Asia Pacific Neurofeedback/ Biofeedback Conferences Penang, Malaysia Vernice Si Toh, MBPsS

Transcription

1 Asia Pacific Neurofeedback/ Biofeedback Conferences Penang, Malaysia 2016 Vernice Si Toh, MBPsS

2 Vernice Si Toh Spectrum of Life MSc Clinical Child Psychology Anglia Ruskin University, Cambridge Member of PSIMA (Membership No. 318/15) Graduate member of BPS (Membership number: ) Division of Neuropsychology Division of Educational and Child Psychology International Affiliate of APA (Membership No ) Division 40: Clinical Neuropsychology

3 Inattentive ADHD Hyperactivity - impulsivity Combined (American Psychiatric Association, 2013)

4 Worldwide prevalence rate: 5.29% Prevalence rate among school age in the US: 3 7% Prevalence rate in Malaysia: 1.61% 96 over 2,766 cases in Malaysia ADHD cases over 2,239 cases in Malaysia 2012 Cormier, 2008 Gomez & Hafetz, 2011 Polanczyk, de Lima, Horta, Biederman, & Rohde, 2007 United Nations Children s Fund, 2014

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9 Lubar & Shouse, 1976 Result shown hyperactivity and distractibility of the child improved. Shouse & Lubar 1978 Effectiveness of EEG biofeedback in combination with drugs are more effective than drugs alone. Shouse & Lubar 1979 Larger open label study Findings similar as above. Effect sustained even after medication being withdrawn. Lubar, Swartwood, Swartwood, & O Donnell, 1995: 19 children (8 19 years old) with ADHD 40 sessions Findings: 1) improved attention, 2) reduced impulsivity and hyperactivity behaviors.

10 Fuchs, Birbaumer, Lutzenberger, Gruzelier, & Kaiser, 2003; Hodgson, Hutchinson, & Linley, 2014; Monastra, Monastra & George, 2002; Rossiter, 2004; Rossiter & La Vaque, 1995 Findings: comparable effect, especially on attentiveness and impulsivity

11 Six-month follow up Meisel, Servera, Garcia-Banda, Cardo, & Moreno, 2014 Neurofeedback training VS pharmacological intervention Significant academic performance detected in NFB group Gevensleben et al., 2010; Leins et al., 2007 Behavioural improvements maintained after neurofeedback training Two years follow up Gani, Birbaumer, & Strehl, 2008: Effect is able to uphold Ten years follow up Tansey, 1993: long term symptom reduction

12 Meta-Analysis of Neurofeedback in ADHD (Journal of Clinical EEG & Neuroscience, July, 2009) Most of the studies are of theta/beta training or slow cortical potential training. Large ES for inattention and impulsivity and a medium ES for hyperactivity

13 Theta Beta SMR Alpha

14 VADPRS CALIS

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16 CLIENT A GENDER Female AGE 8 ADHD subtypes combined CALIS Anxious when outside from home

17 Restless and fidgety Talks excessively and blurted out answers Interrupt or intrude on others Loses temper and impatient Argues with adults and refused to comply Poor attention span, easily distracted and avoid tasks that require sustained mental effort Forgetful and often loses things necessary for tasks or activities

18 Month Sessions Protocols January S1 F3 Beta + F4 SMR February S2 3 P3-P4 SMR March S4 7 April S8 10 May S11 13 June - July S14 Total 14

19 04/02/ /02/ /03/ /03/ /03/ /03/ /04/ /04/ /04/ /05/ /05/ /05/ /07/2016 P3-P4 SMR S2 S3 S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 S14 Delta Theta SMR Hi-Beta Alpha

20 Presenting Symptoms Improvements Restless and fidgety Able to sit still for longer period of time Talks excessively and blurted out answers Able to control, talk lesser during session Interrupt or intrude on others Will still interrupt but will wait for her turns when guided Loses temper and impatient More patient and tantrum reduce Argues with adults and refused to comply Poor attention span, easily distracted and avoid tasks that require sustained mental effort Forgetful and often loses things necessary for tasks or activities Obey to instructions better Attention span prolonged, putting effort during session e.g. neurofeedback session Memory improved

