Autism, ADHD & Neurofeedback: 6 Powerful Strategies to Increase Your Child’s Peak Performance
© 2013 by Lisa Enneis, LMFT & Teresa Lauer, LMHC All Rights Reserved. No part of this publication may be reproduced in any form or by any means, including scanning, photocopying, or otherwise without prior written permission of the copyright holder.
First Printing, 2013 Printed in the United States of America Photo Credits: The images in this book are provided under a Creative Commons License and were obtained exclusively through Microsoft Word 2010.
Autism, ADHD & Neurofeedback: 6 Powerful Strategies to Increase Your Child’s Peak Performance Lisa Enneis, LMFT • Teresa Lauer, LMHC
DEDICATIONS Lisa First, I want to dedicate this book to my nephew, because without him, I would not have set upon this journey to find a tool that could help him. It’s been a wondrous journey these past sixteen years, and I could not have done it without my husband’s love and support. He has always encouraged me to go after my dreams, and believed in me. We have been married for twenty years, and I’m looking forward to forty more! He is the wind beneath my wings and catches me when I fall, sometimes literally. I also want to dedicate this book to my loving kids who put up with Mom being busy and not as available for the past six months. I also want to dedicate this to my Mom, who is a very wise woman. She always encouraged my writing and said that I should give up acting and become a writer. I want to thank my clients over the years who have let me peek in on their private lives, and shown me the challenges they meet daily with such courage. They have taught me a lot over the years, and have inspired me. I want to express my gratitude and appreciation to Teresa, my co-author, who has taught me a lot about 1) her therapy skills, and 2) her extensive knowledge about the publishing world. She is responsible for making my lifelong dream come true. And last, but not least, my dear friend, Melissa. She has always been there through life’s ups and downs. I guess I better hurry and deposit that $1,000,000 check I wrote her two decades ago before she tries to cash it in! She’s a true friend for life. We’ve shared many belly laughs over the years about all kinds of silly nonsense, and I’m glad my kids got to see that side of me on our road trip to Vegas last year.
Lisa
Teresa I’d like to dedicate this book to my loving husband Phil, without whose support and love I wouldn’t even have a career as a therapist! His encouragement and nurturing is forever – and forever appreciated! I would also like to thank my parents and those in my father’s extended family who modeled how to envelope, love, and care for those family members with special needs. Their almost instinctive nurturing and care of a sister, one of 11 children, who was on the Autism Spectrum, allowed her to ultimately find love, marry, and experience the joy of having her own children, two of whom were also on the Autism Spectrum. Her sisters provided the training and care necessary for “girly” pursuits: how to wear makeup, how to be social – how to kiss a boy! And her brothers provided the protection and necessary “selection process” of a person suitable for her affection and considerate of her special needs. Recognizing her need and right for a life full of experiences most of us take for granted, created a bond in which they all instinctively provided her a very special type of “family therapy”. That memory stays with me still! I would also like to thank my colleague and co-author Lisa for introducing me to the part she plays in her client’s life and for giving me a glimpse into her work. I am fortunate to see the results of such important work in this specialty, but rarely am I afforded the detailed and very prolific picture that she has provided in working with her clients and the way she shares her experiences. This has been a joy and honor for me to take such an intimate look into her therapy practice. Lisa’s compassion and empathy for her clients is very moving. Finally, I would also like to thank my clients for their admirable courage for seeking help when not seeking it, would have been more comfortable – they have been an inspiration in my work and confirmation that I am in exactly the right place – doing exactly what I’m supposed to be doing! Thank you to all who I’ve had the privilege to know – and those I’ve yet to meet! Teresa
ABOUT THE AUTHORS Lisa Enneis, MA, MFT
I am a graduate of Pepperdine University and was licensed in 1992. I first worked as an intern in an inpatient psychiatric hospital setting so I could gain a variety of experience working with people who suffered from a multitude of conditions. I realized I really enjoyed working with the kids the most, and have worked with special needs children and their families since becoming licensed. In 1997, I added neurofeedback to my tool chest, and have found it to be an extremely effective tool for stress, anxiety, depression, chronic pain, Post Traumatic Stress Disorder (PTSD), Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD), Learning Disorders (LD), Tourette’s Syndrome, Asperger’s Syndrome, and Autism Spectrum Disorder (ASD).
Teresa Lauer, LMHC
I am an Educational and Behavioral Therapist (Licensed Mental Health Counselor) with one area of specialty being educational assessment and learning disorders. My primary goal for my clients, both adult and child, is their enrichment as individuals or as members of a couple of family, particularly in the face of learning, behavioral, developmental, and social challenges. As a therapist for nearly two decades, I train and supervise clinicians, behavioral therapy professionals, and parents. Below are the areas in which I specialize: Educational assessments Pervasive Developmental Disorders including Autism Spectrum Disorder (ASD) and Asperger’s Syndrome Learning & Expressive Language Disorders involving reading abilities, dyslexia, dysgraphia, dyspraxia, and other disorders of written expression including frustration and anxiety around the learning disorder, i.e., homework completion and test anxiety. I use multi-sensory approaches including visual, psychoacoustic auditory processing and kinesthetic learning techniques to increase learning abilities and executive functioning. Attention Deficit / Disruptive Behavior Disorders primarily focused on ADHD (Attention Deficit Hyperactivity Disorder) in children, teens, adults and those in a couple relationships focusing on home, school, work, and social engagements.
Separation Anxiety Disorder and Social Anxiety Disorder affecting areas of relationship, social, emotional, and academic functioning. Trauma I graduated from the University of San Francisco with a Masters in Counseling Psychology, with a specialty in Marriage and Family Systems Theory. My work is informed by my advanced training in the following modalities in which I specialize: Rational Emotive Behavioral Therapy (REBT), Cognitive Behavioral Therapy (CBT) and Applied Behavioral Analysis (ABA). I’ve written a number of books in the area of educational and behavioral psychology.
CONTENTS Introduction Lisa Teresa How to Use This Book A Word About the New DSM-5 Strategy #1 Obtain a Diagnosis for Your Child Chapter 1 What’s Wrong with My Child? Why a Diagnosis Is Critical Chapter 2 Autism & Neurofeedback A Therapist’s Perspective: Teresa & Henry What is Autism? Autism Characteristics How Is Autism Diagnosed? Can Neurofeedback Help Treat Autism? Chapter 3 ADHD & Neurofeedback A Therapist’s Perspective: Lisa & Randy What Is ADHD? ADHD Characteristics How Is ADHD Diagnosed? Can Neurofeedback Help Treat ADHD?
Chapter 4 Learning Disorders & Neurofeedback A Therapist’s Perspective: Lisa & Angela What Is a Learning Disorder? Learning Disorder versus Learning Disability? Chapter 5 Reading Disorder (Dyslexia) A Therapist’s Perspective: Teresa & Susanna What Is Dyslexia? Reading Disorder Characteristics How Is Dyslexia Diagnosed? Can Neurofeedback Help Treat Dyslexia? Chapter 6 Mathematics Disorder (Dyscalculia) A Therapist’s Perspective: Lisa & Jake What Is Dyscalculia? Mathematics Disorder Characteristics How is Dyscalculia Diagnosed? Can Neurofeedback Help Treat Dyscalculia? Chapter 7 Disorder of Written Expression (Dysgraphia) A Therapist’s Perspective: Lisa & Alex What is Dysgraphia? Disorder of Written Expression Characteristics How is Dysgraphia Diagnosed? Can Neurofeedback Help Treat Dysgraphia? Strategy #2 Explore Neurofeedback As A Treatment Option
Chapter 8 What Exactly Is Neurofeedback? A Mother’s Perspective: Lake Forest Parent What Exactly Is Neurofeedback? Chapter 9 How Does Neurofeedback Work? Chapter 10 Can Neurofeedback Help My Child? A Therapist’s Perspective: Lisa & Eric, John, and Nicole So, Can Neurofeedback Help My Child? Chapter 11 What If My Child Is On Medication? A Therapist’s Perspective: Lisa & Delores Neurofeedback and Medication Chapter 12 How Does Neurofeedback Work? Chapter 13 Why Haven’t I Heard of Neurofeedback? A Mother’s Perspective: Bellevue Parent More Research On the Way! Strategy #3 Define Your Treatment Goals Chapter 14 Prioritizing the Needs of Your Child & Family
Chapter 15 The Role of Your Child’s IEP Chapter 16 Autism & Neurofeedback A Mother’s Perspective: A Parent in Huntington Beach, CA Chapter 17 ADHD & Neurofeedback A Therapist’s Perspective: Lisa & Ryan Chapter 18 Learning Disorders & Neurofeedback A Therapist’s Perspective: Lisa & Jaime Chapter 19 Your Child’s Physical Challenges A Therapist’s Perspective: Lisa & Ryan Food Additives Auditory Processing Disorder Symptoms of Auditory Processing Disorder Chapter 20 Your Child’s Behavioral Challenges A Therapist’s Perspective: Lisa & Anthony Chapter 21 Your Child’s Social Challenges A Neurotherapist’s Perspective: Lisa & Bradley Strategy #4
Implement Your Child’s Treatment Plan Chapter 22 Select a Neurofeedback Therapist Researching Neurofeedback Therapists A Special Word About Training Your Initial Consultation Questions to Ask Making a Decision Chapter 23 Beginning Treatment: What to Expect Strategy #5 Monitor Your Child’s Performance Chapter 24 Monitor Your Child’s Progress A Therapist’s Perspective: Teresa & Eric Why Monitor Your Child’s Progress? The Role of Assessments in Monitoring Progress Strategy #6 Enjoy Your New Family! Chapter 25 Enjoy Your New Family! A Final Word Resources Neurofeedback Therapist Directories Food Additive Resources Learning Disability Resources Screening Tools
Laboratory Testing for Heavy Metals
INTRODUCTION Lisa I learned about neurofeedback in 1996 from a colleague of mine who had taken her stepdaughter to a neurofeedback practitioner for her Attention Deficit Disorder (ADD) symptoms. The more I learned about this method of treatment, the more convinced I became that this would help my nephew Michael. Michael had been born three months prematurely to my drug-addicted, schizophrenic sister, and was born addicted to crack cocaine. He spent his first six months in the hospital and when it became time for him to leave, the State placed him in foster care. Adopted by one of the nurses in the NIC-ICU who had two daughters, he was welcomed into a ready-made family! At the age of three, the day before the adoption was to be finalized the State pulled him out of the home and placed him back in foster care, at which time, the foster mother’s best friend adopted him. She had two other boys the same age that she had already adopted – one diagnosed with ADHD (Attention Deficit Hyperactivity Disorder) and the other with Down’s Syndrome. Michael had Reactive Attachment Disorder and therefore a lot of anger. He wasn’t able to handle public school because of his ADHD and OCD (Obsessive Compulsive Disorder), and his mother had to home school him; he was quite a handful for her. I decided to buy the equipment and software, and complete the necessary training in neurofeedback so I could in turn, train him when he came to visit. I had asked his mother’s permission to do this with him. She knew nothing about neurofeedback but because she trusted me and knew that I wouldn’t do anything to harm him, she gave her consent. I began training him twice daily for the three weeks he was with me. He loved the games and thought they were quite fun! When I sent him home to his mother, she called me, amazed at the
changes she saw in him. His ADHD symptoms had improved significantly. He was much calmer and less impulsive and obsessive. His frustration tolerance had also improved greatly. He had stopped punching holes in the wall, and was no longer displaying aggression towards his brothers or mom. Because I wasn’t able to complete the 40 to 60 sessions of treatment with him, she completed the treatment with a neurofeedback practitioner in Northern California where they live. After he finished neurofeedback training, she was able to re-enroll him in public school, as he was much more manageable since completing training. He would complete his homework within 30 to 45 minutes, whereas previously, it would have taken him two to three hours. He was no longer stuck in his OCD rituals, so instead of taking an hour for him to get out of the bathroom in the morning he was done in fifteen minutes. Michael is now 22 and completing college! Because of the tremendous gains that he made, I decided that I wanted to achieve these amazing results with clients. Having completed advanced training from pioneers in the field and providing neurofeedback with clients since 1997, I’ve achieved great success with a variety of clients and disorders. As a licensed marriage and family therapist for nearly two decades, it has been my privilege to devote my professional life to helping children and their families reach their full potential. In 1997, I added neurofeedback to my practice as an adjunct to traditional talk therapy. I have spent over 20 years working with special needs children. I had been frustrated with the medications for children with ADHD, and was happy to find an alternative to medication that worked so well. My work with clients on the Autism Spectrum is my favorite. Because of the changes that parents see with their children. I am often brought to tears of joy, because there are limited therapies available for them. My mission is to bring neurofeedback to the masses because, as I tell my clients, “It’s the best kept secret in America.” This book is going to change all that! If you have questions regarding neurofeedback therapy, please contact me at
