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ADD/ADHD Research

Research Article: "Efficacy of Neurofeedback treatment in ADHD: The effects on Inattention, Impulsivity and Hyperactivity."

Society for Neuronal Regulation
9th Annual Conference

Monterey, CA 27-30 October 2001
Comparison of Videogame and Standard EEG Biofeedback With AD/HD Children: Results of the First Concept Study.

Roger J. deBeus, PhD, Olafur S. Palsson, PsyD, Alan T. Pope, PhD, John D. Ball, PhD, Marsha J. Turner, MA
Riverside EEG Biofeedback Services (RJD), Mindspire, LLC. (OSP), NASA Langley Research Center (ATP), Eastern Virginia Medical School (JDB & MJT)

Objectives: This project was a randomized and controlled technology concept study, funded by NASA's Langley Research Center. The study assessed whether a new video game 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.

Participants: Twenty-two children with ADHD of the hyperactive-impulsive subtype (DSM-IV criteria plus physician diagnosis) participated. The age range was 9-13 years and there were 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 into treatment groups: video game (n=11) vs. standard neurofeedback (n=11). Children in both groups 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 a QEEG, TOVA and neuropsychological tests. BASC Monitor data was collected pre-and post-treatment and every ten sessions. Children in both groups were trained with a single active Cz electrode, with reference electrode and ground attached to the earlobes.

Equipment: The video game group equipment consisted of J&J I-330 EEG hardware, NASA-built modulation unit and a modified game controller used with a standard Playstation console. Training displays were EEG-influenced off-the-shelf Sony Playstation games. The standard group equipment consisted of Thought Technology ProComp+ hardware and Multitrace Software. Displays were bar graphs and simple figures representing changes in SMR, beta and theta bands.

Results: BASC Monitor and TOVA scores indicated similar significant improvements in both groups. No significant difference in treatment change was seen in between-group comparisons. Parents' subjective appraisal of treatment effect on ADHD was more positive for the video game group. The video game treatment was rated significantly more enjoyable by both parents and children. Trends on pre-post QEEG change maps indicated that the video game training may have advantages in creating more quantitative EEG effect in the therapeutic direction.

Conclusions: We conclude that the video game biofeedback technology, as implemented in the NASA prototype tested, produced equivalent results to standard neurofeedback in effects on ADHD symptoms. Both the video game and standard neurofeedback improved the functioning of children with ADHD substantially above the benefits of medication. The video game technology provided advantages over standard neurofeedback treatment in terms of enjoyment for the children and positive parent perception, and possibly has stronger quantitative post-treatment effects on EEG.

 

 

Society for Neuronal Regulation

8th Annual Conference September 20-24, 2000,

St. Paul, Minnesota, 2000

QEEG based subtypes of Adult ADHD and Implications for Treatment

Robert L. Gurnee, M.S.W.

The last 75 sequential adult patients diagnosed with ADHD at The ADD Clinic in Scottsdale, AZ. that received QEEG's were included in this study. They all clearly qualified for an ADD or ADHD diagnosis after a five-hour evaluation, which included testing for IQ, the TOVA, IVA and Conners' CPT, rating scales and clinical interview. The majority had a second or third diagnosis as well. All were 18 or older.

The subjects were categorized into the following groups based on one standard deviation increases or decreases in absolute and relative power based on the 19 sites specified in the 10-20 system base on the New York University E. Roy John DataBase: High is +1 SD, Low is -1 SD, Mixed is +1 SD and -1 SD, Normal is all locations < 1 SD + or -.

If there appeared any significant chance that deviations are due to artifact, the raw EEG was closely examined. If there was any doubt, the data was excluded from the study.

Five subtypes of ADHD/ADD emerged from the analysis:

  1. Excessive Frontal Alpha, usually with a R > L asymmetry
  2. Excessive Frontal Theta, usually with a R > L asymmetry
  3. Excessive Frontal Theta and Alpha, usually with a R > L asymmetry
  4. Excessive Beta only
  5. Within normal limits

All of those in the last two groups failed to have Alpha attenuate during TOVA testing with a single electrode at CZ. The great majority of the last two groups had Alpha and/or Theta increase significantly during the TOVA, often increasing by 50% to 100%. In some of these cases, Delta increased as well. Slow wave increases with a cognitive challenge are a traditional marker for deactivation and research with the TOVA has found that increased Alpha correlates with increased errors.

