Abstract
Background. EEG is an effective tool due to its ability to capture and interpret the changes in brain activity under different situations. Quantitative EEG (qEEG) can be essential in evaluating and treating children's learning problems. Methods and procedure. Fifty school-going children with difficulty in learning were studied. Analysis of the difference between pre-intervention and postintervention EEG power ratio of frequency bands, including Theta to Beta and Theta to Alpha, while eyes-closed, eyes-open, hyperventilation, writing, and reading conditions and the values for relative powers were calculated. The study correlated postintervention theta/beta ratio (TBR) and theta/alpha ratio (TAR) values with behavioral measures. Results. The findings suggested that there was a significant difference in pre-intervention and postintervention relative TAR and TBR power values. A significant increase of TAR and TBR power values was observed in eyes-closed (resting), hyperventilation, writing, and reading task conditions, indicative of a state of arousal at FP1FP2, T3T4, and O1O2 scalp locations. During eye open conditions, the TAR and TBR were significantly low at all 3 scalp locations, indicating a relaxed, conscious, and aware state of mind. Postintervention TAR and TBR values were significantly correlated with behavioral measures during 5 task conditions on several scalp locations. Conclusion. These quantitative electroencephalogram findings in children with learning problems indicate that with the increased complexity of the cognitive tasks, TAR and TBR increase, while postintervention, children could attain a relaxed and conscious state of mind during eyes-open condition.
Keywords
Introduction
During the primary and elementary school stages, students manifest problems in learning. Available literature suggests that learning difficulty is caused by a conflux of factors such as family psychopathology, a difficult sociocultural environment, a lack of opportunities to learn cognitive skills, frequent migrations, and a deficit in sociolinguistic interaction. These conditions strongly predict negative cognitive and academic performance and high drop-out rates in school children, who are at higher risk for learning problems.1,2
Neurodevelopmental disorders have received considerable attention,3–5 however, the learning problems faced by students due to sociocognitive factors often get ignored. Previous studies have focused on qEEG patterns during students’ engagement in resting and cognitive conditions that support understanding learning difficulty and elucidate the neurophysiological underpinnings of this serious problem.6,7
The present study focused on 2 ratios to understand the brain's activation style: theta/beta ratio (TBR) and theta/alpha ratio (TAR). The theta frequency indicates the subconscious mind's functioning, representing creative/intuitive thought. Theta thought uses images for processing. Beta frequency indicates the functioning of the conscious mind and represents logical/rational/sequential processing using language. A high beta power band was related to better concentration and higher mental activity. 8 Alpha represents a relaxed state and a pure awareness state. 9 Moreover, the TBR depicts a particular brain's balance at a particular location in a particular cognitive task, performing a condition between creative/intuitive and logical/rational processing. Higher TBRs indicate higher levels of theta, while lower TBRs indicate dominating beta frequency. On the other hand, the TAR depicts the relationship between the subconscious processes and conscious awareness. People with low TAR often act out of subconscious motivations but have no idea where the behavior comes from. 10 A consistent line of research specifies the TBR and TAR as potential biomarkers for executive function, particularly attentional processing.11,12 Higher TBR in the EEG among individuals with ADHD suggests affected cognitive processing involving executive cognitive control, specifically attentional control. 13
Review of Literature
Studies have used EEG to measure resting-state networks.1,14 Few electrophysiological resting-state studies of children with LD-NOS demonstrate greater theta power and less alpha and beta power than normal for the child's age during relaxed rest.15–18 Increased theta activity is associated with decreased cortical activity and under-arousal. In the context of Learning Disability (LD), the “maturational delay hypothesis” suggests postponed cortical maturation. EEG slowing and the nature of the qEEG abnormality are related to academic performance. 19
Jäncke and Alahmadi 20 considered TAR as a marker of brain maturity. Pre-intervention elevated TBR in children with ADHD were able to decrease TBR using specific protocols in neurofeedback training. 21 Studies on qEEG reported a negative correlation between lower attentional abilities and high TBR during resting state. 22 Higher TBR is related to mind wandering in healthy adult participants 23 and a higher cognitive load.24,25
Literature suggests that the TBR is related to cognitive processing and motivated decision making 26 to task thoughts12,27 and to reversal learning, 28 to resilient response to the effects of stress on task performance, 29 to down-regulation of negative affect 30 and to the regulation of automatic attentional bias to threat.11,31 Additionally, a higher baseline TBR correlated to a stronger decline in cognitive control after stress induction. 29 TBR has a high test–retest reliability, predicts attentional control, and is a stable electrophysiological marker of executive control. 11 Low TBR, for example, has been related to low approach-driven or hedonically motivated behavior. TBR is considered potent in understanding various phenomena, conditions, and applications, such as stress-cognition interactions, anxious psychopathology, or human performance enhancement.
