Treatment with neurofeedback and executive function training with NeuronUP in a boy with ADD
A 15-year-old boy assessed with psychopedagogical tests and Swingle’s ClinicalQ and whose intervention, given the results, was decided to be double. It was carried out with the neurofeedback technique and executive function training with the NeuronUP platform for this ADD case.
Presentation of the case
The parents, living in the USA, come to the center for the evaluation of their son during a brief stay in our country (Spain). Several age-adjusted tests are administered such as: BAS II, MATRICES, the D2 attention test, CARAS-R, attentional AGL, Stroop, MY for memory, PROLEC-SE reading and writing processes, DSM-IV diagnostic criteria and also data is collected through the BRIEF and SENA questionnaires through the family and self-report and finally the ClinicalQ.
In these cases it is always necessary to collect data and according to these (initial questionnaires, visual, auditory symptoms, …) adjust the assessment tests. Although to affirm or rule out the existence of a diagnosis it is always necessary to pass tests of intelligence, attention, etc.. in order to establish an appropriate intervention plan, it is always necessary to choose whether we should delve into other areas (such as motor, visual, auditory, performing an audiometry, etc.).
Results of the combination of the treatment with neurofeedback and NeuronUP in ADD.
In the present case the results were as follows. High IQ on the BAS II, accompanied and consistent with a high percentile on the MATRICES test of non-verbal intelligence, average results on the memory test (enneotype 5), effective results on the CARAS-R test, average results on the D2 (of longer duration) and on the AGL, results within the average on the STROOP and on the reading and writing processes.
Teacher feedback (it is important to collect quantitative test data and also analyze what they observe in the academic context through teacher questionnaires) concluded problems in sustained attention.
Given the ambiguity of the results obtained, a ClinicalQ is performed.
What is a clinicalQ?
The Clinical Q is a 5-point mapping of the 10/20 system performed by means of a single-channel monopolar mounted neurofeedback device. It is an assessment that determines the design of the neurofeedback treatment.
We perform the measurement in the brain locations related to the functions to be evaluated: central (Cz), frontal (F3/F4 /Fz) and occipital (O1) areas.
The profile is performed by placing the electrodes successively in the different locations and performing different cognitive activities (each of these phases is called “events”) with the patient relaxed, in order to be able to record in real time the brain wave pattern in each of these activities, to be able to compare it with the values, as well as to see the evolution of this pattern in relation to the activities performed.
The EEG Profile gives us information about the level of brain activity in real time and thus be able to determine the best treatment options.
Theta/Beta Ratio (TBR), or the ratio of fast/slow waves in the EEG is a very common measure in neurofeedback treatments. High levels of theta and/or reduced levels of beta are typical in cases of ADHD and attention problems.
Applications: TBR training is mainly used in the treatment of ADHD and more widely in the fields of attention training, learning and performance enhancement.
The Theta/Beta ratio is calculated by dividing the Theta absolute power (4-8 Hz) by the Beta absolute power (13-21 Hz). For training, central locations (Cz, C3 and/or C4) are chosen.
Objective: to reduce the Theta/Beta power ratio, to reduce inattention and to reduce hyperactivity and/or impulsivity in the eyes-open condition.
Conclusions on treatment with neurofeedback and NeuronUP in an ADD case
According to the data collected from the tests, our subject affected with ADD would need training with NeuronUP in the executive functions that were below average such as: working memory (especially auditory component), reinforcement of the verbal part (vocabulary and expression), sustained attention, mental flexibility and planning.
And in parallel, and according to ClinicalQ data, to work on the Theta/Beta ratio in Cz with neurofeedback.
Training from the USA
There was the dilemma of how to comply with this intervention suggestion if the evaluated subject resides regularly in the USA.
We contacted a neurofeedback center near the ADD subject’s residence that uses the neurofeedback technique (and the same equipment with which he was evaluated) and they began to work with him with this protocol.
At the same time, the executive function training sessions are being updated with the NeuronUP platform.
The platform facilitates the adjustment of the exercises, those that have been more difficult, those that have generated better results, worse… information that we can also use to continue adjusting not only the levels or phases of difficulty but also the exercises and their order of presentation to also promote adherence to treatment and motivation towards the work.
Intervention in English and Spanish
The objective of the work was also defined as strengthening the language part, being important to do it both in his native language and in the language he uses in his daily life, English.
The NeuronUP platform has allowed us to adjust to the needs of this case in a complete way, since the training part is carried out in a varied way.
- Remotely with NeuronUP2GO.
- Executive function training with the verbal part in Spanish.
- Executive function training with the verbal part in English.
Therefore, it is important to point out the realization of assessments adjusted and as complete as possible to define the objectives and the treatment plan. In addition, it is essential to be familiar with the assessment tests and to know what they measure and their limitations.
Finally, it is essential to be in continuous training in the field of neuropsychology to offer the most complete assessments and tools in order to establish the most appropriate and optimal intervention plan that offers the best results.
Swingle, Paul, Adding Neurotherapy to Your Practice Clinician’s Guide to the ClinicalQ, Neurofeedback, and Braindriving, 2015. Ed.Springer