HighQ Cognitive Enrichment Program

Transcription

1 HighQ Cognitive Enrichment Program Treating blocks to achievement Dr Shelley Hyman Senior Clinical Neuropsychologist

2 TABLE OF CONTENTS Part A: Treating Blocks to Achievement... 3 COGNIQ: COGNITIVE TRAINING... 4 SKILLS THAT CAN BE TRAINED... 5 BRAINQ: NEUROFEEDBACK... 6 WHAT IS NEUROFEEDBACK... 6 HOW DOES NEUROFEEDBACK WORK?... 6 MODIFYING AROUSAL LEVELS: NEUROPLASTICITY... 7 CHANGES TO MONITOR DURING NEUROFEEDBACK... 8 SCIENTIFIC EVIDENCE FOR NEUROFEEDBACK... 9 EYEQ: ORTHOPTIC VISUAL TRAINING SPEECHQ: SPEECH & LANGUAGE SKILLS EMOTIQ: PSYCHOLOGICAL THERAPY & EMOTIONAL RESILIENCE SOCIALQ: SOCIAL SKILLS TRAINING BEHAVIQ: BEHAVIOUR MANAGEMENT Part B: Individualised Therapy Costs & Rebates

3 PART A: TREATING BLOCKS TO ACHIEVEMENT It is vital that before you engage in any type of treatment program that your child has been thoroughly assessed, so that all the blocks to achievement have been identified, and a proper holistic treatment plan is formulated. Sometimes assessments only look at describing what the learning issues are, however understanding the true cause that has created the learning issues is essential so that the core problem can be treated, rather than just the symptoms. At the SCDC we differ from learning centres as we aim to find the root cause of any blocks, rather than simply repeat over and over information that a child should have learnt in the classroom. We have high level specialists that conduct detailed and precise testing [see Guide to Child Therapy for more details]. Our goal is to remove (or at least reduce) blocks to learning so that your child can learn like all other children in the classroom, and so that additional tuition in the future or learning support can be remove or reduced. MEMORY AUDITORY PROCESSING BRAIN DYSREGULATION PLANNING & ORGANISATION PARENTING LANGUAGE SKILLS IMPULSIVITY & MOTOR RESTLESSNESS 3 ATTENTION EMOTIONAL RESILIENCE Comprehensive Assessment Identification of Blocks to Learning Individualised Comprehensive Treatment Plan VISUAL SKILLS SOCIAL SKILLS MINDFULNESS BEHAVIOUR

4 COGNIQ: COGNITIVE TRAINING Our cognitive training program is based upon principals of neuroplasticity, aimed at changing the actual brain pathways involved in various cognitive skills. For some children these skills can be retrained, whilst for children with more significant deficits, a combination of improving core skills as well as compensating for these weaknesses in daily life will be trained. All training involves weekly one-on-one sessions with a clinician, with a home program set up individually for each child to be completed between sessions. Each area trained undergoes the following 3 stages: Stage 1: Basic core training. At this stage we will build core skills through a variety of abstract tasks. These tasks are aimed at building core skills and strategic mindsets in approaching a variety of tasks specific to the area of cognition that needs to be trained. This stage also involves training the child in concepts of generalisation, so that strategies taught are also applied to new and novel tasks. By doing this we not only train your child on a specific task (like many other computerised cognitive training programs), but we also teach the child to generalise these skills to other tasks. This initial stage is done in the clinic, and then various ipad/computer tasks are practiced at home. Stage 2: Real world task training. At this stage we will then introduce real world daily activities that are impacted by the core cognitive weakness, and train the child to enhance this skill through applying the same techniques learnt in stage 1. This will involve not only in clinic training, but also a variety of tasks that are practiced at home. These tasks are slight modifications to everyday tasks that the child normally has to complete, however the processing demands of the tasks will be altered. Stage 3: Academic enhancement. At this stage we will ensure that all the cognitive areas that are being trained are generalising to specific educational tasks and educational environments. 4

5 SKILLS THAT CAN BE TRAINED Based upon precise cognitive assessment, if weaknesses are found in any of the areas below these can each be trained through our cognitive training program. The extent of the issues listed below supports the need for thorough neurocognitive testing by a specialist neuropsychologist. Depending on your child s specific profile of strengths and weaknesses, an individualised program will be formulated. Cognitive Domain Visual attention Auditory attention Complex attention Executive functioning Visual memory Auditory memory Working memory Specific skill to be trained Visual attention span Visual sustained attention Visual selective attention Auditory attention span Auditory sustained attention Switching attention Divided attention (between 2 tasks) Impulsivity Planning Organisation Problem solving Using feedback Strategy generation Cognitive flexibility Self-monitoring Time management Visual memory span Visual immediate memory Visual delayed recall Visual recognition memory Verbal memory span Verbal immediate memory Verbal delayed recall Verbal recognition memory Auditory working memory Visual working memory 5

