Is Neurofeedback for You?

Proponents say neurofeedback promotes dramatic improvements in attention and self-regulation — but some experts are skeptical. Know the facts before plugging into this emerging therapy.

Brain Training and Autism

BRAIN TRAINING AND AUTISM

Maureen and Terrence Magagnos, of Lynbrook, New York, took their seven-year-old son, Peter, to Dr. Coben after he was given a diagnosis of pervasive developmental disorder in first grade. "Peter had classic symptoms of autism," says Magagnos. "His speech was terrible, he made very little eye contact, and he screamed for attention — literally screamed."

Their exceptionally generous insurance covered neurofeedback, so they decided to give it a try, with sessions twice a week for the next five years. At the start of the treatment, Coben says, he discovered that Peter had been suffering tiny, asymptomatic seizures. He says neurofeedback helped stabilize the child's brain activity, eliminating the seizures. And within three months, says Peter's dad, Peter's teachers were calling to report remarkable improvements.

"Today I'd say he has 'autism light,'" he adds. "He has some symptoms, but he is more manageable."

Whether such results can be achieved with other children is a matter of debate. Still, as practitioners lobby for broader acceptance, including insurance recognition, a sure sign of neurofeedback's increasing popularity is the number of companies selling mind-altering systems to use at home.

With names like SmartBrain Technologies and Learning Curve Inc., they offer equipment purported, respectively, to "pump the neurons" and "make lasting changes in attention, memory, mood, control, pain, sleep, and more." The Food and Drug Administration regulates all biofeedback equipment as medical devices. The only approved use, however, is for "relaxation."

Peter Freer, a former grade-school teacher, is chief executive of a North Carolina firm called Unique Logic and Technology. He says that since he began his business in 1994, he has sold thousands of his Play Attention systems, advertised to improve a child's or an adult's focus, academic performance, and social behavior. The equipment, which costs $1,800, is touted as "a sophisticated advancement of neurofeedback."

Freer says his clients include more than 600 school districts. (He adds that his system, as distinct from "clinical" neurofeedback, aims to put the user in an "attentive state" that makes it easier to teach cognitive skills, shape behavior, and produce performance-based outcomes.)

Neurofeedback is largely unregulated, and its practitioners often devise their own protocols about where on the scalp to place electrodes. Results vary widely, and researchers caution that it is important to choose one's practitioner with care.

When it comes to the actual devices, Cynthia Kerson cautioned that they should never be used without experienced supervision. "Often people get one of these machines on eBay and use it at home," says Kerson, adding that unskilled use could interfere with medications or prompt an anxiety attack or a seizure. "Neurofeedback is a powerful therapy," she says, "and should be treated that way."

KATHERINE ELLISON, a Pulitzer prize- winning journalist, is the author of Buzz: A Year of Paying Attention.

Games Adults Play

Travis, a college sophomore, watches his favorite movie, Flight of the Phoenix. Travis is barely aware of the headset connected to my computer that monitors his brain's activity. Just as the pilot in the film attempts to avert a crash landing in the Gobi desert, the movie freezes. A tower appears on the left side of the screen. To get the movie back on, Travis needs to relax his body and shift his emotions from high to neutral, and focus on a gold bar at the top of the tower. In seconds, a stairway of blue bars creeps up the tower, signaling an increase in blood flow to Travis' prefrontal cortex, the seat of executive functioning. After 20 seconds of sustained focus, Travis moves the blue bars past the threshold and restarts the movie. After 20 to 30 minutes of this mental shifting, Travis says, "Now I know what it feels like to concentrate on a goal without my medication doing it for me." This form of neurofeedback is called passive infrared hemoencephalography, or pirHEG, an efficient way of recruiting the region of the brain responsible for executive functioning.

Travis is one of many adults who prefer a medication-free approach to their ADHD symptoms. Neurofeedback and biofeedback are complementary approaches to ADHD and its co-existing conditions.

> Lisa, a 42-year old-graduate student, has a history of ADHD and anxiety. When overwhelmed with work, she becomes irritable and panicky. Lisa was eager to try a form of biofeedback called Heartmath. With the emWave sensor attached to her earlobe, she learned to monitor her breathing and her thoughts to achieve a state of "physiological coherence." This state is akin to being "in the zone," when the body is calm and relaxed. We also addressed strategies for planning and prioritizing — areas of weakness which were the sources of her anxiety. "After four weeks of Heartmath and study skills training, I felt more in control under stress. My work improved and I sleep better," says Lisa.

> Ben, a 53-year-old software engineer who was diagnosed with ADHD, finds it hard to learn new information and manage multiple projects. This affects his work performance and prevents him from holding down a steady job. Ben decided to try the Cogmed Working Memory Training program. Working memory is a powerful executive function that allows us to hold on to information while we use that information in our thinking. Mental math, problem solving, and reading comprehension are some of the tasks that depend on working memory. Ben did the computerized training at home, completing eight challenging exercises every day. Once a week, I coached him to optimize his performance on the exercises. By the end of the third week of training, Ben noticed that he was able to remember more of what he read and was better able to follow through on projects without being sidetracked. One year later, Ben continues to see gains in his job performance and his self-esteem.

REBECCA SHAFIR, M.A., CCC, is a speech and language pathologist and director of alternative and complementary services at the Hallowell Center for Cognitive and Emotional Health, in Sudbury, Massachusetts.

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