Possible Mechanism for Improvement in Autistic Symptoms with Neurofeedback

A couple of studies have come out recently that seem to support my theory of how neurofeedback benefits some individuals on the autistic spectrum.

In a study done at the Massachusetts General Hospital, magnetoencephalography (MEG) was used to study the brains of young men on the autistic spectrum and compare them with normal controls.  The results showed that both local and long-range connectivity was significantly compromised in the autistic individuals.  The results were so striking that the experimenters could predict with 90% accuracy whether a MEG scan was that of someone on the autistic spectrum. 

Another study out of the University of Montreal in Canada used magnetic resonance imaging (MRI) to study brain structure before and after neurofeedback treatment.  They demonstrated changes in both white and gray matter in the brain.  Some of these differences where clearly in the tracts that are associated with long-range connectivity in addition to localized cerebral structural changes.

I find it plausible to believe that neurofeedback would foster both more organized local activity and long-range connectivity in the brain of those with symptoms of autism.  This would account for those who show calmer behavior, better focus, and improved skills.

-Local and long-range functional connectivity is reduced in concert in autism spectrum disorders.  Sheraz Khan, et al.  Proceedings of the National Academy of Sciences, January 14, 2013.

-Neurofeedback Training Induces Changes in White and Gray Matter.  J. Ghaziri, et al.  Clinical EEG and Neuroscience, March 26, 2013.

How long does it take for neurofeedback to work?

This simple question has a simple answer that needs much elaboration–it is different for each person, and I find it quite difficult to predict who will begin to respond within a few sessions and who will take considerably longer.  The usual person needs 40-60 sessions of neurofeedback to make meaningful and lasting changes.  However, there are factors that might be under the control of person receiving neurofeedback that can augment or counter the effectiveness of neurofeedback.

One of the first things to think about is brain nutritional support.  A diet that is rich in omega-3 fatty acids, a variety of vegetables and fruits, and whole foods is much more likely to foster good brain health than one that consists of fast foods, sugar, and manufactured foods that contain dyes, preservatives, and other additives.  I agree with the notion that the foods that look most like their sources are generally the healthiest.  For instance, whole grain bread looks much more like grain than white bread.  A ragu dish looks more like unprocessed vegetables than a pizza with pepperoni and tomato sauce.

A healthy diet also makes it unnecessary to take most dietary supplements in an otherwise healthy person.  Fad diets based on the latest research “uncovering” a new superfood are silly.  There are many healthy foods and getting a good variety is most sensible.

There are a couple of exceptions.  With the use of sun screens and the decrease in outdoors activities, many people are Vitamin D deficient.  A simple blood test can detect this. If needed, supplements are usually taken once a day.  Readily available sources of omega-3 fatty acids may also be difficult to locate and might not appeal to some palates.  So supplementation with omega-3 fatty acids can be helpful for many people.

Another way to impede progress with neurofeedback is spending excessive time on “screens”.  I lump television, video gaming, and (non-work, non-school) computer/smart pad use in this category.   The way that most of us use media allows our brains to relax in a relatively unfocused way.  Think of a baby with a pacifier or an idling car.  Some amount of this is alright for most, but spending long periods of time in this state makes it habitual and difficult to break away.  Productive and engaged brain states become more difficult.  I usually recommend limiting screens to an hour or less a day.

Regular physical exercise is essential for the health of the brain.  It increases blood flow to the brain providing more nutrients and oxygen.  It speeds the removal of carbon dioxide and waste products.  Aerobic activity for a least a half an hour and at least 5 days a week can make positive changes happen faster.

Getting enough sleep is of vital importance.  Young children need up to 12 hours of sleep per night.  The average teenager needs 9-9 1/2 hours of sleep per night–not just on weekends!  Adults need an average of 7-7 1/2 hours of sleep per night.  Sleep research has shown that adequate sleep is vital for a variety of metabolic activities.  Inadequate sleep promotes poor focus, mood disorders, and cancer.

