Neurofeedback for Asperger's, ADHD, and Tourette's

Many people were taught that the brain is fixed and can never be changed. But the last 20 years of neurological research has showed us that the opposite is true. The brain is constantly changing itself. New brain cells form, new connections grow, and key parts of the brain build themselves up. When you work on a new skill, you actually physically grow the relevant parts of the brain: it gets larger.

This goes against what we were all taught in school. We were taught that since the brain is fixed, if you have a neurological disorder or difference, you have it for life. Only chemical modification (drugs) can change it.

We don't know yet if people are "born" with ADHD, Asperger syndrome, or Tourette's. But even if they were, that would not mean that they must have it all their lives. If the issues are in the brain, then they can be nudged into a more normal and agreeable pattern.

Unlike drugs, EEG neurofeedback does not change a person's personality. There are no biochemical side effects. The person is still as quirky and original as before, except that the bewilderment and suffering is gone.

It's kind of like learning to ride a bicycle. If you can remember learning to ride a bike, you'll remember that for the first long while, it was a frustrating and bewildering experience. And for one simple reason: You didn't know how to balance. But once you figured that out on the 100th try, suddenly you were riding. After that, it was easy.

EEG neurofeedback therapy follows a similar process. Electrodes placed on the child's scalp monitor the brainwave activity and export it to a computer and screen. The computer includes software (usually games and activities) that the child controls with these brainwaves.

What follows is a simple reward strategy. When the child's brainwave falls into the "good" zone, the computer reacts. Sometimes it plays music or rings a tone, sometimes it allows the person to continue playing a computer game. These are very simple rewards that the unconscious brain responds to. If the child's brainwave falls into the "bad" zone, the reward stops. The clinician adjusts the level of difficulty up or down so that the child never gets too frustrated.

At first, the brain doesn't know what to do. The rewards seem random. A good clinician finds that delicate balance between providing enough rewards to the brain to encourage it and providing enough challenge to make the brain work to change itself.

Eventually, the unconscious brain starts responding to the reward pattern. The clinician then starts making the activities more and more difficult till the child's brainwave patterns reach a normal pattern.

After the course of therapy is finished, the child's brain has shed the old distressing patterns and has settled into the new patterns. And like learning to ride a bike, the brain never forgets. Since the new patterns provide their own rewards (happier days, more social success, peaceful nights of sleep), the brain never returns to the old patterns.

Yes. There have been countless studies of neurofeedback related to all childhood neurological issues, including epilepsy, sleep disorders, anxiety disorders, depression, and other difficulties that are usually treated with drugs. Most of the studies have been small in scale, largely due to a lack of funding for large-scale studies. But those big studies are coming.

Here are some general information sites that describe studies:
http://www.isnr.org/
www.eegspectrum.com
www.eeginfo.com/institute
http://brainothermerfoundation.org
www.aapb.org
www.bcia.org
www.aboutneurofeedback.com

The brain has several brainwave frequencies working all at the same time. Some are long, slow waves with a low frequency. Some are short, tight waves with a high frequency.

You need the full range of frequencies because you use each one in different situations. Problems occur when a brainwave frequency gets stuck. People with anxiety disorders know what that means: constantly being in flight-or-fight mode when there is no danger. Neurofeedback is a technique to unstick these frequencies so that they are supple and responsive to the situation, rather than rigid in distressful patterns.

DELTA WAVES (0.5 - 3 Hz): Very low frequency. Extremely zoned out. Newborn infants normally have high delta waves. High delta waves are associated with learning disorders, social difficulties, ADHD, and brain damage.

THETA WAVES (3 - 7 Hz): Low frequency. Sleepy and somewhat zoned out. Focused inward, as when you are trying to remember something or are thinking about a cool new idea. Unfortunately, once you pull out of Theta, you often don't remember what you were thinking about. Toddlers and preschoolers normally have high theta waves. High theta waves are associated with learning disabilities, ADHD, and social difficulties.

ALPHA WAVES (8 - 13 Hz): Calm frequency. The low end of the range is used in meditation and relaxation therapy. Adults normally have high alpha waves. High alpha waves are associated with calm awareness and intelligence.