The analysis has not been completed as of this date but an analysis of 100 QEEG's on child and adult ADHD found that only 37% of the subjects had low Beta, and of these, total of only 10% had both low relative and absolute power Beta.

Implications for treatment from an analysis of this data would suggest the following are treatments:

  1. Down train Alpha when excessive.
  2. Down train Theta when excessive.
  3. Down train Theta and Alpha when both excessive.
  4. Up train Beta only in the 10% of cases where Beta is deficit both in Absolute and Relative power.
  5. Down train Beta in elevated Beta subtype and if Beta is elevated in Theta and or Alpha subtypes if it does not drop with Theta and Alpha down training. Elevated Beta is associated with sleep disturbance, anxiety, alcoholism, bipolar disorder and epilepsy. Up training elevated Beta could cause or exacerbate these symptoms.

Added guidelines:

  1. Utilize mean frequency data and one hertz bins to determine specific bands to train e.g. 3 to 9hz, 6-10hz, 5-7hz. Usually only a part of Theta or Alpha is abnormally elevated.
  2. Train primarily with EC if deviation is only with EC.
  3. Train primarily with EO if deviations are only with EO.
  4. Train primarily with tasks if deviations are only with tasks.
  5. Train in appropriate combination of EC, EO or Task if two or more states appear to have deviations. (Without EO and task norms decisions will have to be made by an experienced evaluation of the data - e.g. Alpha is less than 2 SD with EC, decreases even more with EO, but doubles with a cognitive challenge, then train down only with a task and perhaps train to increase Alpha EC posteriorly.)

We have found dramatic and rapid improvements and significant movement toward normalization with post QEEG's with these QEEG based strategies. Down training Beta usually improves insomnia, anxiety, ETOH/drug dependence, irritability and impatience.

 

 

ADD Subtypes in QEEG with Multi-State Analysis

M. Barry Sterman, Ph.D., School of Medicine,

University of California at Los Angeles

This discussion focuses on the important contribution of quantitative EEG findings to both the classification and treatment of attention and conduct disorders in children. Recent quantitative EEG findings have indicated that a number of different abnormal markers can be found in the eyes closed EEG within this population, and this fact has provided differential guidelines for more effective pharmacological treatments. The addition of multi-state analysis, and particularly mathematics performance, to QEEG assessment has significantly improved pattern differentiation in our clinical studies. In several subtypes, QEEG disturbances were seen only during math performance. Three distinct, but partially overlapping QEEG subtypes of ADD will be described, associated tentatively with affective, attentional, and impulsive disturbances, respectively. QEEG assessment with multiple-state analysis promises important advances for neurotherapy as well. The concept of EEG normalization that is basic to the "re-regulation" model of this treatment modality dictates that these markers in fact guide differential treatment strategies.

 

 

Operant Conditioning or Conditioned Operation, Scientific Panel

M. Barry Sterman, Ph.D.,

School of Medicine, University of California at Los Angeles

Gail Peterson, Ph.D.,

Department of Psychology, University of Minnesota

From a theoretical perspective, two different models have emerged in the clinical application of Neurotherapy. The first derived initially from animal research, and was based on the use of EEG operant conditioning to promote the exercise and thereby the normalization or enhancement of underlying neural substrates. This model has been used primarily in the treatment of structural and metabolic disturbances of the brain, as well as in the pursuit of "peak performance". The second model seeks to guide changes in a state deemed to be therapeutic. It has been used primarily in the treatment of substance abuse and psychological trauma resolution. Our interest in this discussion will be directed exclusively to the first model.

Contemporary approaches to "exercise" neurofeedback are dictated by the equipment available for treatment. This equipment has been developed by engineers who know little of learning theory, or who have failed to obtain necessary information from those who do. The result is a field driven by methods that disregard some of the fundamental principles of operant conditioning. Such deficiency, in turn, may seriously constrain the efficacy of this important new treatment modality. This issue and these principles will be discussed in detail.

 


Quantitative EEG Research with Precociously Reading Children:

The Importance of Alpha Peak Frequency

Shannon Suldo, B.A.,

School Psychology, Graduate Student, University of South Carolina

EEG research with particular clinical populations (e.g. Alzheimer's and mental retardation) has confirmed that reduced alpha peak frequency is often associated with cognitive deterioration. However, a comparable body of research with high-functioning populations does not exist. Thus, increased peak frequency in alpha has only been hypothesized to relate to advanced brain maturation. The purpose of this investigation was to compare the alpha peak frequency of precociously reading children to that of normal children.

