Applying Audio-Visual Entrainment Technology
for Attention and Learning (Part 3)
Author: Siegfried Othmer
PDF Attached at bottom
Abstract: Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder
(ADHD) are unique attentional disorders which primarily involve slowed frontal brain
wave activity and hypoperfusion of cerebral blood flow in the frontal regions, particularly
during tasks such as reading. A variety of disorders, such as anxiety, depression and
Oppositional Defiant Disorder (ODD), are often comorbid with ADD, thus creating a plethora
of complications in treatment procedures. Audio-Visual Entrainment (AVE) lends itself
well for the treatment of ADD/ADHD. AVE exerts a major wide spread influence over the
cortex in terms of dominant frequency. AVE has also been shown to produce dramatic increases
in cerebral blood flow. Several studies involving the use of AVE in the treatment of
ADD/ADHD and its related disorders have been completed. AVE as a treatment modality for
ADD/ADHD has produced wide-spread improvements including secondary improvements in IQ,
behaviour, attention, impulsiveness, hyperactivity, anxiety, depression, ODD and reading
level. In particular, AVE has proven itself to be an effective and affordable treatment
of special-needs children within a school setting.
Introduction
All mental functioning involves an element of arousal, that is, the awakeness or alertness
of the brain. The degree of the brain’s (cortical) arousal dramatically affects how
well a particular function can be performed. For instance, it is almost impossible
to pay attention if the brain is producing an abundance of alpha or theta (Oken & Salinsky,
1992), just as it’s difficult to fall asleep with excess beta and low alpha activity
in an eyes closed condition. People with attentional problems such as Attention Deficit
Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) have particular difficulty
shifting their pre-frontal lobes into gear (suppressing alpha and/or theta) during
cognitive tasks, particularly passive, spatial tasks such as reading (Lubar, et.al.,
1985, Tansey, 1985). However, high levels of stimulation (which AVE provides in abundance)
have been shown to improve attention and reduce hyperactivity (Cohen & Douglas,
1971; Leuba, 1955; Zentall, 1975; Zentall & Zentall, 1976), and the presence of
rock music has also been shown to reduce hyperactivity (Cripe, 1986). This may explain
why those with ADD do so well with video games and action sports. Unless the activity
is exciting (pushing up arousal), the pre-frontal and frontal lobes quickly lose their
attentiveness and activation. Theta and/or alpha brain waves increase dramatically
and the person “fogs out.” ADHD rarely occurs in isolation and is often combined with
other conditions including depression, oppositional defiant disorder, conduct disorder,
obsessive compulsive disorder, learning disabilities, anxiety disorders, and other
significant psychological, psychiatric, and neurological problems (Lubar, 1999; Hunt,
1994; Barkley, 1989).
Quantitative EEG (QEEG) Analysis of Brain Function
QEEGs have proven reliable methods for assessing brain function (Sterman, 1999; Sterman & Kaiser,
2001; John, et.al., 1977; Thatcher, 1998; Chabot & Serfontein, 1996) as shown in
Figure 1, a qeeg of a teenager with ADD. One subgroup (Lubar, 1999; Gurnee, 2000) of
ADD typically shows higher than average alpha, more prominent on the right frontal side
(left image). During a reading task, the alpha activity increases frontally (instead
of suppressing) with larger increases on the right side (center image). This increase
in alpha during a cognitive task is known as inversion, in that higher alpha or theta
levels occur during task (in this case reading) than during a simple eyes-open (EO) condition.
