ADD and NeuroFeedback
This chapter
is taken from ADD: The 20-Hour Solution by Mark Steinberg and Siegfried Othmer. Click here to order this excellent resource
on ADD and Neurofeedback.
The ADD Merry-Go-Round:
Matthew's Story
As his teacher slowly turned down the aisle where Matthew sat, the child's body contracted, as if he wanted to make himself invisible. He dreaded the inevitable scolding, knowing what was coming and yet somehow recoiling in surprise. This time based upon the previous two dozen rebukes of the day Matthew could sense that the hammer was about to fall again. He had just leaned out of his seat to tell William to shut up, and the teacher was glaring at him. William, who sat in the next aisle, teased him constantly, yet the reprimands always seemed to fall upon Matthew.
"Stay in your seat, Matthew!!"
The teacher's voice thundered mercilessly as she stood above him like a storm of clouds gathered in fury. There was no escape. With undisguised irritation and an unmistakably insulting tone of voice, she would assault him with her frustration for transgressions he only partially understood. Actually, it could be argued that most of Matthew's "education" consisted of his teacher's inflamed public proclamations of his many transgressions and infractions. Though a video replay would have proven far more effective in helping the nine-year-old understand why his behavior pressed his teacher's "buttons," Matthew received no such feedback. Instead, his teacher simply castigated and demeaned him in front of his classmates in the misguided hope that this would somehow magically alter his behavior.
"How many times must I tell you to stay in your seat and keep your hands to yourself?" Matthew sat still. Under great duress in these moments when he was on the receiving end of his teacher's harsh glare and undisguised hostility, he was able to control his hyperactivity temporarily; this added to the consternation of those who dogmatically believed he could actually sit still, control his impulsiveness, and be quiet all the time, if only he so desired.
In this no-win situation, Matthew simply went limp with contrition and surrender.
"Do you hear me?" the teacher demanded.
"Yes, ma'am," Matthew murmured.
"Then why don't you follow directions and stop interrupting the class?"
The question, which seemed to invite reply, instead dangled heavily unanswered in the haze of Matthew's humiliation.
Matthew felt a momentary surge of anger, followed quickly by a rush of thoughts about the kids who teased him, how unfair it was, how the teacher always blamed him, and his parents never took his side, either. He smothered his impulse to complain to the teacher about William, who wouldn't leave him alone. Alas, even this silent act of self-control passed unrecognized. Matthew himself failed to recognize the irony in which his forlorn childhood was enmeshed: He was verbally exuberant when others wanted him to be quiet, and he was withdrawn and often clueless when people demanded answers.
Matthew barely understood the cause-and-effect link between his misdeeds and the scripted reactions to these misdeeds. He had no inkling about these effects upon his unhappiness and continued misbehavior. He was a nine-year-old, and children especially children with a diagnosis of ADD didn't think in such objective and analytical terms. Matthew was simply lost in an internal maze of jumbled, intense feelings, sporadic mood shifts, changes in energy level and focus, and incomplete thoughts. He acted, (or, more precisely, reacted) in a play written by others and performed on a stage not of his design, his clumsy entrances and poorly delivered lines often drawing unwelcome laughter and jeers from his audience.
More surprising, however, was the failure of adults in Matthew's world to empathize with the pattern of rebuke and castigation that deluged Matthew without offering pragmatic and applicable hints about how he could respond more acceptably. No one showed him, in concrete terms, how he might control his impulsiveness and rein in his inappropriate behavior, and no one seemed aware of this glaring omission. Were it not for this collective obliviousness, it might seem like a deliberate plot to foil the child the lack of instruction, practice, and reinforcement of socially acceptable behavior. A recipe, in fact, for delinquency.
Matthew, however, could never articulate how the adults in his world were letting him down. He was a scattered, frenetic, poorly organized and poorly regulated kid with an array of disheveled and aggravating behaviors. A lot of people construed these behaviors as conclusive proof that he was hopelessly wicked. Matthew was among those holding such an opinion, although he harbored some ambivalence. Matthew wanted to believe that, deep down inside, he was good, though misunderstood. His soul-wrenching belief that he was deserving lent him some semblance of esteem and the will to survive. Yet, his dignity and existence were regularly under attack.
The teacher scowled at him and continued her tirade.
"Where's your book?" She ruffled the mess on Matthew's desk, emphasizing her displeasure. "Of course, if you had done your homework, you might be able to drum up some interest and follow the lesson instead of disrupting the class."
The teacher would make her points in a series of verbal stabs, punctuated by trips around 'the room with flashes of fiery remarks directed at Matthew. As she strode toward the front of the room, still ranting, Matthew became aware of his classmates timorously stealing nasty glances at him. When the teacher bore down on him, the other students politely looked at their books or stared ahead.
Allowing one disruptive pupil to assume the feature role held numerous dynamic advantages. Other students could hide their distractions and misadventures. The cumulative frustrations that accrue along the course of a school year could find an easy target by scapegoating a vulnerable student. The victim's reactions would often justify the blame. Most children squeal when they hurt; ADD children usually squeal louder.
Under the intense scrutiny and reproof, Matthew's squirming resurfaced. The teacher continued her tirade, wandered around the room in widening concentric circles, commanding the net of obligatory gazes from the students.
Matthew cowered in embarrassment as the teacher blared her refrain.
"I don't know how your parents put up with you... I can't put up with this behavior. You need help your family needs help." Privately, the teacher had spoken with his family and urged them many times to give him medicine and to get counseling. This made Matthew squirm and feel sad that there had to be something very wrong with him.
Matthew again became distracted by a torrent of thoughts. He felt pressed to go to the bathroom, but thought this would be an unwelcome time to ask. The teacher was winding down from her lashing, preparing to .re-engage the reading lesson. Relief visited Matthew temporarily, only to be displaced by a room full of reminders that his torment would continue at recess if the teacher let him go to recess. Matthew was often "benched" during recess he had to sit on the bench in the principal's office due to any one or several of a long list of missing assignments, disruptions, and other citations for misconduct. Matthew hardly understood the particular offense for which he was being punished; he just knew there was a lineup of them, an ongoing debt that never got fully paid.
Sitting on the bench was difficult enough; sometimes, just the sheer effort of sitting there (it was so boring!) made him antsy enough to call out or get up without realizing what he was doing. That would earn him another day's penance on the bench. Matthew didn't see himself as victimized he hadn't yet acquired the vocabulary or indignation required for embodying victimization but he did feel trapped. The main way he expressed his frustration and his feelings was through his behavior loud, impulsive, uninhibited, demanding, self-centered and often disrespectful which brought more of the painful, provoking, and alienating experiences he was accused of formatting in this vicious cycle of transgression, retribution, and frustration that sculpted his young life.