6 BRAINQ: NEUROFEEDBACK WHAT IS NEUROFEEDBACK Neurofeedback is also called EEG Biofeedback, because it is based on electrical brain activity, the electroencephalogram (EEG). It aims to help individuals improve emotional, behavioural and cognitive functioning by training patients to increase certain brainwaves whilst inhibiting others, to promote optimal brain regulation. Unlike medication, neurofeedback has long-term benefits as it actually treats the core functional problem rather than simply masking symptoms. Whilst stimulant medications can be effective for up to 12 hours, completing a program of neurofeedback is found to have long term benefits (with current research showing benefits present after 10 years post treatment). HOW DOES NEUROFEEDBACK WORK? Neurofeedback is based on operant conditioning, a type of training that involves rewarding patients to inhibit certain brain wave frequencies and increase other frequencies. This is done by placing electrodes on the scalp and then providing instantaneous feedback about the brain s activity. This awareness allows the opportunity to gradually recondition brain activity. Changes in brain patterns are associated with positive changes in physical, emotional, and cognitive states. Often the individual is not consciously aware of the mechanisms by which such changes are accomplished, although people routinely acquire a "felt sense" of these positive changes and can then access these states outside the feedback session. For the first few sessions of training, individuals will be able to observe the effect of neurofeedback for up to hours, and the benefits of neurofeedback will last longer following more training sessions. Standard neurofeedback training usually involves sessions. Consistency is very important for the training in order to yield enduring benefits. 6

7 MODIFYING AROUSAL LEVELS: NEUROPLASTICITY Neurofeedback is aimed at improving symptoms of over- or under-arousal. Examples of under-arousal ADHD inattentive presentation Poor concentration Inattentive Distractibility Frequent day dreaming Spaciness/ fogginess Forgetful Lack of motivation Depression/ low mood Lethargy Sensitive/ feelings easily hurt Frequent waking at night Not feeling rested after sleep Falls asleep in low stimulation situations Low self-esteem Examples of over-arousal Busy mind/ many competing thoughts Impulsive Fidgety Hyperactive Easily bored Risk seeker Impatient Agitated Aggressive Anxious/ fearful Tense Feel overwhelmed Frequent tension headaches Holds resentments Difficulty falling asleep Training for Under-Arousal Individuals who are experiencing symptoms of under-arousal tend to have excess theta brain waves and decreased beta brain waves. The treatment goal for under-aroused individuals is to reduce the level of theta waves, the level of drowsiness, and increase beta waves. At the end of each training session, individual should feel more awake, focused and motivated. Training for Over-Arousal Individuals who are experiencing symptoms of overarousal tend to have excess beta brain waves and decreased SMR brain waves. Treatment goal for overarousal individuals is to reduce the level of beta waves, and increase SMR waves. A reduction in excess energy levels allow the mind and body to be more relaxed and calmer, yet alert at the same time. 7

8 Brainwave Modification There are several dominant brainwaves that reflect different states of arousal. Modification is made to the selected brain waves based on the characteristics of arousal level reported. It can take up to 5 sessions to find the optimal training protocol for each individual. Too Little Normal Too much Delta 0-4 Hz Poor sleep Restful sleep Depressed/ Sluggish Theta 4-8 Hz Robotic/ poor emotional awareness Intuitive Drowsiness/ Day dreaming Alpha 8-12 Hz Exhaustion SMR Hz Scattered Beta Hz Hz cycles per second SCDCSS Tired Depressed Unmotivated Relaxed/ Focused Calm/relaxed Mental Alertness Active thinking Engaged Anxiety/ Hypervigilant Depressed Mind chatter Unable to relax Tense CHANGES TO MONITOR DURING NEUROFEEDBACK Neurofeedback training is a painless, non-invasive, non-pharmaceutical procedure, and patients often report it is a pleasurable and fun experience. Everyone s sensitivity to treatment varies and not everyone will have the same reaction to the treatment. For the first few sessions it will be important to get feedback about the effects of the training. 8

