Neurofeedback and Self Regulation

by Dan Dinsmoor, Ph.D.

At Family Compass we see children with a wide array of presenting problems. Very commonly, the children we see can be described as having problems in “self regulation”. Children who have problems in self regulation may have problems in emotional control (frequent tantrums at home and school). They may be inappropriately aggressive. They may be hypersensitive to their environments (hypersensitive to sounds or odors). They may also have problems with inhibition of inappropriate behavior, or problems with maintenance of attention, and the completion of tasks.

Commonly the children we see with self regulation problems range in age from 4 to 10 years of age. For the younger children in this group, the parents may be very concerned about the child’s adjustment to kindergarten, following a rocky experience in preschool. For slightly older children parents may be concerned about their placement in special education, or simply be concerned that their child is not behaving and learning in ways that are predictive of success in later school years.

Problems with self regulation are one area where neurofeedback has a reliable, relatively quick and clinically significant benefit as a treatment intervention. It is usually the case that within 4-5 sessions we see improvement in symptoms of frustration tolerance or having a short fuse. Within about 10 sessions we tend to see an improvement in mood. Within about 15 sessions there is an improvement in the child’s cooperation with parental and teacher directives. At about 20 sessions there is an improvement in terms of decreases in hyperactivity and impulsivity.

We are very concerned about carefully assessing the effects of our treatment process. There are three measurement devices we typically use to measure change. The first is a behavior checklist called the BRIEF (Behavior Rating Inventory of Executive Function). This allows us to assess problems in inhibition, shifting attention, emotional control, initiative, working memory, planning and organization, organization of materials, and self monitoring using parental input and comparing the particular child’s scores with other children his age. The second is the IVA a computerized test of auditory and visual attention that allows us to measure problems with sustained attention in these two perceptual modalities. The third measurement device is a problem checklist of 5 items picked by parents as appropriate target problems for their child. This checklist is reviewed with the parent before each session, so we can track changes in symptomatic behavior from week to week.

An example of this treatment process is D.S. She was an 8 y.o. girl brought to our clinic because her parents noted that she was not performing at school as well as they had hoped, or as well as her intellectual capability suggested she should. She was described by her mom as having “poor work habits”. When there was something she didn’t know, she would “wiggle and move, and become too emotional” ultimately bailing out of the work situation, rather than persevering and working it through. An assessment using the BRIEF suggested that she had clinically significant difficulty in inhibiting her behavior, emotional control, and monitoring her behavior. On the IVA, she demonstrated clinically significant problems with both sustained auditory attention, and sustained visual attention. The parents were interested in specifying 4 problems to track on a weekly basis. This included 1. Getting angry too easily or too often 2. Excessive complaining about fairness 3. Avoiding tasks requiring concentration 4. Moodiness.

Results of a course of 21 treatment sessions are as follows, S.D. On the BRIEF showed a dramatic improvement in her ability to inhibit her negative impulses. She was able to control her overly emotional responses dramatically better. She also made big gains in her ability to monitor her own behavior. These changes were paralleled in the computerized test of attention the IVA. Sustained auditory attention improved significantly and sustained visual attention improved dramatically. Symptoms picked by parents as of particular concern were reduced by 75%. All these values were in the normal range at the end of treatment.

If you are interested in learning more about neurofeedback to help with self regulation, please contact me for a consultation (703 471-5517 ext.2).

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