Mind and Body Connection Learning, Sharing, Collaborating, - - PowerPoint PPT Presentation

ASIA PACIFIC NEUROFEEDBACK/BIOFEEDBACK CONFERENCES PENANG, MALAYSIA 2016

Mind and Body Connection

Learning, Sharing, Collaborating, Networking

Neurofeedback For Autism 21st July 2016

Low Ting Min Bachelor of Arts (National University of Singapore) Neurofeedback Therapist @ Spectrum Learning Pte Ltd Ting_min@spectrumlearning.net

What is Autism Spectrum Disorder (ASD)?

• A neurodevelopmental disorder
• Impaired social interaction, verbal & non-verbal communication,

restricted & repetitive behaviour

• DSM V- merged all subtypes (Autism, CDD, PDD-NOS, Asperger) into
• ne umbrella diagnosis
• Characteristics e.g. delayed learning of language, difficulty making

eye contact or holding a conversation, difficulty with executive functioning, narrow, intense interests, poor motor skills, sensory sensitivities

• A spectrum condition- affected in different ways & different levels of

severity

• Learning, thinking, problem solving abilities differs

Diagnosis of ASD

• Definition according to DSM V manual
• 2 main diagnostic criteria:
• A. Persistent difficulties with social communication and social interaction

(all 3 symptoms)

• A1. Deficits in Social-emotional reciprocity
• A2. Deficits in nonverbal communicative behaviours used for social interaction
• A3. Deficits in developing and maintaining relationships
• B. Repetitive and restricted patterns of behaviours, activities or interests

(at least 2 of 4 symptoms)

• B1. Stereotyped or repetitive speech, motor movements, or use of objects
• B2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal

behaviour, or excessive resistance to change

• B3. highly restricted, fixated interests that are abnormal in intensity or focus
• B4. Hyper or hypo-reactivity to sensory input or unusual interest in sensory

aspects of environment

• Symptoms must be present in early childhood, symptoms together limit and

impair everyday functioning

Statistics

• Global prevalence: Estimates 50-60 per 10,000 school-aged children

(Newschaffer, Croen, & Daniels et.al 2007)

• USA: Estimates 14.7 per 1,000 (1 in 68) children (CDC, 2012)

: ASD is about 4.5 times more common among boys (1 in 42) than among girls (1 in 189).

• No epidemiological study on ASD prevalence in Malaysia and

Singapore

• Malaysia: Estimates 1.6 in 1000 among children of 18 to 36 months of

age (feasibility study, MOH Malaysia, 2006)

• Singapore: At least 400 new cases diagnosed annually at local

hospitals (Clinical Practice Guidelines, MOH Singapore, 2010)

Current Interventions

• Speech, Language and Communication Intervention
• Applied Behavioural Analysis (ABA)
• Occupational Therapy
• Cognitive Behavioural Therapy
• Sensory Integration Intervention
• Social Skills Training
• Developmental or Relationship-based Intervention

Neurofeedback for ASD

• A safe and non-invasive intervention, no adverse side effects
• Positive training outcomes observed over the course of several

months

• Case studies and researches done on NFB intervention for ASD.
• All note favourable clinical outcomes- (Coben 2005, 2006, 2007; Jarusiewicz,

2002; Scolnick, 2005; Thompson & Thompson, 1995, 2003, 2006, 2007a, 2007b, 2009, 2010, 2015b; Kouijzer, de Moor, Gerrits, Congedo, & van Schie, 2009)

• Study on 150 clients with Asperger’s & 9 clients with ASD (Thompson,

Lynda; Thompson, Michael; Reid, Andrea (2010). Neurofeedback Outcomes in Clients with Asperger’s Syndrome

• Controlled studies – Improvements in ASD symptoms supported by
• utcome measures using neuropsychological tests, behaviour ratings,

& neurophysiological tests for treatment group but not control group.

(Coben & Padolsky, 2007; Kouijzer, de Moor, Gerrits, Congedo, & van Schie, 2009)

ASD Improvement programme in SL

Background Information (Subject 1)

• 11yo. Diagnosed with early infantile autism (high

functioning) by psychiatrist in Zurich at 3.5 yo.