21 CLIENT GENDER B Male AGE 9 ADHD subtypes CALIS combined Parents reported anxiety, self-reported non-anxious

22 Restless and fidgety Talks excessively and blurted out answers Interrupt or intrude on others Loses temper and impatient Argues with adults and refused to comply Poor attention span, easily distracted and has difficulty sustaining attention Often loses things necessary for tasks or activities Blame others for his mistakes or misbehaviors Tell lies to get what he wants or to avoid punishment Purposely annoyed others as well as being touchy and easily annoyed by others

23 Month Sessions Protocols December S1 3 F3 B + C3 SMR Pz alpha2 February S4 F3 + C3 SMR S5 7 C4-P4 SMR March S8 9 April S10 12 May S13 Total 13

24 05/12/ /12/ /12/ /02/ /02/ /02/ /02/ /03/ /03/ /04/ /04/ /04/ /05/ /06/2016 F3 Beta S1 com S2 S3 S4 S5 S6 S7 S8 S9 S10 S11 S12 S13 Delta Theta SMR Hi-Beta Alpha

25 C3 SMR /12/ /12/ /02/ /02/ /02/ /02/ /03/ /03/ /04/ /04/ /04/ /05/2016 com S2 S3 S4 S5 S6 S7 S8 S9 S10 S11 S12 Delta Theta SMR Hi-Beta Alpha

26 C4-P4 SMR /02/ /02/ /03/ /03/ /04/ /04/ /04/ /05/ /06/2016 s5 s6 s7 s8 s9 s10 s11 s12 s13 Delta Theta SMR Hi-Beta Alpha

27 Presenting Symptoms Improvements Restless and fidgety Can sit still during session for longer time Talks excessively and blurted out answers Able to control and talk lesser during sessions Interrupt or intrude on others Slight improvement Loses temper and impatient Tantrums reduced and able to wait during setup Argues with adults and refused to comply Still required training Poor attention span, easily distracted Attention span prolonged, parents reported to sit longer while watching movie at home Often loses things necessary for tasks or activities Blame others for his mistakes or misbehaviors Tell lies to get what he wants or to avoid punishment Purposely annoyed others as well as being touchy and easily annoyed by others Still required training Still required training Still required training Slight improvement

28 CLIENT GENDER C Male AGE 7 ADHD subtypes CALIS Hyperactive impulsive with Oppositional defiant behaviour Parent report and self reported to have anxiousness

29 Restless and fidgety Talks excessively and blurted out answers Interrupt or intrude on others Loses temper and impatient Argues with adults and refused to comply Poor attention span, easily distracted and has difficulty sustaining attention Often loses things necessary for tasks or activities Blame others for his mistakes or misbehaviors Tell lies to get what he wants or to avoid punishment Purposely annoyed others as well as being touchy and easily annoyed by others Unable to follow instruction or complete schoolwork although he understand

30 Month Sessions Protocols June S1 4 F3 Beta + F4 Beta July S5 7 C3 HiBeta + C4 SMR Total 6

31 Presenting Symptoms Improvements Restless and fidgety Able to stay in seat longer Talks excessively and blurted out answers Still required training Interrupt or intrude on others Will stay away as per told Loses temper and impatient Still required training Argues with adults and refused to comply Obey to instructions better Poor attention span, easily distracted and has difficulty sustaining attention Improved attention span, still required further training Often loses things necessary for tasks or activities Comply better and listen to others Blame others for his mistakes or misbehaviors Still required training Tell lies to get what he wants or to avoid punishment Purposely annoyed others as well as being touchy and easily annoyed by others Unable to follow instruction or complete schoolwork although he understand Still required training Still required training Able to put in effort to read and understand the instruction

32 CLIENT D GENDER Female AGE 5 ADHD subtypes Combined with anxiety symptoms CALIS Both reported anxiety

33 Restless and fidgety Did not want to talk/ speak very softly Finger biting Loses temper and impatient Longer adaptation time required Poor attention span, easily distracted and has difficulty sustaining attention Accompaniment of transitional objects or toys are required Accompaniment of parents are requested during sessions Keep mentioning she felt scared Refuses to follow instructions although she understands Refuses to comply with adults request

34 Month Sessions Protocols January S1 9 F3 Beta + F4 alpha1 February S10 14 C4-Pz SMR S15 March S16 19 F3 Beta + C3 Beta T4-P4 SMR April S20 22 F3 Beta + F4 SMR May S23 24 T4-P4 SMR S25 26 June S27 29 July S30 Total 30 F3 Beta + C3 Beta F4 + P4 SMR

