1	Case Studies in Neurofeedback
2	Types of anecdotal support Case examples from The NeuroDevelopment Center (with supporting data) Pre and Post Neurofeedback qEEG studies Anecdotal evidence from other centers
3	Anecdotal evidence Widespread and voluminous anecdotal evidence, including my own clinical experience (with measures to support), attests to the power of neurofeedback in several areas of mental health practice
4	Child’s family drawing
5	Same child family drawing some time later
6	Drawing even later
7	Child’s family drawing at beginning of NFB: August 3rd
8	Drawing after twenty sessions September 8th
9	Drawing after forty sessions: November 11
10	"Those most familiar with children’s..." Those most familiar with children’s drawings (elementary teachers, child clinicians) typically estimate that three years passed between the first and last drawings. Not three years passed, but three months. Neurofeedback appears to have facilitated very rapid personal growth.
11	Male, age 9. Drawing before starting Neurofeedback training, 1/6/95
12	Male, age 9. Drawing after 4 months of Neurofeedback training, 5/2/95
13	ADHD Case Example HS Senior, dx ADHD, also mood problems but no formal diagnosis Very poor organizational skills Uncooperative at home, sullen Parents concerned that he would not continue with his medications once he left home for college
14	IVA Computerized Test of Attention, Impulsivity, and Hyperactivity Research proven objective measure Response Control measures impulsivity Attention Quotient measures inattention 100 is average; 15 points is a clinically significant difference
15	Pre NFB IVA 3/25/03
16	Post NFB IVA: 5/23/03 16 sessions
17	"Improved from 2^nd to 53^rd..." Improved from 2^nd to 53^rd percentile in attention 2 standard deviations gain in attention Attention normalized in 16 sessions Mood, flexibility, cooperativeness, organization, and planning improved
18	His mother’s view: Our son was diagnosed with ADD eleven years ago, and since then has been on either Ritalin or Adderal. Although he has willingly taken his medication when it is put out for him, he doesn’t think to take it on his own. I was getting desperate. He is heading off to college next year, and I had visions of him becoming angry, frustrated, and discouraged, as well as missing classes, assignment deadlines, and even meals due to his lack of time awareness. Even though neurofeedback sounded very promising, it seemed almost a little too “woo-woo” (you know, Twilight Zone theme song playing in the background). However, I was at the point where I was willing to give anything a chance!
19	"During his first IVA," During his first IVA, his ability to focus was two standard deviations below normal. After just 17 sessions, when given another IVA, he tested in the normal range. If I had to rely on just a test result, I wouldn’t be impressed, but my husband and I see it first-hand in day to day situations! E’s “stick-to-itness” has improved tremendously. He’s actually able to finish tasks he begins without getting side-tracked ten times!
20	"He functions on a much..." He functions on a much more even keel, and his outlook is much more positive. Incidents which would have angered or frustrated him before neurofeedback, now seem to have very little negative effect. His whole personality has “lightened up,” and he is actually able to laugh at himself! In looking at his report card for the last marking period I was truly amazed; all his grades were good, but in two courses he liked the least, he went from a 70 to an 80, and a 75 to a 95! I very rarely feel the need to give him his medication any more, so I feel much more secure about sending him to college this September…. -MP, Grateful Mom
21	Case examples from The NeuroDevelopment Center: ADHD HS Junior dx with ADHD On stimulants three or four years Helped with attentional symptoms but exacerbated anxiety and oppositional behavior He and parents sought to reduce or eliminate need for medication
22	Pre-NFB IVA 1/21/03
23	Post NFB IVA: 4/10/03 18 sessions
24	"Two standard deviation improvement in..." Two standard deviation improvement in both domains Improved from the 9th to the 75th percentile in impulsivity Improved from 5th to the 75th percentile in attention More even profile, visual and auditory 18 sessions of NFB normalized his IVA His self report and parents report parallel this: attention good, more cooperative, less anxious, less stuck Back to school without any medication
25	Autistic Spectrum Case Example 4 years of old with PDD-NOS When came for NFB, extreme obsession with microwave, freak out if anyone else touched the buttons Tantrums typically >10 per day Largely unrelated to parents: sat on M’s lap as if she a booster seat during early sessions
26	"Limited language:" Limited language: four to five word sentences; much echolalia Attacked his brother if he came near his toys Completely unrelated to peers (school reports) So over-aroused unable to use individual Relationship Development Intervention No pretend play, arranging play - lining toys up exclusively
27	After three months… So busy having fun with face to face interaction with mother, it was hard to get him to look at the screen Many fewer tantrums Little aggression to brother No obsessions Speaking in simple sentences.