The experimental group in this study consisted of 15 Early Readers (ER), labeled such due to exceptional performance on the Reading composite of the Wechsler Individual Achievement Test (WIAT) and the Test of Early Reading Ability (TERA-2). One comparison sample included 15 Age-Level Matched (ALM) readers; this group was similar to the ER groups in terms of cognitive functioning (as assessed by the Kaufman Brief Intelligence Test: K-BIT) and age, but scored in the normal range of the WIAT and TERA-2.

A second comparison group, composed of 15 Reading-Level Matched (RLM) controls, had WIAT and K-BIT scores equivalent to the ER group, but were 2.5 years older than the experimental sample.

QEEG evaluations of each participant were made during a resting, eyes closed condition. Results indicated that, as hypothesized, peak frequency in alpha did separate the groups. Specifically, the ER group had significantly higher alpha peak frequency than the ALM group at 16 of the 19 sites examined.

This difference was consistent across all brain regions, as the mean alpha peak frequency at each site was between 9.0 and 9.3 Hz for ER group and between 8.6 and 8.8 Hz for the ALM subjects. Furthermore, peak frequency in alpha did not differ significantly between the ER and RLM sample. These results suggest that increased peak frequency in the alpha band is indicative of brain maturation and is associated with precocious reading ability.

 


Quantitative Electroencephalography and Neuropsychological Assessment of Adult ADHD

J. Noland White Jr., Joel F. Lubar, & Teresa A. Hutchens,

The University of Tennessee

Contemporary diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) is based on subjective reports of developmentally inappropriate behaviors across the three symptom domains of inattention, impulsivity, and hyperactivity (American Psychiatric Association. & American Psychiatric Association. Task Force on DSM-IV., 1994; Monastra et al., 1999; Swanson, Castellanos, Murias, LaHoste, & Kennedy, 1998).

Although originally considered a disorder of childhood, ADHD symptoms have been shown to persist into adolescence and adulthood (Barkley & Biederman, 1997; Gansler et al., 1998; Mancini, Van Ameringen, Oakman, & Figueiredo, 1999; Murphy & Barkley, 1996). Given the enduring quality of clinical symptoms and the present reliance on subjective methods for determining an accurate diagnosis, attempts have been made to identify objective measures and criteria to aid in the diagnostic process. However, instruments with sufficient sensitivity and specificity have not yet been established to replace a thorough clinical case history for diagnosing ADHD (Swanson et al., 1998).

Research has indicated that quantitative electroencephalography (QEEG) may be a useful adjunct in the diagnosis of ADHD (Chabot, Merkin, Wood, Davenport, & Serfontein, 1996; Chabot & Serfontein, 1996; Mann, Lubar, Zimmerman, Miller, & Muenchen, 1992; Monastra et al., 1999).

The typical QEEG pattern of ADHD consists of an excess of theta activity and a deficiency of alpha or beta activity in children (Chabot & Serfontein, 1996; Clarke, Barry, McCarthy, & Selikowitz, 1998; Mann et al., 1992). In other children and adolescents, increases in theta or alpha activity may be prevalent (Chabot & Serfontein, 1996; Lazzaro et al., 1999). Given that there are age-related changes in the EEG and possible QEEG age-related changes in adult ADHD (Bresnahan, Anderson, & Barry, 1999), additional QEEG measures may have diagnostic qualities for adult ADHD.

The current study examines the QEEG relationships of college-aged adults, with and without ADHD. All recordings were obtained from 19 locations according to the 10-20 system of electrode placement (Jasper, 1958) against linked earlobe references. EEG recordings were made using a fitted electrode cap (Electro Cap Co.) and a Lexicor NeuroSearch-24 Electroencephalograph with a sampling rate of 128 samples per second. In addition to the EEG channels, electrodes were placed at the outer cantheus of each eye to monitor horizontal eye-movement; 2 cm above and below the left eye to monitor vertical eye-movement; and at the base of the mentalis muscle on the chin with reference to the left cheek to monitor jaw movement during vocalization.

QEEG recordings were obtained during two baseline conditions and during three neuropsychological test procedures. The baseline conditions included both an eyes-closed and an eyes-open recording. The three task conditions included administration of the Paced Auditory Serial Addition Task (PASAT) to assess attention and information processing; administration of the Wisconsin Card Sorting Test - Computerized Version (WCST-CV) to assess abstract reasoning ability and ability to shift cognitive sets; and administration of the Integrated Visual and Auditory Continuous Performance Test (IVA) to assess response control and sustained attention.