[email protected]
Teresa First, you are not alone! If your child has been diagnosed, or you suspect a Pervasive Developmental Disorder (PDD) such as Autism Spectrum Disorder, an Attentional / Behavioral Disorder such as Attention Deficit Hyperactivity Disorder (ADHD) or a Learning Disorder (LD), there are many compassionate, caring professionals waiting to help you and provide guidance. PDDs and LDs typically first appear in a person’s childhood years. Even if diagnosed years later or as an adult, many clients relate difficulties in their early years, finding that, with a definitive diagnosis, a piece of the puzzle has finally fallen into place for them and is greeted as a relief. Many adults who experienced PDDs and LDs as children were labeled which has followed them throughout their lifetime. Early diagnosis is key! Learning is fun – or at least it should be! But children diagnosed with a Pervasive Developmental Disorder (PDD) or Learning Disorder (LD), are robbed of this joy, as learning becomes a frustrating experience leading to serious consequences such as a lack of self-esteem that can affect them into their adult years. As a parent, you are truly your child’s first teacher and are in a position to love, guide, mentor, and inspire them to reach their full potential! My passion and hope for you, your child with special needs and your entire family is that you reach a level of happiness that you may have felt unattainable. If you would like more information on Educational and Behavioral Therapy or have questions regarding assessment and screening I am happy to help! Whether you’re a parent of a child with special needs or an adult who suspects you may have a learning disorder yourself, please feel free to contact me at
[email protected]
How to Use This Book We have addressed specific strategies that we feel help you in being the best advocate possible for your child in the face of a Pervasive Developmental Disorder (PDD), Attentional Disorder (ADD/ADHD), or Learning Disorder (LD). We all want happy, well-adjusted, social kids who can enjoy their childhood, learn what they need to learn, and have fun! Many children with PDDs or LDs struggle simply with being a kid – and never reach their peak performance or realize their potential. Our book hopes to change that in introducing you to one form of therapy as it relates to these PDDs, ADD/ADHD, and LDs – neurofeedback. We are providing, in the pages that follow, six specific strategies for helping your child reach his or her peak performance: In our first section, we discuss different diagnoses and how neurofeedback can help, providing a number of inspiring and detailed cases of how it has helped individual clients, particularly from Lisa’s perspective as a neurofeedback therapist. In the second section, we answer your most pressing questions regarding neurofeedback as a therapy option. In our third section, we discuss defining your treatment goals for your child and how neurofeedback can fit into his or her overall educational plan. In addition, we briefly address physical, behavioral, and social challenges he or she may be experiencing. Next, we take you step-by-step through selecting a qualified neurofeedback clinician. Leaving no stone unturned, we provide you with questions to ask both during and after your consultation. We help you monitor your child’s progress and provide you with additional information about assessment. Finally to the last of our strategies: Enjoying your new family!
A Word About the New DSM-5 The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM) used by the mental health community in identifying and diagnosing mental health disorders. The DSM-IV, published in 1994 is the most recent version, with minor updates in 2000, leading to the publication of the DSM IV-TR (“TR” in this case referring to a “text revision”). The next major release, the DSM-5 (the DSM will no longer be identified with roman numerals), is scheduled for publication in May, 2013. The purpose of the DSM is to standardize diagnostic categories and criteria, and while the International Classification of Diseases (ICD) published by the World Health Organization is the official diagnostic tool for disease and health issues, the DSM is more widely used in the U.S. Major changes affecting our clients are included in the new DSM-5 and warrant a mention. Preliminary information relates that Asperger’s Syndrome and the lesser diagnosed PDD-NOS (Pervasive Developmental Disorder-Not Otherwise Specified) are no longer going to be included as a diagnosis, with most current clients possibly being included under the umbrella of Autism Spectrum Disorder (ASD). A new category in the DSM-5, Social Communication Disorder (SCD), is expected to better characterize individuals with social and communication challenges that cannot be explained by low cognitive abilities and that occur without the repetitive and stereotyped behaviors (RSBs) that are found in Autism Spectrum Disorder. At the time of this writing, and according to the APA, a diagnosis of ASD must be ruled out for SCD to be diagnosed. In relation to SCD, children (and adults) with Pragmatic Language Impairment (PLI) have challenges in two areas: Semantics (the meaning of what is being said) and pragmatics (using language appropriately in social situations). PLI, previously referred to as SPD (Semantic-Pragmatic Disorder) can be related to autism, Asperger’s Syndrome and mental retardation. We have determined that it is in the best interest of our readers to include case studies and information related to Asperger’s Syndrome and update our readers in the future, as information on the new DSM-5 becomes available.
STRATEGY #1 OBTAIN A DIAGNOSIS FOR YOUR CHILD
Chapter 1 What’s Wrong with My Child?
Sadly, as therapists, we are asked this question far too often. Frustration, confusion, and fear often overtake many parents when they suspect that something is wrong or their child has been diagnosed with special needs and multiple therapy modalities or educational interventions are tried and fail. Something must be able to help them, but what? And where to start? Every child deserves a happy, healthy life of quality, love, respect, selfesteem, the joy of learning and discovery – and so much more! The suspicion that your child has a developmental, Attentional, or learning disorder may begin as simply a feeling that things may not be "right". Perhaps you've noticed that your child is not doing well in class or that, compared to your other children, he or she has not as advanced as you had anticipated. Or perhaps your child doesn’t behave as your other children had at the same age and somewhere in the back of your mind you continue trying to stem these nagging feelings that something could be wrong with him or her. These feelings can be overwhelming, scary, and confusing and leave you hesitant about your next step
and your child’s future. Please know that you are not alone – and that there are many resources and caring, empathic professionals waiting to help you! Why a Diagnosis Is Critical As mentioned earlier, early diagnosis is critical and your first strategy in helping your child reach his or her peak performance and true potential. While the list of disorders that neurofeedback can help is huge, the scope of this book is presenting it as an effective therapy for: Pervasive Developmental Disorders (PDDs) such as Autism Spectrum Disorder Attentional Deficit and Disruptive Behavior Disorders such as Attention Deficit Disorder (ADD) and (ADHD), the H signifying hyperactivity, and Learning Disorders in reading, math, and written expression In this chapter, we address these three major disorder categories and provide you with case studies, along with information about how neurofeedback can help when faced with such a diagnosis.
Chapter 2 Autism & Neurofeedback
A Therapist’s Perspective: Teresa & Henry Henry came to see me when he was seven years of age. His speech was somewhat staccato and he spoke mostly in bursts. I saw him for assessment purposes after his fifth and then his tenth neurofeedback therapy sessions and saw a marked improvement in several areas. His mom reported following his tenth appointment that his language skills were improving and his testing scores bore that out. I saw a real improvement however, in his eye contact. For his first assessment, he barely looked up at me; following his tenth neurofeedback session, he actually looked directly at me as I was providing instructions for his assessment. The focus of Henry’s neurofeedback therapy in this case was socialization, which, based upon his parent’s reporting and my direct observation along with socialization assessments, was a success. What is Autism? Autism, also referred to as Autism Spectrum Disorder (ASD) is classified as a Pervasive Developmental Disorder (PDD) and is almost exclusively
diagnosed in childhood. Autism is very difficult to diagnosis as there are no medical tests to perform, making evaluations and assessments the primary methods of diagnosis. In any case, the earlier that diagnosis is made and treatment begun, the higher the chances of successful life for your child. Nearly everything is overwhelming to a child diagnosed with Autism Spectrum Disorder – touch, smell, sounds, etc. – all can seem as if they are simply overwhelming. Imagine if the car horn that you hear is ten times louder – and that the touch that’s so comforting to you is so intense it actually feels painful. That is what a child or adult with autism experiences on a daily basis. The American Academy of Pediatrics (AAP) recommends that autism screening be done for all children between 18 and 24 months of age, however as you will see below, there are assessments available that allow testing and diagnosis to begin as early as 16 months of age. Autism Characteristics Most parents point to two of the common signs of autism early on: The lack of smiling and social responsiveness, and the lack of response to their child's name being spoken. Those signs, along with others below can signal Autism Spectrum Disorder (ASD) quite early. Indicators of ASD that should prompt further evaluation and assessment include: Lack of babbling and pointing by age 1 Lack of voicing single words by 16 months Lack of voicing two-word phrases by age 2 A lack of social skills A lack of language skills Poor eye contact Obsessive behavior such as lining up objects Other indicators in older child can include: Aggressive and/or self-injurious behavior
An aloof, almost cold manner; prefers to be alone Resistance to change and very inflexible in terms of routine or schedule Difficulty with expression; may use pointing or gestures instead of communicating their needs Repeats words or phrases instead of using normal responses; has an abnormal expression of words Shows distress, cries or laughs for no apparent reason Experiences tantrums Shows poor or no eye contact Is unresponsive to normal teaching methods Inappropriate, almost obsessive attachments to objects Over-sensitivity or under-sensitivity to pain or touch; resists cuddling Noticeable physical over-activity or extreme under-activity Uneven gross/fine motor skills No response to verbal cues; acts as if deaf, although they can hear Known as a “spectrum” disorder because the characteristics can appear from mild to severe, each child is unique and exhibits different limitations and abilities. Many children and adults with autism laugh, smile, show affection, and demonstrate a wide range of emotions. Some children develop good functional language while others create alternatives to traditional communication such as sign language, the use of pictures or even a creative communication style that the family will come to understand as their child’s own particular form of “speaking” such as whines, whistles, grunts, etc. Children don’t “outgrow” the symptoms of autism, but rather experience a lessening of the symptoms as effective treatment is delivered. How Is Autism Diagnosed? Your child’s pediatrician is likely your first source for an evaluation and
diagnosis as he or she conducts developmental milestone screenings. It is important when your concerns are raised, that the pediatrician refer you to a developmental specialist for intervention as quickly as possible. In this case, time matters. There are several assessment tools commonly used in diagnosing Autism Spectrum Disorder: M-CHAT The Modified Checklist of Autism in Toddlers is a widely used screening tool recommended by the American Academy of Pediatricians. The M-CHAT may identify ASD however, it may also expose other developmental delays. As a parent, you may register, complete the assessment, print the results and take them to your pediatrician with your concerns should you receive a score that indicates a risk for autism or developmental delay. Please visit M-CHAT.org to learn more. This service is free and you are provided instant score results. The M-CHAT is available for toddlers from 16 to 30 months of age. ADI-R The Autism Diagnostic Interview (Revised) is an interview-based assessment tool for both parents and caregivers of children and adults when autism or a Pervasive Developmental Disorder (PDD) is suspected. The diagnostic interview for the ADI-R may be scheduled for home or clinic assessment. ASIEP-3 The Autism Screening Instrument for Educational Planning: Third Edition a screening tool that helps professionals caring for your child develop an appropriate instructional and educational plan. It also helps distinguish children with autism from those with other disabilities. Used for children from 2 to 14 years of age, the ASIEP-3 encompasses five aspects of behavior including: The Autism Behavior Checklist outlines 47 behaviors typical of children with autism. The Sample of Vocal Behavior measures four characteristics of speech including non-communication, intelligibility, babbling and repetitiveness.
