The effects of forehead EMG biofeedback training on the EEG and behavior of hyperactive children

Twelve non-retarded, non-psychotic hyperactive children and twelve normal controls averaging nine years of age were selected for a study of the therapeutic value and effects of electromyographic (EMG) biofeedback training. The children were first given Bender-Gestalts, Digit-Span tests (WISC-R), baseline EMG's, and assessed by their parents on the Connors rating scale for hyperactivity. The twelve normal children were given only the pretest measures, but the twelve hyperactives were given an electroencephalogram (EEG) measurement and came to the laboratory twice weekly for six weeks of training. The hyperactives were randomly assigned to either a group that was given EMG biofeedback training of the forehead muscles plus relaxation training, or to a group receiving relaxation training alone while the forehead EMG was monitored by the experimenter. All the children were given a cassette recording of a modified version of Jacobson's progressive relaxation and were asked to practice the tape at least once a day. The children's parents and responsible physicians agreed to stabilize the medication levels throughout the three month study and to encourage the children to practice regularly. The hyperactives were given another EEG, EMG, and posttest battery after training. The twelve hyperactive children had higher forehead EMG levels than the normal controls on pretest measures (3.37 versus 2.44 microvolts, p<.01). The hyperactives also had higher Connors scores (91.4 versus 52.8, p<.002) and shorter Digit-Span levels (9.0 versus 13.8, p<.02). The hyperactives were able to reduce their average forehead EMG levels by 43% by the end of training (3.37 microvolts down to 1.96 microvolts, p<.01). The hyperactive children failed to significantly improve their average scores on the Connors (91.4 to 84.5, NS) on the Bender-Gestalt (5.6 to 4.4 NS), or Digit-Span (9.0 to 9.2, NS) test measurements. The EEG records showed significant changes from pretest to posttest. The interhemispheric synchrony of the frontal and occipital cortexes increased significantly (frontal 69%, occipital 73%, both p<.05) and appeared to be related to changes in hyperactive behavior. Other significant changes that occurred in the EEG were the intervals between the major, imtermediate, and minor period counts and indicated a greater degree of organization in the brain waves of these children after training. Trends in the data indicate that three children that had higher Connors scores after training were younger, had shorter Digit-Span scores and more Bender-Gestalt errors. The three children that seemed to worsen showed a 29% decrease in interhemispheric EEG synchrony and higher forehead EMG levels before training than those that improved. This study failed to demonstrate that the effects of EMG biofeedback training plus relaxation are superior to relaxation training alone. The changes in the EEGs may have been due to factors other than biofeedback and/or relaxation training. The tool of EMG biofeedback does not seem indicated as a primary therapy in childhood hyperkinesis at this time.