The bench was hard time, and it made Matthew reel with restlessness. Though he felt isolated and deprived, he reminded himself that, here in the protection of the office, peers could not tease him (at least, not openly). Disapproving glances from passersby weren't fun, but they were innocuous compared to the aggressive taunts hurled at him daily on the playground.
Matthew was excluded from games. His attempts to join were rebuffed, and he was teased without remorse. His callow bids for attention caused him to be regularly ostracized, and his initiative often escalated into quarrels.
Because Matthew had little sense of future time and lived almost exclusively in the now, he defended himself against the demands of the world by unconsciously denying and avoiding the unrelenting exigencies that were continually being imposed on him. Chief among his unwitting tormentors was his mother, to whom he would have to answer for his poor performance and misbehavior in school. The afternoon and evening beckoned with promises of yelling, teasing, blaming, and restriction.
At home, there were other injustices. Matthew detested the way his brother and sister managed to blame him and get his mother to buy their stories. The anger welled up inside of him just thinking about it. What stinkers the two of them were!
To make matters worse, his siblings made fun of his reading, and needled him about his homework and poor attention. Matthew was confused about this; it was hard to pay attention, but, God, most of it was so boring! As if it were his fault! He tried to do the work... but, most of the time, he just kind of drifted away.
What always got his attention, even more reliably than a call from his bladder, was the piercing sound of his own name:
"MATTHEW!!"
Many people sounded the call, but none as shrilly and constantly as his mother.
MATTHEW'S FAMILY
The lineup of cars trudged toward the school's main entrance where a sputtering, then a gush, of students heralded the afternoon dismissal. Matthew's mother, Julie, nudged her car in dutiful procession. She was always uneasy driving up to the school, and the reasons were understandable. Matthew and school were like oil and water, a combination that wouldn't mix, despite all the circumstantial shaking. Almost daily, Julie was confronted with Matthew's legacy of misdeeds; these ranged from outright scuffles to missing assignments, disrespect, and social blunders. Julie felt that she was being personally denigrated when the teacher or the principal reported Matthew's latest transgressions. She reminded herself that these were professionals, and that it was their duty to inform her of her son's activities. The reports, however, felt more like a reading of charges against her. Once, while the principal was recounting Matthew's latest offense, Julie tried to listen, but had to suppress laughter as she entertained the errant thought that the principal would soon ask, "And how do you plead?"
She was never asked for her views, however, or even given a chance to discuss her frustrations about the ways the teacher was handling Matthew. She felt coerced into accepting the educators' disapproval and pressing concerns about Matthew. What was she doing about his ADD? Had she seen a doctor? When was Matthew going to take medication so the school could do its job of teaching? What about counseling? "Many families have problems, you know, and the children act them out. "
These scenarios made Julie cringe. They also made her angry angry at the school, angry at Matthew, angry at her husband, Dave, who had the freedom to escape the daily battles with Matthew and his world. Julie was also a bit angry at herself for putting up with the accusations and demands, and for not expressing herself more forcefully. She had talked to a number of close confidants about this, and they had comforted, encouraged, and pushed her to be more assertive. Julie appreciated their support, but realized that Matthew was not their problem, and that she would have to find some solutions on her own. But how? These inner conversations left Julie feeling alone and increasingly despondent. She was responsible, and strong indeed, a good wife and mother, and minister to needs of an entire family. But she was wearing out and approaching desperation.
She loved Matthew, but he made it hard. Taking him (actually, dragging him) places was loathsome; he was a constant reminder to her and a symbol to others of perceived defects in parenting. Julie reflected with distasteful irony that Matthew represented her scarlet letters: She felt she wore them on her sleeve, as Matthew constantly pulled at her to get his way. Everyone could see it. Most had comments and criticism. Few suggestions even remotely addressed constructive and realistic fixes to the awful state of disrepair that characterized Matthew's interactions with the world.
Julie parked her car in the school lot and approached the dismissal area. She hoped that Matthew would just come to the car like other children; but, she knew from experience that he was likely to become distracted in some scuffling or teasing, and she had best be there to intercept a likely negative outcome. Waiting for Matthew was a habitual and aggravating routine the less of it done in public, the better.
She spotted him and called his name. Mercifully, he noticed her, and it took only her methodical march toward him and a grasp of his arm to head him toward the car. Julie tensed and prepared to screen out the customary teasing that followed Matthew. She didn't want to hear the childish name-calling, didn't want to exert the energy to figure out whether she imagined or actually heard the taunts. Reminding herself that she was a mother picking up her child from school, Julie bit her lip and fought the encroaching tears, the anger, the embarrassment and the powerlessness. Preoccupied with her self-consciousness, Julie only gradually heard Matthew yammering at her. They entered the car, and Matthew pitched his complaints in earnest: The teacher yelled at him; William punched him, Carlos teased him, and when he protested, the teacher scolded him for that; he got another detention; could they please stop at McDonald's, he's so hungry...
As Julie looked at her hapless, animated son, she noticed an envelope scrunched into his backpack, sticking out like an afterthought. She mentioned this to him.
"Oh, yeah, Mom, this is for you." He thrust it at her. Julie fumbled the envelope, then ripped it open. It was a short note from the teacher, reminding her that Matthew should see a doctor and get some medication.
Julie felt a flash of irritation. She was ambivalent about this whole medication business, and she reacted defensively when people (especially people at school) pushed it. Who were they, anyway, to insist that medication was the solution? Julie hated the pressure. She'd read something about how educators' insistence on medication was a violation of civil rights. A friend told her that another parent had filed a complaint after being harassed about medication this parent had accused the teacher of practicing medicine without a license! Reflecting upon this made Julie more overwhelmed. She was not militant; no, thank you, she had quite enough conflict in her life already. She was tired of fighting everybody. Matthew was gradually turning her into a defeated warrior.
She knew he needed help, and, though she hated the way the school
hammered the medication drumbeat constantly, a part of her couldn't
blame them. Something had to be done. Narrow though it was,
medication seemed a ready solution, a bandwagon on which many were
jumping.
Julie wasn't so sure. She worried about side effects. She'd heard and read about too many cases where medication made things worse. There was even a new problem to worry about she believed it was called "polypharmacy management" children taking additional "medications" to control for the side effects of previous ones. In many cases, the children's lives were overtaken by the effects of the drugs, thereby diminishing or overshadowing the good they were supposed to do in the first place.
