Approaches that help autism are widely varied and individualized. Autistic symptoms are also unique to the individual, although they tend to fall into clusters or patterns. So where does it all come together? We know that all of these approaches affect the autistic’s brain, and most of the symptoms emerge from the brain as a result of some sort of malfunction.
So, it makes sense to look at methods that can improve the functioning of the brain to see if they can help improve autistic issues. One group of methods that has been gaining popularity recently is brainwave biofeedback or neurofeedback.
I will provide an overview of the various types of neurofeedback that have been used and give you an idea about the important questions and possible answers to consider. Later, I will suggest that a more direct effect on a particular system in the brain can be particularly helpful.
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Since the mid-1950s, scientists have been changing the way that the brain functions by teaching people how to modify the small electric voltages that the brain produces.
They have detected the changes in the voltage patterns—the EEG (electroencephalogram)—and used better and better methods to pick out patterns of size and/or frequency of the EEG to show to the person being measured and ask them to make intentional changes in their brain function. The clinicians took note of what kinds of changes in the person’s feelings, brain state, or function went along with this biofeedback training, over a few or many sessions.
This is now called neurofeedback training, neurotherapy, or sometimes neurovideofeedback training, when the output of the filtered brainwaves actually starts or changes the size or brightness of a video being played on the PC to keep the trainee interested. The output can also change the volume or pitch of the sound being created by the PC’s speaker to give more informative feedback to the trainee and help him steer his brain toward better functioning.
The first picture shows a user with a headpiece picking up these voltages from the middle of his forehead and his ear with a dry sensor and sending them via Bluetooth to a Windows laptop, where they are instantaneously processed and displayed. The user sees the display with colored bars representing different types of brainwaves shifting up and down, and the video gets bigger and brighter the more successful he is (second picture), so he can react to this to improve his view by improving his performance. The screen also tracks his performance over time with a trend graph and numbers.
There are several other approaches to using neurofeedback, and every practitioner is slightly different as well. There are major differences between neurotherapists (and clinicians with additional skills) in the sites on the head the EEG is obtained from and how it is analyzed. Some therapists use many sites, others few.
Picking out the right sites and frequencies to analyze is generally more effective than using a wide variety that covers all the bases. This became clear to me when I presented the first case of autism (three independent diagnoses) and attention deficit disorder (ADD) we trained with simple neurofeedback and followed her up over the years.
After about 22 sessions, the Indiana University Center on Autism observed her and told the parents of this eight-year-old girl that there were no signs of autism left. This eventually became a verified story on our local TV station. Years later, after a total of 28 sessions of training, she graduated high school as a talkative valedictorian! Of course, she then successfully finished college.
There are a variety of practical considerations about neurofeedback training. Is my child capable of doing the mental exercise for at least 15 to 25 minutes two or more times a week? Most children are interested in watching television and will stay with this if they can pick the video.
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It also depends more on how much of a hassle is involved than their level of functioning. Setting up the training session can be simple (as previously described) or can require head measurements, scraping the scalp, and applying goopy electrode paste, after traveling to the therapist’s office. Some therapists start on the wrong foot with the client by insisting on doing complicated and expensive brain maps (Quantitative EEGs or QEEGs) at the beginning of training.
My experience is that these are really not necessary in most cases, certainly not to start. The value of a clinical EEG to rule out hidden epilepsy is a separate matter to consider with a neurologist; 30 percent of autistics have epilepsy. Neurofeedback has a long-established record of success with epilepsy, one of the first illnesses it ever treated successfully. It also works rather well with ADD or attention deficit hyperactivity disorder (ADHD) symptoms, which are present in about 50 percent of autistics.
The bottom-line question for many parents is how much progress they are likely to see in how many sessions. There are published studies that indicate very substantial progress in 18 sessions by combining simple training for enhancing single-pointed focus and stabilizing the brain’s system for understanding and reacting to events, using a unique training called Neureka!, which also improves positive feelings and encourages participation in the sessions. Other methods are much slower, often taking over 200 sessions, even with very sophisticated equipment, QEEG, and brain mapping. I suggest that you ask the neurotherapist about his methods and results.
Another issue is cost, which can mount up quickly at $75 to $150 a session, particularly after adding a QEEG. There is some insurance coverage for neurofeedback, but many companies still deny coverage for this 60-year-old approach as “experimental.” Other programs don’t pay a reasonable fee to the therapist. Buying a neurofeedback instrument, such the Socialize ACE, and doing the sessions at home can be a lot easier and lead to more frequent training and better progress, not to mention the added convenience (no travel) and lower overall cost.
Exploring the feasibility of using neurofeedback training for any child or adult five and over with autistic, attention, and/or epileptic problems may well be worth the effort.
This article was featured in Issue 92 – Developing Social Skills for Life