ADHD score indicates the severity of the patient’s attention problems. A score more negative than -1.80 suggests a strong likelihood of ADHD; the problem becomes more and more severe as the score decreases from that point. However, a score above -1.80 does not suggest ADHD. If the patient’s ADHD score increases, it indicates improvement. 

Patient 1

Sex: Female
Age: 11.6 years old
Medications: Prozac (however she was taking this medication before, during, and after the neurofeedback sessions)
Diagnoses: ADHD, Depression
Neurofeedback sessions completed before retest: 22 sessions

Test Type	iQ (Abstract/ Verbal)	Subject	Initial	Final	Change in Standard Deviation
Connors	104/80	Ommision Errors	34 blank	4 blank
		Commision Errors	27 wrong	16 wrong
TOVA	104/80	Ommision Errors	57 blank	28 blank
		Commision Errors	31 wrong	35 wrong
		Omission Score	<40	<40	cannot be shown
		Commision Score	81	75	-0.4
		Response Time Score	71	93	1.46
		RT Variability Score	<40	<40	cannot be shown
		ADHD Score	-7.68	-7.51

The girl’s TOVA omission errors decreased by 29, which is indicative of fast improvement. The patient’s commission errors increased, but only by 4. On the whole, improvement seems likely. The omission score stayed below 40 (this is the lowest score on the TOVA test). But we can assume it increased from its initial value since her omission errors decreased greatly. Her commission score decreased by 0.4 standard deviations, which was caused by slightly increase amount of commission errors on the retest. Her response time score increased by an astonishing 1.46 standard deviations. Previously, her score was 71, which is indicative of a problem with an iQ score of 104. However, it increased to 93, which is within the acceptable range. Her ADHD score increased by 0.17. While this does not seem to be a vast improvement, coupled with her other improvements, it is safe to assume that this patient has made some progress with her neurofeedback sessions.

Patient 2

Sex: Male
Age: 47 years old
Medications: Mirax (however he was taking this medication before, during, and after the neurofeedback sessions)
Diagnoses: severe ADHD, Depression
Neurofeedback sessions completed before retest: 28 sessions

Test Type	iQ (Abstract/ Verbal)	Subject	Initial	Final	Change in Standard Deviation
TOVA	125/119	Ommision Errors	0	1
		Commision Errors	12	5
		Omission Score	101	86	-1
		Commision Score	92	110	1.2
		Response Time Score	82	83	0.0667
		RT Variability Score	<40	56	1.0667
		ADHD Score	-6.78	-5.1

While this patient’s omission errors increased from 0 to 1, his commission errors decreased from 12 to 5, which is a much more significant change. The omission score decreased by 1 standard deviation. We can see that, in fact, his omission errors only decreased by 1, so this is not much of a concern. The commission score change reflects improvement, as it increased by 1.2 s.d. The Response Time score stayed about the same. The Variability score however increased from a point below 40 to 56, which is a minimum improvement of 1.0667 s.d. This is vast improvement, so this patient has made significant progress with his 28 sessions of neurofeedback therapy. To support this, his ADHD score increased by 1.68. While this still is indicative of severe ADD, the patient has made significant progress. 

Patient 3

Sex: Male
Age: 45 years old
Medications: Vyvanse for ADHD (however he was taking this medication before, during, and after the neurofeedback sessions)
Diagnoses: slight ADHD, Attention/Impulsivity problems
Neurofeedback sessions completed before retest: 24 sessions

Test Type	iQ (Abstract/ Verbal)	Subject	Initial	Final	Change in Standard Deviation
Connors	107/100	Ommision Errors	1	0
		Commision Errors	2	3
TOVA	107/100	Ommision Errors	0	0
		Commision Errors	4	1
		Omission Score	101	101	0
		Commision Score	112	120	0.533
		Response Time Score	96	87	-0.6
		RT Variability Score	109	112	0.2
		ADHD Score	0.95	2.59

This patient’s number of errors decreased on the whole. His omission score stayed the same while his commission score increased by 0.533 standard deviations. It is important to understand that based on his initial ADHD score, this patient did not have severe ADHD. So an improvement of 0.533 standard deviations is not negligible. However, the response time score decreased by 0.6 standard deviations. On the whole this patient has made some progress but not a significant amount. However, the change in his ADHD score of +1.64 indicates vast progress.

