We treat a variety of Diagnoses and Conditions using EEG Neurofeedback and Biofeedback at our clinic. We also incorporate a number of additional therapy approaches which are discussed in more detail under the Related Therapy section of this website.
We specialize in Attention Deficit Disorder with or without Hyperactivity, Migraines and Tension Headaches, Sensory Processing Disorder and Autism Spectrum Disorder. When treating a diagnosis of Stroke and Traumatic Brain Injury we require a Quantitative EEG or Brain Map as these conditions are very complex and require a more specific analysis than just using related standardized testing and presenting clinical symptoms.
The following are a list of the conditions we treat. Detailed information has been provided under the categories that we specialize in.
ADD / ADHD
Autism Spectrum Disorder
Migraines and Tension Headaches
Sensory Integration Disorder / Sensory Processing Disorder
Cerebral Palsy and Motor Apraxia
Chronic Pain (Under the direction of Otto S. Kramer, M.D.)
ADD / ADHD
Attention Deficit and Attention Deficit Hyperactivity Disorder is the most common psychiatric disorder in children (2%-5%) (American Psychiatric Association 1994)
ADD/ADHD is caused by a disruption to the functioning of certain neural networks in the brain. It is hereditary in more than half of the cases; 30%% of those affected have at least one parents with ADD/ADHD; 30% to 50% of children with this disorder have significant difficulties that persist into adulthood and they also have an 80% chance of having at least one child with ADD/ADHD. This disorder is neurological in origin and does not develop because of any environmental demands or difficulties.
ADHD is frequently co-morbid or occurring with other behavioral disorders (Barkley, 2006), including Sleep Disorders (30-56%), Oppositional Defiant Disorder (40%-80%), Conduct Disorder (20-56%), Anxiety Disorder (10-40%), Depression (30%), Tic Disorders (10-15% for simple tics) and Dyslexia (20%). It is also seen in Autism Spectrum Disorder and non-verbal Learning Disorders.
Typically, ADD/ADHD is diagnosed using a number of subjective behavioral ratings. However, this can lead to persistent doubts about whether this is in fact an accurate diagnosis. Over the last ten years, independent research groups have published a large number of articles on the value of using QEEG or Quantitative Electroencephalogram in the diagnosis of ADD/ADHD. As a result, the American Academy of Pediatrics, in their guidelines on ADHD, have described the QEEG as a valuable diagnostic assessment. At our clinic, we have the QEEG available to direct our Neurofeedback approach but also use other standardized measures to diagnose this condition, including Continuous Performance Tests which are also helpful as a re-assessment tool in order to document changes with therapy. In addition to using EEG Neurofeedback, we also utilize Biofeedback, Listening Therapy, Sensory Integration and Cognitive strategies which we will be happy to discuss with you in more detail during the initial consult.
Neurofeedback is probably the most interesting and promising treatment modality for Attention Deficit Disorder in use today and this is an area of specialization at our clinic. The goal of treatment is to teach a child or adult how to change the way one's brain works, so that they can better cope and function with this neurological based disorder. EEG Neurofeedback or Biofeedback is not a "cure" for ADD/ADHD. Nonetheless, there is an increasing body of evidence that it leads to "normalization" of behavior and can enhance the long-term academic performance, social functioning, and overall life adjustment. An additional area that we have found to be present in a large number of children and even adults who present to our office with ADD/ADHD is Sensory Processing Disorder. It appears this is a foundational issue that greatly impacts on behavioral organization and is often seen by Linda Marshall-Kramer OTR/L in the initial assessment. This Disorder can be diagnosed by Linda Marshall-Kramer as she is an experienced and Certified Sensory Integration clinician with over 30 years of experience working with children having sensory based behavioral issues.
We also have Research studies available at our office on a number of topics, but especially on this disorder which we will be happy to share with you. In addition, there are links on this website which can direct you to more research based information.
Ritalin Gone Wrong by L. ALAN SROUFE - Published: January 28, 2012 »
SYMPTOMS AND CATEGORIES OF DISORDERS IN ATTENTION
The principle characteristics of ADHD are inattention, hyperactivity, and impulsivity. This disorder used to be known as attention deficit disorder (ADD) but was renamed attention-deficit/hyperactivity disorder (ADHD) in 1994 and broken down into three subtypes, each with its own pattern of behaviors. However, the use of ADD/ADHD is often seen in literature; the below gives more specific information on the breakdown of the different types.