9 Changes to observe after a training session: State of relaxation Feelings of being tense Levels of alertness Clarity of thinking Thinking about problems excessively Levels of anxiety Changes in mood Any physical discomfort. (e.g., headaches) There is no evidence from the literature that the treatment is harmful or that it creates negative side effects. Sometimes in sensitive individuals the training can be too strong and the individual may become overly aroused (if under-aroused) or overly under-aroused (if over-aroused). Usually these symptoms wear off and the training can be adjusted, although it is possible to have the effects reversed in another training sessions if preferred. If you notice any unusual changes or negative effects after a training session, such as anxiety, agitation, difficulty falling asleep, fatigue, feeling spacey/ cognitively dull, please let your trainer know as soon as possible so that the training protocol can be modified. SCIENTIFIC EVIDENCE FOR NEUROFEEDBACK Research has shown that problems with brain regulation are associated with a broad range of psychological and psychiatric conditions (e.g. attention issues, anxiety, and sleep issues). Research over the past 40 years has shown that neurofeedback can be highly effective in altering brain dysregulation via principles of neuroplasticity, without the use of medication, in a non-invasive manner. A meta-analysis looking at the efficacy of neurofeedback treatment in patients with ADHD showed that neurofeedback treatment has a medium to strong effect in reducing inattention, impulsivity and hyperactivity symptoms for ADHD patients (Arns, de Ridder, Strehl, Breteler & Coenen, 2009). In November 2012, the American Academy of Paediatrics approved biofeedback and neurofeedback as a Level 1 or best support treatment option for children suffering from ADHD. Likewise, the American Psychological Association has also recognised that research has proven this treatment to be at the highest level of efficacy of treatment for ADHD ( Level 5 by their ratings). It has also shown promising benefits with various behavioural disorders, anxiety, depression, sleep problems, chronic pain, minor head injury and seizure disorders. 9

10 EYEQ: ORTHOPTIC VISUAL TRAINING Orthoptic visual training is conducted when a child is assessed to have either a functional eye issue or an issue with higher level visual processing. Visual issues with acuity such as far sightedness, long sightedness or astigmatism can be treated with appropriate lenses. Functional eye problems including issues with eye teaming (binocularity, fusion or stereopsis), fine eye movements (e.g. tracking), accommodation or convergence, will all require an individualised visual training program. This program involves weekly training with our Orthoptist as well as exercises to be conducted during the week, often on a daily basis to see the best results. Higher level visual processing issues such as problems with spatial orientation, visual memory (e.g. learning sight words), figure-ground, visual discrimination or the visual side of visual-motor integration, can all be trained through a different type of visual training program focusing on improving visual skills through processes of neuroplasticity. Often when children have basic functional visual issues these issues can create higher level processing weaknesses due to disruptions in brain development from limitations in the visual information presented to the brain. If both higher level and functional visual issues are present, the functional issues will be treated first in order to correct the information presented to the brain. In some cases the higher level issues will automatically resolve, however in others the processing may need a boost before it is normalised. The average child after a course of visual training (approximately 1-2 terms) will have totally normalised functional and processing skills. NOTE: At our centre we do NOT use coloured lens as we only use scientifically proven strategies to improve functional and processing issues. Far-sightedness Long-sightedness Astigmatism Eye teaming Binocularity Fusion Stereopsis Fine eye movements Tracking Accommodation Convergence Visual discrimination Visual memory Spatial skills Form consistency Figure-ground Visual closure 10

11 SPEECHQ: SPEECH & LANGUAGE SKILLS Speech therapy is aimed at improving speech and language skills, social communication and oral motor abilities. After having identified via assessment the precise issues your child is exhibiting, an individualised plan can be made to address the noted weaknesses in speech, language or literacy. A speech therapy program may address issues with articulation, problems with general communication (such as vocabulary, grammar and sentence construction) or the ability to comprehend language. If issues are noted with aspects of auditory processing (such as sound discrimination) or phonological processing (blending or segmenting words when reading/writing), these skills can also be targeted in therapy. Issues with language comprehension and expression may also create issues with reading comprehension and written expression. These issues can also be improved in therapy once more basic language skills are built. Six specialist literacy programs are run by our speech therapist consultant, Ciara Holland, who is part of The Language Tree. Program 1: Handwriting Program 2: Spelling & Reading Program 3: Vocabulary development Program 4: Comprehension Program 5: Story Writing Program 6: Essay Writing 11

12 EMOTIQ: PSYCHOLOGICAL THERAPY & EMOTIONAL RESILIENCE At the SCDC all of our therapists tend to use a combination of both Cognitive Behavioural Therapy (CBT) as well as ACT therapy. We find that each child is highly individual, hence we rarely decide on the style of therapy that we think is going to be beneficial for them without first meeting and talking with the child and finding out their personality, cognitive skills and therapeutic needs. We find some children have little insight into their thoughts and emotions and may need to engage in a more thinking style therapy to get more into their heads. This will help them understand why they are doing certain unhelpful behaviours and why they are experiencing negative emotions. These types of children often do well with a more cognitive-based style of therapy like CBT. Other children are too much in their heads, over thinking things in their lives, to the point they stop living and experiencing life. For these patients we find they need to get out of their heads and start working on what they want in their lives to achieve a more meaningful life. These patients do better with ACT therapy, which focuses on acceptance and mindfulness as a means of being more engaged in life. We also offer family therapy if we feel that family dynamics are creating negativity in a child s life. For children under the age of 7 years or with those who cannot engage in a more talking style therapy (for a variety of reasons) we tend to offer more play-based therapy. We also run group Positive Psychology courses as well as mindfulness courses to help enhance resilience in all children even without a clinical diagnosis. For some children with low mood or depression that have a profile of general under-arousal, some neurofeedback may be helpful to increase mood and energy levels in combination with therapy. For some children with high anxiety who have issues turning off their thoughts and who have a profile of general over-arousal, some neurofeedback can also be helpful in therapy to reduce this over-arousal and enhance calmness and relaxation if they find it hard to use therapeutic strategies when overwhelmed. Depression Anxiety Phobias Panic Attacks Obsessive Compulsive Disorder Low Self-esteem Anger Aggression Defiance Adjustment Disorder Post-traumatic Stress Disorder & Acute Stress Disorder 12

