NEUROFEEDBACK THERAPY IN GROUP SETTING. Ms Jerry Lee Association of Resource & Education for Autistic Children (REACh)

Transcription

1 NEUROFEEDBACK THERAPY IN GROUP SETTING Ms Jerry Lee Association of Resource & Education for Autistic Children (REACh)

2 I. INTRODUCTION Neurofeedback therapy (NFT) is a technique that presents real-time feedback on brainwave activity as measured by sensors on the scalp through the form of a video game, movie or music display. (See, 2010) NFT is used as an complimentary therapy for special needs children and has produced positive effects as found in previous research.

3 1) Autism Spectrum Disorder (ASD) Jarusiewicz (2002) 24 participants: 12 received NFT 12 acted as control group 36 sessions: Inhibit theta, enhance low beta at C4 site

4 26% average reduction in total ATEC rated autism symptoms versus 3% in comparison with control group. Children in NFT group showed Improvement in socialization, vocalization, anxiety, schoolwork, tantrums, and sleep, compared with control group.

5 Pineda et al. (2008) 8 high-functioning ASD participants Assigned to either placebo or experimental groups 10 weeks training of the mu frequency band (8 13 Hz). Experimental participants showed increased sustained attention ability, and improved scores on subscales of the ATEC compared to the placebo group.

6 Kouijzer, de Moor, Gerrits, Congedo, & van Schie (2009) 14 participants: 7 children received NFT 7 children acted as control group 40 sessions Inhibit theta, enhance low beta at C4 Participants who received NFT showed improvement in social interaction, communication and concept generation.

7 Improvements in cognitive functions include: Sustained auditory selective attention Inhibition of verbal responses Inhibition of motor responses Set shifting (switch between the numerical and alphabetical mode) Planning ability

8 Fauzan & Mahayuddin (2014) 34 participants (age 3 to 20) 36 training sessions Inhibit theta, enhance beta at frontal lobe Participants were reported to show improvement in their social behaviors, sleeping pattern and reduction in aggressiveness and tantrum.

9 2) Attentive Deficit Hyperactivity Disorder (ADHD) Kaiser & Othmer (2000) 1089 subjects 726 children 186 subjects with ADHD or ADD diagnoses 20 or more sessions SMR-beta neurofeedback training

10 Neurofeedback training produced significant improvement in attentiveness, impulse control, and response variability. Significant clinical improvement in one or more measures was seen in 85% of those subjects with moderate pre-training deficits.

11 Fuchs, Birbaumer, Lutzenberger, Gruzelier, & Kaiser (2003) 34 children (age 8 to 12) 22 in neurofeedback group 12 in methylphenidate group Neurofeedback group: reinforcement on the production of cortical SMR and beta activity

12 Both neurofeedback and methylphenidate groups reported: Improvements on all subscales of the Test of Variables of Attention. Improvements on the speed and accuracy measures of the d2 Attention Endurance Test. Significant reduction in behaviors related to the disorder as rated by teachers and parents on the IOWA-Conners Behavior Rating Scale. These findings suggest that neurofeedback was efficient in improving some of the behavioral concomitants of ADHD in children.

13 Mohammadi, Malmir, Khaleghi (2015) 16 children (age 9-15) 13 boys and 3 girls All children were diagnosed with ADHDcombined type 1 st phase (15 sessions): enhance SMR and reduce theta at C4. 2 nd phase (15 sessions): enhance beta and reduce theta at C3.

14 Assessments consisted of d2 attention endurance test, ADHD rating scale (parent form) at three time periods: before, middle and the end of the training. Based on parents reports, hyperactivity/impulsivity were improved after the 2 nd phase of beta training.

15 II. OBJECTIVE OF STUDY 1. To explore the possibility of having parents conduct the NFT in group. 2. To explore the possibility of using standardized neurofeedback treatment protocol for children with autism.

16 III. STUDY STATEMENT Increase in the power of SMR on C4 is associated with the reduction of hyperactivity/impulsivity symptoms. Enhancement of beta waves and decrease in excessive theta in the left hemispheric on C3 are recommended to improve attention.

17 Alpha activity is trained most frequently in parietal regions and had shown positive effects in improvement of cognitive performance and to achieve relaxed mental state.

18 IV. METHOD Duration: 6 weeks The study was carried out in a free service centre for children with autism in Penang, Malaysia.

19 Eight children were selected to participate in this study. They were assigned to 2 groups (4 persons in each group). Each group received 10 sessions of NFT (2 sessions per week).

