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 sixteen year old female who, as reported by her parents, was struggling with a constellation of cognitive and behavioral challenges. The girl's difficulties included auditory processing problems, Dyslexia, insufficient academic achievement (almost being held back a grade), an inability to focus and pay attention, and sleeping in class. In addition, the girl was involved with other at risk students and had experimented with drugs. She had long-standing difficulties with waking up in the mornings. Despite extensive tutoring, cueing and coaching, the girl was unable to organize herself enough to track, complete and turn in assignments. She also struggled with low self-esteem; her feelings were easily hurt, and she tended to hold grudges for a long period of time. The girl was in counseling and was medicated with prescribed stimulants. The physician had recommended an increase in medication, but her parents hoped to avoid this.
After she received an initial Neurofeedback session the Mother reported the girl was involved in a terrible fight with peers at school. After several more training sessions a teacher contacted the Mother by phone to inquire about a “drastic change” in her daughter; it was as "as if all of a sudden a light went on", the teacher reported. She “is suddenly able to listen and seems to understand what is being said” the teacher noted, and asked if there was something the parents were doing that could account for such positive changes. The teacher also reported the girl as having a much brighter affect. As training progressed, the girl’s interim report card showed minor improvements in all subjects except math. Later, the parents reported their daughter had formed new and more appropriate friendships. In addition, they were working with the prescribing physician to titrate the girl's medications with an eventual goal of cessation. Further into treatment the girl's report card demonstrated one and two letter grade improvements in all subjects. The parents reported their daughter’s Dyslexia was diminished, and that she was able to titrate off of stimulant medication. By discharge, the parents reported that their daughter “wakes up easily most mornings, remains focused, and gets out the door on time”. They reported feeling “deeply relieved” that “our daughter enjoys school most days, and is doing well socially and academically".
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Case B
This case involved a thirteen year old male who, despite placement in special accommodations remained severely academically challenged. His Mother described the nightly process of completing homework as "two or three hours of sheer torture" as he remained distraught and under-focused while she frustratingly helped him every step of the way. He often forgot his assignments, daydreamed or slept in school, and misplaced his things regularly. The boy was unable to fall asleep easily at night and had difficulty waking up in the mornings and organizing himself to catch the bus on time. The boy struggled with low self-esteem and the parent felt he was struggling with on-going depression, reflected in traits such as monotonic, slow speech and a lack of motivation. His parent also reported that fine motor-graphic deficits and compromised short-term memory were contributing to her son’s over-all lack of motivation. The boy had few interests beyond his video games. Cognitive therapy was beneficial only to an extent. Though the boy was taking prescribed antidepressant and stimulant medications, these did not seem to be helping him overcome his symptoms.
After he received an initial Neurofeedback training session the parent reported her son was having the usual difficulties with homework completion, falling asleep late, etc. Shortly into training she noted that homework was becoming noticeably easier for the boy due to improved focus and ability to stay on task, as well as sleep improvements (her son seemed less irritable in the evenings). As training progressed, the boy’s teachers reported improved classroom participation, as well as voice modulation changes (brighter tone). Midway through training the boy’s report card reflected modest improvements in math, but all other subjects had improved by one letter grade. Towards the end of Neurofeedback training the parent reported that her son was "doing less obsessing about his problems". His widening interests included involvement in sports. The Mother noted her son was doing homework on his own with little to no assistance. By discharge the boy's handwriting and fine motor coordination were on par with his age group, and his academic achievement scores had improved significantly.
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