The initial results are based an a sample of 10 adults with ADHD and 21adults serving as non-clinical controls. Preliminary findings suggest that there are QEEG differences both between the ADHD and control groups and between the baseline and task conditions. Of particular interest is the finding that activity in the low-alpha (8 - 10 Hz) range compared to activity in the low beta (13 - 21 Hz) range, as indicated by a low alpha-beta power ratio, appears to show greatest diagnostic quality for these ADHD adults. Implications of various QEEG measures will be discussed accompanied by a review of the procedural and methodological concerns for concurrent neurops

 


A Comparison of the Electrophysiological and Psychoeducational Treatment Effects of Audio-Visual Stimulation (AVS) and Bloodflow Feedback (HEG) on Children with ADHD

Sheryl A. Brim, Joel F. Lubar, Jared Blackburn,
Dianne Whitaker, Kerri Towler, Jon Frederick

Barkley (1998) reports that 36% of students with ADHD never finish high school. DuPaul and Eckert (1997) reported that academic improvement was "almost uniformly low" with school-based interventions, even for a significant minority of children on stimulant medication.

A primary objective of this study was to explore how AVS and HEG interventions affect the psychoeducational and physiological states of the student with ADHD. There is little information published in peer-reviewed journals regarding the use of these interventions for children with ADHD.

Fifteen participants from the ADHD population, having varied psychoeducational and physiological manifestations of the disorder, including girls and boys ages 8-15 were chosen for the study. This was done in an effort to define changes that may occur in an ADHD population, as a result of AVS or HEG, laying the foundation for further investigations of narrower focus.

Five participants received AVS, five received HEG, and five were matched controls who had ADHD. Experimental participants received 20 sessions of training, lasting 25 minutes each. At the conclusion of the study, each group received all of the physiological and psychometric measures employed at the beginning of the study, with the exception of the measure for intelligence.

The academic and behavioral manifestations of ADHD are different from child to child, eliciting differences for children within the same family, so these data were more descriptive as case studies. Just as the behaviors and abilities of children with ADHD vary from day-to-day, their individual treatment effects of the interventions varied. Some changes were positive, and some were not. There were significant changes on the T.O.V.A. Errors of Commission test for 4 out of 5 children in the AVS group only.

 


Neurofeedback Combined with Training in Metacognitive Strategies: Effectiveness in Students with ADD*

L. Thompson, Ph.D. & M. Thompson, B.Sc., M.D., D.Psych.

A review of records was carried out to examine the results obtained when 160 people (this number may be increased by the time of the conference) with Attention Deficit Disorder received 40 sessions of training that combined neurofeedback with the teaching of metacognitive strategies. While not a controlled scientific study, the results, including pre and post measures, are consistent with previously published research concerning the use of neurofeedback with children. A description of procedures will be included in this talk and, in addition, new procedures to optimize performance and the efficiency of training will be introduced.

The subjects usually came twice a week. Feedback was contingent on decreasing slow wave activity (usually 4-7 Hz, occasionally 9-11 Hz) and increasing fast wave activity (15-18 Hz for most subjects but initially 13-15 Hz for subjects with impulsivity and hyperactivity). Metacognitive strategies related to academic tasks were taught when the feedback indicated the client was focused. Some clients also received temperature and/or EDR biofeedback during some sessions.

Adult clients were given RSA (Respiratory Sinus Arrhythmia) feedback and taught to relax while simultaneously increasing their alertness. Thirty percent of 151 children were taking stimulant medications (Ritalin) initially. Six percent were on stimulant medications after 40 sessions. All charts were included where pre and post testing results were available for one or more of the following: the Test of Variables of Attention (TOVA, n = 139), Wechsler Intelligence Scales (WISC-R, WISC-III, or WAIS-R, n = 103), Wide Range Achievement Test (WRAT 3, n = 163).

The first 66 client's charts have been reviewed for the electroencephalogram assessment (QEEG) providing a ratio of theta (4-8 Hz) to beta (16-20 Hz) activity and this will be reported. In addition, a sample of 40 of these children were placed in a separate study to examine the effects of neurofeedback on reading comprehension. The reading comprehension portion of the CAT (Canadian Achievement Test) was used.