She had brought such concerns up with her pediatrician. He reassured her that these drugs had been thoroughly tested, and were safe, effective, and non-addicting. Julie had wanted to believe him it seemed so easy. But her doubts lingered, even grew stronger. Nobody had provided a satisfactory rebuttal to the concern that medicating children with narcotics (yes, indeed, that is the classification for most of the commonly prescribed ADD drugs) predisposed them to a pattern of addictions and dependence upon chemical controls to make their brains work. These were the children who were most vulnerable, most impulsive, most heedless of consequences, and most at risk in the first place. To Julie, using psychotropic drugs with kids seemed illogical and eerie.
The avoidance of medication was a desire Julie shared with her husband. Ironically, Julie thought that was one of the few topics about which she and Dave lately agreed. Their relationship was becoming more fractured and certainly less compassionate and loving. Dave was distant, caught up in his own world and his own concerns. His presence raised the level of tension in the household. He shouted regularly at Matthew and continually griped about his misbehavior. In her moments alone, Julie thought about Dave and wondered if she was handling the situation as badly as her husband. Maybe she just couldn't see it. She tried to be the peacemaker. She labored in the homework battles. Dave mostly complained.
All the while she hated his carping, Julie agreed with his points. Matthew was not "up to speed," as Dave put it. He was struggling academically, making enemies at school, and avoiding virtually all of his responsibilities. He seemed to have an uncanny knack for getting under
people's skin. Julie knew Matthew didn't enjoy being singled out, picked on, punished, criticized, and ridiculed. But it was only a matter of time before most people became exasperated with him.
Dave shared similar frustrations, but these were far from joyous bonds with his wife. He thought she was much too impressionable and indecisive; thus, Matthew took advantage of her. He deplored Matthew's manipulative wiles and undisciplined habits. Dave reasoned that Matthew was smart, but had not learned how to use his ability and translate his intellectual gifts into common sense and productive behavior. Though he maintained publicly that Matthew was just "exercising his right to be a boy," Dave inwardly brooded about the obvious differences that Matthew showed. Most of the time, Dave could abide the hyperactivity, but it really bothered him that Matthew carried many things too far. What could have been an aggressive competitive edge seemed to Dave like a death wish featuring consistently poor judgment. This puzzled Dave, for he saw clear indications of high intelligence in Matthew, yet the boy did stupid things with amazing regularity. It was as if his son was intent on willfully sabotaging himself.
Dave berated himself privately for his impatience. He resolved over and over again to take Matthew under his wing and lovingly, methodically, and patiently teach him better ways. All his good intentions crumbled, however, each time he encountered the irritating effects of Matthew's behavior. Dave would drive home rehearsing his positive approaches, only to be confronted with the latest series of crises, emergencies, and antics. Usually, he arrived home to a family of frayed nerves and combative arguments. Not particularly comfortable or calm in the role of administering relationship triage, Dave found himself retreating to his home office or bedroom to avoid hostilities. When he tried to help Matthew with homework, the situation escalated into a full-blown confrontation replete with angry words, unproductive interrogation, resentment, reiterated demands, intractable defensiveness, chronic denial of responsibility, evasiveness, and manipulative behavior. All too often, it would happen like this:
"Matthew, let's see your homework. What are you supposed to do?
"I don't know."
"Whaddya mean 'I don't know'"?
"Like I said, 'I don't know'."
"Come on... you know. You have to know!"
"I don't know"
And it would degrade from there. If Dave continued, Matthew (feeling cornered and desperate) might throw a tantrum, and often would lie. This gave his dad something specific to pursue, and so the "conversation" would continue:
"Why did you lie?"
"About what?"
"Oh, you know!"
"I don't know!"
"Yes, you do!"
At this point in the immaturity spiral, Julie would enter and disapprovingly separate the two of them. Her choice of lines was often regrettable.
These engagements did little to spare the erosion of family harmony and dedication Julie and Dave had to each other's and their children's well-being. Everybody in the family was suffering, and the general consensus (as announced periodically by his brother) was that it was all Matthew's fault.
They tried to squash any overt blaming of Matthew (the experts had assured them that blaming would cause damage), but Dave and Julie silently colluded in their growing resentment of their son's negative impact on the family. Dave had once sarcastically referred to Matthew as "Dennis the Manic Menace." Julie found it hard to get that phrase out of her mind. On the surface, they denied and ignored as much as possible. Inwardly, they brooded, prayed, and rationalized.
Julie felt isolated, overwhelmed, helpless, and dismissed by Dave's simplistic solutions. She believed that Dave minimized the seriousness and urgency of Matthew's problems. Dave, in turn, felt misunderstood and wrongly accused of not listening and not being empathetic. Moreover, he believed that he was the one being denied a receptive and sympathetic ear.
They had even tried marriage counseling and family therapy. At first, it was aimless, then pointless; eventually, they discontinued. Therapy was expensive, and Matthew continued to act in a dysfunctional manner.
Dave didn't like the invasiveness of family counseling. He was open to talking, but he was convinced that he and Julie weren't the problem. After all, the problem was Matthew.
Indeed, Dave was confused. At heart, he really didn't think there was anything wrong with his son. He found it difficult to trust the professionals. At the bottom of their fancy theories, he suspected that there was blame, and that, somehow, it had to be directed at his family. He was worldly, and had grown up in a family and an environment where people blamed each other. To an extent, he had survived well by learning to point his own finger quicker. His tough veneer barely disguised the wellspring of his love and compassion for Matthew. It grieved him, even choked him up at times, that his son behaved idiotically in front of others. Dave covered it with reprimands, but each time Matthew acted out inappropriately, Dave died a bit inside, forfeiting more of his pride and hope for his son's future. Dave was psychologically sophisticated enough to understand the conflict with which he grappled: He loved Matthew, felt bound to protect him, and envisioned his potential. Yet, the realist in him begrudgingly agreed that the world's reproof of his son was justified.
As the crises and despair mounted, both parents became somewhat inured to their son's continual acting out behavior. Neither had a clue about how to handle the situation. It was especially frustrating that such little assistance was offered by the educators and other professionals in the way of treatment options. And, the insinuation that not medicating Matthew showed that they were negligent parents in denial well, that was simply infuriating.
