Olafur S. Palsson, Psy.D.Mindspire, LLC

Alan T. Pope, Ph.D.NASA Langley Research Center

John D. Ball, Ph.D. Marsha J. Turner, M.A.

Stephanie Nevin, M.S.Eastern Virginia Medical School

Roger DeBeus, Ph.D.Riverside EEG Biofeedback Services

Neurofeedback videogame ADHD technology: Results of the first concept study

Aims• This project was a randomized and controlled

technology concept study, funded by NASA’s Langley Research Center

• Assessed whether a new videogame biofeedback technology developed at NASA Langley Research Center was as effective as traditional neurofeedback in treating Attention-Deficit Hyperactivity Disorder (ADHD), and whether there were significant differences in its appeal as a clinical method compared to standard neurofeedback treatment

• The study was conducted in the Behavioral Medicine Clinic at Eastern Virginia Medical School

Subjects

• 22 children with ADHD of the hyperactive-impulsive subtype (DSM-IV criteria plus physician diagnosis)

• Age range: 9-13 years, 3 girls and 19 boys• All the children were on short-acting medications

for ADHD• The children had to be of at least normal

intelligence, and have no history of affective problems or learning disabilities

Design• The children were randomized to treatment groups:

videogame (n=11) vs. standard neurofeedback (n=11)• Children in both group completed 40 individual treatment

sessions, usually seen once or twice a week. • The children came for one test session before and after

treatment, where they completed QEEG, TOVA and neuropsychological tests.

• BASC Monitor data and actigraph (physical activity) data was collected pre-and post-treatment and every ten sessions

• Children in both groups were trained with a single active Czelectrode, with reference electrode and ground attached to the earlobes

Thought Technology Procomp+ hardware and Multitrace Software

Displays were bar graphs and simplefigures representing changes in SMR,beta and theta bands

Training consisted of fixed-length training intervals interspersed with listening, reading and unmodulatedvideogame playing

J&J I-330 EEG hardware, NASA-built modulation unit and a modified game controller used with a standard Playstation console

Training displays were EEGinfluenced off-the-shelf SonyPlaystation games

Training consisted of fixed-length training intervals interspersed with listening and reading

VIDEOGAME GROUP STANDARD GROUP

ADJUSTABLEMODULATION

UNIT

The Videogame Neurofeedback Loop

Spyro the Dragon

Tony Hawk

Gran Turismo

Examples of Games Played in the Study

10 seconds

VibrationSignal Vibration Signal

Loss of Steering

Adj

usta

ble

Thre

shol

dfo

r Sha

pingSMR

Bet

a/(T

heta

+ A

lpha

)Full Racing Speed

Barely MovingAccelerator (X) Button Pressed

Adj

usta

ble

Off

set

for S

hapi

ng

Speed

Accelerator (X) ButtonPressed

70

75

80

85

90

95

100

70

75

80

85

90

95

100

p=.001

p<.002 p<.02

p<.02

PercentilesAttention Problems

PercentilesHyperactivity Symptoms

Videogame

Pre 10 20 30 40

BASC Monitor

Pre 10 20 30 40

Videogame

40

50

60

70

80

Pre 10 20 30 40

p=.005

p<.01

PercentilesInternalizing Problems

0

10

20

30

40

50

n.s

n.s

PercentilesAdaptive Skills

VideogameVideogame

Pre 10 20 30 40

BASC Monitor

TOVA:TOTAL PERCENTAGE OMISSION AND COMMISSION ERRORS

Omission % Comission %

0

1

2

3

4

5

6

7

8

PRE POST

Videogame n.s. (p<.09)

p<.05

0

1

2

3

4

5

6

7

8

9

10

PRE POST

Videogame p<.02

p<.02

PRE POST260

270

280

290

300

310

320

Videogame

p<.05p<.03

2

2.5

3

3.5

4

4.5

5

PRE POST

p<.004

p<.01

TOVA:TOTAL CORRECT RESPONSES AND D PRIME

Total # of correct responses D prime

Videogame

0

1

2

3

4

5

6

7

8

9

10

Satisfactionwith results

How much their children enjoyed coming for treatment

PARENT POST-TREATM.SATISFACTIONSURVEY

Game Standard Game Standard

p<.03N.S

0

1

2

3

4

5

6

7

8

9

10

Satisfactionwith results

How much theyenjoyed coming

for treatment

CHILDREN’S POST-TREATM.SATISFACTIONSURVEY

Game Standard Game Standard

p=.03N.S

0

10

20

30

40

50

60

70

80

90

POST-TREATM.SATISFACTIONSURVEY

ESTIMATES OF HOW MUCH(0-100%) ADHD PROBLEMS HAVE IMPROVED

FOLLOWING TREATMENT

Parent Ratings Children’s Ratings

Game Standard Game Standard

N.S.