ADHD – Predominantly Hyperactive-Impulsive Type that does not show significant inattention, but with signs that include:
» fidgeting or squirming
» difficulty remaining seated
» excessive running or climbing
» difficulty playing quietly
» always seeming to be "on the go"
» excessive talking
» blurting out answers before hearing the full question
» difficulty waiting for a turn or in line
» problems with interrupting or intruding
ADHD - Predominantly Inattentive Type that does not show significant hyperactive-impulsive behavior, but may include the following:
» inability to pay attention to details or a tendency to make careless errors in schoolwork or other activities
» difficulty with sustained attention in tasks or play activities
» apparent listening problems
» difficulty following instructions
» problems with organization
» avoidance or dislike of tasks that require mental effort
» tendency to lose things like toys, notebooks, or homework
» forgetfulness in daily activities
ADHD - Combined Type which involves a combination of the other two types and is the most common. To be considered for a diagnosis of ADHD:
» child must display behaviors from one of the three subtypes before age 7
» behaviors must be more severe than in other children the same age
» behaviors must last for at least 6 months
» behaviors must occur in and negatively affect at least two areas of a child's life (such as school, home, day-care settings, or friendships)
The behaviors must also not be linked to stress at home. Children who have experienced a divorce, a move, an illness, a change in school, or other significant life event may suddenly begin to act out or become forgetful. To avoid a misdiagnosis, it's important to consider whether these factors played a role in the onset of symptoms.
We started out with a very active little boy, who got into everything. Then we progressed into more and more behavior problems. At the time, we couldn't understand why he was doing these things. By first grade, we were really having a hard time. It was really taking a toll on the whole family. I dreaded the thought of birthday parties or any kind of social gathering. Everything we did was a struggle. He really had a hard time in school. We had problems with not paying attention, talking out of turn, non-stop talking, starting fights, not getting along with other kids, stealing, temper tantrums that could get out of control. He also fought me on shoes, socks, coats, and shirts.
When the school social worker told me about sensory disorder, I had never heard of it. I researched it and thought that this sounds like the problem and now we can understand him and help him. Then we got him diagnosed and started with OT. We also joined a social thinking group, started seeing a psychologist and started taekwondo. He was also tested for ADHD and we were told he had that too. I did not want to start him on medicine, but eventually when the problems at school continued, we did. One thing that made is so hard was that I saw both sides of him. He is funny, kind, affectionate and loving. He always tries so hard to make good choices and do the right thing. I could tell how hard he was trying and he still struggled everyday. Even with everything we were doing to help him, I still saw very little improvement. He had no friends and he was unhappy with himself.
When one of the mom's at taekwondo told me about Neurofeedback I thought it sounded crazy. We were doing all these other things and I wasn't about to try something like that. Then about a year later another mom told me that she saw something in the waiting room of Children's Therapy Services, and it was called Neurofeedback. I'd been researching treatments for ADHD and sensory disorder and still really didn't know anything about Neurofeedback. Then I really started to read about it. I ordered books, searched on-line and I was amazed at what I was reading. This sounded like it was really helping people, and the more I found out about it and how it works, it made sense to me. I couldn't wait to try it. Then I made a mistake. I was in such a hurry to start that I went somewhere that didn't have people that were trained properly. After about 10 sessions I knew from what I had read that something wasn't right. I called Linda at CTS and told her what was going on and she explained to me how it really should be done. We started coming to CTS in April 2011 - I was so excited! My son was so excited, he finally felt that something was going to help him. Right away he connected with Linda. He felt like she 'got' him and he knew she was going to make his life easier. I wanted to do things right, so we had Dr. Otto Kramer do a QEEG and it felt so good to see it on paper. It also showed that we had a more severe case of ADHD to deal with. I wanted to see a change right away, but that's not how it happened.
There were times when I was discouraged because I didn't think I was seeing any improvements and we were over 40 sessions. I was afraid we were going to start fifth grade with all the problems we had before. Then it started to happen, I'd notice little things. He started playing better with his cousins and with friends. They would even look forward to playing with him. They would play for hours and there would be no fighting, I couldn't believe it. I wasn't holding my breath any more waiting for things to go bad. When I talked to his teacher, I told her that he struggled with his peers and she said that she didn't notice that. Did she really just say that! He came home from school and said that a boy who has been in his class before told him that he wasn't as weird. Most people would think that was not a nice thing to say, but it was amazing for us to hear it. We can enjoy spending time with him. He's happy with who he is. He's still a 10 year old boy and I know he'll still have issues from time to time, but what a difference this has made. We're not done yet, we've decreased the medicine and over time will eliminate it. I can't say enough good things about Childrens Therapy Services and Neurofeedback - this thing turned out to be not so crazy after all!