In her relentless search for answers, Julie heard and read about a treatment for ADD called EEG biofeedback. The procedure involved training brainwaves to improve concentration and behavior. Supposedly, by playing video games while attached to special computers, children could learn to control themselves, pay sustained attention, improve their behavior, and maintain the gains they made over the long-term. This intrigued Julie, but, at the same time, she wondered if the claims were too good to be true. Was she just grasping at straws, or could the program really help Matthew? The more she found out, the more EEG biofeedback began to make sense: It was natural, non-invasive, fun, and promised both quick and long-lasting results.
Julie had heard enthusiastic commendations third-hand about the positive effects of biofeedback. Not knowing anyone personally who had experienced it, she decided to find out for herself. Through experience, she had become wary of the arguments and counterarguments expounded by experts and professional pundits, and she had come to rely her own instincts and her abilities to evaluate what she found. She scoured the websites of the EEG Institute (www.eeginstitute.com), EEG Directory (www.eegdirectory.com), the Brian Othmer Foundation (www.brianothmerfoundation.org), and EEG Spectrum International (www.eegspectrum.com) respected Sources of information about EEG biofeedback. From these organizations, she obtained the name of a highly reputable licensed psychologist in her area who was extensively trained in EEG biofeedback and who had been affiliated for many years with the EEG biofeedback professional community.
After perusing the psychologist's website, Julie called and made an appointment. Following years of frustration, they were about to embark on a radically different approach to handling Matthew's problem. Like so many families in the throes of dealing with ADD, Matthew and his family hardly knew what to expect. Despite this uncertainty and a degree of justifiable trepidation, Julie felt, for the first time in years, that there was actually hope. Just maybe they had stumbled onto something that could transform their son's life and remove the black cloud that hovered above their family.
A PREVALENT PLIGHT AND A PROPER SOLUTION
Matthew's plight is a wrenching example of the anguish of
ADD/ADHD. This nightmare is played out every day in thousands of classrooms
throughout the
The differences that make ADD/ADHD children conspicuous also predispose them to a childhood (and beyond) of interactive torment between them and the surrounding world whose standards, tempo, and conventions they find so difficult to meet.
Marching to the (often hyperactive and erratic) beat of their own drums, these children typically do poorly in school and establish marginal or unsatisfying relationships. They are often involved in unruly manipulations, either as aggressors or victims.
Though not a uniform group, some eight million American children are currently diagnosed as having Attention deficit disorder or Attention deficit hyperactivity disorder (ADD/ADHD). Each year, more than ten million prescriptions are written for psychotropic drugs to treat what appears to be an epidemic whose symptoms include distractibility, inattentiveness, hyperactivity, behavioral problems, forgetfulness, social conflict, difficulty finishing schoolwork, impulsivity, anger and moodiness, aggression, daydreaming, avoidance, procrastination, disorganization, insolence, and erratic performance.
These children often have problems and vulnerabilities associated with the condition stereotyped as ADD/ADHD. Many struggle with mood disorders, learning disabilities, or other neurological irregularities. Because of their difficulties, this population is highly at risk for achievement failure (both in every day expectations and in fulfillment of their potential), social acceptance, legal difficulties, addictions, and health problems.
The prevalence and effects of this trend are alarming. Ten percent of American school children are being medicated every day for two purported reasons: To help them learn more effectively and to make them more manageable at home and in the classroom. Many physicians, educators, mental health professionals, and parents are apparently convinced that, without aggressive pharmacological intervention, ADD/ADHD youngsters are fated to struggle academically, suffer psychologically, alienate their parents, teachers, siblings, and classmates, and function below their abilities.
The families of those afflicted are caught between the proverbial "rock and hard place." Spurred by disruption and conflict to remedy the problem, they often find little recourse but to drug their children and/or migrate to a new classroom or social circle in the hope that a tarnished reputation will vanish. However, they have many misgivings, and face ambivalence and uncertainty about their children's maladjustments and the consequences of chemically and environmentally controlling them.
Fortunately, a better option for resolving the pernicious aspects of ADD/ADHD is available. Along with thousands, Matthew and his family are emerging from the haze of suffering to the welcome relief of the 20-hour solution for ADD/ADHD.
How EEG Neurofeedback Addresses ADD/ADHD
We have suggested a framework for understanding ADD/ADHD that recognizes disregulation as the underpinning problem spawning the core characteristics of ADD/ADHD and that must be corrected in order for its symptoms to resolve. We have also intimated that the human brain is capable of "self-healing," by which we mean the ability to learn or re-learn the self-regulatory mechanisms that are basic to its normal design and function.
In dealing with ADD, it is vital to correct the disregulated condition. When the brain becomes organized and self-regulated, symptoms from seemingly disparate origins ameliorate. Behavior improves, concentration and focus increase, sleep normalizes, and moods become more even.
What a marvelous testimony to the innate flexibility and plasticity of the human brain! These inherent capabilities can be activated through brainwave training, known as EEG biofeedback or neurofeedback.
Neurofeedback improves brain function and self-control in many ways, but the underlying mechanism involves the refinement of self-regulatory mechanisms necessary for effective functioning.
Let's review the real-world problems the ADD/ADHD child experiences and tie them to the disregulation and core characteristics they reflect. Then, we will show how EEG neurofeedback addresses and resolves these problems.
1. Disregulation of the arousal system
In Chapter 1, we introduced the notion that our bodies and minds have a system for managing arousal that is, the states of excitation and relaxation that are in constant relationship with each other.
This continuous feedback loop of central nervous system (sympathetic and parasympathetic) activity controls states of attention, wakefulness and sleepiness, impulsivity, mood, awareness, and behavioral inhibition/disinhibition.
The arousal system is the "thermostat" that senses changing conditions and manages our adjustment to those conditions.
Remember how Matthew had trouble staying in his seat and keeping his hands to himself? Note that he was "verbally exuberant when others wanted him to be quiet, and ...withdrawn and often clueless when people demanded answers... Matthew was simply lost in an internal maze of jumbled, intense feelings, sporadic mood shifts, changes in energy level and focus, and incomplete thoughts." These are hallmark signs of disregulation.
Matthew's difficulty staying seated, his wandering attention, difficulty concentrating, and inconsistent performance all reflected the underlying disregulated state of his nervous system. His brain was not in charge, even though it may be very capable. That's why his teacher kept prompting him to re-focus and his mother must remind him of routine things. If we could look inside Matthew's head (and, in a way, we can, by looking at the electrical signals generated by his brainwaves), we would probably see a de-activated EEC This would signify a brain that isn't utilizing all its cylinders, so to speak - and, in this state, Matthew would be less able to differentiate things happening within and around him. Therefore, he would be less likely to notice important clues that would tell him how to act clues like the teacher giving instructions or, perhaps, that someone next to him was becoming annoyed.
