Assessment

In this section we cover only instrumentation-based assessments, and our near-term emphasis is on the Continuous Performance Test (CPT). This is for a number of reasons. First of all, we have found the CPT to be the single most useful assessment instrument for purposes of evaluating neurofeedback progress with clients. Secondly, we have a long history with the technique and are therefore in a position to confirm that any protocol innovations do not exact a price vis-a-vis more established protocols. In such appraisals, having a computer-scored test of such broad scope as the CPT is helpful indeed. Thirdly, the CPT is reassuring to parents even early in the training when they may still be resolving their doubts about the value of neurofeedback for their child. That is because positive effects are typically seen quite early in training. And finally, although not least, our own research on CPTs has led to improved methods of analysis and new insights into the failure mechanisms of the brain.

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Evidentiary Basis for Infra-Low Frequency Neurofeedback
by Siegfried Othmer, Ph.D. - Chief Scientist, The EEG Institute
September 12, 2018

Abstract
Infra-Low Frequency Neurofeedback impinges on brain-based dysfunctions quite comprehensively, but the resulting improvements in self-regulatory competence cannot typically be captured both quantitatively and unambiguously. A measurable functional challenge is called for, and the Continuous Performance Test (CPT) offers such a challenge, one that both tests critical neuro-regulatory functions and has the benefit of broad acceptance within the neuropsychological community. A concise appraisal of results from a large database, one that extends over more than a decade and over thousands of clinical offices, is offered here as supportive testimony to the clinical effectiveness and practical utility of ILF neurofeedback in application to a wide variety of clinical conditions.

Introduction
The conventional terms of discourse in mental health are the diagnostic categories and symptom descriptors relevant to those categories. Prominent in connection with childhood issues are terms such as distractibility, impulsivity, inattention, hyperactivity, perseverative behavior, rage behavior, stimming, oppositionality, etc. With reference to neurofeedback, a new terminology is required that is descriptive of the task at hand. In neurofeedback we are engaged with the means of enhancing the brain’s self-regulatory competence, which calls for us to view the brain in the perspective of a regulatory system.

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The Role of the Continuous Performance Test
by Siegfried Othmer, Ph.D.
April 4, 2016

INTRODUCTION
We have in neurofeedback a physiologically-based tool that should, in the best of circumstances, be accompanied by physiologically-based assessments in addition to the usual symptom-tracking.

A case can be made for tracking measures that monitor the training process as well as for pre-post assessments. These assessments can either consist of passive monitoring of physiological variables or of active functional challenges. Typically both of these approaches are handicapped by intrinsic variability in the measures. When it comes to real-time tracking measures, our response to lack of reliability is to employ several independent measures, and to look for consistency among them. When it comes to pre-post measurements, we look to repeated measures to gain statistical precision.

Summary
The CPT test may well be the most revealing and efficient test available to accompany neurofeedback as a progress measure. Among the CPTs available, the design philosophy implicit in the TOVA is the most suitable for our purposes. The QIK updates the TOVA to modern technical requirements and allows open-ended future developments. Finally, it allows complementary EEG measurements to be made that allow more subtle failure modes to be identified.

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TOVA Results Following Inter-Hemispheric Bipolar Training
by J.A. Putman, S.F. Othmer, S. Othmer, and V.E. Pollock,
Journal of Neurotherapy, 9(1), 27-36 (2005)

ABSTRACT

INTRODUCTION
This study examines recovery of attentional measures among a heterogeneous group of clients in a pre-and post-comparison using inter-hemispheric EEG training at homologous sites. A continuous performance test was used as an outcome measure. The client population was divided into three groups: (a) primarily attentional deficits, (b) primarily psychological complaints, and (c) both.

METHOD
Neurofeedback protocols included T3-T4, Fp1-Fp2, F3-F4, C3-C4, and P3-P4. A wide range of reward frequencies was used, and these were individually selected to optimize the subjective experience of the training. Participants were 44 males and females, 7-62 years old, who underwent treatment for a variety of clinical complaints. Dependent variables were derived from a continuous performance test, the Test of Variables of Attention (TOVA), which was administered prior to EEG training and 20 to 25 sessions thereafter.

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Updating the Analysis of the Continuous Performance Test (Analyzing the Reaction Time Distribution)
by Siegfried Othmer, Ph.D.
April 4, 2016

Summary
For more than twenty years we have been using either the TOVA or the QIKtest with anyone who is able to take the test, in order to track progress in training. Both tests yield an incredible amount of information that is directly relevant to our project of training the brain toward improved stability and self-regulatory competence.

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Interpretation of the Reaction Time Distribution II
by Siegfried Othmer, Ph.D.
April 4, 2016

Summary
In the previous article it was established that the outliers in the distribution of reaction times could not be interpreted as the tail of the Gaussian distribution. They had to be treated as a distinct phenomenon. When it came to characterizing the distribution function that describes the outliers, the analysis suffered from insufficient data. After all, reaction time outliers are relatively rare, so even a database of over 1500 did not give us enough to work with.

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CPT Data for Infra-Low Frequency Training with Cygnet
by John Putman and Siegfried Othmer, Ph.D.
April 4, 2016

Summary
We have just reviewed all of the CPT data sets we have acquired over the last three years at the EEG Institute for which post-training data are available. The data were acquired with the QIKtest, but they were analyzed with T.O.V.A.® norms. The data cover a variety of diagnostic categories and ages. Every case represented here received infra-low frequency training with target frequency in the range of 0.1mHz to 10mHz. The results are broadly consistent with what we have observed over the years even with the higher-frequency training. Obscured in those comparisons is the fact that we are presently working successfully with a more challenged population than we did years ago.

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Continuous Performance Test Results following Neurofeedback and the Efficacy of Frequency Optimization using Bipolar training Montages
by J. Putman, MA, MS, S.F. Othmer, PhD (cand.), S. Othmer, PhD, R. Sasu, MD, G. Dizon, MSN
April 4, 2016

ABSTRACT
Continuous Performance Test measurements are presented for the time frame of 2006 to 2012, a period of rapid evolution in neurofeedback training protocols with the introduction of infra-low frequency training. The objective was to assure that outcomes were not compromised in any way by the change in training procedures.

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