28	After six months Asked his mother to get a toy for his brother when shopping Engaging in joint pretend play with brother Inviting brother to get into his bed with him Thriving in RDI work with professional Consistently interacting with peers in school
29	"Special education team in school" Special education team in school: “We have worked with ASD kids for many years. E’s development over the past year has been amazing. We have never seen anything like it. We do a good job, but we know what to expect from our work. The unbelievable changes have been primarily from the neurofeedback…” Paraphrased by mother
30	His Mom.. “My son was a normal baby who, around 15 months old, stopped talking, more or less stopped smiling, started screaming a lot, and became very obsessive….By the time he was 3.5 years old, he was very non-compliant, obsessive, and aggressive toward his younger brother. He spent much of the day screaming or smashing his head into the wall or floor. His obsessions were so strong they ran our lives. I had difficulty bathing him, getting him dressed, and especially, keeping him from hurting his brother. Everything was a struggle. He was diagnosed with autism (PDD-NOS) around this time.
31	"A few months later my..." A few months later my son started EEG biofeedback… He is now a nice little boy. He gives me kisses when I am sad. He is no more aggressive with his brother than any normal kid. In fact, he is very tolerant. His obsessions have decreased markedly. He plays cooperatively with his brother and shows concern for him...I am extremely grateful to have my child back. I am convinced that it is this treatment (EEG biofeedback) that has changed him.” R. H. , N. Attleboro, MA
32	ASD Case Example #2 Age 8, Asperger’s Disorder, high functioning After 11 once weekly sessions, his teachers wrote: “Since S began his appointments with you we have noticed the following changes in him: A new interest in conversing with his peers; he has been joining in conversations during snack He now listens to whole group instructions and asks appropriate questions if he does not understand something, instead of needing the directions repeated one on one after the lessons
33	"He works more independently in..." He works more independently in all curriculum areas and is very proud of his independence He is able to generate ideas for writing and organizes his thoughts independently He remembers to do his classroom job without prompting When he is out of the classroom for services, he asks a classmate without prompting for the assignment he missed and writes it down In general, he seems more “aware” of everything than he used to be”
34	Pre NFB IVA: 1/23/03
35	6/12/03 IVA after 18 NFB sessions
36	"1 SD improvement in impulsivity" 1 SD improvement in impulsivity: Improved from 50th to the 84^th percentile 3 SD improvement in attention Improved from .4th to the 84^th percentile IVA normalized in 18 sessions Major improvements in other areas of executive and social function
37	Case example:NLD Fourth grader Frequent aggressive outbursts Highly inattentive Extremely impulsive Poor organization Poor social relationships
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41	"17 point improvement in impulsivity" 17 point improvement in impulsivity: 1 SD Improved from the 2^nd to the 25^th percentile 16 point improvement in attention: 1 SD Improved from the 25^th to the 63^rd percentile From extremely severe hyperactivity to almost none His therapist (of many years) described enormous gains in self control, social relationships, cooperativeness
42	Parents’ continued: NLD “ My son is 10 years old and has been diagnosed with non-verbal learning disorder. He was challenged every day to control his emotions and manage his frustrations with everyday situations. He would become very upset when he perceived situations as unfair or negative...He would become overly aggressive, (showed) ragelike behavior, and (was) extremely defiant to everyone. ….
43	"After approximately 10 sessions of..." After approximately 10 sessions of neurofeedback, we began to see a difference... He is now handling the same situations with grace. He is handling the loss of football games and recess at school without incident. He is a better friend and is in better control of his emotions.” -C.L., N Providence, RI
44	ADHD, Anxiety, and Depression Case Example 7 year old boy Attention deficits, impulsive, hyperactive, oppositional behavior, extreme emotional sensitivity, anxious, irritable, depressed mood Numerous medications tried and in various combinations Either negative side effects or no positive change Training focused on reduction of anxiety, impulsivity, and overarousal symptoms
45	Pre NFB IVA 4/2/03
46	7/2/03 IVA after 17 sessions
47	Mother’s view: My son had been having difficulty at home and school managing throughout the day, struggling with social interactions, and staying focused at school. We had tried many things including 5-6 different medications, none of which helped. Most made him more agitated, aggressive, angry and less able to focus. The last straw was when he asked me to kill him because his life was way too hard. He is only 7. This brought me to seek alternate routes of treatment, thus The NeuroDevelopment Center.