This inversion is experienced as mental “fog” while reading. Following one session (right
image) on the DAVID Paradise XL, alpha normalizes and reading speed and comprehension
are improved. Figure 1 QEEG “Brain Map” Image of ADD Profiles Glucose Uptake Characteristics
of ADD Considering that alpha is basically an “idling” rhythm, it would be logical to
assume that both cerebral blood flow (CBF) and glucose metabolism would fall during periods
of increased alpha activity. ADD children show hypo-perfusion of blood (as measured with
functional magnetic resonance imaging) in the striatum (putamen), and this directly correlates
with hyperactivity (Teicher, et.al., 2000). When the same children are treated with methylphenidate,
the relative increase in blood flow through the putamen directly correlates with reductions
in hyperactivity. Single Photon Emission Computerized Tomography (SPECT) is a process
where a small amount of radioactive tracer is put into the blood stream through an artery.
The parts of the brain that receive the most blood flow also absorb the most tracer through
metabolism which shows up as a bright area on the image. Areas that don’t absorb any
radioactive tracer appear as black. Figure 2 shows the pre-frontal blood flow and metabolism
in a person diagnosed with ADD (Amen, 1998, p. 123). Notice that the pre-frontal lobes
do not function well at the best of times. During concentration the pre-frontal lobes
shut down quite completely, making it very difficult for this person to pay attention
and process what is being read. After an application of Adderal, prefrontal lobe function
improves considerably, improving attention and reducing hyperactivity. Notice the similarities
between the black “holes” in Amen’s spect (centre image) and the alpha inversion shown
on the brain map (centre image) during the task conditions. Both Adderall and AVE increase
cerebral blood flow. Notice the “smoothing” of brain function in Amen’s third image and
the alpha “smoothing” following AVE on the DAVID Paradise. Figure 2 SPECT Images of ADD
Profiles The Educational Challenge of ADD (excerpted from Michael Joyce – New Vision
School, Minneapolis, MN) Traditionally, educators have viewed conditions such as ADD,
ADHD, and Obsessive Compulsive Disorder (OCD) as primarily medical conditions and therefore
outside the realm of education. Typically, children with such conditions are referred
to the medical world to identify an appropriate medication to ameliorate the problem
behavior. Children with ADHD are often disruptive in the classroom, require frequent
teacher input, do not generally keep up with their peers in academic pursuits, and often
require additional services due to their significant difficulty with all aspects of learning.
Additionally, many children are misdiagnosed and actually have conditions of depression
and anxiety. Medicating such children with stimulant medications in these cases is contraindicated
and may make their conditions significantly worse. More recently, schools have become
involved to a much greater degree, and now provide screening tests to identify students
with attentional disorders. This scenario suggests that a training program that results
in more or less permanent resolution of ADHD symptoms would be preferred over the traditional
medication management approach. NeuroTechnology (NT) is such an approach. NT, comprising
neurofeedback and AVE, has been studied extensively in clinical and research settings
for the past twenty years. Because intervention with NT is a training process and not
a clinical intervention, it is more appropriately applied in the educational setting
rather than in the clinical setting. It is also clear that this intervention will not
be available through medical channels to the vast majority of children who need it due
to the medical profession’s reliance on medication management, rather then educational
approaches for such problems. Additionally, the evidence that medication compliance is
significantly lower in low-income families suggests that applying NT in inner city and
rural schools in low-income areas would be a more effective method of addressing such
impediments to learning. Further, low-income students often cannot afford such training
from a physician or psychologist and so do not have access to such an alternative approach
for the remedy of their disability, even if it is available in their area. Studies of
Attentional Disorders Using AVE as the Treatment Modality Throughout the 1980s there
were a variety of case reports of improved attention and school grades when applying
AVE to treat autism and ADD, but larger studies did not yet exist. Finally, in 1990,
the first group study took place of the effects of AVE on 26 eight to twelve-year-old
learning disabled boys from a private and public school (Carter & Russell, 1993).
In this study, fourteen children (from a private school) received two minutes of 10 Hz
stimulation, 1 minute of no stimulation, and 2 minutes of 18 Hz for 5 cycles over a 25-minute
period. The students received AVE once a day, five days per week for eight weeks, totalling
40 sessions. They also listened to a tape of binaural beats (recorded from the AVE sessions)
for 40 sessions at home. The public school children (n=12) received three treatments
per week for six weeks totalling 18 treatments. All children could see out of their eyesets,
and were encouraged to play checkers and hand-held electronic games during the treatment.