Analysis

            On the whole, all three patients made progress. I administered each of their neurofeedback sessions from beginning to end, and was able to watch their progress. Patients 2 and 3 in particular, according to their TOVA retests, made the most progress and their ADHD scores increased by a large amount. While patient 1’s progress was not as vast, it is clear that the neurofeedback therapy made a difference: her scores, on the whole, increased, and her ADHD scores proved progress.

Conclusion 

Once again, I recognize that my data may not be as accurate as I had hoped since I only tested 3 patients. Confidentiality and patient protection laws prevented me from collecting more data. These 3 patients were the few that consented the use of their data for this project. However, since my internship Scottsdale Neurofeedback Institute was kind enough to share their own proven 94% success rate, I can see the validity of my results. While neurofeedback therapy may not be absolutely perfect, the majority of patients benefit from these sessions. All 3 of my patients improved greatly within even 25 sessions of neurofeedback. I conclude that my data is consistent with the already well established 94% success rate of Scottsdale Neurofeedback Institute. I acknowledge that neurofeedback therapy is quite effective at treating neurological problems (in this case, specifically ADHD), and decreasing attention/impulsivity problems, listening problems, etc. My patients’ cognitive functioning benefited greatly from the therapy. 

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Gathering Data

To determine whether this clinic's patients' scores had improved over the course of their neurofeedback sessions, I needed, unsurprisingly, real patients. However, various HIPPA laws prevent me from obtaining too much information. As a result, I created these anonymous patient release forms (Special thanks to Mrs. Miller, my adviser, for sending me ideas). They allow me to obtain the patient's files and analyze their test scores before and after neurofeedback. Please click the images for a larger version.

Unfortunately, I was only able to analyze three patient charts. I will acknowledge the small sample size in my final paper and blog analysis results. 

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Identifying Improvement

So far, I have described in detail how to use brainmaps to find and solve neurological problems through neurofeedback therapy. But how does the patient or the therapist know that their efforts are not in vain? Surprisingly, the developing field of neurofeedback has developed a fairly accurate method of assessing improvement.

When patients are tested and brainmapped, they are also given numerous other assisting documents. As a rule of neurofeedback therapists, the brainmap cannot be used to diagnose neurological diseases by itself. While it is extremely accurate, its major shortcoming is that it cannot measure where (3 dimensionally) the brainwave abnormalities are coming from. So therapists use many patient surveys, rating scales, and any medical history to diagnose accurately. Below are a few of such forms.

Patients are also given specific rating forms to identify ADHD, Depression, etc. Using the responses as supplements to the brainmap, therapists can diagnose diseases fairly accurately.

So how do they show improvement? These surveys are not the only preliminary task given to the clients. They also take a variety of standardized tests both before and after the therapy. An improvement in the test scores shows an improvement with the therapy.

The Connors Test for ADHD: This test uses ADHD rating scales to identify attention problems. While rating scales tend to be very subjective, the Connors assigns values to each option marked. When the total is calculated, each total value corresponds to a different degree of attention problems. Below are the rating scales and their corresponding diagnoses.

Test of Variables of Attention (TOVA): The T.O.V.A. is an objective measure of attention, not a subjective rating of behavior. It is a 21.6 minute long, very simple "computer game" that measures your responses to either visual or auditory stimuli. These are compared to the TOVA norms for all age group, which come up with an objective, normed ADHD score. If the score is < -1.80 cutoff score, then ADHD is very likely. When the test is administered again after many neurofeedback sessions, a more positive ADHD score is indicative of improvement. In addition, a change from a "very likely ADHD" score to a "not clinically likely" score indicates improvement.

The Integrated Visual and Auditory Continuous Performance Test (IVA): The IVA uses a variety of exercises to test reaction time, attention level, and responses to visual/auditory stimuli. This test is EEG supported, meaning that simply through recording the patient's brainwaves during certain exercises, a neurofeedback clinician can obtain the test results. The scoring is based on EEG backed data, meaning they are based on normalized databases for that patient's age/sex, An increase in  percentage score would be indicative of a normalization of the brain. For patient's with severe attention problems or abnormal behavior, this is improvement.

http://www.tovatest.com/
http://www.braintrain.com/iva-plus/

In the next posts I will use my anonymous patients' test scores to assess whether improvement was occurring or not. This is the data for my Senior Research Project.

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