The Interaction Assessment assesses your child's spontaneous social responses and reactions to requests made of him or her. The Educational Assessment measures five areas of functioning including: receptive language (listening and understanding what is being said), expressive language (verbal and written expression), body concept, speech imitation, and the ability of your child to remain in his or her seat. The Prognosis of Learning Rate subtest examines the rate at which your child learns using a discrete trial / direct instruction approach. Can Neurofeedback Help Treat Autism? Neurofeedback helps shape the behavior of a child diagnosed with Autism Spectrum Disorder in attempting to change the level of brain activity versus behavioral techniques, but ultimately, as we see from the mother above, behavioral changes do occur through the “exercise” of the brain that neurofeedback therapy provides. Electrodes are attached to your child’s scalp and your child is shown what he or she considers basically, a video game. When your child’s brain is calm, he or she is rewarded with the game continuing – and the opposite when the brain is not calm. Verbal and social cues are particularly difficult for a child on the Autism Spectrum. Human interaction is difficult and confusing, both for the child and the parents as you may have experienced and neurofeedback has shown to be particularly helpful in removing, or at least lowering, that “wall” that many parents feel exist between themselves and their child.
Chapter 3 ADHD & Neurofeedback
A Neurotherapist’s Perspective: Lisa & Randy Randy was a 10-year-old boy who came into my office and inquisitively asked, “What’s this for? What do you do with this paste? What are all these buttons for?” His speech was very staccato and he was kinesthetically touching everything that caught his eye. He was a sweet kid, but I am sure he drove his teacher nuts with all of his questions, and his inability to keep his hands to himself. Before starting neurofeedback, he had tested severely Attention Deficit Hyperactivity Disorder (ADHD), two standard deviations out. Another issue Randy had was enuresis (bed-wetting) which embarrassed him greatly. He had never been able to have a sleepover without a pull-up. He wanted to be able to go on his Boy Scout camp out with his troop, but his bedwetting had always been a very real concern. Neurofeedback targeting this symptom completely eliminated his enuresis. When Randy returned to his sessions with me, he excitedly recounted all the fun things he had done, and gave me a huge bear hug of thanks. By the time he completed treatment, he had
tested normal and his hyperactivity had calmed down so much, most would have a hard time believing he was the same boy. What Is ADHD? Attention Deficit Hyperactivity Disorder (ADHD) is a concentration and attention disorder characterized by impulsivity, distractibility, and a low threshold and intolerance for frustration. ADD and ADHD appear along a continuum with symptoms and characteristics generally first recognized in childhood. There is no “cure” and ADD/ADHD cannot be outgrown, however, treatment that is started in early childhood has a very high rate of success and can greatly improve the quality of your child’s life now and into adulthood. There are recognized “subtypes” of ADHD that you may find familiar: The “absent minded professor” who is brilliant and creative but is disinterested in things, and people, boring to him The child (or adult) who does well under pressure, but cannot perform or freezes when under stress or anxiety. ADHD is often found in conjunction with other disorders making diagnosis difficult, including: Anxiety Mood Disorders such as depression and dysthymia Bipolar Disorder characterized by extreme mood swings from highly elevated to depressed Conduct Disorder Learning Disabilities Oppositional Defiant Disorder ADHD Characteristics As we have noted, many behavioral, cognitive, social and affect (mood) characteristics of ADHD are first recognized in childhood in behavior; some
of which include: Behavioral characteristics, which encompass a wide range including: Restlessness and the inability to sit still through meals, class time, church, etc. The urge to run, skip, jump, and play is tempting for a child with ADHD, often disrupting others. The inability to finish projects, some smaller tasks or engage in longer conversations The need for constant supervision and direction; needing direct eye contact in most cases to ensure listening and attention Little self-regulatory control of actions and lack of ability to follow through to consider the consequences of actions or comments Eccentric and repetitive behaviors Mood may deteriorate throughout the course of the day Cognitive characteristics can include: Attention difficulties Academic difficulties including problems with recognizing letters and words, sounds and mistakes with similar-sounding words; may exhibit confusion around academic tasks Disorganized work habits including difficulty gathering materials for projects, the proper order or priority to accomplish a task and trouble getting started, losing items like books, homework, etc. General academic performance may be lower than average because of difficulties with concentration and attention; typical rewards and punishment or consequences that a parent or teacher would give lack meaning Social characteristics can include: Talks out of turn, blurting out words and noises without concern for others who are talking, breaks class and school rules
Hitting, fighting, slapping, teasing, biting, crying Avoids talking about his or her own problems or difficulties Generally has difficulty making and keeping friends Affect (mood) characteristics can include: Unpredictability and mood swings Low self-image and self-esteem Easily frustrated and emotional Easily angered and upset; impatient and excitable Temper outbursts and may exhibit explosiveness How Is ADHD Diagnosed? If you suspect that your child has ADHD, early detection, as we mentioned previously can greatly improve his or her quality of life as well as that of your family. Formal assessments are the preferred method of determining how severe your child’s ADHD may be, as well as allow you to focus your efforts on treatment. Several effective assessment tools that you may want to discuss further with your child’s school psychologist, therapist, or physician include: ADDES The Attention Deficit Disorders Evaluation Scale is a paper-based assessment tool identifying behavioral concerns based on parent and school observations. TOVA The Tests of Variables of Attention is a computerized assessment tool measuring attention. ACTeRS The ADD-H Comprehensive Teacher’s Rating Scale is an assessment measuring behavioral concerns, best completed by your child’s teacher based
on classroom behavior. CPRS Conners' Parent Rating Scales identifies behavioral concerns based on parent observations. Can Neurofeedback Help Treat ADHD? As we discussed earlier, neurofeedback is a very interactive type of therapy in that your child is learning to "train" his brain through the use of specifically designed computer programs that mimic a video game. The video game continues, in effect, based on your child's ability to produce the desired brainwaves. In the case of Attention Deficit Hyperactivity Disorder (ADHD) it is believed that children who are hyperkinetic (fast paced, frenetic) produce abnormal proportions of brainwaves, which in this case, the neurofeedback program, attempts to normalize.
Chapter 4 Learning Disorders & Neurofeedback
A Therapist’s Perspective: Lisa & Angela A child with a Learning Disorder can definitely be helped with neurofeedback. I was treating an eight-year-old child with both an Auditory Processing and Learning Disorder (reading) who was having a lot of difficulty with comprehension. Treating her left hemisphere, where Wernicke’s area is located, enabled her to improve her reading level tremendously. Her speech therapist told her mother that she was making gains much more rapidly since she had started the neurofeedback. When attention deficits are treated in addition to the Learning Disorder, the brain has a better opportunity to reach optimum levels of functioning. What Is a Learning Disorder? A learning disorder is neurological in origin. Our brains are responsible for receiving, processing, storing, and responding to information. When a learning disorder is present, some aspect of this process is impacted in some way.
