AAPB and ISNR have established standards for Neurofeedback research [Moss & Gunkleman (2002)] that confer a status of Level 5 Efficacy for ADD/ADHD, where evidence meets all of Level 4 criteria and investigational treatment has been shown to be statistically superior to credible placebo, pill or alternative bona fide treatment in at least two independent researcher settings. Neurofeedback provides evidence-based practices on par with health care establishment demands (Gemon, Devon & Ramsey (2000), Sacket et al, (2000). Levels of evidence include: case reports, observational studies, randomized clinical trials, fMRI scans (Andrasik & Rime (2007), and so on. “Efficacy” determination of training or treatment effect is derived from systematic evaluation in controlled clinical trial (La Vaque et al (2002).
Case A
This case involved a very bright ten year old male who was easily distracted and extremely hyperactive. In class and at religious services the boy was unable to sit still, was often verbally disruptive, would speak out of turn, make noises, or blurt out his thoughts. His parents described his challenging behaviors: he often failed to follow directions, had a very short attention span, talked excessively, was unable to finish chores and often failed to remember his homework assignments. In addition, he apparently would flit from one thought to the next, sometimes in mid-sentence. When disciplined, his parents reported the boy could be very oppositional. The parents had enrolled him in Martial Arts classes to help him with focus and discipline. They wanted to minimize or avoid physician recommended medication.
After the boy received an initial Neurofeedback training the parents reported no significant changes, but after more training they reported the boy was remembering to bring home assignments. Thereafter, the parents reported the Martial Arts instructor had commended their son for significant improvements in performance areas requiring discipline and calm focus. Following this, the parents reported the boy’s excessive verbosity had slowed, with fewer instances requiring disciplinary measures, and some residual setbacks on stressful days. By discharge, teacher academic and behavioral reports were significant for noticeable improvements in the boy: class disruptions and maladaptive behaviors substantially minimized, an ability to follow instructions correctly in most cases, and one or two letter grade improvements in all but one subject.
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Case B
This case involved a thirteen year old male who was adopted and diagnosed by age eight with Executive Function deficits, ADHD and Reactive Attachment issues. From a young age, the parents noted, the boy demonstrated hyperactivity with poor eye-contact and oppositional/defiant behaviors. They also reported their son was reluctant to engage in social activities requiring sleepovers, since he continued to wet the bed nightly, and though he was obsessed with his "friends" at school, he had no significant friendships with peers outside of school. The boy was combative with his siblings, was prone to lying, and showed poor judgment/could be easily taken advantage of. His parents described him as "moody and emotionally immature" and expressed concerned he might get into "worse trouble" as he got older. The boy’s only relationships were with children who were half his age. He struggled with academic underachievement, and had been medicated with prescribed stimulants since he was ten years old.
After receiving an initial Neurofeedback training the boy’s parents reported a slightly improved mood, but were unsure about this, as the change was very subtle and "difficult to qualify". In another early visit, the Mother reported the boy was still "getting in trouble" at school on a regular basis. As training progressed, the parents noticed the boy’s improved eye contact, significantly less hyperactivity overall, and no bed-wetting for one week continuously. Moreover, the parents cited less fighting between the boy and his siblings, and felt they had "turned a corner", as the boy now responded appropriately to calm negotiation. His grades showed continued improvement. Mid-way through training the boy proudly reported a month of "dry nights"; he had attended a sleep-over with school mates and seemed to be genuinely enjoying his school experience. By discharge, he jubilantly reported making the honor roll at school.
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