SENSORIMOTOR RHYTHMS (13-15 Hz): The SMR waves are different from the other frequencies because they are produced very deep in the brain, often in different places. The SMR frequencies are difficult to pinpoint as a result. SMR indicate the brain's ability to work with the body's senses and muscles. Low SMR corresponds to sensory difficulties (hyper- and hyposensitivity), motor difficulties, involuntary movements (tics), and lack of self-regulation (impulsivity). HIgh SMR corresponds to alertness and focus. Children with low SMR often also have anxiety issues because of the long-term bewilderment caused by not understanding the body.

BETA WAVES (16 - 20 Hz): High frequency. Beta are the concentration brainwaves. You use them to solve math problems, read a map, or learn a new skill. Once you have learned a new skill, you don't need as much beta. Beta waves are hard to sustain, which is why people get tired doing high-concentration brainwork. Low beta waves are associated with some forms of ADHD.

HIGH BETA WAVES (19 + Hz): Shrill frequency. Associated with alarm and emotional intensity. People with high high-beta waves have anxiety disorders, such as panic disorders, obsessive-compulsive disorder, phobias, general agitation, post-traumatic stress disorder, eating disorders, etc. Children with sensory disorders, cognitive disorders, or social difficulties can end up with problems in this frequency due to long periods of stress.

You can find lists of recent studies at these links:

http://www.isnr.org/information/index.cfm#Reprints
http://www.cbc.ca/health/story/2008/02/27/neurofeedback-study.html

Be aware that any study of neurofeedback that uses inexperienced clinicians with no kid skills (e.g., grad students), poor rewards (e.g., no prizes to work toward), and insufifcient time (e.g., anything less than 30 hours per child) will yield lackluster results. So it is important to check the parameters of the study.

The usual brainwave pattern in ADHD is excessive slow-wave activity (Delta and Theta), often accompanied by insufficient Beta activity. As a result, the child lives in a thick fog. Some may also have difficulties with low SMR, which leads to impulsivity and hyperactivity.

Recent studies have also shown that many children diagnosed as ADHD actually have mild brain injuries. Because psychiatrists tend to use questionnaires to diagnoses ADHD, few of these children are properly identified. An EEG scan by an experienced clinician will be able to identify brain trauma and help the brain work around the injured area.

Stimulant medications are currently the most popular treatment for ADHD. For many children, these meds cause extremely distressing side effects, and for some, they trigger tic disorders. For children with any anxiety issues, stimulants are contraindicated because they increase anxiety. As well, once the stimulant therapy stops, the child returns to the ADHD state. For these reasons, stimulant therapy is not an ideal treatment choice nor a long-term solution.

EEG neurofeedback for ADHD can run between 20 and 40 sessions.

Information websites:
http://www.addcentre.com/Pages/ADHD-NFB.html
http://www.addcentre.com/Pages/dealing_with_add.html
http://www.medicalnewstoday.com/articles/157843.php
http://www.ecnsweb.com/journal/jul09/07.html

The usual brainwave pattern in Asperger syndrome can vary a great deal, since there is so much variation within Asperger syndrome diagnoses. Low SMR is a typical pattern, and it causes the sensory-motor problems that Asperger kids often have. They usually also have high Delta-Theta waves, which contribute to head-in-the-cloud personalities. However, unlike ADHD, Asperger kids usually have very strong Beta waves, which is why they usually do well in school. Asperger kids often have additional problems with the High Beta waves.

Asperger syndrome is generally harder to treat than ADHD. Autism spectrum disorders are often a collection of traits and difficulties, and few kids have them all. The regions of the brain involved in Asperger syndrome (e.g., the thalamus) are usually much deeper than those involved in ADHD. Therefore treatment can be very long.

It is important to have realistic goals when treating Asperger syndrome with neurofeedback. Good examples are reduced spaciness and better focus, elimination of agitation and anxiety, elimination of tics and impulsivity, reduced hyper- and hyposensitivity.

Information websites:
http://www.addcentre.com/Pages/asperger.html
http://www.sciencedaily.com/releases/2008/04/080423175535.htm

Tourette's syndrome focuses on the SMR waves. The tic disorders, impulsivity, and lack of self-regulation associated with Tourette's is caused by low SMR. Since SMR is produced deep in the brain, therapy for Tourette's can be long. However, since it focuses on just one brainwave pattern, it is usually successful.