Significant improvements (p < .001) were found in ADD symptoms (Inattention, Impulsivity, and Variability of response times on the TOVA), in both the ACID pattern and the full scale scores of the Wechsler Intelligence Scales, in academic performance on the WRAT3, and in reading comprehension. The average gain for the full-scale IQ equivalent score was 11 points. A decrease in the EEG ratio of Theta/Beta was also observed. These data are important because they provide an extension of results from earlier studies (Lubar, Swartwood, Swartwood, & O'Donnell, 1995; Linden, Habib, & Radojevic, 1996). They also demonstrate that systematic data collection in a private educational setting produces helpful information that can be used to monitor students' progress and improve programs.

Since this clinical work is not a controlled scientific study, the efficacious treatment components cannot be determined. Nevertheless, the positive outcomes of decreased ADD symptoms plus improved academic and intellectual functioning suggest that the use of neurofeedback plus training in metacognitive strategies is a useful combined intervention for students with ADD. Further controlled research is warranted.

*ADD and the term Attention Deficit Disorder are used in this paper to refer to students who meet diagnostic criteria for Attention-Deficit/Hyperactivity Disorder; Inattentive type, Hyperactive-Impulsive type or Combined type. (American Psychiatric Association, 1994) Dr. Thompson, ADD Centre, 50 Village Centre Place, Mississauga, Ontario, Canada, L4Z 1V9.

 


QEEG Based Diagnosis and Treatment of Normal and Elevated Beta Subtypes of ADD

Robert L. Gurnee, MA, MSW, Board Certified Neurotherapist (BICA)
Director, Attention Deficit Disorder Clinics of Scottsdale, Arizona & Albuquerque and Santa Fe, New Mexico.

Recent studies in our clinic suggest that Beta does not appear to be a central issue in ADD unless, perhaps, there are clearly low levels or Beta minima. The key issue appears to be excessive frontal lobe slowing with excessive Theta (usually slowed Alpha) or Alpha, especially in the lower Hz ranges. Up training Beta may, in fact, be potentially harmful given the reported correlation of elevated Beta with anxiety, alcoholism, bipolar disorder and, in the case of spindling excess Beta, with cortical irritability and epilepsy.

A recent study demonstrated that, of 407 children with a diagnosis of ADHD, only 56% were found to have normal Beta levels, 16.1% had elevated Beta levels and 27.9% had low Beta levels (Robert Chabot, Ph.D., Brain Research Labs, School of Medicine, New York University).

Barry Sterman, Ph.D. of the University of California at Los Angeles, conducted research with normals for over twenty years and developed the Skill normative data base for eyes closed, eyes open, as well as various types of task performance. His data indicate that Beta typically is unchanged with successful sustained attention and is as likely to decrease, as increase, with skilled performance due to desynchronization.

Sterman has identified a key issue in attentional deficits as activity in the 6 to 11 Hz range that increases with tasks. Janzen et al, performed T.O.V.A.s on normals and found that Alpha drops, a finding consistent with our own observations. We also repeatedly find that with ADHD patients Alpha increases with tasks. The great majority of research demonstrates that Alpha attenuates with cognitive challenges in normals.

Research by I. A. Cook and co-investigators at the University of California at Los Angeles, comparing PET and QEEG, determined that Alpha is inversely related to glucose metabolism-- with an increase in Alpha there was a decrease in glucose metabolism. In SPECT studies conducted by D. Amen, M.D., he found that reduced frontal lobe blood flow with tasks was a marker for ADHD. Thus, there is strong clinical evidence supporting the finding that ADHD involves frontal lobe de-activation with a task: increased Alpha, reduced blood flow, and reduced metabolism, but not for Beta changes.

 


Findings of ADHD in an Adult PSUD Treatment Population.

Rubin, Yael, MA and Trudeau, D.L., MD.

Introduction: In the process of screening adult males in a residential treatment program for chronic substance use disorder, we were surprised to find a very high incidence of childhood Attention Deficit Hyperactivity Disorder (ADHD). Attention Deficit Disorder (ADHD) has been reported in high incidence in adolescent psychoactive substance abuse disorder (PSUD). Adolescents and children with ADHD have a higher incidence of PSUD as adults.

Methods: Adults from a residential treatment center completed a Wender-Utah, a self-administered questionnaire that is validated for childhood ADHD, and is a valuable instrument for making a retrospective diagnosis. All subjects also completed a self-administered scalar rating of current inattention and hyperactivity/impulsivity symptoms based on DSMIV modified adult ADHD criteria. Detailed drug histories were obtained.