Poor Matthew was riding on the ADD merry-go-round an up-and-down, on-and-off again cycle of fluctuating brain activation that robs him of the ability to automatically control his own brain and its levels of arousal. It's not a fun ride, really a "not-so-merry-go-round," this carousel of a brain activating and (mostly) de-activating around the irritating and seemingly random prompts and intrusions of others in a demanding environment.
This fluctuating, irregular "arousal-go-round" produces other effects that lead children like Matthew off-track. As we shall see, EEG neurofeedback enables the brain to self-correct arousal fluctuations so that children can stay on-task and on-track.
2. Poor integration with environmental demands
When disregulation prevails, children find it very difficult to remain in step with others. Although they may seem distracted by novel stimuli or mesmerized by some entertaining activity, they are actually more focused inside themselves and less attuned to subtle changes and shifts in the conditions and events around them. This is because the lack of automatic self-regulation requires a rather constant energy to manage things internally. As a natural consequence, such children falter in perceiving and responding appropriately to the world around them on a consistent basis.
Matthew "was able to control his hyperactivity temporarily," frustrating those who "believed he could actually sit still, control his impulsiveness, and be quiet all the time, if only he so desired."
Matthew paid attention sometimes to the communal or important focus. Often, he didn't follow directions, interrupted the class, or engaged in (neurologically) stimulating conflict behavior that tended to boost attention and involvement, even if it was unproductive.
Matthew "had little sense of future time and lived almost exclusively in the now... he defended himself against the demands of the world by unconsciously denying and avoiding the unrelenting exigencies that were continually being imposed on him." Thus, Matthew's fluctuation in arousal and his selective attention reflected a classic difficulty ADD individuals have with schedules, deadlines, timeliness, and conformity. As mentioned, people with ADD tend to function at much higher levels when they choose what they will do and when they will do it. Schedules, specifications, and demands imposed from the environment require arousal management in order to integrate what goes on inside the person with the demands from outside.
Like Matthew's parents, you may notice your child's lack of smooth transition from one activity to another. This can become obvious in the child not wanting to leave one activity or in "forgetting" important materials or cues for the next activity. Matthew "forgot" to give his mother the teacher's note until she saw it scrunched in his backpack and mentioned it. He forgot what he was supposed to do for homework when his father asked him. For the ADD child, "out-of-sight, out-of-mind" holds truer than for most people. In this manifestation of disregulation noticing, remembering, and integrating cues from the environment the fluidity of arousal necessary for the brain to shift gears and modify brainwaves often is erratic or insufficiently developed.
The difficulties in shifting, remembering, integrating, and adapting to schedules and outside demands are also bound up with problems of perceptual focus, brain stress, and inflexibility.
3. Perceptual focus problems
An accompaniment to disregulation is the perceptual distortion and distractibility that interfere with the ability to maintain focus and complete goal-oriented behavior. Whether it is distractibility, over-sensitivity, or foggy and disconnected thoughts, many ADD people have thinking patterns that cloud clarity. These patterns tend to distract them, compel them to react to the urgent rather than persist with the important, and result in atypical perceptions and distortions of interpretation. We compared this in the first chapter to a "zoom lens" malfunction in which control over the mix of attention to detail and the bigger picture becomes impaired.
Matthew's selective attention, his forgetting, his likeliness to become distracted in some scuffling or teasing on the way to his mother's car after school, his minimal sense of future time, the anger welled up inside of him just thinking about his siblings and the injustices heaped upon him these are all examples of the exaggerated effects that perceptual focus problems bring.
By training the brain to self-regulate and focus, EEG neurofeedback organizes thinking, promotes flexibility in shifting the "zoom lens," and regulates the emotional excesses and narrow focus that tend to entrench people in idiosyncratic and "stuck" patterns of thinking. By reducing impulsivity, neurofeedback also allows children to better evaluate circumstances and consider conclusions and consequences before acting. Improved focus and brain communication result in better apprehension of social and environmental cues and less likelihood of negative feedback in response to precipitous or inappropriate behavior.
4. Stressed brain syndrome
There is a very familiar and unnerving pattern to which the ADD child is predisposed: Ineffective or inappropriate behavior, negative response, sanction, or punishment by others, stress and defensiveness, and reinforcement and repetition of the inappropriate behavior.
Effective performance, efficient learning, flexibility of response, accuracy, and sustained attention and effort all depend upon the brain's ability to rest. Just as our lungs (and brains) require a steady supply of oxygen to function, our brains must alternate between work and rest, even during the actual time we perform tasks. This happens so automatically for most of us that we only notice it when we are either really stressed or fatigued or when we are in that special state (sometimes called the "zone") where everything seems to go well effortlessly.
The ADD child, however, is more susceptible to stress because his brain is not in the habit of active resting. The ADD brain often responds to challenge (a demand from the environment) by shutting down (avoidance) or by over-reacting and staying in the "on" (adrenaline) mode. This is not only ineffective it leads to burnout, emotional turn-off, and a cycle of underachievement and poor self-esteem. For the ADD person, ordinary tasks incur extraordinary stress and hardship a brain reaction most of the world does not seem to understand.
EEG neurofeedback solves this vicious cycle by teaching the brain how to automatically and integrally rest as it meets the challenges of imposed demands. It's as though the brain learns to pace itself and bring forth that second and third wind instead of hyperventilating or choking. With brainwave training, children learn fairly quickly that they cannot force or sprint to effective brainwaves; they have to observe and repeat the cycles of effort and rest. This neurological habit then generalizes to whatever they do. Neurofeedback teaches the brain to adapt and pace itself to demands and challenges.
Incidentally, the "bored" brain is a very stressed brain. Many ADD children are chronically bored. Often (as with Matthew), they attribute this boredom to properties of the task as in, "schoolwork is so boring." The experience of boredom is actually a combination of under-stimulation of the brain (a de-activated EEG) and avoidance of over-stimulation by a task (like reading) to which the brain overreacts by trying too hard and not adequately resting within the task.
When children learn how to regulate their brain activity, they learn to rest automatically, and they become noticeably more involved and less bored. It's amazing how much more interesting tasks become when the brain gets involved!
5. Compromised flexibility
Flexibility is so integral to responding appropriately and effectively. It is an interactive cause-and-effect cycle of making adjustments, shifting gears, and modulating our behavior in order to fit in and to achieve desired outcomes.