20 GROUP 1 GROUP 2 Received standardized neurofeedback treatment protocols. Received individualized neurofeedback treatment protocols. Protocols: 1. C3 Beta - improve attention 2. C4 SMR - reduce impulsivity and restless behavior 3. Pz Alpha - improve sensory regulation and cognition Protocols were based on participant s critical needs. (clinical symptoms)

21 GROUP 1 V. SAMPLE Four children diagnosed with autism spectrum disorder (moderate level) Age 7 to 11 Selection criteria: Able to sit through a 45 minutes session Children who can commit to 10 sessions of NFT

22 GROUP 2 Four children diagnosed with autism spectrum disorder (3 moderate, 1 severe) Age 5 to 20 Selection Criteria: Children are able to sit through a 45 minutes session Children who can commit to 10 sessions of NFT

23 GROUP 1 VI. PROTOCOLS Child Protocol Period Frequency A, B, C & D C3 Beta 6 All sessions C4 SMR 6 Sessions 1, 3, 5, 7 & 9 Pz Alpha 6 Sessions 2, 4, 6, 8 & 10

24 GROUP 2 Child Protocol Period Frequency E (moderate) P3 Beta T4 Delta 4 4 All sessions F (moderate) C3 Beta F8 Delta 4 4 G (severe) P3 Beta T4-P4 Delta 4 4 H (moderate) C3 Beta T4-P4 Delta 4 4 Protocols are decided based on children s needs.

25 VII. TRAINING GROUP 1 & 2 Parents were given 3 hours of training on placement of electrode, how to get good signal and how to run the neurofeedback training.

26 VIII. PROCEDURE GROUP 1 & 2 Parents of the selected children were given briefing on the purpose and requirements of the study. All parents signed consent forms to allow their children to participate in the study.

27 Children in each group started the session together. Parents conducted the sessions with minimal supervision from neurofeedback therapist. Children played games as feedback for beta training. Children watched video as feedback for SMR, alpha and delta training.

28 Training duration and thresholds were adjusted if necessary based on parent s feedback on child s behavior. Parents were asked to rate child s behavior with the individualized progress checklist after each session.

29 Therapist supervised the NFT from session 1 to 5. Supervision was reduced and faded off from 6 th session onwards.

30 IX. RESULTS: GROUP 1

31 Child A and D showed negative effect after the 3 rd and 4 th session: Uncontrollable laughing Increased restless behavior Unable to attend to task Increased self talk Sudden shouting without reason

32 Adjustment to the training duration were made at the 6 th session. 4 periods for beta training 8 periods for SMR and alpha training After adjustment, child A and child D s inappropriate behaviors reduced.

33 Child B and Child C showed positive effect from the standardized neurofeedback protocols: Improvement in concentration and attention Faster response in answering questions Increased awareness to their surroundings

34 GROUP 1 CHILD A Uncontrollable laughing Unable to sustain attention on school work Restless behavior increased (walked in and out of classroom, running around) Increased in making meaningless sounds Slow in response to instructions Increased self talk CHILD D Increased hyperactivity Increased impulsivity (Gets excited very quickly and shouts) Stiffen body and tense face muscle Able to stay asleep better After adjustment: Uncontrollable laughing reduced Restless behavior reduced Increased attempt to communicate with mother Respond to instructions slightly faster Able to make request more often but in single word Makes more meaningful communication with mother Attention and concentration improved Memory improved

35 CHILD B Able to follow instructions promptly Able to engage in sequential tasks (origami) with minimal guidance Improved understanding of context Improved memory recall Attention and concentration improved Able to answer questions correctly and promptly CHILD C Increased awareness towards surrounding Showed more initiative to communicate with mother though not in complete sentence Comment on his surroundings to mother Restless behavior reduced Able to answer question correctly and promptly Attention and concentration improved Self talk reduced

36 RESULTS: GROUP 2

37 Child Protocols & Objective Changes observed E P3 Beta - Improve speech processing and learning T4 Delta - Moderate emotion After protocol adjustment: P3-P4 Alpha - Improve sensory processing C4 Delta - Reduce restless behavior Increased in self talk, repeat sentences / instructions that parents usually say (irrelevant to situation) Increase of self stimulatory behavior Increase in hyperactivity Body coordination improved (able to pedal on bicycle with training wheels, do cross limb training in OT session) Self stimulatory behavior reduced Increased awareness of surroundings Improved in answering questions and making request Repeat phrases relevant to situation Able to understand non verbal cues better Response time is faster Started to memorize and spell words

38 Child Protocol & Objective Changes observed F C3 Beta - Increase awareness to surrounding F8 Delta - Reduce anxiety Self talk increased Gets irritated easily Snoring reduced C3 Beta maintained 4 periods F8 Delta increased from 4 to 6 periods Able to construct complete sentence better and vocalize Self talk and self singing decreased Increased awareness of surrounding (initiated to keep floor mats after activity, greet people without mother s reminder) Eye contact improved Less anxious when she played with dogs, able to feed, play and kiss the dogs. (She was guided physically previously)

