ASIA PACIFIC NEUROFEEDBACK/BIOFEEDBACK CONFERENCES PENANG, MALAYSIA 2016 Mind and Body Connection Learning, Sharing, Collaborating, Networking Neurofeedback For Autism 21 st 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 one 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 outcome 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) Stage 1: Activation training – Left central (C3), mid frontal Fz, Pz Alpha 60 50 ( C3 Beta + Hibeta ) 1 st : Trend was rather Delta 40 flat and slight increase in Delta and Theta Theta. Beta 30 Hi-Beta 20 Linear (Delta) 10 Linear (Theta) 35 Delta 0 1 4 7 10131619222528313437404346495255 30 Theta 25 20 Beta 15 Hi-Beta ( C3 Beta + Hibeta ) 10 th : Significant 10 decrease in Delta and Theta trend. 5 0 1 5 9 131721252933374145495357616569737781
Journey of Neurofeedback (S1) Stage 1: Activation training – Left central (C3), mid frontal Fz, Pz Alpha 45 40 35 ( Fz Beta ) 1 st : Trend was rather flat and Delta 30 slight increase in Delta and Theta. Theta 25 Beta 20 Hi-Beta 15 Linear (Delta) 10 Linear (Theta) 5 0 70 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 Delta 60 50 Theta 40 Beta 30 ( Fz Beta ) 19 th : Significant decrease in Delta Hi-Beta 20 and Theta trend. 10 0 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81
Journey of Neurofeedback (S1) Stage 1: Activation training – Left central (C3), mid frontal Fz, Pz Alpha 45 40 ( Pz Alpha ) 1 st : Trend was rather flat. 35 Delta Theta 30 Alpha 25 Linear (Delta) 20 15 55 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 50 45 Delta 40 Theta 35 Alpha ( Pz Alpha ) 12 th : Significant decrease in Delta 30 and Theta trend with slight increase in Alpha Linear (Delta) 25 trend. Linear (Alpha) 20 15 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61
Journey of Neurofeedback (S1) Stage 2: Activation training – Left Temporal (T5), mid Frontal (Fz), Pz Alpha 50 45 Delt 40 a (T5 Beta + HiBeta ) 1 st : Trend was rather 35 flat and slight increase in Delta and 30 Theta. 25 Thet 20 a 15 10 5 40 0 35 1 6 11 16 21 26 31 36 41 46 51 56 61 66 71 76 81 86 91 Delta 30 Theta 25 Beta 20 Hi-Beta (T5 Beta + HiBeta ) 12 th : Significant 15 decrease in Delta and Theta trend. Linear (Delta) 10 Improved in command of English language. Linear (Theta) 5 0 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69
Training outcome • 16 sessions: More interested in reading, start to see the link between different chapters • 24 th 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. • 34 th session: mum said he is more exploratory, not so rigid, ask more questions. English better. • 36 th : 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. 0.98 Hz 5.13 Hz Theta 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
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