Learning Disorders (LDs) can present a lifelong challenge for your child and can spell academic disaster if not treated. Early diagnosis and treatment for LDs is critical, as they are not “outgrown”. The cost of not treating learning disabilities can be high over the lifetime of your child in loss of self-esteem, depression, behavioral problems, and loss of potential learning and income producing opportunities. Assessments are necessary in order for you to receive a proper diagnosis and prepare a strategy for your child from a position of knowledge. Your first sign that your child may have a Learning Disorder may be that he or she is not performing at a level for their age or grade level. Standardized testing or comparison of what your older children may have demonstrated at the same age may give you further cause for concern. Let us share with you what LDs are – and just importantly, what they are not! At the time of this writing, there are four Learning Disorders (LDs) categorized in the DSM-IV that we address in the following chapters separately due to the fact that they are so unique in their characteristics and how they respond to neurofeedback. These include: Reading Disorder, characterized by difficulty in: Phonemic awareness Reading fluency Word recognition Comprehension Differentiating letters and words
Mathematics Disorder characterized by difficulty in: Counting Carrying numbers Adding
Multiplication Understanding and using mathematical symbols
Disorder of Written Expression characterized by difficulty in:
Holding a pen or pencil Writing legibly Spelling Handwriting Understanding grammar and punctuation Composing written information Learning Disorder, NOS (Not Otherwise Specified) This encompasses learning disorders not meeting the criteria for inclusion in the other earlier disorders mentioned above. Learning Disorder versus Learning Disability? It is understandable if you are confused as to the difference between a learning disorder and a learning disability. Are they one and the same? Actually, no. A Learning Disorder (LD) is a medical term and a learning disability is a legal term that the State’s Department of Education use in order to provide guidance relating to the extent of special disability services that a child may receive in response to his or her learning disorder. For example, your child may have a learning disorder such as dyslexia and yet not meet the requirements for your state’s special disability services in order to remediate and treat her. Proper assessment and development of a 504 Plan and Individual Education Plan ensure that your child receives the help that he or she requires in order to success academically. For further information and
resources on development
[email protected]
of
a
504
and
IEP
please
contact
Chapter 5 Reading Disorder (Dyslexia)
A Therapist’s Perspective: Teresa & Susanna Susanna was a bright, social 6-year-old who was not performing at her level academically. She could not read nor write at her grade level and was falling behind her peers, which concerned her parents greatly. Eager to determine what might be the problem and get her the help she required as soon as possible, was their primary concern. While Susanna was above average in grade level, assessments showed that she was in the testing range for dyslexia, primarily in the areas of word recognition and phonologic processing. Susanna’s parents reported that was a kinesthetic learner (hands on or learning while doing a physical activity) with minor behavioral issues with sitting still and focusing, although an ADHD diagnosis was ruled out. They went on to tell me that what did hold Susanna’s attention was any type of video game or “brain training” games on their iPad. After further consultation regarding a treatment plan and development of a 504, I suggested that perhaps neurofeedback would be of help, in addition to intensive reading instruction and provided her parents with a referral to a neurofeedback therapist. The
results were impressive: After ten sessions (over a two and a half month period) with the neurofeedback therapist and remediation, Susanna showed significant improvement in her ability to recall phonemes (the smallest measure of a word) and showed an increase in her spelling accuracy. Reading fluency and comprehension, along with further work to build on the foundation being established in word recognition and spelling, were areas that we identified for the next phase of her remediation. There is consensus among researchers that a functional impairment within the brain, specific to language development, is responsible for phonologic analysis. This area is predominantly in the left hemispheric temporal areas and was the focus of her neurofeedback therapist. Her parents, impressed with the results, are considering home treatment options in neurofeedback therapy. What Is Dyslexia? Leonardo di Vinci had it. John Lennon, too. Steve Jobs, one of the most brilliant minds of our time, had is as well – as did President John F. Kennedy. The list is endless of famous and accomplished people diagnosed with dyslexia. Enormously gifted and above all perhaps, perseverant, all the famous people mentioned, and scores more, have achieved success in the face of a dyslexia diagnosis, the most common learning disorder. Dyslexia is an impairment primarily in the ability to read, however it may also affect your child’s writing, spelling, and pronunciation of words. As the most common learning disorder, dyslexia carries the potential to plague your child throughout his or her lifetime if not properly treated. Dyslexia is an information processing disorder, and not the cause of an intelligence deficit, mental retardation, or (in most cases) a vision or hearing problem however, studies have shown that the brain of someone with dyslexia does develop and function differently. Identifying certain speech sounds within a word and how letters represent those sounds can also be a challenge for people with dyslexia. Word recognition is a challenge for dyslexics, so without early remediation and training, tackling more challenging language processing tasks such as grammar, spelling, reading comprehension, critical analysis, and writing skills are frustrating. Children and adults with dyslexia often create ways to compensate and as a result, may function at a higher level of performance than
average in areas such as art, music, sports – even mathematics – that don’t rely on exceptional language skills. Reading Disorder Characteristics Dyslexia is genetically linked, meaning it can run in families. If you or your spouse have been diagnosed with, or have symptoms relating to dyslexia, there is a higher propensity for your children to experience it as well. There are three types of dyslexia including: Trauma dyslexia is primarily a result of traumatic brain injury or stroke and is rarely seen in children. Primary dyslexia is the most common form and is one that responds best to neurofeedback therapy. In this case, a dysfunction of the cerebral cortex, the left side of the brain, exists and is not “outgrown” and Secondary or Developmental dyslexia is the result of developmental difficulties experienced during fetal development. Mostly affecting boys, the symptoms of dyslexia in this form diminish, as the child grows older. You’ve heard, no doubt, the myth that people with dyslexia read backwards, and in Vision dyslexia, number and letter reversals do indeed occur as well as the inability to write letters, words, and symbols in proper sequences. Words and letters may very well appear jumbled to a person with dyslexia, in addition to characteristics such as: Difficulty learning to speak Comprehending what is being read Organizing written and spoken language Spelling difficulties A family history of dyslexia Difficulty with word recognition A command of higher level language skills such as getting the meaning of what is spoken and expressing one's thoughts with lower level language skills
such as recognizing and making sounds, which creates a deficit in reading and spelling A lack of fluency in reading Difficulty identifying, pronouncing, and recalling sounds Vocabulary challenges (determining the meanings of words) How Is Dyslexia Diagnosed? We are fortunate in that screening for reading disorders now begins in kindergarten in order to provide early intervention. Formal evaluation and assessment is also available if early intervention has not been provided; it's never too late – even if you, as an adult, are experiencing symptoms of dyslexia! In fact, because dyslexia is genetically linked, you great empathy for your child with dyslexia as you recognize many of her struggles. There are a number of assessments available designed to test for reading and language processing challenges. The following are two tools that are especially helpful in evaluating dyslexia: PAR The Predictive Assessment of Reading is a K-3 assessment tool administered by your child’s school designed to evaluate single word reading, fluency, phonemic awareness, and vocabulary knowledge. TPRI The Texas Primary Reading Inventory is an early reading assessment for K-3, also administered by your child’s school. Both Screening and Inventory sections are included to provide information about your child's strength and weakness in reading accuracy and fluency, listening and reading comprehension, word reading, and phonemic awareness. Can Neurofeedback Help Treat Dyslexia? Neurofeedback targets two specific areas of the brain when treating learning disorders: those responsible for speech (Broca's area named for Dr. Pierre
Paul Broca) and the area of the brain responsible for understanding written and spoken language necessary for reading (Wernicke area named for Dr. Carl Wernicke). Research has shown that these two areas do not work in concert in the brain of those diagnosed with dyslexia, however because neurofeedback therapy provides a fun (non-invasive and completely painless form of therapy) children are able to “retrain” in a sense, these areas of the brain to achieve desirable results in a relatively short amount of time, often within 10 to 20 sessions. Auditory processing remediation is often indicated in those cases in which the brain is trained in effect, to recognize higher or lower registered phonemes (the smallest unit of a word) as well.
Chapter 6 Mathematics Disorder (Dyscalculia)
A Neurotherapist’s Perspective: Lisa & Jake At the time of this writing, I have a boy, age 14, who I am treating for Attention Deficit Disorder (ADD) and social anxiety. Last year in 8th grade, he was getting D’s and F’s in math. He began neurofeedback training in June, which we continued throughout the summer. Now in 9th grade he has advanced to a higher math class and is earning an A. He was awarded the honor of being named the best student for the semester. Jake says that his attention and focus has improved significantly, as well as his processing speed, because he now finishes both his homework and his math tests more quickly! What Is Dyscalculia? Dyscalculia is an impairment in the ability to learn grade-appropriate mathematics, most commonly due to one of two reasons: either difficulty in visual-spatial processing (that is, what the eye sees) or difficulty in language
processing (that is, what is being heard). While dyslexia is the most common learning disorder, dyscalculia is not far behind and is in fact, the source of anxiety for many people. And, while a reading disorder can cause discomfort and even loss of self-esteem for many children and adults, a disability in math is much more socially acceptable with even a common refrain of “I hate math!” uttered by most of us at one time or another! Many parents in fact, proclaim their own distaste at having to help their children with math homework. Physiological, genetic, scholastic, and (unlike dyslexia) social factors are at play in better explaining the disparity between boys and girls in learning math. Math curriculum is designed according to chronological age however, unless certain constructs are learned as a foundation and built upon, the results in math “learning” won't be successful. Until the age of about 12, girls have found to test better than boys, however, after that age, research shows that boys test better. Deficits in math can have a long-term impact on your child's academic success, particularly in his or her later school years and when attempting college entrance exams. In addition, because math skills build primarily on previous learning, it behooves your child to obtain remediation as soon as possible. Who among us truly feels “gifted” in math? It's not uncommon to feel somewhat underprepared academically in this particular subject. How is Dyscalculia Diagnosed? A true diagnosis of Mathematics Disorder as defined by the DSM-IV (soon to be DSM-5) is often accompanied by a diagnosis of ADHD affecting focus and attention and dyslexia affecting one's ability to "read" symbols, learning math facts, manipulating numbers, etc. A Mathematics Disorder (per the DSM-IV) is often the diagnosis used when referring to dyscalculia and is used on the Independent Educational Plan (IEP). Dyscalculia is often referred to as a Specific Learning Disability (SLD). Can Neurofeedback Help Treat Dyscalculia?
Yes: in many cases, as evidenced by Lisa’s case study above. Neurofeedback therapy for a Mathematics Disorder (dyscalculia) helps enhance focus and attention, similar to a Reading Disorder (dyslexia).
Chapter 7 Disorder of Written Expression (Dysgraphia)
A Neurotherapist’s Perspective: Lisa & Alex I had a 13-year-old boy whom I had treated for Attention Deficit Disorder (ADD), and his mother reported that not only did his focus improve, but also his expressive language did as well. He was receiving B’s in English for the first time ever. Alex had a lot of difficulty holding the pen and would get tired easily. He had a lot of difficulty putting his thoughts down on paper and construct sentences. With the help of neurofeedback, Alex was able to write essays for English class, and not tire as easily because his visual processing speed and language processing speed improved. Again, as discussed earlier in the book, neurofeedback helps shape the brain through operant conditioning towards optimum brain functioning. What is Dysgraphia? Dysgraphia is an impairment in the ability to write and form words and
symbols and to communicate thoughts. Often found in children and adults with dyslexia, those with dysgraphia experience difficulty in processing what their eyes see (visual-spatial processing) as well as processing what they hear (language processing). Disorder of Written Expression Characteristics Characteristics found in dysgraphia include: Difficulties forming letter shapes Disinterest in and avoiding drawing and writing Inability to draw a line or stay within margins Inability to write Confusion surrounding upper and lower case letters Tight pencil grip or position; inability to hold a pen or pencil Disinterest or becoming tired while writing Difficulty putting thoughts and concepts on paper Inconsistency in spacing and letter shapes Illegible handwriting How is Dysgraphia Diagnosed? OWLS The Oral and Written Language Scales is an assessment of oral and written language for individuals 3 to 21 years of age (5 through 21 for Written Expression). There are three scales in this assessment: Listening Comprehension to measure the comprehension of spoken language Oral Expression to measure the understanding and use of language which is spoken and Written Expression measuring writing skills including conventions (spelling,
punctuation, etc.), linguistics (use of modifiers, verbs, etc.) and content (communication through word choice, coherence, etc.) WRAT3 The Wide Range Achievement Test 3 measures the development of reading, spelling, and mathematics skills (appropriate for individuals from 5 to 75 years of age) and takes from 15 to 30 minutes. Can Neurofeedback Help Treat Dysgraphia? Critical writing areas are found in the left front and central portion of the brain. Neurofeedback may be of particular interest to parents of children with dysgraphia because, in addition to visual and audio feedback, tactile feedback is provided. Orthographic coding is our brain's ability to store unfamiliar words in our working memory, which is related to handwriting and for children with dysgraphia, actions such as planning sequential finger movements (i.e., touching the thumb to successive fingers on the same hand) are difficult. The motor skills addressed within neurofeedback training may prove particularly helpful. Handwriting, spelling, and comprehension are all areas in which a child with dysgraphia would benefit from further remediation along with neurofeedback therapy.
