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<h4>Meet Joel Lubar.</h4>
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<h4>Joel Lubar's Accomplishments</h4>
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<p><img src="@@PLUGINFILE@@/Joel%20Lubar.png" alt="Joel Lubar" width="400" height="454" class="img-responsive atto_image_button_left">Dr. Joel Lubar studied the effects of lesions and stimulation
    on animal brains in his early career (early 1960s to mid 1990s).&nbsp;<span style="font-size: 1rem;">In 1972, he had already
been studying ADD/ADHD for several years when he came across the published
works of Dr. Barry Sterman.&nbsp; As aforementioned, Sterman had been working
with epileptics, training them with neurofeedback to help reduce the frequency
of grand mal seizures. He sought to duplicate Barry's work&nbsp; on human subjects with epilepsy and did so, in work published in the </span><i style="font-size: 1rem;">Archives of Neurology</i><span style="font-size: 1rem;"> (1981). When Lubar read about Sterman’s work, he realized that
there was an application to his work with ADD/ADHD patients.&nbsp; Lubar
states:</span></p>

<p>“Sterman’s paper said there is a brain wave frequency known as SMR that may be dysfunctional in epileptics, and when that rhythm is partially restored, a resistance to seizures occurs.&nbsp; As soon as I read that, I said, ‘My God, I think this will work
    for controlling hyperactivity in children because the circuitry is very similar.’ If you could quiet the motor responses for epileptics, then quieting the motor responses in hyperactive children should be a piece of cake.”</p>
<p>At the time, ADHD went by the name "minimal brain dysfunction syndrome," later to be called hyper kinetic disorder (now Attention Deficit Hyperactivity disorder). Joel then published a paper with Margaret Shouse showing that training up SMR rhythms while
    training down theta rhythms led to significant improvements in ADHD behaviors. One of his earliest observations was about the theta beta ratio, finding that individuals with inattentive ADHD showed significantly higher theta/beta ratios than normal
    controls, and the ratio decreased as a function of age.&nbsp;<span style="font-size: 1rem;">Lubar (1991) laid the foundation for the
concept of the theta/beta power ratio as a measure that could discriminate
“normal” children from children with ADD, learning disorders and ADHD (Lubar,
1991).&nbsp;</span>This initial observation of the theta beta ratio was not intended by Lubar to be a diagnostic marker for ADHD, but it has become a standard diagnostic, approved by the American Academy of Pediatrics, as well as the US Food and Drug
    Administration, for the diagnosis of ADHD.</p>

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<div>Today, excess theta and elevated TBR have been found favorable predictors for treatment outcome to stimulant medication (Arns, Gunkelman, Breteler, &amp; Spronk, 2008; Clarke, Barry, McCarthy, Selikowitz, &amp; Croft, 2002; Suffin &amp; Emory, 1995) and
    neurofeedback (Arns et al., 2012; Monastra, Monastra, &amp; George, 2002), thereby demonstrating the prognostic value of this measure (assuming a slow alpha peak frequency is ruled out (Arns et al., 2008; Lansbergen, Arns, van Dongen Boomsma, Spronk,
    &amp; Buitelaar, 2011). B<span style="font-size: 1rem;">ased
on studies, the excess theta and TBR is found in a substantial subgroup of
patients with ADHD (25%-40%) and has been demonstrated to be of prognostic
value in predicting treatment outcome to stimulant medication and
neurofeedback.</span></div>
<div><span style="font-size: 1rem;"><br></span></div>
<div>However, even with the success, reliability and duplicability the theta-beta ratio has had as a marker of ADHD, Lubar has made it clear that it is only a correlated measure. In his words: "Unfortunately, the theta-beta ratio, which is being used universally in many
    studies and practices, has been interpreted as a diagnostic criterion, which it absolutely is not!" In addition, he states "there are many other factors that can cause a high theta beat ratio, such as poor sleep quality, which is often the case with many individuals
    with ADD--ADHD, [as well as] time of day, the measures taken, and possibly nutritional, possibly endocrinological, and a variety of other factors" (Lubar, 2020).&nbsp;</div>
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<p>And, finally, in a 2013 meta-analysis of 9 studies on the theta-beta ratio in ADHD, Martijn Arns and colleagues found that this ratio is ultimately unreliable. The below graphic shows the following results:&nbsp;&nbsp;<span style="font-size: 1rem;">Two age groups are presented:
younger children (age 6–13; A) and all children (age 6–18; B). Theta/beta ratio
(TBR) means and standard deviations are presented. The 9 studies are shown chronologically as
published. Note how the differences between ADHD and controls narrowed over
time, and how much scatter is seen in TBR measurements among studies of younger
children. From Arns et al.&nbsp; (2013).</span></p>
<p><span style="font-size: 1rem;"><img src="@@PLUGINFILE@@/THETA%20BETA%20RATIO.png" alt="THETA BETA RATIO" width="700" height="432" class="img-responsive atto_image_button_left"><br></span></p><br>
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