35 13/02/ /02/ /02/ /03/ /03/ /03/ /03/ /04/ /04/ /04/ /05/ /05/ /05/ /05/ /06/ /06/ /06/ /07/2016 F3 Beta S13 S14 S15 S16 S17 S18 S19 S20 S21 S22 S23 S24 S25 S26 S27 S28 S29 S30 Delta Theta Beta Hi-Beta Alpha

36 C3 Beta /03/ /03/ /03/ /03/ /04/ /05/ /05/ /06/ /06/ /06/ /07/2016 S16 S17 S18 S19 S20 S25 S26 S27 S28 S29 S30 Delta Theta Beta Hi-Beta Alpha

37 T4-P4 SMR /02/ /03/ /03/ /03/ /03/ /04/ /04/ /04/ /05/ /05/2016 S15 S16 S17 S18 S19 S20 S21 S22 S23 S24 Delta Theta SMR Hi-Beta Alpha

38 F4 SMR /04/ /04/ /05/ /05/ /05/ /05/ /06/ /06/ /06/ /07/2016 S21 S22 S23 S24 S25 S26 S27 S28 S29 S30 Delta Theta SMR Hi-Beta Alpha

39 P4 SMR /05/ /05/ /06/ /06/ /06/ /07/2016 S25 S26 S27 S28 S29 S30 Delta Theta SMR Hi-Beta Alpha

40 Presenting Symptoms Improvements Restless and fidgety Less fidgety and able to sit still longer during session Did not want to talk/ speak very softly Speaks louder and clearer now Finger biting Totally weaned off Loses temper and impatient Tantrums reduced and more patient Longer adaptation time required Able to adapt in shorter time Poor attention span, easily distracted and has difficulty sustaining attention Accompaniment of transitional objects or toys are required Accompaniment of parents are requested during sessions Attention approved a lot, even feedback from school teacher No TOs or toys are seen Able to attend session alone Keep mentioning she felt scared No longer mentioning Refuses to follow instructions although she understands Able to listen and follow instructions better Refuses to comply with adults request Comply with adults more

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46 References American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D. C.: American Psychiatric Publishing Fifth edition. American Psychological Association. (n.d.). Anxiety. Retrieved on November 30, 2013 from Appendix S2: Evidence-based child and adolescent psychosocial interventions. (2010) Pediatrics, 125(3), S128. doi: /peds H Arns, M., Heinrich, H., & Strehl, U. (2014). Evaluation of neurofeedback in ADHD: the long and winding road. Biological Psychology, 95, doi: /j.biopsycho Arns. M., de Ridder, S., Strehl, U., Breteler, M., & Coenen, A. (2009). Efficacy of neurofeedback treatment in ADHD: the effects on inattention, impulsivity and hyperactivity: a meta-analysis. Clinical EEG and Neuroscience, 40(3), doi: / Brain waves 1 [Online image]. (2014). Retrieved June 5, 2016 from Cormier, E. (2008). Attention deficit/hyperactivity disorder: a review and update. Journal of Pediatric Nursing, 23(5), doi: /j.pedn Freepik [Online image]. (2015). Retrieved June 5, 2016 from Gomez, R., & Hafetz, N. DSM-IV ADHD: Prevalence based on parent and teacher ratings of Malaysian primary school children. Asian Journal of Psychiatry, 4(1), doi: /j.ajp Lubar, J. F., & Shouse, M. N. (1976). EEG and behavioral changes in a hyperkinetic child concurrent with training of the sensorimotor rhythm (SMR): a preliminary report. Biofeedback Self Regulation, 1(3), Retrieved September 30, 2015 from Polanczyk, G., de Lima, M. S., Horta, B. L., Biederman, J., & Rohde, L. A. (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American Journal of Psychiatry, 164(6), doi: /appi.ajp Shouse, M. N., & Lubar, J. F. (1978). Physiological basis of hyperkinesis treated with Methylphenidate. Pediatrics, 62(3), Shouse, M. N., & Lubar, J. F. (1979). Operant conditioning of EEG ryhthms and Ritalin in the treat of hyperkinesis. Biofeedback and Self-regulation, 4(4), doi: /bf United Nations Children s Fund (2014). Statistical data from the Ministry of Health. Children with Disabilities in Malaysia. Kuala Lumpur: UNICEF Malaysia. Wehmeier, P. M., Schacht, A., & Barkley, R. A. (2010). Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life. Journal of Adolescent Health, 46(3), doi: /j.jadohealth

47 Questions?