Any clinician that treats ADHD and Asperger syndrome can treat Tourette's.

Neurofeedback must be done by a trained professional. EEG is not a toy, and the software doesn't work on its own. Accreditation and licensing are important.

Over 1000 professionals are accredited in the world, most in the USA. Several universities currently offer training programs.

A credible neurofeedback clinic has BCIA accreditation (The Biofeedback Certification Institute of America). This certification is recognized by the America Psychological Association. BCIA offers three types of certification, only one of which is EEG Biofeedback (neurofeedback). Be sure to check the certification.

In addition, a clinic must have a licensed professional at the helm. That professional can be a psychologist, psychiatrist, doctor, nurse, or other therapist. The license is your state or country's assurance that the person is not a quack.

Check the BCIA website (www.bcia.org) for a list of certified clinics. The International Society for Neuronal Regulation (www.isnr.org) also features lists of members.

Here are some tips for ensuring that you find a clinic that specializes in the right area:

1. Research the clinic thoroughly on the Web. Most clinics list the areas they work on. You want to find a clinic that lists ADHD, Asperger, and/or Tourette's near the top of the list. If the list is very long, and the clinic is a little bit into everything, then it probably lacks the expertise to get good results in a timely manner.

2. Find out as much as you can about the head of the clinic. Google to find out if this person has published any books or articles, or is associated with any university.

3. Arrange a visit to the clinic to look around. The clinic should look like a place that focuses on kids. Ask a lot of questions while you are there. Get information on how long therapy is likely to take. Ask about qualifications, not just for the head of the team, but also for the individual trainers. (Clinics usually employ and train people to do most of the training sessions.) If permitted, ask if you can watch a session in progress.

4. Ask to see testimonials from parents and children. Look for signs that kids are happy and engaged. The ability to work with kids and elicit their cooperation is a key skill.

5. Try to get the person talking. When people get going on their pet topic, they just talk. This will tell you a lot about the focus of the clinic, what gets them excited, why they are doing it, what motivates them, etc.

What do you do if there is a reasonably good clinic close by, but a clinic run by a key neurofeedback researcher farther away? Get the best quality assessment you can. It's worth the drive to go to the best clinic possible. Once you have the assessment, ask if you can share some of the treatment time between the two clinics so that you spend less time in the car and more time on training.

Other options:

1. Ask your doctor. More and more parents are turning to neurofeedback, and doctors often hear about the success stories.

2. Ask your local autism or ADHD chapter for referrals, or attend a meeting and ask around.

Dr. Barry Sterman, Dr. Joe Kamiya, Dr. Joel Lubar, and Dr. Siegfried Othmer: Pioneers of EEG neurofeedback who created the foundation of the treatment programs.

Dr. Michael Thompson, and Dr. Lynda Thompson: Focus on ADHD and related disorders and have published many books and articles.

Dr. Paul Swingle: Clinician and author of popular books and articles on neurofeedback and its newest applications.

Dr. Robert Thatcher: Key researcher.

Dr. Shane Dunne: Developer of new and promising neurofeedback technologies to improve accessibility, reduce costs and time-costs, and improve results for ADHD, Asperger, and Tourette's kids.

Because the FDA still has not designated neurofeedback as a controlled therapeutic procedure, it is available on the open market. Recently, video game companies have started using EEG in video games. You can now buy video games that are controlled by electrodes attached to your head, just like neurofeedback therapy.

This is pure recklessness. Using neurofeedback for recreation is no different from using medications as recreational substances. It will train young brains out of their normal patterns and actually create neurological and mental disorders.

The failure of the medical establishment to recognize and control neurofeedback leaves it open to this kind of abuse.

Wouldn't it be great if we could do neurofeedback in the home? It would certainly speed up the progress!

However, currently home training is not a good idea. Unless you are very skilled and know a lot about computers, frequencies, and imaging, it will be more trouble than it's worth. The hardware is very fiddly and delicate, and getting levels set properly is a skill that takes a long time to learn. Until better hardware and software is available, it's not worth it unless you are good with technology.

The most important reason is that the clinician is not there simply turning the machine on and off. The clinician is guiding the process. Without the clinician nudging the levels, encouraging the child, changing the course of the treatment, and focusing the activities, the sessions meander and don't usually get much done.