The above literature review has supported the role of TBR and TAR in children affected with ADHD, adults suffering from anxiety and stress, and the relationship of TAR and TBR with executive functions and other cognitive control during resting and other task performance conditions, but little research has examined the mechanisms of TAR and TBR in school children with learning problems. This study investigated if TBR and TAR vary after the intervention is provided. The current study questions whether TBR and TAR change when students perform different cognitive task conditions. Furthermore, the study aimed to examine the qEEG signatures in different cognitive task conditions while focusing on resting, eye-open, hyperventilation, writing, and reading before and after the cognitive-behavioral intervention is imparted. Moreover, the study also assessed the relationship between postintervention TAR and TBR with cognitive-behavioral measures. In line with that, 2 hypotheses were formulated. H1 stated that the TBR and TAR would significantly differ after exposure to cognitive-behavioral intervention on 5 task conditions. H2 stated that postintervention TAR and TBR values will significantly relate to cognitive-behavioral measures during 5 task conditions.
Method
Design
A pretest and post-test quasi-experimental research design was utilized to assess the difference in EEG patterns before and after the Program for Enhancing Academic and Behavioral Learning Skills (PEABLS), a self-designed cognitive-behavioral intervention. This intervention program caters to school students of 8 to 12 years of age (3rd-7th grade) with difficulty in learning. The intervention was designed to build their self-regulation and resiliency along with the Individualized Educational Program (IEP) and assist students in improving their Psycho-social-behavioral and academic performance. The intervention PEABLS was carried out in 15 sessions, including 60 min per session twice weekly. PEABLS comprised of 3 components: (1) self-regulation therapy, (2) resilience-building training, and (3) academic remediation. The intervention PEABLS aimed to counter their negative beliefs and allow them to develop cognitive flexibility when confronted with negative thoughts. Students learned to resolve their interpersonal conflicts, communicate assertively, deal with their aggressive spells, passivity, and decision making in various day-to-day situations. IEP helps them cope with conceptual deficits. The intervention was delivered at 2 places: within the school premises and at the university lab set-up closer to their residence after school. As part of this program, students’ baseline performance was assessed, and teaching modules were designed to meet their specific needs. In their intervention causative model, Zimmerman and Martinez-Pons 32 proposed that improvement in a fundamental aspect of learning (including self-regulation, behavior, emotions, and resilience) in children with learning difficulties helps them learn to pay attention, regulate their behavior, and control their impulses. Empowering executive functioning skills in students gives promising results in the domains of academic, social, and personal life, where they often require problem-solving and decision-making skills. 33 Recipients of PEABLS intervention exhibited improvements in cognitive skills like working memory, verbal and written expressions, self-regulation and resilience skills, and academic skills.7,34
Sampling
The study included 50 students from government-run schools, ages 8 to 12 years (mean age = 10.38, SD = 1.39), studying in grades 3 to 7 (mean = 4.78, SD = 1.32), belonging to urban slums, showing low academic performance for 2 years before starting the study, and behavioral issues at school. Their average body mass index was 13.88 (SD = 2.01). Their mean pre-intervention academic aggregate score was 37.9%, and the mean postintervention academic aggregate score was 47.78%. Their vulnerability to dropping out of school due to frequent academic failures and behavioral problems highlighted their need for this intervention, especially since evidence indicates the problems in multiple domains further elevate that risk.35–37 Permission from concerned authorities was obtained before conducting the study on the school premises. Both parents and teachers were informed about the purpose of the study. A list of students with learning difficulties was prepared based on feedback from the class teachers of concerned grades and their respective parent's reports.
Inclusion criteria: (1) age range from 8 to 12 years (3rd-7th grade), (2) obtained IQ score ≥ 50 percentile on Raven's Color Progressive Matrices (RCPM), 38 (3) failed in class for 2 consecutive years, (4) low classroom participation and co-curricular activity, and (5) behavioral issues. The exclusion criteria: (1) obtained IQ score ≤ 50 percentile on RCPM, (2) sensory impairments, (3) any known case of developmental disorder, and (4) physical disability (as they may have associated co-morbidities). For the study, 50 students with learning problems matched with exclusion and inclusion criteria were identified. None of them withdrew from the study after the intervention started. The study followed the Ethical Guidelines Involving Human Subjects suggested by the Declaration of Helsinki. A Clinical Psychologist supervised the process of student selection, assessment, and intervention.
