AAPB and ISNR have established standards for Neurofeedback research [Moss & Gunkleman (2002)] that confer a status of Possible Efficacy for Autism/Aspergers. 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 five year old male diagnosed with Autism. The parents noted their son had undergone various therapies with mixed results, and reported he suffered from tantrums when stressed, and demonstrated extreme excitability and hyperactivity. The boy was apraxic; was unable to mirror the behaviors of others. His parents described other traits such as uncontrolled motor tic behaviors, including arm flailing, walking on tip toes, freezing in position, breath-holding, head rolling and lunging or darting. The parents also referred to other behaviors: the boy was prone to bouts of unpredictable, unprovoked anger, hitting, and biting or socking/slugging of others. The parent's felt their son was very bright, and demonstrated the ability to learn some behaviors, but only in carefully controlled environments. His sentence and thought construction was unusual, and communication was demonstrably difficult for him.

After an initial training session the boy's parents reported “meltdown” behavior that same evening. After several more sessions the parents reported overall improvements in their son’s aggressive behaviors and a new apparent composure in his demeanor, which they attributed to his gains in the ability to better perform mirrored social behaviors. As training ensued, the parents reported “good” behavior while at an amusement park, where previously the boy could not have handled such a tumultuous environment. The parents reported their son was calmer, more composed and more focused overall, with diminished levels of self-stimulating behaviors, and successful modulation of his voice volume. Later, the parents reported ongoing gains after some set backs (several incidents of aggression and an intermittent increase of motor tics) over a number of weeks. Midway through training the parents reported a marked increased in the boy’s ability to calm himself when excited. They noted that overall he was consistently demonstrating cooperative, harmonious behaviors. In addition, the boy was able to communicate coherently, as his syntactic construction had improved. By discharge, the parents reported fewer behavioral setbacks overall --- but were unable to continue with additional recommended treatment with transition to home-training.

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Case B

This case involved an eleven year old boy who had benefited from applied behavioral modification training, and extensive communication, occupational and physical therapies, along with social play interventions. Prescribed neuroleptic medications were discontinued due to problems with muscle spasms, dehydration of the mouth, excessive constipation and general agitation. The boy's parents reported demonstrated social deficits in interpreting social cues, including responding appropriately to anger or affection. In addition, the parents described other behaviors: emotional self-regulation proved difficult, with loss of control when frustrated, or when faced with strange or sensorialy overwhelming environments. Verbal outbursts, disruptive and physically aggressive behaviors were part of the boy’s daily experience, along with banging his head, biting, and sudden freezing in position. The boy had an extensive vocabulary and was hyperlexic, but was challenged by an inability to coordinate his thoughts with logical sentence construction. He also demonstrated facial contortions, gesturing and tone mismatches with his behaviors,and compulsively self-stimulated with inappropriate touching. He appeared to have a high tolerance for and lack of awareness of extreme pain, yet could be overly sensitive to minor sensations such as tags on his clothes.

Early after the boy completed Neurofeedback training sessions his parents reported their son’s behaviors were unchanged. Shortly thereafter the parents reported minimal aggressive incidents for two days in a row and that he had hugged his Mother spontaneously and appropriately a couple of times. Thereafter reports were mixed, with a few “difficult days” and numerous “incidents", replete with verbal outbursts, head banging, biting, crying, etc. As training progressed, the parents noted the boy’s improved ability in thought construction and therefore with communication. The boy seemed to be less frustrated, and had no incidences of “melt down” for almost a full week. Midway through treatment the parents reported the boys self-stimulating behaviors had diminished and the Mother noted the boy could tolerate tags and certain sensations against his skin more readily then in the past. The Mother also reported on the boy’s siblings, who were apparently enjoying their brother’s company and were starting to include him in more activities. Later the parents reported “more congruent” self-expression from their son, with fewer facial distortions and incidences of arrested movement. The boy was consistently able to modify his behavior in most instances, appropriately expressing his needs and also responding appropriately to social cues. Toward the end of in-office sessions the boy reported with a very wide grin that he had won a Sunday-school award for “most admired” student. The parents reported that because traits such as inappropriate touching, facial contortions, and strange gesturing had all but abated, they felt their son’s progress was sufficient. The boy was discharged and transitioned successfully to home-training.