48	"The results have been amazing" The results have been amazing. He now looks at the world in a totally different perspective. The glass is now half full, not empty. He is able to handle frustrations and challenges without getting angry and aggressive. His social situations have also become much easier for him to negotiate. He no longer feels the need to be in control of everything the group is doing. He is now willing to put his ideas on hold, and follow through with what others want to do. His laughter is one of the most beautiful sounds and something we rarely heard. We and he discovered he has a good sense of humor.
49	"To all parents who are..." To all parents who are lost and torn and feel like they’re on a merry-go-round that doesn’t stop, please take a look at the alternatives. Neurofeedback has certainly had a huge impact on our family and hopefully on the outlook he has for his future. The fears/anxieties that he still has at least now he can verbalize, and we can discuss them openly. We now have some idea as to what he is thinking/feeling. -SF
50	"He began school this September..." He began school this September on no medications. The special education teacher (who knew him from last year) reports that his attention, behavior, and social relationships are markedly improved.
51	RAD Case Example 12 diagnosed with RAD, ADHD, ODD Years of individual and family therapy produced minimal gains Medications minimally helpful Expelled from numerous schools for behavior problems Parents had decided to send him to military school as last resort Chief goal was to reduce impulsivity and angry, oppositional behavior
52	Pre NFB IVA 6/18/03
53	7/29/03 IVA after 12 sessions
54	Overall >2 SD improvement in impulsivity in 12 sessions: we did not train for attention Improved from .4^th to 25^th percentile Parents reported much more affectionate, less aggressive, better self-control, less angry behavior Family and individual therapists made similar observations. Also more able to communicate, more self-reflective and open
55	Case example: Phobia 7 year old girl, anxious temperament Developed severe phobia of fire Missed more days of school than she attended in the spring of 2001 due to fear of fire drill Family took her to Disney World to cheer her up. Had to leave after first night due to terror of fire.
56	"12 sessions of neurofeedback" 12 sessions of neurofeedback After 5 or 6, did small amount of cognitive behavioral work (5 minutes at the end of a few sessions to orient her to growing ability to “beat” her fears Complete remission of her symptoms Two years later, gains maintained, no further fears or substitute symptoms
57	Severe phobia of fire “It is hard to believe that a year ago my family was living in Hell. My daughter was so scared of everything in life and my husband and I didn't know what else to do for her. The level of stress, fear, and sadness was unbearable. Her anxieties and panics were becoming mine. It is unbelievable the change which has occurred. The confidence she has built in herself and in facing her fears is remarkable.” -F.P., East Providence, RI
58	In general for anxiety In past, would often do cognitive behavioral therapy Good results, but many still “felt” anxious, but better at managing/coping, so CBT frequently did not change the basic condition of having an easily over-aroused nervous system Have repeatedly seen with NFB that anxiety symptoms just go away, because the nervous system calms down: eg 9 year old, NLD, severe anxiety re dogs, could not use CBT: too much panic to tolerate any exposure After 2 months of NFB, symptoms gone: petting dogs on walk around neighborhood
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60	Pre and Post qEEG: depression
61	Overall response rate: our experience 21% some improvement 69% major improvement 4% huge improvement Only 6.4% no improvement Of the first category, many are still in early stages
62	What NFB helps with reliably, from our experience Attention, impulsivity, hyperactivity Anxiety Mood state (frequent report: he says he just feels happier since neurofeedback) Mood regulation: greater stability Flexibility, cooperativeness Organization, planning, and other executive function (Emmett: school goals for the year)
63	"More “with it”:..." More “with it”: attentive to the external world Better self reflection, self regulation More affectionate Improved regulation of sleep, better sleep quality Improved motor functioning and motor planning Frequent report: he’s spending much more time reading since neurofeedback In several cases, improvements in learning weaknesses in reading and math
64	Realism It is not (always) a cure. It is not miraculous. It doesn’t help every child. It can be complicated and trying. Sometimes it helps a lot, sometimes a little. But it does often help in ways that no other method I know of can match.