Procedure
The study was categorized into 3 phases. During the first phase, the baseline assessment of the student participants was done. Students were screened for IQ scores using RSPM and the Diagnostic Test of Learning Disability (DTLD). 39 To maintain confidentiality, the pre-intervention and postintervention assessment details were only shared with teachers and respective parents. Those participants who obtained IQ ≥ 50th percentile in the RCPM and a score of ≥40% in the DTLD were further subjected to recording EEG data. The baseline level of academic performance was obtained from the aggregate scores of each student received in their final term in the previous grade. During phase II, all the students were introduced to PEABLS intervention that continued for 2 months (15 sessions, twice a week). Immediately after the 2-month intervention, they were re-assessed on the cognitive measures, and EEG patterns were recorded in phase III. Postintervention academic performance was obtained from aggregate scores received after mid-term exams of their current grade. The age and grades of the participants were approximately normally distributed, with skewness of −0.21 (SE = 0.34) and kurtosis of −1.17 (SE = 0.66) for the age variable and skewness of 0.15 (SE = 0.38) and kurtosis of −1.11 (SE = 0.66) for the grade variable.40,41
Measurements
The students were assessed twice, that is, before and after the intervention, with EEG recording and the cognitive measurements described below.
Cognitive-Behavioral Measurements
The DTLD is a screening tool for measuring students’ visual and auditory perception and cognitive functioning.
The RCPM is the standardized measurement for assessing students’ IQ levels.
The Digit Span Test, forward and backward, a subtest of Malin's Intelligence Test for Indian Children, 42 was conducted to assess students’ working memory status.
The Bender Gestalt Test (BGT) was administered to assess visual-motor functioning, developmental disorders, and neurological impairments in students. 43
The Problem Behavior Check-List 44 (PBCL) was conducted to assess problematic behavioral issues displayed by the students. The parents of participants filled out the checklist.
Electrophysiological Measures
qEEG of the participants was recorded twice at a gap of 2 months, at the psychophysiology lab of the University Department. EEG was acquired for one subject at a time during 5 conditions, that is, 120 s each during each condition during eyes-closed, eyes-open, hyperventilation, writing, and reading. During the eyes-closed, the student was asked to relax while listening to music, and during the eyes-open condition, the subject was instructed to look at a fixed (+) mark on the computer screen. The subject was asked to inhale and exhale rapidly during hyperventilation. For the writing task, subjects were asked to write a paragraph they had learned during IEP; for the reading task, subjects were asked to read a section from their respective school English textbook. The EEG recording was done in the afternoon after school hours after lunch and rest. EEG data were acquired using BIOPAC system MP36 (BIOPAC Systems, Inc.) from the 4 digital channels of the 10 to 20 system and analyzed with AcqKnowledge 4.1 software MP150, referenced to the linked earlobes (A1-A2). The reference of EEG bandwidth of waveforms was placed within the range of 0.5 to 70 Hz. All electrodes, input and output impedance were set at 2 MΩ and 50 Ω, respectively, with a gain of 50 000. EEG data were sampled at 2000 samples/second for every 0.5 ms. The raw EEG signals were processed with the help of AcqKnowledge software, and delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), beta (13-30 Hz), and gamma frequency (30-60 Hz); frequency band was then extracted from it. The mean ratios of relative power of theta to beta and theta to alpha frequency bands for 50 participants were calculated during 5 conditions. EEG was recorded with 6 electrodes placed according to the international 10 to 20 system on the FP1FP2, T3T4, and O1O2 scalp locations. After raw EEG data were extracted from MP36 BIOPAC, the independent component analysis (ICA) was done using BIOPAC software. The artifacts were estimated using reference channels. Further, Fast Fourier Transformation (epochs were set at 120 s), power spectrum density, and relative band power were calculated using MATLAB coding.
Statistical Analysis
The pre-intervention and postintervention mean scores of TAR and TBR were compared using a paired t-test. Cohen's d was calculated to assess the effect size for measuring the difference between 2 group means. Pearson's correlation coefficient was computed to assess the relationship between TAR and TBR with cognitive-behavioral measures. The statistical analysis was computed using SPSS version 27.