13 SOCIALQ: SOCIAL SKILLS TRAINING Social skills are paramount to a child s success in navigating the world around them. If social skills are poor this can affect peer relationships and open up a child to bullying, ridicule and social isolation. This can make school a nightmare for the child, creating much anxiety and frustration. If social issues are present at home this can affect family dynamics, creating parental frustration as well as issues with siblings.. At the SCDC we have several social skills programs both individualised and group based. For each child it needs to be determined whether the therapy is best conducted in a group or individually. For children with symptoms of ASD with poor theory of mind, some individualised therapy may be required before group therapy can be conducted. Likewise, for a child with ADHD who has impulse control issues, the training is often best done individually first to control the more ADHD features of the social issues before moving on to general social skills. Co-operation Communication Responsibility Empathy Engagement Self-control 13

14 BEHAVIQ: BEHAVIOUR MANAGEMENT A child s behaviour can be very different across various situations depending on how challenging the situation is, as well as the levels of boundaries that are in place. Some children have very challenging behaviours at home, whereas in school they are well behaved. This is often due to the more ridges boundaries, clear expectations of behaviour and clear punishment systems. Conversely some children are well behaved at home where there are little expectations in regards to challenging work, but can become very defiant or shut down in the classroom. Other children through various underlying weaknesses learn from a young age that in today s society the current acceptable punishments (removal of TV, computers, ipads etc.) can easily be lived with, and that the alternative (e.g. doing chores or homework) actually feels worse than the punishment. These children often look like they do not respond to traditional reward and punishment systems. Working with children s behaviour is often about understanding the core thoughts underlying their behaviour, and then giving a child more helpful alternatives that make sense to them. This often requires therapy directly with the child, whilst at the same time looking at parenting tools, and then coming up with a system that the child will respond to. Often with behaviour management we have sessions alone with your child, sessions alone with the parents, as well as sessions all together. If issues exist with behaviour at school we may do a school visit and then work closely with the teacher/school to help modify behaviour. 14

15 PART B: INDIVIDUALISED THERAPY COSTS & REBATES Depending on the type of therapy required we have various clinicians who can work with your child. If multiple therapies are needed we regularly hold group meetings where we can discuss your child s progress so that we all work closely together as a team. Note: Private health rebates will depend on your insurer and level of insurance Dr Shelley Hyman: Senior Clinical Neuropsychologist & Director Neurocognitive assessment Psychological assessment Cognitive training Psychological therapy Neurofeedback supervisor Behaviour management Parenting Initial consultation - $250 Subsequent sessions - $200 Both Medicare and Private rebates available for therapy consultations. Marika Donkin: Clinical Neuropsychologist Neurocognitive assessment Cognitive Training Initial consultation - $200 Subsequent sessions - $180 Both Medicare and Private rebates available for therapy consultations. Nicole Andrews: Clinical Psychologist Psychological assessment Cognitive Training Psychological therapy Initial consultation - $200 Subsequent sessions - $180 Both Medicare and Private rebates available for therapy 15

16 Eyal Pat: Consultant Orthoptist Orthoptic Visual Training Initial consultation: $180 Subsequent sessions: $120 Private Healthcare Insurance rebates Ciara Holland: Speech Pathologist Speech, Language & Literacy Therapy 30/45/60 minute session: $85/$115/$140 Both Medicare and Private Healthcare rebates available for therapy consultations, FaHSCIA Funding Candice Michael: Cognitive Trainer & Provisional Psychologist Cognitive Training Cognitive training sessions: $120 Discounted rate as no rebates available Vivian Chiu: Provisional Psychologist & Neurofeedback Provider Neurofeedback Neurocognitive assessment Psychological assessment Cognitive training Psychological therapy Cognitive training sessions: $120 Neurofeedback sessions: $80 Discounted rate as no rebates are available 16