p<.07

+2.0+1.8+1.5+1.3+1.0+0.8+0.5+0.30-0.3-0.5-0.8-1.0-1.3-1.5-1.8-2.0

DELTA: 0.50-4.00 Hz (-14%)

+2.0+1.8+1.5+1.3+1.0+0.8+0.5+0.30-0.3-0.5-0.8-1.0-1.3-1.5-1.8-2.0

THETA: 4.00-8.00 Hz (-30%)

+2.0+1.8+1.5+1.3+1.0+0.8+0.5+0.30-0.3-0.5-0.8-1.0-1.3-1.5-1.8-2.0

ALPHA: 8.00-13.00 Hz (15.02%)+2.0+1.8+1.5+1.3+1.0+0.8+0.5+0.30-0.3-0.5-0.8-1.0-1.3-1.5-1.8-2.0

SMR: 13.00-14.00 Hz (12.04%)

+2.0+1.8+1.5+1.3+1.0+0.8+0.5+0.30-0.3-0.5-0.8-1.0-1.3-1.5-1.8-2.0

BETA: 14.00-21.00 Hz (117.17%)

Videogame Group: QEEG Treatment Changes

Standard Group: QEEG Treatment Changes

+2.0+1.8+1.5+1.3+1.0+0.8+0.5+0.30-0.3-0.5-0.8-1.0-1.3-1.5-1.8-2.0

DELTA: 0.50-4.00 Hz (3.97%)

+2.0+1.8+1.5+1.3+1.0+0.8+0.5+0.30-0.3-0.5-0.8-1.0-1.3-1.5-1.8-2.0

THETA: 4.00-8.00 Hz (5.76%)

+2.0+1.8+1.5+1.3+1.0+0.8+0.5+0.30-0.3-0.5-0.8-1.0-1.3-1.5-1.8-2.0

ALPHA: 8.00-13.00 Hz (58.36%)+2.0+1.8+1.5+1.3+1.0+0.8+0.5+0.30-0.3-0.5-0.8-1.0-1.3-1.5-1.8-2.0

SMR: 13.00-14.00 Hz (2.40%)

+2.0+1.8+1.5+1.3+1.0+0.8+0.5+0.30-0.3-0.5-0.8-1.0-1.3-1.5-1.8-2.0

BETA: 14.00-21.00 Hz (29.51%)

40

45

50

55

60

65

70

Pre Post

n.s.

n.s.

Videogame

Personality Inventoryfor Children (PIC)

Hyperactivity

Summary of Findings• Both the videogame and standard neurofeedback

groups improved significantly on most main ADHD outcome measures. No significant difference in treatment change was seen in group comparisons

• Parents’ subjective appraisal of treatment effect on ADHD was more positive for the videogame group

• The videogame treatment was rated significantly more enjoyable by both parents and children

• Trends on pre-post QEEG change maps indicate that the videogame training may have advantages in creating more quantitative EEG effect in the therapeutic direction

Conclusions

• We conclude that the videogame biofeedback technology, as implemented in the NASA prototype tested, produces equivalent results to standard neurofeedback in effects on ADHD problems

• Both the videogame and standard neurofeedback improve the functioning of children with ADHD substantially above the benefits of medication

• The videogame technology provides advantages over standard neurofeedback treatment in terms of enjoyability for the children and positive parent perception, and possibly has stronger quantitative post-treatment effects on EEG

Advantages of videogame biofeedback• Inherently motivating, keeps trainees on task continually• Blends sophisticated neurofeedback (or biofeedback)

training into popular entertainment in such subtle ways that none of the entertainment value is lost and EEG biofeedback is no longer a chore but a treat

• Allows individuals to select the games that they like best, making sure that the games stay current and are suitable for each person’s gender and developmental level

• Can be used largely without clinician involvement or effort – making group treatment or properly arranged home use easy

• Is inexpensive technology, as game software does not have to be written for EEG biofeedback