Results
Data obtained was compared on electrophysiological variables assessed at baseline and postintervention. EEG recordings were done during eye-closed, eyes-open, hyperventilation, writing, and reading conditions. The results of EEG variables of pre-intervention and postintervention TAR and TBR in the relative band power values of delta, theta, alpha, beta, and gamma of the qEEG were compared using a t-test for paired samples. The results are described in section I (Tables 1–5) and section II (Tables 6–10). Tables 11 and 12 of section III depicted the relationship between postintervention TAR and TBR values with cognitive-behavioral measures.
Comparison of TAR Values Before and After Intervention for Students With Learning Difficulty During Eyes-Closed Condition.
* Significant at 0.05 level; ** significant at 0.01 level; d = Cohen's d.
Abbreviations: SD, standard deviation; TAR, theta/alpha ratio.
Comparison of TAR Values Before and After Intervention for Students With Learning Difficulty During Eyes-Open Condition.
* Significant at 0.05 level; ** Significant at 0.01 level; d = Cohen's d.
Abbreviations: SD, standard deviation; TAR, theta/alpha ratio.
Comparison of TAR Values Before and After Intervention for Students With Learning Difficulty During Hyperventilation Condition.
* Significant at 0.05 level; ** Significant at 0.01 level; d = Cohen's d.
Abbreviations: SD, standard deviation; TAR, theta/alpha ratio.
Comparison of TAR Values Before and After Intervention for Students With Learning Difficulty During Writing Condition.
* Significant at 0.05 level; ** Significant at 0.01 level; d = Cohen's d.
Abbreviations: SD, standard deviation; TAR, theta/alpha ratio.
Comparison of TAR Values Before and After Intervention for Students With Learning Difficulty During Reading Condition.
* Significant at 0.05 level; ** Significant at 0.01 level; d = Cohen's d.
Abbreviations: SD, standard deviation; TAR, theta/alpha ratio.
Comparison of TBR Values Before and After Intervention for Students With Learning Difficulty During Eyes-Closed Condition.
* Significant at 0.05 level; ** Significant at 0.01 level; d = Cohen's d.
Abbreviations: SD, standard deviation; TBR, theta/beta ratio.
Comparison of TBR Values Before and After Intervention for Students With Learning Difficulty During Eyes-Open Condition.
* Significant at 0.05 level; ** Significant at 0.01 level; d = Cohen's d.
Abbreviations: SD, standard deviation; TBR, theta/beta ratio.
Comparison of TBR Values Before and After Intervention for Students With Learning Difficulty During Hyperventilation Condition.
* Significant at 0.05 level; ** Significant at 0.01 level; d = Cohen's d.
Abbreviations: SD, standard deviation; TBR, theta/beta ratio.
Comparison of TBR Values Before and After Intervention for Students With Learning Difficulty During Writing Condition.
* Significant at 0.05 level; ** Significant at 0.01 level; d = Cohen's d.
Abbreviations: SD, standard deviation; TBR, theta/beta ratio.
Comparison of TBR Values Before and After Intervention for Students With Learning Difficulty During Reading Condition.
* Significant at 0.05 level; ** Significant at 0.01 level; d = Cohen's d.
Abbreviations: SD, standard deviation; TBR, theta/beta ratio.
Correlation of Postintervention TAR With Cognitive-Behavioral Measures.
* Significant at 0.05 level; ** Significant at 0.01 level.
Abbreviations: PBCL, Problem Behavior Check-List; TAR, theta/alpha ratio.
Correlation of Postintervention TBR with Cognitive-Behavioral Measures.
* Significant at 0.05 level; ** Significant at 0.01 level.
Abbreviations: BGT, Bender Gestalt Test; DTLD, Diagnostic Test of Learning Disability; TBR, theta/beta ratio
Section I. Comparison of TAR Values Before and After Intervention for Students With Learning Difficulties During Various Cognitive Tasks
Section I depicts a paired sample t-test values and their respective Cohen's d values and P-values to compare EEG TAR values of alpha, beta, theta, delta, and gamma on FP1FP2, T3T4, and O1O2 locations during eyes-closed (Table 1), eyes-open (Table 2), hyperventilation (Table 3 and Figure 1), writing (Table 4 and Figure 2), and reading (Table 5) conditions for the groups of students with learning difficulty before and after the intervention.
Electroencephalographic variables theta/alpha ratio during hyperventilation condition, before and after intervention.