Remember that Matthew and school "were like oil and water, a combination that wouldn't mix." Matthew's flexibility was severely compromised by his poor self-regulation. Like many ADD children, he had trouble shifting perspective, attending to what was relevant and important, adjusting his mood and his reactions, and evaluating cause-and-effect in order to make adaptive adjustments.
The feedback Matthew received from his environment was mostly negative it told him when he was doing something wrong, not when he was doing something right or how to correct himself. Thus, Matthew could not develop the habits of self-modification, adjustment, accurate evaluation, and flexibility because he was not getting adequate and constructive feedback. His true brain abilities were dormant.
This is the situation that poorly regulated ADD people face every day. However, EEG neurofeedback is ideally suited to providing the interactive feedback method for alleviating these deficiencies and teaching the brain how to regulate and maintain its proper functions.
HOW EEG NEUROFEEDBACK ADDRESSES ADD/ADHD CHARACTERISTICS
With this understanding about the underpinnings of ADD symptoms in disregulated arousal, it becomes apparent that developing and maintaining better self-regulation is the key to overcoming ADD. Toward this end, EEG neurofeedback (biofeedback) is an elegant and effective solution.
EEG neurofeedback is a technique in which people learn (by means of real-time computer feedback) how to produce more of the brainwaves associated with desired behaviors such as concentration, attentional focus, relaxation, cooperative behavior, and reduction in irritability, pain, bad mood, hyperactivity, and sleep disturbance.
This technique is remarkable in that the results are so obviously generalizable; this is because the procedure teaches people specifically to modify brainwave activity it addresses no specific symptom directly, yet it has profound and enduring effects on a wide variety of symptoms. This is because EEG biofeedback very efficiently modifies the control mechanisms responsible for producing and maintaining the symptoms. The struggles and inconsistencies people have with learning, paying attention, modulating moods, pain, and alertness are largely caused by irregularities in the way the brain self-regulates its "housekeeping" and higher-order functions. EEG biofeedback trains the brain to produce more waves in the bandwidths associated with better self-regulation.
EEG biofeedback is a training regimen in which the client reinforces himself often 2000 times or more during a 30-minute session! It is a relatively pure learning paradigm with no punishment, negative reinforcement, or emotional content. It does not require talking. The client's cortical EEG is simply displayed in a way that allows him to change it, earn rewards, and see and hear the results of his efforts, moment by moment.
Let's review how the application of neurofeedback addresses each of the maladaptive characteristics of ADD/ADHD:
A. How neurofeedback corrects disregulation of the arousal system
Arousal functions and their regulation are closely tied to brain-body, bio-physiological electrical signals. These are measured through the EEG (electroencephalogram) or brainwaves. An underactivated or overactivated brain reflects its irregularities in the EEG. By challenging
and modifying the EEG response, we can influence brain activation and, ultimately, the brain's control mechanisms for regulating itself.
EEG biofeedback presents the brain with a continuous stream of challenges. By feeding back to the client information about what his brain has been doing in the last few seconds, this training system challenges the client's brain to adjust, modulate, and maintain brain activity within specific parameters. In effect, the brain is asked to "juggle" different brainwaves by making more of certain waves and less of others. This is done on a "real-time" basis where the parameters for success are externally set and may be changed over time. Thus, the brain learns to target the goals based on the direction of the goal (in electrical activity) relative to where the brain has just been. This process is very different from a conscious process of analyzing, figuring out, or describing the solution. It is problem-solving at its most instinctive and
visceral level.
Just as a thermostat must sense (measure) temperature and send adjustment signals based on a continuous sensing, the brain relies on similar mechanisms to maintain balance and make adjustments. Though the adjustments are not based upon feelings (per se), the effects of those adjustments will result in different feelings as the temperature rises and falls or, in people, as the arousal level increases, decreases, or shifts in balance.
By practicing these constant adjustments, the brain not only becomes more adept at making them, but it also establishes new reference points (or settings) for its recognition of normal or "home base." Through this process of excitation and relaxation, the brain gradually learns and accepts induced states of arousal as normal and appropriate.
Thus, the child who is underaroused (often showing symptoms of inattention, crankiness, distractibility, lack of motivation, etc.) can be neurologically taught to naturally stimulate his neurotransmitter functions (much in the way that stimulant medications do this artificially) so that his brain eventually functions that way independently, having discovered and ingrained a more useful setting in its repertoire.
Similarly, the child who is overaroused (possibly angry, anxious, impulsive, overreactive, "wired") develops new brain activity patterns that maintain calmness, attentiveness, reflectiveness, self-observation, cheerfulness, and patience.
Importantly, because the human brain is so adaptable and able to conform itself to new and changing demands (this is known as plasticity), these new arousal levels are maintained, as they are more rewarding and functional.
B. How neurofeedback fosters better integration with environmental demands
We are constantly monitoring, exchanging, negotiating, and renegotiating the give-and-take between ourselves and the outer world. We give and we get; we meet the needs of others and the demands made upon us, and we make our own requests, demands, and expectations. To be successful (or even reasonable) in this on-going process, we need to constantly monitor and make adjustments. Failure to do so adequately makes us out-of-sync with others and with the requirements of varying situations. This is true at all levels of development, from a toddler who is tired, frustrated, or hungry to an adult faced with overwhelming demands and stressors.
Inappropriate arousal levels or rampant fluctuations in arousal breach the delicate interplay our nervous systems must maintain to meet inner and outer demands. Continual adjustments are necessary, and they should, for the most part, be automatic. Neurofeedback trains the brain and nervous system to make these adjustments automatically and consistently. It conditions the brain to achieve and maintain states of quiet activation.
When the brain is quietly activated, it is easier to attend to and recognize environmental signals and to adjust one's responses to demands of the situation. During and after the training, children who have had great difficulty transitioning between activities or breaking away from activities they like show much more flexibility and adaptable compliance to demands and schedules not of their own choosing.
For example, the child no longer experiences a parent's request to follow a direction as an intrusion. The tendency to over-focus (such as to become absorbed in TV or video games) evaporates under the incipient warmth of the brain's newfound ability to relax.
When arousal is regulated, learning becomes more efficient and performance more consistent. Attention to detail, accuracy, and reliability improve. The considerable energy that was formerly devoted to self-soothing (keeping arousal from "boiling over") is now available for environmental demands.
People become more competent and comfortable with outward focus.