The results of the first group were considerably better. They received 22 more AVE treatments
than the public school children. Unfortunately this large difference in AVE treatment
had confounded the study, making it unclear as to whether or not the binaural beats on
cassette tape had any influence. Figures 3 and 4 show the pre-post results of IQ measures
and the Burks Teachers’ behavior index for the private school children. Referring to
Figure 4, which class of students would you want to teach?
AVE Program as a Treatment for Behavior Disorders in a School Setting
In 1997, Michael Joyce began using a unique dual frequency AVE session using the TruVuTM
eyesets (independent field stimulation used with the DAVID Paradise units) to treat
ADD and reading challenged students in two Minnesota primary schools (Joyce & Siever,
2000). He measured the children for changes in inattention, impulsiveness, reaction
time, and variability as measured with the TOVA (Greenberg & Waldman, 1993), a
computerized continuous performance test (CPT). Figure 5 shows the children’s improvements
after an average of 33 sessions (over a ten week treatment period). A normal score
is 100. A score of 85 represents one standard deviation away from the norm and is considered
aberrant. These results clearly show improvements in all TOVA measures. Michael also
evaluated reading ability in students from the SPALDING reading program school. The
children were tested on the STAR (Standardized Test for the Assessment of Reading).
Figure 6 shows their comparative improvements as compared with the controls’ performance.
The grade equivalent (GE) ranges from grade 0 to 13 and represents a child’s actual
grade reading level. For instance, if a child is assessed with a GE of 4.7, then the
child is reading at the level a typical child in the seventh month of grade 4. Figure
6 shows the differences in performance between the treatment (AVE) group and the control
group. The percentile rank (PR), ranging from 1 to 99, shows a student’s performance
compared to his/her peers nationally. For instance, if a child has a PR of 78, then
the student is performing at a level that equals or exceeds that of 78% of the children
in the same grade, based on the national average. This measure shows that the control
group performance decreased slightly while the AVE group improved considerably.
The Brain Blood-Flow Connection
Cerebral Blood Flow (CBF) has been examined in other disciplines concerned with cognition.
For instance, vinpocetine, an extract from the periwinkle plant has been shown to increase
CBF (Gold, et. al., 2003). In studies of seniors with memory problems or dementia-related
disease, the application of vinpocetine produced improvements in attention, concentration
and memory. Hershel Toomim, a long-time pioneer in the field of neurofeedback (NF),
has examined the role of cerebral blood flow in brain regulation and attentional disorders
(Toomim & Toomim, 1999). He has been using a technique called hemo-encephalography
(HEG), which measures the perfusion of cerebral blood flow, and has observed decreases
in frontal blood flow in ADD children during reading. By translating the HEG measures
into auditory biofeedback, Toomim has been able to train such children to increase
CBF. He reports results greater than those of traditional NF. Because of the cerebral
blood connection between HEG and AVE, Toomim (2001) analysed six well respected NF
studies (studies with ADD children) and found that the Joyce study, while treating
ten children simultaneously, showed better improvements on the TOVA than had NF, conducted
one child at a time (Figure 7).