Electroencephalographic variables theta/alpha ratio during writing condition, before and after intervention.
A significant difference was observed in TAR values in beta and gamma waves of temporal location during eyes-closed conditions (Table 1). During the eyes-open condition, TAR values in alpha, beta, and gamma in occipital scalp location showed significant differences (Table 2). Whereas during the hyperventilation condition (Table 3), a significant difference in the postintervention state was observed in alpha, beta, and gamma waves of frontal and temporal scalp locations, while significant changes in TAR were noticed in frontal theta and delta power values. During the writing condition (Table 4), postintervention, significant differences were observed in the relative power values of alpha, beta, theta, delta, and gamma of the frontal region, along with beta and gamma relative band power values of temporal scalp locations. During the reading condition (Table 5), significant postintervention changes were observed in the relative band power values of alpha, beta, and gamma of frontal scalp location. Effect size in the pre-intervention and postintervention mean values during eyes-closed, eyes-open, hyperventilation, and reading conditions showed low to moderate differences, whereas, during the writing condition, the effect size was slightly greater than the moderate level.
Section II. Comparison of TBR Values Before and After Intervention for the Groups of Students With Learning Difficulties During Various Cognitive Tasks
Section II depicts a paired sample t-test and their respective Cohen's d values and P-values to compare EEG TBR values of alpha, beta, theta, delta, and gamma on FP1FP2, T3T4, and O1O2 locations during eyes-closed (Table 6), eyes-open (Table 7), hyperventilation (Table 8 and Figure 3), writing (Table 9 and Figure 4), and reading (Table 10 and Figure 5) conditions for the groups of students with learning difficulty before and after the intervention.
Electroencephalographic variables theta/beta ratio during hyperventilation condition, before and after intervention.
Electroencephalographic variables theta/alpha ratio during writing condition, before and after intervention.
Electroencephalographic variables theta/alpha ratio during the reading condition, before and after intervention.
TBR values in alpha. Beta, theta, delta, and gamma relative power values at temporal scalp location significantly differed during eyes-closed conditions (Table 6). TBR values were not significantly different at any scalp location during the eyes-open condition (Table 7). During the hyperventilation condition (Table 8), a significant difference in the postintervention state was observed in alpha, beta, theta, and delta waves of frontal scalp location. During the writing condition (Table 9), postintervention, significant differences were observed in the relative power values of alpha, beta, theta, delta, and gamma of the frontal and temporal scalp locations. During the reading condition (Table 10), significant postintervention changes were observed in the relative band power values of alpha, beta, theta, and delta of frontal and temporal scalp location. Effect size measures between pre and postintervention mean values during eyes-closed, eyes-open, hyperventilation, and reading conditions showed low to moderate differences, while during the writing condition, it was slightly greater than moderate level.
Section III. Correlation Between Postintervention TAR and TBR Values With Cognitive-Behavioral Measures During Various Cognitive Tasks
This section depicts the Pearson's correlation between postintervention TAR values (Table 11) and TBR values (Table 12) with cognitive-behavioral measures. There was a significant association between TAR and TBR values on FP1FP2, T3T4, and O1O2 scalp location with cognitive-behavioral measures such as IQ (measured with RCPM), working memory (measured with Digit Span Test), BGT (for neurological assessment), DTLD (to assess levels of learning disability), and PBCL (to assess problematic behavior).
Postintervention TAR values were significantly low to moderately correlated with working memory during eyes-closed, eyes-open, hyperventilation, and reading conditions at frontal alpha, beta, theta, delta, and gamma; occipital beta, and gamma. A significant low correlation was also observed with IQ values at frontal delta, and PBCL values had a significant low correlation with frontal beta and gamma (Table 11).
TBR postintervention values were significantly low to moderately correlated with IQ during eyes-closed (frontal alpha, beta, theta, and delta), writing (occipital alpha, beta, and gamma), and reading (frontal theta and delta) conditions. TBR postintervention values were low to moderately significant during eyes-closed (frontal alpha, beta, and theta), eyes-open (frontal alpha, theta, and delta), hyperventilation (frontal alpha, beta, theta), and reading (frontal alpha, beta, theta, and delta; occipital alpha, beta, theta, delta, and gamma) conditions with working memory. During eyes-closed (occipital theta, gamma) and reading (occipital alpha, beta, theta, delta, and gamma) conditions, TBR postintervention values were low to moderately significant with DTLD values. BGT values were significantly correlated with temporal (theta and delta) during eyes-open and temporal (alpha, beta, theta, delta, and gamma) during reading condition (Table 12).