STRATEGY #2 EXPLORE NEUROFEEDBACK AS A TREATMENT OPTION
Chapter 8 What Exactly Is Neurofeedback?
A Mother’s Perspective: Lake Forest Parent Before Anthony started neurofeedback, he was on the verge of getting kicked out of his third preschool and I was at my wit’s end. He was biting and kicking other children on the playground and had even kicked his teacher. But after the first two weeks of neurofeedback training, there was a dramatic change in Anthony’s behavior. He no longer exhibited his violent outbursts and handled frustration much better. He also improved tremendously in his schoolwork because he was able to sit still and concentrate on his work. Everybody that knows Anthony noticed the changes and I have referred many friends to neurofeedback. The changes speak for themselves. What Exactly Is Neurofeedback? Neurofeedback is basically, exercise for the brain! Also referred to as neurotherapy or EEG biofeedback, neurofeedback “feeds back” the results of
brainwave activity so your child can learn over time, how to self-regulate his or her brain functioning. Painless and non-invasive, neurofeedback may be a desirable treatment of choice, especially for children who experience undesirable side effects from medication. Brainwave activity is recorded via sensors placed on your child’s scalp providing him or her real time information for the purposes of improving focus, attention, and performance. These sensors are placed on areas of the scalp corresponding to areas in the brain that are determined to be producing less than desirable brainwave activity. The sensors are connected to a computer, which provides constant analysis, in graphical form, detecting positive and negative shifts in brainwave activity. This is done via computer software, much like a game that your child may play on his own, that detects the brainwave activity and then speeds up the action, providing a reward, in a sense, for the increased focus and attention of your child. So, if the game is featuring a car, for example, the car’s speed would increase. When a negative pattern is produced, the car will slow. The activity that your child sees on the screen is in direct connection with his or her brainwave activity, reinforcing the positive and not reinforcing the negative. Brain mapping is a term that your neurofeedback therapist may use. This provides guidance as to where problems may exist within the brainwave activity. It is from this information that a treatment plan is produced. Different areas of the brain reflect certain brainwave patterns that correlate to an EEG signature of Attention Deficit Hyperactivity Disorder (ADHD), for example, or an anxiety disorder or depression. Consistent treatment is important in learning to master brain regulation and to get lasting benefits from neurofeedback treatment. However, you as a parent are able to perform this training for your child at home with supervision by a qualified neurofeedback therapist, once certain performance levels are reached.
Chapter 9 How Does Neurofeedback Work?
A healthy brain has the ability and versatility to change states of arousal and attention. As each new situation in life demands a specific level of arousal and awareness, the healthy brain can quickly move to the appropriate level of alertness. In contrast, the unhealthy brain may be under-aroused, sluggish or over-aroused and anxious. Either way, the dysregulated brain has a diminished ability to respond to specific demands. The immature, injured, or disordered brain lacks the normal elasticity of the healthy brain. Scientifically speaking, there appears to be discontinuity in the brain and nervous system processing or breakdowns in the way the brain and nervous system communicate. The brain is not processing information at the right speed. It is either too fast or too slow. Also, the brain is not communicating information correctly, so it is out of synch with itself. The disordered brain seems to be stuck or “parked” at the wrong place. It produces brainwaves that are inappropriate for the immediate situation. For example, the ADD (Attention Deficit Disorder) brain tends to produce more daydreaming-type brainwaves than it does thinking, concentrating-type brainwaves.
Neurofeedback training teaches the individual what specific brainwave states feel like and how to turn those states on voluntarily. Training helps move the brain to different physiological states, depending upon what the immediate situation requires. With biofeedback, therapists have been training people for many years to change their physiological state by altering their temperature or muscle tension. With neurofeedback, we are using a more sophisticated system that trains a central process allowing direct access to the central processing system of the brain, rather than the peripheral systems of skin and muscle. Hence, the name: neurofeedback. Neurofeedback makes the brain more flexible, and seems to have a generalizing effect on the full nervous system. Training the brain to correct its dysregulated state seems to have a positive effect on neurological functioning as well as the cardiovascular, gastrointestinal, immune, and endocrine systems. Self-regulation not only enhances the brain’s ability to improve cognitive and intellectual functioning, but it also aids in the process of helping the body to heal itself.
Chapter 10 Can Neurofeedback Help My Child?
A Neurotherapist’s Perspective: Lisa & Eric, John, and Nicole One of my clients, a mother of three kids with autism, asked that I begin treating them with neurofeedback. I told her that I had been trained in the protocols for autism but hadn’t actually treated anyone with it, and that it would be experimental. She said that would be fine, because she didn’t like the unprofessional setup of the neurofeedback practitioner she had hired. So began my work with autistic children. Her eight-year-old son, diagnosed with Asperger’s Syndrome, a disorder on the Autism Spectrum, had a tendency to complain about everything. With training, he became much more cognitively flexible, having more empathy for others, and displaying a more positive outlook. Her six-year-old daughter was the most severe of her three children. She did not have any sensible speech, and would just repeat jingles she had heard on television (a condition known as echolalia). She displayed poor eye contact and refused to engage with anyone socially. Following a few weeks of
training, she started making intelligible speech, and having more eye contact, eventually beginning to banter with me. Two or three months into her treatment, the mother reported to me that her grandmother had been talking to her granddaughter. When she was handed back the phone, the grandmother asked her who she had been talking to. Mom exclaimed, “That was Nicole!” What a really exciting day for all of them! The youngest son had been diagnosed with PDD-NOS (Pervasive Developmental Disorder – Not Otherwise Specified). In order words, not all the criteria for a diagnosis of Autism Spectrum Disorder or Asperger’s Syndrome were met or the symptoms were mild. When he first started neurofeedback, he had a lot of meltdowns and would cry for 45 minutes or more, depending on what he was stuck on. He also had difficulty focusing and staying on track. Following training, his focus improved tremendously. He became much calmer and experienced shorter meltdowns. His obsessiveness decreased remarkably, which helped him make friends. Following vacations or long breaks, their mom would schedule a session. Without the neurofeedback, John, the oldest, would start to lose his empathy and become more negative. Nicole’s speech would slip and she would become unintelligible. And Eric, the youngest, became more obsessive. After a couple years, mom became busy with work and stopped bringing the kids for a while. I have been treating the two youngest ones on and off for ten years now. They both have great eye contact, lots of friends, and are performing exceptionally well at school. So, Can Neurofeedback Help My Child? This is the ultimate question for any parent: “What is going to help my child be happy and healthy?” People of all ages can benefit from EEG biofeedback training (neurofeedback). Neurofeedback helps treat a variety of childhood problems including bedwetting, nightmares, anxieties, tics, attention, and other forms of disrupting and disturbing behaviors. Neurofeedback helps adolescents struggling with anxiety, depression, and alcohol or drug use and helps maintain good brain function. Again, clients of all ages can benefit from neurofeedback and experience remarkable change.
Lisa has provided neurofeedback therapy to children from 2 years of age to elderly clients just south of 78 years old. Neurofeedback empowers your child to take control of attention and concentration, particularly during times of the day when medication may interfere with sleep.
Chapter 11 What If My Child Is On Medication?
A Neurotherapist’s Perspective: Lisa & Delores Delores was a 57-year-old seeking treatment for her Attention Deficit Disorder (ADD) and, although outside the scope of our book concentrating on children with special needs and how they can be helped through neurofeedback, we thought relating Delores’ story might be of interest to you if you have a child currently on medication. Delores had been on Ritalin for about fifteen years. I discussed the dietary changes she should make to enhance what we were doing with neurofeedback. She started taking fish oil supplements for better brain function and improved memory and avoided the preservatives and food coloring, processed foods, as well as simple sugars, and ate fresher fruits and vegetables. Delores attended 40 training sessions. When she saw her psychiatrist, he took her off Ritalin, declaring that since she had been doing neurofeedback her brain had improved so much that she no longer met criteria for ADD, and that the Ritalin was reacting as it did on normally functioning brains. She was glad
to be off Ritalin because the effect was as if she were on speed. Now she comes in twice a year, just to follow up and remind her brain of the focused state of faster brainwave activity. Neurofeedback and Medication Research has shown that medications for disorders like Attention Deficit Hyperactivity Disorder (ADHD) such as Adderall, Dexedrine, and Ritalin, to name several, reduce the symptoms of ADHD. However, most medications found effective at treating ADHD are stimulants and, while perhaps reducing symptoms, they don’t actually change your child’s ability to focus or gain better attention skills. Behavioral therapy, counseling and certainly, as we hope to have shown throughout this book, neurofeedback may help your child build skills that may help reduce his or her need for medication, or get off of them entirely. Medications targeting brain function may no longer be necessary, or dosage requirements significantly lowered, with successful neurofeedback training as your child learns to train his brain to self-regulate better. It is important for you to discuss neurofeedback training with your child’s prescribing physician to discuss lowering dosage or stopping medication altogether once training shows this may be indicated. Neurofeedback therapy does not conflict with your child’s medication however, so if your child’s prescribing physician finds that medication should be continued, there should be no change to his or her neurofeedback therapy schedule. Again, neurofeedback is non-invasive and non-medicinal and is a specialty within neuropsychology, so many doctors are unaware of its efficacy in treating developmental and learning disorders. Please contact at
[email protected] if you would like to provide your child’s physician with additional research or a brief consultation.
Chapter 12 How Does Neurofeedback Work?
Training your brain is similar to exercising or developing a muscle! Sensors attached to the scalp with EEG paste record your brainwaves. It is painless and does not involve the application of any voltage or current to the brain, so it is entirely non-invasive. As your child begins neurofeedback training, he or she is asked to perform cognitive skills such as math or reading in order for the instruments to measure and process electrical signals from the brain. A computer processes the brainwaves and extracts certain information from them. Your child is shown the ebb and flow of his or her brainwaves and the specific amplitude obtained from them in the form of a video game. Your child is shown how to play the game using only his or her brain – and don’t worry; everyone can do it! The specific brainwave frequencies we reinforce and the sensor locations on the scalp are unique to each individual. This is a fun and exciting process and most people really enjoy viewing the results and watching their ability to manage their brainwaves! This computerized feedback is critical in letting you know that your child is maintaining optimal brainwave states and thus increasing his or her skills to
self-regulate during this cognitive activity. It must be practiced until it becomes automatic or an unconscious activity. Your child develops learning strategies and quieting techniques that can be further enhanced until he or she is able to achieve the same results without computerized feedback.