Academic Performance and the Alpha Rhythm - Revisited
Several studies have been completed showing the comparison between peak alpha frequency
and intelligence. In 1996, Anoukhin and Vogel observed 101 healthy males ranging from
20 - 45 years of age. They discovered that those who scored well on the Raven’s IQ
tests had a scant 1 Hz faster alpha rhythm than did the poor performers. In 1971, Oloffson
reported that healthy human alpha production was in the range of 9.3 - 11.1 Hz. A 1990
study by Markand showed that a dominant alpha frequency of 8.5 Hz or lower reflected
a state of mental dysfunction. Other studies by various research teams; Vogt, Klimesh
and Doppelmayr (1998), Jausovec (1996), Giannitrapini (1969) showed a distinctive relationship
between mental performance and peak alpha frequency. Roughly speaking, peak alpha production
of less than approximately 10 Hz can be associated with poorer than average academic
performance while dominant alpha production higher than 10 Hz is associated with better
than average academic performance. The above findings prompted Budzynski and Tang (1998)
to conduct a “peak alpha” experiment with AVE. Fifteen minutes of photic stimulation
at 14 Hz was given to 14 people. Peak alpha frequency was found to increase following
the cessation of photic stimulation. The prestimulation dominant alpha average frequency
was 9.78 Hz., which continually increased to 10.38 Hz., 20 minutes post stimulation
(the latest measure taken).
Budzynski Study Using AVE to Improve Cognition and Academic Performance in College Students
Tom Budzynski and colleagues (1999) further divided the typical alpha band (8 - 13 Hz)
into three separate bands. Band “A1” represented 7 -9 Hz, “A2”, 9 -11 Hz, and “A3”,
11 -13 Hz. They then examined the A3/A1 ratio. If, for example, there was 15 uv of
A3 activity and 12 uv of A1 activity, the ratio would be A3/A1= 1.25. Based on previous
findings, a ratio exceeding “1” was considered to equate with better than average mental
performance, while a score below “1” equated with poorer than average mental performance.
A group of struggling college students (n=8), defined as those receiving tutoring,
attending the Western Washington University, were chosen for the study. EEGs were collected
and the A1/A3 ratios were calculated while the students were attending to a variety
of mental tasks. As shown in Figure 8, average alpha slowing (as indicated by the negative
ratio) was apparent across all measures and in particular alpha slowing was most apparent
during the Digit Span task. This task requires remembering progressively longer strings
of numbers until they can no longer be remembered. Following 30 sessions of repeating
cycles of 14 and 22 Hz AVE, mean alpha frequency (positive ratio) increased. The positive
alpha ratio continued across all tasks, indicating heightened mental performance (a
reversal of the control group). The 30 AVE sessions were completed in the Fall of 1997
and the students’ marks from their spring exams were recorded and compared against
a control group (Figure 9). Notice the AVE group showed improvement in grade-point
average (GPA) over the course of the year while the controls showed a decrease in PGA.
This study demonstrates that the carry-over effect following the cessation of AVE treatment
continued for at least five months.
Comparing AVE with Psycho-stimulants in the Treatment of ADHD in Children
This study by Lawrence Micheletti is unique in that it compares outcomes of an AVE group
with a Ritalin/Adderall group, and with an AVE and stimulant combined group (total
N = 99). A control group was also included in the study. The demographics are as follows:
Control Group N = 31 Stimulant (Ritalin & Adderall) Group N = 20 AVE Group N =
21 Combined AVE & Stimulant Group N = 27 Testing was done just prior to treatment
(pre), immediately following (post) and after four weeks (post-post). I.Q. was tested
on the Wide Range Achievement Test (WRAT), Peabody Picture Vocabulary Test (PPVP) and
Raven’s Progressive Matrices (Raven). The children received a 20 minute session, five
days a week for a total of 40 sessions. The first training session was administered
by the researcher while the remaining 39 sessions were completed at home and were supervised
and recorded by a parent or legal guardian. The AVE unit was programmed to begin with
both auditory and visual stimulation at 10 Hz for two minutes and at that time visual
stimulation would cease and only auditory stimulation would continue for one minute.
After the auditory only stimulation, the AVE unit would switch to both auditory and
visual stimulation at 18 Hz for two minutes. The children experienced four complete
cycles (five minutes per cycle) for the completion of a 20-minute training session.
Absolute measures were taken, but for the purpose of this article, only the comparative
data between the controls, the Ritalin Group, the AVE Group and the Combined AVE & Stimulant
Group are shown (Figure 10).