Discussion
The aim of the present study was to evaluate the difference between pre- and post-PEABLS intervention qEEG power ratio of frequency bands, including TBR and TAR, while eyes-closed, eyes-open, hyperventilation, writing, and reading conditions among students with learning problems. PEABLS, a cognitive-behavioral intervention, has significantly improved academic, cognitive, and behavioral measurements.5,7,34,45 Some findings from the study included significant differences in relative TAR and TBR power values at the FP1FP2, T3T4, and O1O2 scalp locations during the eyes-closed, eyes-open, hyperventilation, writing, and reading conditions. The results showed an overall postintervention increase in relative TAR and TBR power values except during the eyes-open condition, as the brain cannot sustain the faster processing speeds required to perform the task. Related studies have suggested that a decrease in TAR and TBR P-values during an eyes-open condition signifies a state of alertness, a relaxed and conscious state of mind. 29 Previous studies support our findings that when the eyes are closed (resting) and other complex task conditions like reading or writing, the TAR and TBR increase, signifying the state of arousal, creativity, stress, and brain maturation. The findings reflect that exposure to intervention corresponds to significant changes in TAR and TBR power values in children with learning problems. 9
A higher TBR shows us dominant theta, indicating higher logical and creative processing. Higher TAR shows a person's ability to bring subconscious material into conscious awareness. 10 TBR is likely a stable electrophysiological marker of executive control 46 that can be decreased by anxious, distracting thoughts that impair working memory. 47 Jäncke and Alahmadi 20 reported high levels of TAR and TBR in the frontal region in children in LD-NOS. Putman et al 29 reported TBR and TAR as valid biomarkers for attentional control capacity. Strong TAR values in LD children are expected, especially at posterior locations, since these children might mature slower.
Most children with ADHD with elevated TBR before the training could decrease throughout theta/beta neurofeedback training. 21 qEEG studies have demonstrated negative relations between lower attention abilities and high TBRs.48–50 Moreover, higher delta, theta, and lesser beta are related to lower attention abilities during resting state conditions among children. 23 A high TBR is also related to mind-wandering 12 and a higher cognitive load, 25 decreasing working memory and reading comprehension. 51 Additionally, a higher baseline TBR correlated to a stronger decline in cognitive control after stress induction. Low TBR has been related to low approach-driven motivated behavior.29,52,53 Angelidis et al 11 demonstrated a negative association between TBR and self-reported negative, anxious affect. Due to a lack of specificity, the effects of high and low TBR and TAR in healthy and affected groups must be thoroughly investigated.
Limitations
The present study could not compare findings with the control group, and only paired t-tests, Cohen's d, and correlation were calculated to check the hypotheses, making the study descriptive. Sound methods for hypothesis testing can be incorporated to generalize the findings. Moreover, students’ age groups of 8 to 12 years could have caused heterogeneity and maturity effects. Varying stages of brain development during this phase may modulate the learning process. The data was recorded on 4 channels; future studies can explore multiple-channel recordings. It is suggested that these limitations be overcome in future research.
Conclusion
The present study sheds light on several concerns related to psycho-socio-cognitive and biological aspects of the brain involved in children with learning problems, with particular reference to brain immaturity, lack of effective pedagogical exposure, and sensory-linguistic stimulation are some of the possible factors in the genesis of such conditions among children.
Footnotes
Availability of Data and Material
Data is secured with the corresponding author; it will be made available whenever reviewers require it for verification.
Consent to Participate
Written consent forms were signed by the parents of the student participants, and the student was given an ascent to participate in the study.
Consent for Publication
The publication of the manuscript has been approved by all co-authors and provides consent for publication of the manuscript entitled “QEEG Characterizations during Hyperventilation, Writing and Reading Conditions: A Pre–Post Cognitive-Behavioral Intervention Study on Students with Learning Difficulty.”
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethics Approval
The study was approved by the responsible authorities of the Department of Psychology, University of Delhi, where the study was carried out, and the Indian Council of Social Science Research (ICSSR file no. 3-80/ 17-18/PDF/GEN), from where fellowship was approved.
Funding
The authors disclosed receipt of the following financial support for the research and authorship of this article: This work was supported by the Indian Council of Social Science Research (grant number 3-80/17-18/PDF/GEN).