39 Child Protocols & Objective Changes observed G (severe) P3 Beta - Improve speech processing and learning T4-P4 Delta - Reduce impulsiveness and emotional outburst P3 Beta maintained 4 periods T4-P4 Delta increased from 4 to 6 periods Responds faster when his name was called. Better in following instructions. Attention and understanding of task improved. Able to listen to mother s reasoning when he is upset / frustrated. Temper tantrum reduced. (He hits a Barney soft toy at home when he s upset. The hitting behaviour reduced)

40 Child Protocols & Objective Changes observed H C3 Beta - Improve attention T4-P4 Delta Reduce impulsiveness and emotional outburst After 1 st Adjustment: C3 Beta 3 periods T4 Delta 3 periods P4 Delta 3 periods Increased awareness of surrounding Able to imitate teacher s body movements in class Temper tantrum intensified Impulsivity increased (shout without reason) Showed more aggressive and destructive behaviours during temper tantrum (scratch and bite others, turn over table, threw things on floor) No changes were reported after changing bipolar (T4-P4) to monopolar (T4, P4).

41 Child Protocols & Objective Changes observed H After 2 nd adjustment: T4 Delta - Moderate emotion F4 Delta - Reduce strong emotion No temper tantrum reported. Mother reported child seemed calmer and sleeps earlier than usual. Able to understand better when parents reason with him when he couldn t get things that he wants.

42 Objective 1: X. CONCLUSION Neurofeedback therapy is recommended to be conducted in individual setting. The child s emotional state and movements in the room caused distraction to other children during NFT.

43 Children who were frustrated or agitated displayed behaviors such as shouting, crying and body rocking. These behaviors caused distraction to other children. During session, few children ended earlier and left the room. The movements in and out of the room also caused distraction for those who were still doing the NFT.

44 Objective 2: Individualized neurofeedback treatment protocols are recommended for children with autism. Children who received individualized neurofeedback treatment protocols (Group 2) showed positive and immediate effect from NFT.

45 Only 2 children who received standardized neurofeedback treatment protocols (Group 1) showed positive effect from NFT. Adjustments to the standardized neurofeedback protocols were needed to suit the children s needs.

46 REFERENCES Coben, R. & Padolsky, I. (2007). Assessment-guided neurofeedback for autistic spectrum. Journal of Neurotherapy, 11(1),5-22. doi: /j184v11n01_02. Fuchs, T., Birbaumer, N., Lutzenberger, W., Gruzelier, J., & Kaiser, J. (2003). Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: A comparison with methylphenidate. Applied psychophysiology and biofeedback., 28(1), Retrieved from Jarusiewicz, B. (2002). Efficacy of Neurofeedback for Children in the Autistic Spectrum: A Pilot Study. Journal of Neurotherapy: Investigations in Neuromodulation, Neurofeedback and Applied Neuroscience. 6(4), Kaiser, D. A., & Othmer, S. (2000). Effect of Neurofeedback on variables of attention in a large multi-center trial. Journal of Neurotherapy, 4(1), doi: /j184v04n01_02 Kouijzer, M. E. J., De Moor, J. M. H., Gerrits, B. J. L., Congedo, M., & Van Schie, H. T. (2009). Neurofeedback improves executive functioning in children with autism spectrum disorders. Research in Autism Spectrum Disorders, 3(1),

47 Mohammadi, M. R., Malmir, N., Khaleghi, A., & Aminiorani, M. (2015). Comparison of Sensorimotor rhythm (SMR) and beta training on selective attention and symptoms in children with attention deficit/hyperactivity disorder (ADHD): A trend report., 10(3),. Retrieved from Norsiah Fauzan and Nurul Aina Mohd Mahayuddin / Procedia - Social and Behavioral Sciences 143 ( 2014 ) Pineda, J. A., Brang, D., Hecht, E., Edwards, L., Carey, S., Bacon, M., Futagaki, C., Suk, D., Tom, J., Birnbaum, C, Rork, A. (2008). Positive behavioral and electrophysiological changes following neurofeedback training in children with autism. Research in Autism Spectrum Disorders, 2(3), doi: /j.rasd Pineda, J. A., Friedrich, E. V. C., & LaMarca, K. (2014). Neurorehabilitation of social dysfunctions: A model-based neurofeedback approach for low and high-functioning autism. Frontiers in Neuroengineering, 7,. doi: /fneng See, C. M. (2010). The Reach Way to Transformation. Penang: Association of Resource and Education for Autistic Children.

48 THANK YOU