Chapter 13 Why Haven’t I Heard of Neurofeedback?
A Mother’s Perspective: Bellevue Parent Our daughter, 16, was diagnosed with Attention Deficit Disorder (ADD) along with a number of other physical and emotional issues. Her behavior was an overriding issue in our family. Given to outbursts for seemingly no reason, I always felt in my heart that she had some private pain that I just couldn’t address – couldn’t take care of for her and as her mom, that’s all I wanted to do was take this pain away. We had tried a number of different therapies for her: behavioral, psychotherapy - everything we could think of. Our psychotherapist told us about neurofeedback but I was honestly skeptical – I didn’t want to put both of us through yet another treatment that didn’t work. But I spoke with the neurofeedback therapist and asked for a demonstration myself because it looked a little intimidating, but I actually found it quite enjoyable and thought my daughter would as well. Just 20 sessions later (two sessions a week) she was much more attentive;
could sit through several hours of doing homework without being fidgety and looking around – anxious to do anything but. I asked her what she felt had changed with the neurofeedback and she responded that it was just a lot of fun to control the program and she made the connection between increased attention that she gave to the program and the reward of making it go. She said she thought if she could do it there, maybe she could learn to do it “for real” so she could get more done. Somehow, she’d made that connection. It was amazing for me to hear; I’m so happy for her. This is training that I feel is going to take her well into her college years – which, has never felt like a possibility before! More Research On the Way! EEG technology has been used in training epileptics to manage seizures for nearly three decades, and in training in the treatment of attention challenges for over two decades. Although research has shown that an identifiable brain signature pattern is present in those with learning disabilities and attention deficits, neurofeedback is not yet taught in most medical schools or psychology programs, so many professions are unaware of the techniques and benefits of this particular treatment modality. However, a growing number of published studies have shown the value of EEG Neurofeedback Therapy for treating the symptoms of Autism Spectrum Disorder, ADHD, and additional developmental disabilities. Research also shows that in over 20,000 cases no significant negative side effectives have been reported. Sleeping pattern changes are the most commonly reported challenge, lasting only one or two nights. These sleeping difficulties were most often reported: resistance to getting up, difficulty falling asleep, and restless sleep. However in Lisa’s sixteen years of experience she has found that making minor adjustments in the frequency that she rewards for better sleep, resolves the sleeping issues. She has found that sleep problems are usually the first issue that resolves fairly quickly.
STRATEGY #3
DEFINE YOUR TREATMENT GOALS
Chapter 14 Prioritizing the Needs of Your Child & Family
We have addressed obtaining a diagnosis for your child and exploring neurofeedback as a treatment option. Now we’d like to share with you how to define your treatment goals for your child so you can take an active and knowledgeable role in his or her treatment. Determining your priorities in your child’s treatment and addressing that which matters to you, is of utmost importance. The fact is, all families have different needs, and all parents of children with special needs have unique concerns. Perhaps your child has a very sweet disposition, but cannot concentrate enough to finish homework. Or perhaps your family is suffering from the effects of behavioral problems. Let’s begin with the most often used document in planning your child’s educational and behavioral goals: his Individual Education Plan (IEP).
Chapter 15 The Role of Your Child’s IEP
There are over six million children and youth with disabilities, and they are all guaranteed a "free and appropriate" education based on the Individuals with Disabilities Education Act (IDEA). The IDEA is a law that governs how states and public agencies must provide intervention, special education, and services to infants (Part C covers ages birth to 2 years of age) and children and youth (Part B covers ages 3 to 21 years of age). As we have mentioned in our first strategy for helping your child reach his or her full potential, assessment, and diagnosis of a Pervasive Developmental Disorder (PDD), an Attentional/Behavioral Disorder such as ADHD or a Learning Disorder (LD) is critical. Early intervention in is key to getting your child the help he or she needs. It is simply never too early to begin observing and assessing your child’s behavior and cognitive abilities. In determining whether neurofeedback therapy is a treatment of choice for their child, many of our clients must consider costs. Juxtaposed to this consideration is the cost of not opting for a particular treatment plan that could possibly help your child reach his or her potential more quickly. When considering costs, also factor in services your child may
receive through his Individual Education Program (IEP) and whether services provided for that through your school system can help defray costs for neurofeedback and behavioral therapy. What Is An IEP? An Individual Education Program (IEP) helps serve as a guide to your child’s treatment. It is likely, if your child has been diagnosed with a PDD (Pervasive Learning Disorder), Attentional/Behavioral Disability, or LD (Learning Disorder) that that your child currently has an IEP. An IEP is customized to address your child's educational goals and assists teachers and other providers (such as paraprofessionals) in helping treat your child. Your child's IEP defines how she learns best and how to help her be a more effective learner. Goals are developed for her to reach her potential learning in the lease restrictive environment possible, meaning with nondisabled peers. It is a federal requirement that schools develop an IEP for every student with a disability to meet both Federal and State requirements for special education, that is for those students who experience challenges with: Emotional or behavioral disorders Physical disabilities and developmental disorders Learning Disorders are difficult to identify and diagnose in order to qualify for special education services because they are often missed in early childhood. Two models however, exist for identifying learning challenges: The Discrepancy Model (that is, what is noticed by the teacher as they recognize performance that is below what would be expected) and The Response to Intervention Model (RTI), which addresses difficulties during the first or second year after starting school The bottom line is that it is important that your child receive the services to which she is entitled so that you may seek other possible therapies to work in conjunction with her treatment and remediation. There are other terms you should become familiar with in order to protect your child's rights that we have
discuss thus far: FAPE FAPE stands for free and appropriate public education which is a requirement of every school district. There are 13 (and more in some states) eligibility criteria that your child must meet in order to qualify for special services under FAPE. These services are provided to your child at no cost in order to meet state education standards, consistent with your child's IEP: a right of every child from 3 to 21 years of age, or until they graduate from high school. Monitoring your child's IEP is particularly important in this regard, as it will determine further services based on: Year to year standardized tests Classroom performance Progress made on goals and objectives Attendance Behavior and Report card grades IEE IEE represents Individual Educational Evaluation, which is conducted by a professional who is not an employee of your child's school district. LRE LRE represents least restrictive environment meaning that your child must receive services in an environment alongside children without a disability to the greatest extent possible. If your child requires more specialized services, she may leave the classroom for several hours a day, for instance. You may hear the term "push in" and "pull out" referring to the actual act where she'll receive services: either outside the general education environment or in a special classroom. The subject of special education is far reaching, however, it may behoove you
to learn your child's rights under IDEA so that collaborative therapies such as neurofeedback therapy, CBT (Cognitive Behavioral Therapy) and ABA (Applied Behavioral Analysis) therapies can help your child reach his or her potential more quickly and with longer lasting results. For more information visit the U.S. Department of Education.
Chapter 16 Autism & Neurofeedback
A Mother’s Perspective: A Parent in Huntington Beach, CA My child is so much calmer now. He used to get frustrated so easily and beat up his little brother. I was afraid to leave my kids alone in the same room because of fear that he would hurt his brother. He is much calmer now, and not getting cards pulled at school for misbehavior any more. Trips to the principal’s office were almost a daily routine before we started this training. My daughter and I have also started this training to improve our focus, and we are noticing results as well.
Chapter 17 ADHD & Neurofeedback
A Neurotherapist’s Perspective: Lisa & Ryan There is a lot of overlap with DSM diagnoses. I have found that some kids, such as Ryan, have ADHD and autism, and both conditions need to be treated. Usually they have to be treated for quite some time on the right hemisphere before we can add the left side training to address the attention piece of their condition. To understand how neurofeedback works, I must begin with how the brain communicates to all systems, including itself, through electrical activity. It appears that the brain has generators that produce the brainwave activity, which are actually low-frequency electrical rhythms. This electrical activity gives the information about what and how to do everything. This lowfrequency rhythmic activity is central to life and the second-to-second functioning of every organ system in the body. If this rhythmic activity
becomes dysregulated, it leads to dysfunction. We could end up sleeping rather than reading, feel anxious rather than calm, feel dull rather than alert. We know now that the brain responds to many forms of intervention, including classical and operant conditioning. Because neurofeedback directly affects the brain, it has the opportunity to elicit a faster, more comprehensive, longer lasting resolution to functional problems. Children and adults who have attention disorders demonstrate a dominance of low-frequency waves. Both epileptics and children with ADD show a dominance of slower EEG waves and a deficit of faster frequency waves. If the patient is asleep, it is appropriate to have a dominance of slow waves, but if he is producing excessive slow waves in math class, there is a problem. He would appear to be in a fog; short-term memory is compromised and lethargy is common (i.e. he probably has ADD). A multitude of symptoms may be present when we see a dominance of lowfrequency waves. If the brainwaves are not normalized, all other areas of the patient’s life may be affected. If the rhythmic activity is normalized, normal functioning is restored. The normalization of the brain generally produces the following types of positive changes: improved executive functioning, restful sleep, improved memory, improved concentration, reduced hyperactivity, and elimination of depression and anxiety. Neurofeedback treats the patient’s central processing, the brain. It doesn’t merely chase one symptom with one drug and another symptom with a second or third drug. Neurofeedback treats the cause and not the symptoms, which is why it gets better results than stimulant medications overall.
Chapter 18 Learning Disorders & Neurofeedback
A Neurotherapist’s Perspective: Lisa & Jaime Jaime Hernandez was an eight-year-old boy who had been a Special Education student since first grade. Classified as “severely emotionally disturbed” due, I believe, to his numerous meltdowns. I suspect that if he had been properly diagnosed he would have been diagnosed Pervasive Development Disorder, NOS (Not Otherwise Specified). He would become unglued when he got a haircut, and it would take an hour or more to recover. After about three or four sessions, I found the best frequency to train his brain, and it settled him right down. His mother was amazed at the results. As a bit of background: Jaime used to go under his desk when he got overwhelmed, and the teacher would try to coax him out, to no avail. Mrs. Hernandez would be called to the school and retrieve him, because she was the only one he would listen to. He missed a lot of school because of his high anxiety. I trained Jaime on his anxiety, focus and memory for four months and, gradually, his grades improved going from F’s to B’s and 2 C’s. During our
conversations, Jaime opened up about his life slowly: He lived in Santa Ana where there were gangs and gun shootings, with which he had to contend – a far cry from my other clients who came from more affluent neighborhoods. He was such a sweet, sensitive boy; no wonder he had had such anxiety. The compassion and wisdom this boy exhibited, humbled me. He was wise beyond his years – definitely an old soul. When the student is ready (me), the teacher will appear (Jaime). Jaime’s mother wanted him mainstreamed into regular classes, but the school fought against it because they didn’t feel he was ready. She argued that she knew him better and thought he was. She was a formidable opponent and he subsequently transferred to regular classes. He had some holes in his learning because it’s a much slower pace in special education and his teachers expected little from him. Mrs. Hernandez employed tutors to fill in the gaps and he got through 8th grade English. However, they stopped coming for therapy at that point and I didn’t know how he had fared in high school. I got a voicemail message from Mrs. Hernandez four years later. She was ecstatic to report that Jaime had graduated from high school and was now attending Santiago Community College. The first high school graduate in his family, and the first to attend college! Yahoo!! Mrs. Hernandez related that she was grateful for what neurofeedback training had provided for her son and that the four months of training had changed the course of his life. She considered neurofeedback his miracle and felt it was a shame that it was not yet offered in schools across America. In fact, most medical schools do not include neurofeedback in their curriculum so many doctors are unaware of its efficacy. It’s promising for those in Mrs. Hernandez’ position as parents of children with special needs, as well as clinicians, that more research is now being done; large, statistically significant and replicated studies are the gold standard for the medical community as they should be. Learning Disabilities & Neurofeedback Neurofeedback has been shown to provide excellent potential for treatment of Learning Disorders. A randomized, controlled treatment study of 19 children was conducted in which both groups received neurofeedback and remedial treatment for dyslexia. Each child was provided with neurofeedback training
for 20 sessions over a 10-week period. Substantial gains in spelling were reported, thought to be a result of the attention processing that takes place in the neurofeedback session. Please read more about this study (Breteler, et al. 2009) at the National Institutes of Health website.