• Delayed milestone in speech and physical development.
• Fixed interest e.g. plane schedules
• Received ABA therapy, language training, remedial teacher.
• Good memory, good with details.
• Challenges: Difficulty interacting with peers, poor

comprehension, difficulty perceiving big picture, short attention span, easily distracted, limited language ability

qEEG Brain Mapping

• A Brain- Based approach using qEEG brain mapping

(Quantitative Electroencephalography)

• A peek into areas of the brain which are active, under-active

qEEG findings (subject 1)

• Delta dominant at rest. Delta increased more at back of head

when on task

• Elevated Theta at mid-frontal site

qEEG findings (subject 1)

• Alpha powers were weak at all sites, except at the occipital

sites.

qEEG findings (subject 1)

• When on task, Betas remained unchanged at most sites

while high-Betas increases varied between tasks. This indicated poor neuronal activation.

On Task On Task

Neurofeedback Training Protocols (subject 1)

• Training protocols identified:

1) Activation training at C3, Fz, T5 2) Alpha training at Pz

• Training objectives:

a) To improve language processing ability, comprehension b) Integration of information c) Executive functions, Focus and attention span

Journey of Neurofeedback (S1)

10 20 30 40 50 60 1 4 7 10131619222528313437404346495255 Delta Theta Beta Hi-Beta Linear (Delta) Linear (Theta) 5 10 15 20 25 30 35 1 5 9 131721252933374145495357616569737781 Delta Theta Beta Hi-Beta

(C3 Beta + Hibeta) 1st: Trend was rather flat and slight increase in Delta and Theta. (C3 Beta + Hibeta) 10th: Significant decrease in Delta and Theta trend. Stage 1: Activation training – Left central (C3), mid frontal Fz, Pz Alpha

10 20 30 40 50 60 70 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 Delta Theta Beta Hi-Beta 5 10 15 20 25 30 35 40 45 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 Delta Theta Beta Hi-Beta Linear (Delta) Linear (Theta)

Journey of Neurofeedback (S1)

(Fz Beta) 1st: Trend was rather flat and slight increase in Delta and Theta. (Fz Beta) 19th: Significant decrease in Delta and Theta trend. Stage 1: Activation training – Left central (C3), mid frontal Fz, Pz Alpha

(Pz Alpha) 1st : Trend was rather flat. (Pz Alpha) 12th: Significant decrease in Delta and Theta trend with slight increase in Alpha trend.

15 20 25 30 35 40 45 50 55 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 Delta Theta Alpha Linear (Delta) Linear (Alpha) 15 20 25 30 35 40 45 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 Delta Theta Alpha Linear (Delta)

Journey of Neurofeedback (S1)

Stage 1: Activation training – Left central (C3), mid frontal Fz, Pz Alpha

5 10 15 20 25 30 35 40 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 Delta Theta Beta Hi-Beta Linear (Delta) Linear (Theta) 5 10 15 20 25 30 35 40 45 50 1 6 11 16 21 26 31 36 41 46 51 56 61 66 71 76 81 86 91 Delt a Thet a

Journey of Neurofeedback (S1)

(T5 Beta + HiBeta) 1st: Trend was rather flat and slight increase in Delta and Theta. (T5 Beta + HiBeta) 12th: Significant decrease in Delta and Theta trend. Improved in command of English language. Stage 2: Activation training – Left Temporal (T5), mid Frontal (Fz), Pz Alpha

Training outcome

• 16 sessions: More interested in reading, start to see the link between

different chapters

• 24th session: More curious in things, also speak about what happen in

school other than just his schedule. First time he can read a thick book and discuss with dad.

• 34th session: mum said he is more exploratory, not so rigid, ask more
• questions. English better.
• 36th: over party, he can interact with 3 people at a time and he is easy
• going. Used to be only 1 person at a time or isolate himself. Now

interact more and with more people. Teacher also noted he often play with other kids in school. This is something new.