C. How neurofeedback improves perceptual focusing
Putting things in perspective is a combination of many factors: Maturity and experience, knowledge, attention, temperament, practice, and... a calm and focused mind. When the mind is cluttered, preoccupied, distracted, stuck, or foggy, it is difficult to see things as they are. When the brain is in a state of balance, perceptions and reactions are less constrained by the priority of modulation; therefore, we can attend much more calmly to what is really happening, rather than to internally projected needs for stimulation or calming. This state dramatically improves vigilance, accuracy, and the ability to shift between details and the larger picture the mind's "zoom lens" works better!
As neurofeedback establishes modulated arousal, people tend to become more goal-oriented and less tangential. Impulsive reactions to urgencies and crises give way to concentrated awareness of the truly relevant and important aspects of tasks, events, and people. There is a reduction in compulsive preoccupation and an enhanced integration of .verbal and nonverbal messages.
D. Neurofeedback reduction of brain stress
We have all experienced being "stressed." Interestingly, the stress seems to come from "out there" something outside of ourselves that invades or imposes at least, that is the subjective experience. Many of us have also enjoyed the converse of stress, the sense of being "in the zone," when everything works well and effortlessly.
Actually, both of these experiences are inside us; they are brain states, and, of course, they exert internal and external consequences. The difference between feeling stressed and feeling on top of things is in the way the brain and nervous system manage challenge and relaxation.
There is a natural biologic interplay between gearing up for response and resting between responses. When the rest periods are insufficient, the brain is stressed. In a state of stress (lack of proper relaxation/effort balance), the harder one tries, the more stress that results. It is, indeed, a vicious cycle.
Neurofeedback corrects this malfunctioning cycle by teaching the brain how to acquire the goal by relaxing at the proper times. The brain achieves this balance by continuously combining effective neurologic electrical activity during the session. Each moment of such effective activity is rewarded.
In the EEG biofeedback process, the stress reaction is simply not rewarded. This teaches the brain to relax and rest in the face of constant challenges. A rested brain is a smarter, happier, less irritated, more effective brain.
E. How neurofeedback improves flexibility
Since flexibility involves making adjustments, the EEG neurofeedback model is ideal for conditioning this "flex-ability." By responding to the continuous challenges the video games present, each person trains his brain to make adjustments "on-the-fly" based on moment-to-moment changes in conditions of brain activity relative to environmental demand. The driving analogy captures the essence of flexibility in a simple manner comparable to the brain-training model. In driving a motor vehicle, you must make constant adjustments. These adjustments are dictated by ever-changing conditions, as well as by the interplay among the road conditions and the driver's skills, frame of mind, and the vehicle's capacities. Just as safe and goal-oriented driving necessitates the ability to drive at the speed appropriate for the conditions, effective responses to life situations depend upon flexibility. Indeed, human development is thematic in its reliance upon flexibility as cells and tissue progressively differentiate (become more specialized) with maturity. Life experiences, learning, and the right kind of practice help us add on options and variations to our repertoires of answering life's challenges.
Improved flexibility yields better and faster learning because it allows the individual to try different responses, thus improving the odds of positive reinforcement. More flexibility allows the ADD person to escape the vicious cycle of frustration and criticism.
Self-monitoring and evaluation which are bedrocks of flexibility are inherent in the continuous adjustment process by which EEG neurofeedback fosters self-regulation.
DRIVING IT HOME
A true personal story ironically illustrates the effects of limited flexibility in the context of driving:
In college, I had a friend who became quite excited about getting her driver's license. Though happy for her, I had mixed feelings when she enlisted me to accompany her as she practiced driving around the city. We spent a lot of time together and, because of our relationship, I felt duty-bound to meet her request. As a new driver, she wanted encouragement, and she was sensitive to criticism. She did, however, exhibit a quirk with regard to driving flexibility: She felt uncomfortable with left turns, so she didn't make them.
As you can imagine, this limitation in flexibility lengthened many commutes, errands, and arguments. Over the years, I have reflected back upon that experiential learning, as I have gained new understanding about the role of flexibility in relationships and task accomplishment and powerful tools for augmenting flexibility. Exercising the brain's plasticity develops fitness and behavioral agility in everyday life.
Case Histories
JAKE
One of my memorable cases was Jake. He is a colorful example of the right road taken to divert disaster. In terms of the effectiveness of treatment modalities, Jake's history illustrates the efficacy of EEG biofeedback at resolving ADD/ADHD in patients who had responded unsatisfactorily or marginally to other interventions.
Jake had received a lot of treatment, including medications, counseling, and special education. Nothing had done much good. Using traditional psychological approaches (counseling, behavior modification, environmental supports, altered expectations), I wasn't doing much good with him either. We had a rapport based upon our mutual failure with each other.
Jake came to me just as I was incorporating neurofeedback into my practice. I suggested neurofeedback to his parents, who were willing to give it a try.
In a comparison of EEG biofeedback with other forms of treatment, Jake would be an ideal test case. We didn't think of him as such, however; he was a series of failures looking for a tube to go down. Most of his family had given up on him, as he lived from one scrape to the next. Jake was as ADD as someone gets. To boot, he had several manifestations of learning disability, and a mood disorder. Medications did not seem to modify Jake according to society's wishes. He was oppositionally defiant with a twist. I had never seen a student who inspired such active contempt from teachers. I had worked with Jake and his family across several grades and schools. No fewer than five public schools tried to get rid of him. Teachers who disliked each other would unite to get Jake out of their classes. This boy was not mean, by the way. He just had raw talent for getting people's goats, coupled with a nervous system that couldn't adjust to the demands of school. He had a sordid educational history, punctuated by academic failure and a rap sheet of memorable pranks. He was not simply a class clown; he was genuinely funny. Like many impaired people, however, Jake had the misfortune to become the victim of his own humor. His talent, his frustration, and his coping mechanisms lit fuses that led back to him.
The baseball cap incident was an example of Jake's notorious
career in the principal's office. At his middle school, Jake was repeatedly
reminded that school rules forbade the wearing of hats in class. Jake persisted
in wearing his favorite baseball cap. (
Therapy with Jake had been arduous for both of us. He was distractible, and felt uncomfortable with talk. I knew Jake liked me and understood that I was on his side. (It became apparent that loyalty was a prime motivator for him.) He really did not want to sit with me developing "insight." He could barely sustain a conversation, unless he stimulated himself by infusing wisecracks indiscriminately. Jake was funny but inappropriate. He simply could not sit still. He hated to write, and he was terrible at it. Math was a losing battle. Jake was excellent working with his hands, and he was a gifted athlete. Indeed, he played high school football until he was disqualified by poor grades. He had tried stimulants and antidepressants, but they did little for his performance, and he did not like to take them.