Chapter 19 Your Child’s Physical Challenges
A Therapist’s Perspective: Lisa & Ryan I have seen firsthand how preservatives, food coloring, and growth hormones in the food we eat have affected children that I treat. One boy on the Autism Spectrum, with ADHD, drank a popular drink with red food dye in it before he came in for his training session. He had a terrible time just sitting in the chair while playing the video game controlled by his brainwaves. I could see how his squirming easily translated into being disruptive in the classroom. Many children are more aggressive because of hormones in milk, and I have encouraged my clients to purchase hormone-free milk in an effort to counter this aggression. Food coloring can make some children more hyperactive or extremely impulsive. I have also learned that some children have food sensitivities, which can affect their behavior. I had been treating a boy named Ryan who was tested for Attention Deficit Hyperactivity Disorder (ADHD) before seeing me. He had
tested severely ADHD, two standard deviations from the norm. He was touching everything in my office. He had no impulse control. His hyperactivity was the worst case I had ever seen in all my years of practice. I trained him for his hyperactivity, lack of impulse control, and his obsessiveness. After seven sessions, the insurance company with whom I was working required that he be tested for ADHD in order to prove that the neurofeedback had been helpful and to justify continued treatment. Frankly, I was nervous about this because I didn’t think the testing would reflect the changes in his brain so quickly. The testing came back saying he was normal and no longer met criteria for ADHD, however, I recommended further treatment in order to maintain the gains we’d made. Unfortunately, the insurance company refused to pay for any more sessions. Ryan’s mother had to fight the insurance company to get them to agree to pay for 40 sessions that research has shown to solidify the gains made. Finally, the insurance company did agree, and Ryan completed the treatment with me. His parents were thrilled with the results. However, during his course of treatment, he started coming in on Tuesdays, and his brainwaves, and subsequent behavior regressed as though he had never received neurofeedback training. I was puzzled and thought perhaps he had eaten something that was causing an allergic reaction. I encouraged his mom to start by investigating what he was eating during the day while at school. We discovered that they started serving pizza for lunch on Tuesdays so she began making him brownbag lunches to eat as an alternative. Of course, Ryan became disappointed that he couldn’t eat pizza. Serendipitously, at around the same time, a colleague had shared with me that she had become trained in NAET (Namuripad’s Allergy Elimination Technique) and was getting great results with this technique. I connected the two of them to see if Ryan’s allergy to pizza could be eliminated. After he went through NAET treatment, Ryan was able to eat pizza again, without having the changes in his brainwaves and subsequent behavioral changes. I invite you to check out NAET.com to learn more. I have learned that we have to look at the child’s whole system. Many children on the Autism Spectrum are gluten intolerant. It causes a leaky gut and does not allow them to absorb the nutrients their brains need. Allergens and food
sensitivities need to be treated in addition to their brainwaves. Food Additives Below is a list of food additives to consider avoiding if food allergies are an issue for your child: Tartrazine (yellow 5) Quinoline yellow Yellow 2G Sunset yellow FCF Cochineal, carminic acid Carmoisine (red) Amaranth (red no.2) Ponceau (red no.4) Erythrosine (red no.3) Red 2G Allura red AC (red no.40) Patent blue Indigo carmine (blue) Brilliant blue FCF Black Brown FK Chocolate brown HT TBHQ (preservative, may also be listed as “antioxidant”) BHA (preservative, may also be listed as “antioxidant”)
BHT (preservative, may also be listed as “antioxidant”) Below is a list of additives that do not appear to cause problems for most people: Curcuma or turmeric Riboflavin (vitamin B2) Chlorophyll Caramel Carotene Annatto Betanin Calcium carbonate Titanium dioxide Iron oxide Sorbic acid and sorbates Acetic acid Lactic acid Propionic acid Sodium propionate Calcium propionate Potassium propionate Carbon dioxide Ascorbic acid (vitamin C) and salts of ascorbic acid Tocopherols (Vitamin E)
Lecithin Lactates (unless lactose intolerant) Citric acid Tartaric acid Sodium citrate Potassium citrate Calcium citrate Tartaric acid Sodium tartrate Potassium citrate Potassium citrate Potassium bitartrate (cream of tartar) Niacin (Vitamin B3) Alginic acid and alginates Carrageenan Carob-bean flour Tamarind-seed flour Guar gum Xanthan gum Sorbitol Mannitol Pectin Galatine
Powdered cellulose Sodium caseinate (avoid if milk-sensitive) Calcium silicate Stearic acid Auditory Processing Disorder A Neurotherapist’s Perspective: Lisa & Leslie Leslie was a ten-year-old being treated by a speech therapist when her mother brought her to me for neurofeedback. I trained her for her inattention, and after a month her speech therapist contacted me to learn more about this treatment modality she had never heard of before. She was amazed by Leslie’s improvement in her speech and language skills and the rapid gains she had made. I explained to her that neurofeedback helps the brain move towards optimum brainwave function, thus improving the child’s learning. Auditory Processing Disorder (APD), another disorder that presents a physical challenge to your child, is neurologically based and is a result of weak connection in the auditory cortex of the brain. Individuals with this disorder are unable to distinguish between certain sounds or consonants and, as a result, have difficulty interpreting the information they receive. Individuals, especially young children, are perceived as not paying attention, however, they are simply not able to process what they are hearing and in fact, may be missing entire words. For instance, like many disorders Auditory Processing Disorder can result in a lack of self-esteem for children and adults alike. Symptoms of Auditory Processing Disorder A medical history of ear problems in early childhood Poor academic performance, particularly in spelling, reading, grammar, and punctuation, difficulty with word problems in mathematics Difficulty following verbal directions
Difficulty giving directions A tendency to ramble and talk in circles, unable to get to the point or find the correct word A tendency to use words such as "ya know", "thing", "like" Note that these last several symptoms are due to the lack of ability to organize one's thoughts and adequately express oneself. Neurofeedback helps strengthen the connections in the auditory cortex of the brain.
Chapter 20 Your Child’s Behavioral Challenges
A Neurotherapist’s Perspective: Lisa & Anthony Anthony began therapy because of his temper. Asked to leave the last three preschools he had attended, Anthony’s current principal warned his mother that if she didn’t get help for him, they would have to ask him to leave as well. Anthony was a four-year-old boy who lived with his single mother. He had never met his father. His mother had gotten pregnant by her boyfriend, and he wanted her to terminate the pregnancy, which she refused to do. Her boyfriend wanted nothing to do with this child and he broke up with her. She had her son and raised him by herself. Fast forward four years later: Anthony is now in preschool. He gets frustrated easily and is quite obstinate. He does not take “no” very easily and hits other children when he gets mad at them. He even got in trouble for kicking his teacher.
I started treating Anthony with neurofeedback to help him with his selfregulation, using the protocols to treat his right hemisphere to calm him down, and help him be more flexible. His angry outbursts became much less frequent and eventually disappeared altogether. He became more cooperative with his teacher and wasn’t being sent to the principal’s office anymore. I also began working with his mother, teaching her parenting techniques. She needed to take charge more and be the boss. Her stubborn son was much more forceful than she. She had been too passive, and needed assertion training to be able to set firmer limits. Since there was no father in his life, it was important that she be the authority figure in Anthony’s life. She needed to be firm yet consistent. At first, Anthony tended to run the show. He had a strong personality, and tended to dominate others that were more passive than he. As his mother became stronger and started setting firmer limits, Anthony of course tested these new boundaries. She needed a lot of support to stay strong and firm. However, I am glad to report that, with the changes that began with neurofeedback training (calming down Anthony’s anger and defiance), and the behavioral changes that happened with cognitive-behavioral therapy and family therapy, Anthony completed kindergarten and his elementary years successfully.
Chapter 21 Your Child’s Social Challenges
A Neurotherapist’s Perspective: Lisa & Bradley Bradley was a ten-year-old boy diagnosed with Asperger’s Syndrome. Treating him with the newly discovered protocols (infra-low frequency protocols) on his right hemisphere reduced his irritability, improved his cognitive flexibility, and increased his empathy significantly. He made many more friends at school. The occupational therapist that led the social skills group for Asperger’s Syndrome teens told his mother that he exhibited much more empathy than the typical students in the group. His mother told him that before neurofeedback training her son didn’t show any empathy towards others.
STRATEGY #4 IMPLEMENT YOUR CHILD’S TREATMENT PLAN
Chapter 22 Select a Neurofeedback Therapist
As the purpose of this book is to discuss the role that neurofeedback in particular can play in your child’s treatment and remediation, we would also like to share with you, information specific to finding a neurofeedback expert in the following section. We have discussed obtaining a diagnosis for your child, exploring neurofeedback as a treatment method for your child, defining your treatment goals, and we are now ready to implement your child’s treatment plan – and your first step: Selecting a neurofeedback therapist! It is extremely important that you select your neurofeedback therapist carefully. While neurofeedback is non-invasive, it is also a very powerful therapy modality and uses technology in delivering treatment. For this reason, it is also extremely powerful and should not be used by an unqualified provider. We are providing questions we recommend that you ask during your
initial consultation. In addition, we encourage you to research the professional associations that we have included in the Resources section. Generally, neurofeedback therapists are state-licensed clinicians such as: mental health therapists, educational therapists, rehabilitation specialists, psychologists and rehabilitation specialists to name but a few. Researching Neurofeedback Therapists You will find a wealth of information and prequalify the therapists you are interested in consulting with, on their websites. A good source to begin with is through the directories of neurofeedback associations or a simple Internet search for (your city) (neurofeedback therapist). Below is a list of the larger neurofeedback association directories to help in your research: BCIA EEG Institute International Society for Neurofeedback & Research When reviewing the membership directories and those that you find through your search, keep the following questions in mind: 1. Is he or she licensed in your state to provide mental health counseling? 2.
