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Visual-Motor Integration and its Relation to EEG
Neurofeedback Brain Wave Patterns, Reading, Spelling,
and Arithmetic Achievement in Attention Deficit Disorders
and Learning Disabled Students
T. Nick Fenger, Ph.D.
St. Louis Psychological & Educational Associates
Page 2 of 4
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 METHOD
 Participants
Children and adolescents ages 8 to 18 were accepted into the study if they were referred for academic problems and/or attentional deficits. Forty-three S's were included in the evaluation and treatment sequence. Each except two was diagnosed ADD according to DSM-III-R criteria. Two were diagnosed with a developmental visual-motor integration disorder. These behavioral diagnoses coincided with microvolt TBR's of greater than two to one. The ADD Ss had greater than two to one TBRs while reading, listening, and drawing, while the developmental visual-motor integration disorder LD S's had a greater than two to one TBR during drawing only. (Lubar considers a three to one TBR or greater in children ages 8 to 12, and two to one in older ages indicative of abnormal brain wave activity - personal communication, June 1, 1991.) Four did not complete the minimum 40 treatment session requirement and the final evaluation. One was on Ritalin medication and was changed to other medications and doses during the time of treatment and was removed from the study because of a question of appropriate similarity to the study group. Eight females and 30 males participated. Thus 38 S's are included in the following.
Design and Procedure
The training protocol employed 16-20 Hz augmentation training, with concurrent inhibition of excessive 4-8 Hz amplitudes. Reward and inhibit filters were set such that rewards were given approximately 70% of the time on the beta band, and the reward is inhibited 20% of the time on the theta band. Thus the rewards were given approximately 60 per minute for most Ss with a range of 50 to 100. After 30 sessions the reward percentage was incrementally reduced to 40 to 50% and the number of rewards to 40 to 60 per minute at the conclusion of training. The criterion for termination of training and administration of the final evaluation was the achievement of TBRs that were within 0.2 across activities for five or more sessions.
Electrode placement was bipolar at FZ and PZ per the International 10-20 system. An ear ground on the left side was also used. Choice of electrode placement was a copy of the work of Lubar. All electrode skin contact was below 10 k ohms impedance.
During the initial evaluation session, the S's appropriateness for the training was determined by an evaluation of school problems and attention characteristics, The Ss willingness to undergo the evaluation was determined. TBR's were determined by measuring a baseline, eyes closed, reading, listening, drawing, and concentration TBR. During the reading activity a portion of a book at appropriate reading level was read silently by the S. During listening a further portion of the same book was read to the S. During the drawing portion the Beery test of Visual-Motor Integration (BVM) was administered. During the concentration portion the S was asked to concentrate on the fish display to maximize rewards. Each condition lasted three minutes. Often the BVM administration took longer than the three minute EEG period. Following the administration of the EEG and BVM the Jaztac Wide Range reading (WRR), spelling (WRS) and arithmetic (WRA) was administered.
Following the initial evaluation, the results were discussed, appropriateness of the treatment was determined, and the S was asked to commit to a minimum of 40 sessions of training twice a week with the possibility of more training to be determined. Training was conducted for an average of 46 sessions. During the summer months some S's trained up to five times per week. Median time in treatment was 18 weeks.
Instrumentation was by a two channel EEG amplifier from Stolting Autogenics (A620). After setting the thresholds for reward and inhibition, the S is taught to maximize rewards by attending to one of three displays: a light bulb that increases in size, a fish that follows a course, and a wheel that fills with colors while playing a two octave musical scale. Concurrent with the video display which counted the rewards, an auditory display Presented sounds to announce the rewards. A second visible display shows red when the inhibit threshold is exceeded. The 45 minute training time was divided into three 15 minute sessions, Following each session the number of rewards were reviewed. Differences were discussed to determine S's awareness of less or more attention during the training. The S was encouraged to increase the number of rewards through attention. This protocol was followed for five sessions. Thereafter each fifteen minute condition constituted a different activity: reading silently, reading aloud, and working on visual-motor activities such as mazes, hidden figures, copying written material, or working on jig-saw puzzles. The activities could be completed in any order. Sometimes the reading was from school material and at other times from story books appropriate to the reading level of the S. During the reading aloud condition, any mistake was corrected and repeated correctly by the S.
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