Following regular routines is quite helpful for the brain.  As it becomes expert at following certain procedures, they become more and more automatic to the point that you might get many things done while barely thinking about them.   For example, when most of us first learn to drive a car, we tend to overuse the accelerator and brake pedals, oversteer, and forget to use our mirrors and peripheral vision.  Once these skills have been practiced enough, we hardly notice that we have them.  It seems like my car drives itself to my office.  So make a conscious effort to make regular tasks follow set patterns and schedules to free up your energies and brainpower for more worthwhile activities.

Positive behavioral incentives can work wonders.  Catch yourself or your loved ones being good and pay attention to it.  We are too quick to criticize and punish.  Emphasize the positive and correct!

My Road to Neurofeedback and Integrative Medicine

In 2004, my 11 year old, high-functioning autistic child, B, was not doing well.  He was on the best medications known to help his symptoms, including the anti-psychotic Risperdal, a stimulant amphetamine, and an SSRI anti-depressant.   He was receiving special education, speech therapy, occupational therapy, and social skills therapy.  However, he still lived in constant anxiety and fear.  Sounds were too loud or annoying,  Physical contact was irritating.  Being around other people was so stressful that it caused him to either disappear into his own world or have hours-long meltdowns.  He was getting into physical altercations with fellow students, as well as hitting, kicking, and biting his teachers and aides.  At home, he seemed content only when he was playing with a video game or alone in his room.  He had already been asked to leave 2 previous schools, and it looked like it was going to happen again.

We conferred with his doctors and therapists, but we had already tried every alternative medication at the highest doses and exhausted each therapists’ toolkit.  As we were leaving a conference with his social skills therapist, she looked at us with obvious discomfort as she explained that she had had a previous client who tried this “crazy” thing called EEG neurofeedback and it had really made a positive difference.  She looked sheepish as she felt that she could only suggest it  because she knew how desperate we were.

We contacted the EEG neurofeedback therapist and set up a course of therapy.  We were gratified that B was at least cooperative, but discouraged by his initial reaction to the neurotherapy.  He would fall asleep during the session and then sleep for an hour or so afterwards.  This went on for about 10 sessions when we suddenly realized that B had gone an entire day without having a temper tantrum or meltdown.  Soon these days of relative calmness became frequent, and daily messages from school about behavioral problems almost disappeared.

We were so encouraged that I went for training as an EEG neurofeedback therapist to the EEG Institute in Woodland Hills, California.  There, Sue and Siegfried Othmer taught me the basics of therapy, helped me obtain the proper equipment, and offered on-going support.  B continued receiving home therapy several times a week.  Further progress was slow–apparent only over months.  But the child who could barely write a sentence learned to write competent paragraphs within a couple of years.  Some friendships were being formed.

B’s abilities grew even greater as we added biomedical protocols that I learned about at DAN (Defeat Autism Now) conferences.  For instance, eliminating casein, the protein in milk, from his diet suppressed “stimming” and hyperactive behavior.  Yeast control measures helped with digestive function and helped clear his skin rashes.  Neurotherapy continued for several years as B went through hundreds of sessions, and EEG neurofeedback equipment and protocols improved.

B entered high school with most of his classes still considered special education and in special classrooms.  However, testing now showed an average IQ even though other testing shows some persistent weaknesses in some of his academic abilities.  By the time B reached his senior year, he had moved into all regular classes except for his AP Psychology class.  He took the AP exam and scored a 4/5.  His special education teachers in their final parent conference with us proudly told us that they had never seen a autistic student make the positive changes that they had seen in B, and that he was the first autistic child that they knew of to graduate with a regular diploma.  B is now a regular student at a major university where he has been on the Dean’s list each semester except his first.  He has studied abroad on an academic program.  He has a wide circle of friends and participates regularly in sports.

I got into the practice of neurofeedback and integrative medicine when the parents of other special needs children asked me what I was doing that made such remarkable changes in B.  I had retired from family medicine to help care for B several years earlier, but since he was beginning to do better, I had enough time to offer treatment to others.  My practice was started.