Does he or she have specialized knowledge and training in neurofeedback?
3.
What is the general feeling that you get from the therapist’s website? Are they warm and supportive? Is this someone with whom you can form a trusting relationship?
4.
What types of disorders do they treat? Neurofeedback is the noninvasive, non-medicinal treatment of choice for many disorders including: attention and learning, headaches, chronic pain, PTSD, autism, brain injuries, headaches, sleep disorders, etc. so research their experience and expertise in the area of concern for your child.
5.
Do they have advanced certification, training or assessments that they have performed through the association?
6. Are their fees and insurance in alignment with your needs? 7. Which theory of neurofeedback do they practice? A Special Word About Training As we have mentioned, neurofeedback therapy is highly specialized, therefore a great deal of advanced training is required with didactic training, as well as supervised practicum in order to gain confidence in evaluating their clients and selecting the proper protocol. In addition, because computers and software programs are used, your therapist should be trained in implementing treatment. Ongoing clinical consultation, like any other counseling specialty, is also recommended. Your Initial Consultation Defining and communicating your expectations are key to succeeding in therapy. You can expect a relationship of trust and free-flowing communication between you and your therapist and for this to happen, it is imperative that you feel comfortable in relating and being in agreement as to the direction you will be taking as a team. Your first step is to gather your notes that you’ve made when we discussed Strategy #3, Define Your Treatment Goals. Clearly stating your priorities for both your family and your child is critical when interviewing potential therapists. Also select certain areas in your child’s IEP to discuss with your therapist as well items that pertain to both the long and short-term goals for your family as a whole. Be able to clearly define the tasks that you would like to work on with your therapist, for example, if you would ultimately like to provide in-home training to your child directly, be sure to mention this so your therapist can work steps necessary to do that in his or her long-term treatment plan. Your second step is to prepare an overview of what you would like to discuss: Questions to Ask
1.
How do we set goals together for my family as well as my child? Be as specific as possible. For example, if your child is having tantrums and this disrupts the other family members on a daily basis, you may want to address these behavioral issues as your top priority. On the other hand, if your child is having difficulty with a learning disorder and you are concerned that there is a problem with attention and focus, this may be a priority for you. It is up to you as your child’s parent to begin defining where your therapist can be of value to you.
2.
How will we know when we have reached that goal? Is there a way we can measure our success? There are two ways that we can determine whether certain goals of treatment are being met: Informal, such as observations by you, your child’s teacher and those he or she comes into contact on a regular basis and formal which are assessment instruments. Specific, formal assessments provide you and your therapist with objective feedback
3.
Once you call for an appointment, how were you treated? Was your call promptly returned and were your initial questions answered? It’s important that your call be returned in a timely manner, as this is an indication of the importance your potential therapist places on you as a client. You want to be assured that if you need him or her in an emergency, that your call with be a top priority.
4.
Finally, when interviewing these three therapists, be sure to make notes as soon as possible after your appointment so you can recall what was discussed. It’s a decidedly stressful and emotional situation and notes will help!
Making a Decision Once you’ve completed your three initial consultations (we recommend no more than three at a time), take the time to analyze each of them in relation to the following questions for each of the therapists you interviewed: 1. Describe one of your short and long terms goals. 2. What knowledge does this goal require?
3. Does this therapist have the knowledge and skills to help you reach your goal for your family and your child? 4.
Is this therapist well trained in anatomy of the brain? Does she have a good working knowledge of the older protocols that have stood the test of time, as well as the newer protocols of infra-low frequency training?
5.
Was he or she forthcoming with references, referrals, and testimonials (even if on the website, this counts!).
6.
Is the therapist’s timing and cost in alignment with what you can invest? Is he or she willing to work out some arrangements regarding their fee for their services
7.
Is this someone whom you feel you can trust and in whom you have confidence?
Chapter 23 Beginning Treatment: What to Expect
Neurofeedback sessions typically take between 30 to 60 sessions, depending on the complexity of issues that your child is experiencing, the frequency of which varies from two to three times per week, for a period of four months to one year. Progress is generally evident after approximately 20 sessions and improvements in behavior in the classroom or home are typically apparent after about two months of training, with additional, continuing to be sure to train the brain to solidify the gains made. Treatment sessions begin with an update on the impact of the previous session on focus, sleep, attention, school, and play. Your child sits in front of a computer screen with electrodes attached to their scalp to measure brainwave activity only, just like an EKG shows measurements of heart waves but doesn’t do anything to them. While the student is receiving visual and audio feedback in the form of a video, and often listening to soft music, the therapist
monitors brainwave activity on another computer. The feedback that provided during these sessions trains your child how to relax and focus, improve concentration and alertness, all while decreasing impulsiveness. Training lasts long after the time spent with the therapist – somewhat like riding a bike! Once mastered, the skills are retained.
STRATEGY #5 MONITOR YOUR CHILD’S PERFORMANCE
Chapter 24 Monitor Your Child’s Progress
A Therapist’s Perspective: Teresa & Eric Eric, a very bright and very verbal 10-year-old began neurofeedback therapy prior to my seeing him in another area prior to their move to my area. Because I specialize in educational assessment however, it was important to his parents that they have a sense of how he was progressing through both his neurofeedback therapy, as well as the intense remediation that they had him undergoing. I reviewed a number of documents from his previous therapists, doctors, and school including: vision and hearing screenings, teacher reports of his classroom activities along with accommodations that they had made for him, his IEP and 504, samples of his schoolwork and notes taken during his parent/teacher conferences. Diagnosed with ADHD and a Learning Disorder
(Reading – Dyslexia) he was performing much below his grade level, however, he showed progress made during periodic assessments. I suspected a Disorder of Written Expression as well, as an informal assessment showed a lack of being able to form and write his ideas on paper. His handwriting was illegible with no regard to linguistics or convention. After consultation with his parents, I concluded that taking into account the number of sessions he had had with his neurofeedback therapist, he should have tested higher, so made a referral to someone whom I knew to be particularly adept at treating learning disorders. Follow up assessments showed that he was indeed improving as she focused on both the issues at hand, placing a priority on the ADHD in order to help with focus and concentration. Why Monitor Your Child’s Progress? In order to ensure that your child is reaching his or her true potential, or reaching their peak performance, we must have a way to measure their progress. All the research in the world doesn’t guarantee success for your child in a particular therapy. We are all unique – we all have strengths and weaknesses – likes and dislikes. What works for one child may not work well at all for another. For that reason, it’s important to be attuned to your child’s progress, both formally through assessments and informally in observing behaviors, moods, communication, etc. Soliciting the help of your child’s teacher is helpful in this regard as he or she sees your child for such a large part of his day. It’s impossible for a therapist to know definitively how well a particular therapy is working, however one of the advantages of neurofeedback is that results are more quickly determined. Why track your child’s progress? As a busy parent, your reasons are likely similar to most: First, you need to optimize your time and money in treating your child’s emotional, behavioral, and cognitive needs just as you would his or her physical needs. If something isn’t working, we must take the steps to correct the path we’re on. Second, if your child is currently taking medication for his or her ADHD or other disorder, working closely with the prescribing physician to communicate the positive changes he’s making due to the
neurotherapy ensures that adjustments can be made to the dosage. The Role of Assessments in Monitoring Progress Re-assessment, such as a TOVA test, is beneficial in determining the level of progress made and provide you and your therapist with the data needed to modify your child’s treatment plan, if required, and ensure her progress.
STRATEGY #6
ENJOY YOUR NEW FAMILY!
Chapter 25 Enjoy Your New Family!
A Final Word There are ultimately two reasons that people consider therapy: either they are in great pain and continuing the way things have been is unacceptable, or they are anticipating great rewards if they are able to change. Change isn’t easy for any of us, but the rewards can be tremendous: A child reaching his or her true potential makes for a very happy family! Family therapy as an adjunct to neurofeedback therapy works wonderfully well for many of our clients. The challenges and obstacles that a family face with a child with special needs are oftentimes overwhelming, but can be reduced, and even alleviated altogether, with therapy. None of us exist in our families alone; we must attend to those members who need extra care while at the same time, respect and honor the needs and desires of other family members. Of special importance is the relationship between you and your spouse as a couple. Without the constant care of your relationship as the nucleus of your family, you shall run the risk of weakening the foundation that you have built prior to having children.
Family therapy is particularly helpful in lessening feelings of isolation that the two of you share as a couple, or as a family unit. There is the propensity to feel as if others couldn’t possibly understand what we are going through at times, which is to be expected, however, there are many professionals waiting to help you at this very moment, as well as support groups and psychoeducational resources that may prove to be of great comfort. Areas of special concern for the family who has children with special needs include: Constructing a relationship with your spouse that draws upon your strengths and allows you to build a cohesive, loving environment for all of your family members to grow and thrive Attending to issues of sadness, anxiety, depression, etc. that any of your family members may be experiencing Preparing contingency and emergency plans for the physical needs of all your children and in particular, your child with special needs if she is experiencing physical challenges Preparing your household financially for emergencies that may arise Providing developmental, cognitive, social, and educational support to your child with special needs as she grows and matures Along these same lines, preparing for different stages of your child’s development and planning for very pragmatic issues of aging within various systems Providing for the physical and emotional needs of your other children to help them grow and develop Addressing any issues of sibling rivalry that may be occurring within the family As we mentioned earlier, couples and family therapy can be of tremendous help. The unforeseen challenges that arise for a family with a child with special needs can include financial stress, time demands, anxiety, medical and emotional issues, personal health, and of course parenting, but with help, you
can enjoy a successful, happy family and all the rewards that having a child with special needs has to offer. We hope that information we have provided has been of help and comfort to you and wish the best for you and your family. Best, Lisa & Teresa
RESOURCES National Institutes of Health Fact Sheets Asperger’s Syndrome Attention Deficit Hyperactivity Disorder (ADHD) Autism Spectrum Disorder (ASD) Dyslexia Learning Disorders (LD) ADD/ADHD Resources ADD Resources ADDitude Magazine Autism Spectrum Disorder Resources Autism Society AutismSpeaks.org Food Additive Resources Feingold Association of the United States Learning Disorder Resources International Dyslexia Association Learning Disabilities Association of America National Center for Learning Disabilities National Institute of Child Health and Human Development (NICHD) National Institute of Mental Health (NIMH)
Laboratory Testing for Heavy Metals We use the King James Medical Laboratory for DMSA challenge testing and for hair analysis screening: The King James Medical Laboratory, Inc. 24700 Center Ridge Road Cleveland, Ohio 44145 800-437-1404 440-835-2177 (fax) Neurofeedback Therapist Directories EEGInfo.com EEGSpectrum.com Screening Tools M-Chat.org (Autism screening tool: Can be used by parents)