New Visions School Neurotechnology Replication Project
In 2001, Michael Joyce, at the New Visions School (A Chance To Grow), a charter school
in Minneapolis2 specializing in special needs children (attentional and behavioral)
completed the largest AVE study to date. This study substantiated previous work in
schools in Minneapolis and Perham, MN, and in Yonkers, NY. The study illustrated that
the public school setting is an ideal environment for conducting AVE training, particularly
for low-income inner city and rural families who typically do not have access to such
training. This study involved the efforts of seven Minnesota public schools (five elementary,
one middle, and one K-12) with the majority of elementary age. This study employed
AVE to address the inattention, impulsiveness and behavioral challenges in school-age
children, thus reducing the need for medication management of these children and reducing
the educational resources that are devoted to responding to their disabilities. Students
selected had a history of learning and reading challenges, impulsiveness, and a propensity
to be distracted and to distract others. The students were selected by an ongoing,
dynamic evaluation process based upon referrals from classroom teachers, parents, special
education staff, and/or other concerned people in the student’s life. Parents and teachers
completed a behavior rating scale, while the students completed a standardized reading
inventory.
Apparatus
The AVE device used was the DAVID Paradise XL (manufactured by Mind Alive Inc, Edmonton,
Alberta, Canada). The eyesets used in the study were field independent, in that they
are able to independently stimulate the individual left and right visual fields of
each eye thus producing a different frequency in each hemisphere of the brain. At two
schools, the DAVID Paradise XL was attached to a multi-user amplifier, which enabled
up to ten students to receive treatment simultaneously (Figure 13). Each student had
his/her own station, which consisted of a set of headphones and an eyeset. The students
could control both the audio volume and the light intensity. The students preferred
brighter intensities, between approximately 400 and 600 lux (full spectrum) measured
approximately 0.3 inches from the eye set screen (approximating their average eye distance
from the screen). Students participated in two or three AVE sessions (20-30 minute)
per week, averaging nearly 30 sessions over a period of three months. Some students
with severe impairments underwent daily sessions. The training was part of the student’s
regular curriculum, scheduled around other activities. Training was accomplished using
protocols established by the foremost clinicians and researchers in the field, modified
to reflect New Visions’ experience working within the school environment.
Results
Pre- and post-intervention data was obtained using direct assessment and behavior rating
scales completed by both parents and teachers. Behavioral and personality ratings were
obtained via the BDS, both the home and school versions and normed to a value of “10”
(Figure 11). Oral reading proficiency was assessed with the Slosson-R reading test.
Students showed reductions in anxiousness, depression, hyperactivity and inattention.
On average, students gained eight months (p<.001) in grade-equivalent oral reading
scores (Figure 12). Shown below in Figure 13 is Michael Joyce’s storage box containing
the AVE Multiple System. Michael’s box has an audio -mixer that “mixes” a microphone
and CD player into the multiple system for the children to hear. These storage systems,
which are used throughout several schools are on wheels so that they may be easily
transported throughout the schools for use in different classrooms. Conclusion Several
studies show that AVE is a useful tool for treating attentional disorders. The frequencies
used in its operation are similar to those frequencies used with common NF techniques.
As added bonuses, the ability to have pre-programmed sessions makes AVE useable by
people not skilled in NF, such as teachers and parents. A single clinician may also
treat several children at one time, thus drastically cutting costs. The results include
many behavioral improvements in addition to the primary attentional concerns.
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at “Mind Alive” (formerly Comptronic Devices Ltd). Toll Free: 1 - 800-661-MIND (6463),
Ph: 780-450-3729. Address 9008-51 Avenue, Edmonton, Alberta, Canada, T6E 5X4. Web:
www.mindalive.ca Email: info@mindalive.ca 2 New Vision School – A Chance to Grow (Michael
Joyce). Minneapolis, MN Ph: 612-706-555
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