Jake trained with neurofeedback for many months. Nothing seemed to happen for a long while. Though I didn't know it at the time, Jake was among the small percentage of people who do respond well to neurofeedback only after many sessions. We kept it up because his parents trusted me and because no one knew what else to do. At times, I felt that discontinuing biofeedback would signify giving up, rather than reflect an appraisal of his progress. Then, something unexpected happened. As if to spite everybody (a superbly developed skill of his), Jake became observably better. In the middle of our wishing and hoping that he would respond positively to the treatment, Jake surprised us. He began to calm down. The daily screaming tirades that were a part of his repertoire for years suddenly diminished. He cooperated with household tasks, sometimes volunteering. He was on time much more often, and he was findable when he needed to go somewhere with his parents. Jake's mother fell in love with him all over again. His father, a former policeman, took great pride in the development of his son, whom he had lavished with copious amounts of time and patience. He thanked me for diverting Jake from what he dreaded as an almost certain clash with the justice system.
Jake graduated high school and is gainfully employed. He is outstandingly sober, and free of medication. He helps his extended family with child care. He is still very funny and quite a bit absent-minded. He is the kind of wise guy you can trust. After about 60 biofeedback sessions, Jake was able to discuss his relationship problems and satisfactions with me. We did some brief counseling therapy directed at helping him make some practical career choices, grieving over the loss of a dear relative, and disentangling himself from some unsatisfying relationships. Jake and I had developed an understanding of what we could and could not do. It was enlightening for both of us. He learned about his limitations, even as he broke new ground in accomplishment and in self-control. I discovered a productive alternative to hitting my professional head against a wall in therapy (this was not the first time!). Biofeedback made a huge difference for Jake. It was a seminal experience for me in discovering how this fantastic technique could empower people who were stifling in their own disarray. The gradual learning of internal control, improved management of biological "housekeeping," and the ability of the brain (even one with quirks) to regulate itself more efficiently would lead many people to plateaus of functioning and happiness well beyond what I could induce through coaching, behavior management, and insight.
ANDREA
She was only five years old but what a handful of tragedy, pathos, charm, and need! From beneath the thick and lustrous hair swaddled by her pink helmet, Andrea fired her smiles like sudden darts. Her mercurial expressions led me on a rollercoaster of beguilement and emergency.
Though I had treated many epileptics and patients with seizures and ADD/ADHD, Andrea was a special challenge: Her parents had called me as a last resort before capitulating to the neurologist's recommendation to schedule brain surgery. Andrea had intractable seizures hundreds of them every day - and these could not be controlled or managed medically with drugs. Despite years of intense and varied chemotherapy, Andreas brain was still an earthquake factory, generating disruptive patterns from deep within that shook her feet out from under her.
She could rarely walk across a room without falling down. She looked to her parents for support, as they literally had to hold her hands and body, lest she stumble, seize, and fall. This child with the bubbly eyes hobbled with more dependence than if she were blind, her zestful glow quickly replaced with panic and then vacancy. She startled so easily, and any sudden noise or movement launched her into an epileptic emergency. Her waking hours required that she wear a helmet, and so this little charmer fashioned her movements under the aegis of pink plastic a hard pink band-aid across a head that lived in slow motion and was headed rapidly for destruction. What limited life she led was threatened internally by electrical revolt every few moments.
Her parents were desperate. Family life revolved around her fragile condition. Both parents worked, and they had another small child. Still, their lives revolved around Andrea's constant needs, guiding her steps, keeping vials of medicine in each car and location, and making frequent crisis visits to the hospital emergency unit.
We pulled out all the stops: EEG neurofeedback, parent counseling, communications with the neurologists, a QEEG, neuropsychological testing, behavior modification, anxiety-reducing techniques. This family was in grave trouble. Seizures can be life-threatening, and Andrea was stumbling against time. The medical recommendation was to cut the corpus callosum, the structure connecting the left and right cortices of the brain. Such a surgery might save her life, but would undoubtedly have severe repercussions, likely causing significant brain damage. Despite her medical fragility, Andrea was precious, and her parents did not want to sacrifice her personality and abilities. This was a girl who sparkled and who demonstrated normal intelligence and verve.
As if they didn't have enough burdens, the parents were fighting, even considering divorce. The stresses were becoming intolerable. Their medical insurance would not cover EEG biofeedback (or any medical service outside the restricted plan), but the parents shouldered the cost, and we began Andrea's training.
I contacted the new neurologist. This was a doctor the parents considered receptive. For years, they had been lambasted, pushed around, and ultimately ignored. They became increasingly suspicious that the medications were making their daughter's seizures worse and more frequent. The sharing of these thoughts made them unpopular with the doctors. Whenever they inquired or challenged the medical recommendations, the result was that the physician referred them away. One physician even went so far as to threaten them with calling Child and Family Protective Services if they deviated one bit from his prescriptive care plan.
The new neurologist was courteous to me, but she seemed indifferent to the neurofeedback intervention. She told me, "I think your counseling will do way more good for all concerned than any biofeedback." This prediction would prove quite errant.
Training Andrea was difficult. She was so unstable that slight variations threw her into seizures. I had trouble finding protocols that her sensitive brain could tolerate. Often she would slump off the chair, and occasionally she delved into paroxysmal grand mal seizures. Once, the paramedics headed for my office. Her brainwaves were so erratic that I wondered how my computer screen could contain the spikes. Setting her thresholds and containing the brainwaves on the screen required a continual manipulation of instrument controls.
Andrea, however, learned to control her brain! After her 24th session, her parents reported the following:
Andrea's parents are getting along much better. They are living together as a family unit. Though the parents have engaged in smatterings of other interventions (such as a few sessions of counseling), they attribute their newfound harmony, relief, and relative contentment to their daughter's amazing progress. They are extremely grateful.
I have kept the current neurologist apprised of the treatment and of Andrea's progress. During one phone conversation, I mentioned how thrilled I was about Andreas lengthy tenure of seizure absence (nine months), especially in light of her several-year history of virtually continuous and accelerating seizure activity. The neurologist never mentioned neurofeedback, nor the miracle of Andreas progress. She never expressed thanks or acknowledged my work, nor did she even ask any questions. She merely said, "It's a strange phenomenon. It doesn't make sense. Something is clearly out of whack."