Findings: Fifty-five percent of clients had Wender-Utah scores compatible with childhood ADHD. Fourteen of 54 subjects met at least 6 of 9 DSMIV ADHD criteria for either inattention or hyperactivity/impulsivity and 11 more nearly met these criteria (at least 4/9 of either or both sets) for a total of 25/54 or 46%. A relationship between childhood and adult symptoms ( r = .59) was found.

Childhood ADHD correlated with some type of chemical use: childhood ADHD subjects were 1.83 to 3.92 times more likely to use crack cocaine (p = .0112) and 1.63 to 3.13 times more likely to use stimulants overall (p = .0073). Generally, whites that used stimulants used drugs other than crack 10/15 or 66% of the time, whereas blacks used crack cocaine 17/18 or 94% of the time.

Discussion: ADHD is a significant risk factor for both adolescent and adult PSUD. Our findings support a very high incidence of ADHD in an adult PSUD population that is characterized by chronicity, arrests and stimulant abuse. ADHD is a unrecognized, but clinically significant, comorbidity for adult PSUD, that may be linked to lower socioeconomic status and may predispose to treatment non responsivity, early dropout, staff discharge, and relapse. The treatment of ADHD with stimulants is contraindicated in the presence of stimulant PSUD. We are currently treating ADHD/PSUD adults with brain wave biofeedback, a non-drug treatment, focusing on remediation of adult residual ADHD and QEEG demonstrated drug neurotoxicity.

 


QEEG Findings of ADHD and chronic PSUD substance associated neurotoxicity.

Trudeau, DL, MD.

Introduction: To better understand Quantitative EEG (QEEG) findings associated with attention deficit hyperactivity disorder (ADHD) and chronic psychoactive substance use disorder (PSUD), we studied a population of chronic male PSUD/ADHD subjects vs. a matched sample of non ADHD subjects with PSUD.

Methods: Eyes closed QEEGs were obtained and two independent artifacted 60 second samples were compared for reliability. The Thatcher database was used with the NeuroRep v3.0 reporting system. The incidence of abnormalities (Z's greater than chance) of phase, amplitude asymmetry, coherence, and relative power were tabulated across groups of drug abuser types. Averaged relative powers were computed for drug abuser types and ADHD types and averaged Z's for relative power were compared.

Findings: Most (93%) of the subjects' QEEG's were found to have abnormalities beyond chance alone. Findings associated with drug use were seen: 1) Stimulant abuse PSUD Subjects had substantially more alpha relative power and less delta, theta, and beta power. 2) Stimulant abuser PSUD subjects were about 10 times as likely as non stimulant PSUD subjects to show right temporal abnormalities ( Log odds 9.74, 95% confidence limit 1.66- 81.36, p = .036) 3) Stimulant abuser PSUD subjects were about 8 times as likely as non stimulant PSUD subjects to show high frontal alpha ( Log odds 8.63, 95% confidence limit 1.03- 72.4, p = .0.47).

Cocaine abuser PSUD subjects were about 5 times as likely as non cocaine PSUD subjects to show high frontal alpha ( Log odds 4.63, 95% confidence limit 1.11- 19.26, p = .0.35) 4) 58 % of the cannabis and stimulant group had right temporal abnormality, as compared to none of the cannabis only group and 23 % of the stimulant only group. (chi square p = 0.021) 5) 42% of the cannabis and stimulant group have abnormal high alpha, as compared to 8% of the cannabis only group and 15% of the stimulants only group. (chi square p = 0.048) The differences between ADHD and non ADHD groups were small and in the direction of stimulant abuse. Therefore, they might be explained by the bias of higher stimulant preference (21/27 vs. 15/29 p = 0.02) in the ADHD/PSUD S's.

Conclusions: 1)Cannabis and stimulants together produce more QEEG change than either alone. 2) In the absence of stimulants, the effects of cannabis are relatively small. 3) The presence or absence of ADHD does not explain the classic (Prichep and Alper) findings of stimulant abuse. 4) Right temporal abnormalities are associated with stimulant abuse. 5) The Thatcher database gives results similar to the John database for chronic stimulant abuse findings. These findings are discussed in light of other reports of abnormalities in cannabis and cocaine abusers. Implications for neurofeedback treatment are discussed.