• Area of Improvement: diverse interest, talk about things, improved

language & communication

Background information (Subject 2)

• 10yo. Diagnosed with Autism at age 3+yo.
• Observed to have anxiety issue, get stressed and cries easily.

Often gets into a loop of thinking

• History of delayed language development
• Poor concentration, strong in reading, restless and always

fidgeting

• Received extensive therapy in social skills
• Main challenge: Anxiety issue

qEEG findings (subject 2)

• Deltas were the dominant EEG during EO and EC.
• No Alpha peaks observed (EO) except very weak Alpha at

parietal and occipital sites. (EC)

qEEG findings (subject 2)

• When on task, Betas and high-Betas could increase at most

sites, except inconsistently at left frontal. This indicated increase in neuronal activities.

On Task On Task

qEEG findings

Subject 1 Subject 2

VS.

5.13 Hz Theta 0.98 Hz Delta

Neurofeedback Training Protocols (subject 2)

• Training protocols identified:

1) Recovery training at F7-F8 2) Alpha training at Pz 3) Activation training at front: F3, Fz Training Objective: Reduce anxiety, promote calmness, affect regulation, to execute without being overly stressed

Journey of Neurofeedback (S2)

Protocols Used

• No. of sessions

Observations F7-F8 Delta, Fz Beta 17 Restless, not at ease. Pz Alpha, Fz Beta 5 Calmer, lesser “overload” episodes Pz Alpha Fz Beta+F3 Beta 4 4 Not frustrated by music; Affected by game scores F3 Beta, Fz Beta 4 Felt stressed again Pz Alpha, F3 Beta, Fz Beta 9 Calm down, deep breathing to relax, can manage better, popular in school Pz Alpha Fz Beta+F3 Beta 5 5 Emphasize on strategy used; hold still throughout F3 Beta, Pz Alpha 8 Challenging game- induce stress Remain calm with challenging game

Journey of Neurofeedback (S2)

(F7-F8 Delta )1st: Slight decrease in Delta (F7-F8 Delta ) 10th: Significant increase in Delta Calmer, lesser overload episodes

5 10 15 20 25 30 35 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 Beta Delta Hi-Beta Linear (Delta) 5 10 15 20 25 30 35 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 Beta Delta Hi-Beta Linear (Delta)

Stage 1: Recovery training – F7-F8 Delta

Journey of Neurofeedback (S2)

(Pz Alpha) 1st: Fluctuations in eeg

• trend. Inconsistent

Fidgety, restless (Pz Alpha) 19th: Significant decrease in Delta and Theta trend. Can calm down and relax with training.

5 10 15 20 25 30 35 40 45 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 Delta Theta Alpha Hi-Beta 5 10 15 20 25 30 35 40 45 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 Delta Theta Alpha Hi-Beta Linear (Delta) Linear (Theta) Linear (Alpha)

Stage 2: Alpha & Activation training – Pz Alpha, Fz, F3 Beta

Journey of Neurofeedback (S2)

(F3 Beta) 1st: Trend was rather flat and slight increase in Delta and Theta. Cried when score dropped (F3 Beta) 21st: Significant decrease in Delta and Theta trend. Able to calm himself down with more challenging/ stressful game level.

10 20 30 40 50 60 1 3 5 7 9 1113151719212325272931333537 Delta Theta Beta Hi-Beta 5 10 15 20 25 30 35 40 45 1 4 7 10 13 16 19 22 25 28 31 34 37 40 Delta Theta Beta Hi-Beta Linear (Delta) Linear (Theta)

Stage 2: Alpha & Activation training – Pz Alpha, Fz, F3 Beta

Training outcome

• A lot more able to calm down
• Lesser temper tantrums
• Episodes of overload, “brain is full” reduced significantly

Conclusion

• ASD, like other disorders, often requires a combination of

intervention to bring out the best results.

• NFB, should be one of the core therapies in managing this

neuro-developmental condition.

• Neuroimaging tools such as qEEG is very useful in

understanding this spectrum condition better and to provide guide in NFB treatment plan

Thank you