Autism Spectrum Disorder
Autistic Spectrum Disorder (ASD) includes Autism, Pervasive Developmental Disorder and Asperger's. Behavioral treatment have been the traditional option for ASD along with Sensory Integration Therapy, among others, in order to address the over-reactivity to certain stimuli and to develop adaptive responses in the areas of motor control, attention and social interaction including expressive and receptive language abilities.
Autism is viewed as a unique attention problem related to ADD and ADHD. This viewpoint has been adopted by many clinicians and researchers today, as ASD and ADD share some of the same abnormal genes and neurotransmitters. There are, however, many significant differences from Attention Deficit Disorders.
Examination of the brainwaves of Autistic individuals reveals an abnormal EEG signature. The Autistic EEG signature is different from the ADD one. The ADD individual does not produce enough of the faster Beta wave activity while most ASD individuals produce too much. Their brains appear to be over-focusing. This overstimulation of the brain contributes to many known behaviors such as fascination with certain things, obsessions, repetitive rituals or other self-stimulatory behaviors. That is why we see stereotypic interest in certain toys, movies and especially computer based games.
Using the QEEG it is possible to more specifically target the specific brain wave activity relative to where they are dominant in the brain during certain conditions and also assist in recognizing an identifiable pattern among the ASD individuals in terms of seizure activity. This can be mild or severe and occurs in one third of ASD individuals. When doing a QEEG it is also helpful if a neurologist is able to review the EEG map in order to detect any possible seizure activity. The QEEG process at our Clinic is performed and analyzed by a board certified medical doctor.
Neurofeedback targets the over-production of fast wave activity and at our Clinic it is used with children beginning from the age of three years, as long as they are capable of sitting on their parents lap and tolerant of the application of the sensors. Often, we use Neurofeedback after a Sensory Integration session because the sensory system has received specific input which is calming and organizing, allowing the child to now tolerate the Neurofeedback therapy process better. In addition, we use various sensory diet activities throughout the session to better engage and normalize the child's ability to attend. EEG Neurofeedback with ASD individuals is a complicated process and should be guided when at all possible by the results of a QEEG Brain Map and performed by experienced Neurofeedback clinicians. Current research suggests that ASD may be associated with functional disconnectivity between brain regions so coherence training is an integral component of our protocol. There is evidence for anomalies in the functional connectivity of the medial temporal lobe. Abnormalities have been found specifically in the functional integration of the amygdala and parahippocampal gyrus. These areas are part of the Limbic system. This system is involved in emotions, learning and motivation and has connections to many lobes of the brain so this is an important area to target when performing Neurofeedback in order to specifically impact upon behavior. EEG Neurofeedback has been shown to increase neuro-regulation. In contrast to behavior therapy alone, positive outcomes as a result of neurofeedback training are often achieved over the course of several months as opposed to years of behavioral training. However, it should be noted that research has indicated that Neurofeedback often requires more than double the number of sessions as opposed to other conditions such as Attention Deficit Disorder and involves precise training of the brain. Our experience suggests the best results are obtained when they are paired with Sensory Integration Therapy and a home program tailored to the sensory needs of the child.
Migraines and Tension Headaches
Migraine headaches affect approximately 26 million people in the United States. This disorder causes incapacitating and disabling headaches, especially in women and can significantly impact upon one’s quality of life, both at work, school and socially. In addition to the physical symptoms there can also be cognitive impairments which include difficulties in thinking clearly, attention, concentration, memory, judgment, calculation and problem solving. These symptoms can then lead to frustration, impatience and irritability lasting for hours after the headache subsides. (Black et al, 1997/John Meyer et al 2000).
A study by Kropp et al (2002) showed that migraines can be controlled better with Neurofeedback and improvements can occur. After treatment with Neurofeedback the number of migraine days decreased significantly, and a number of other migraine parameters had decreased over time as well as in comparison with a group who had not been treated with Neurofeedback. Neurofeedback does not work for a minority of those with Migraines and it is not clear why not.
At our Clinic we treat Migraines and Tension Headaches with a variety of approaches, depending upon the presenting symptoms and the physical findings from the Physician in charge of the treatment protocol. Biofeedback in the form of Thermal therapy using PIR HEG is an especially valuable tool used in conjunction with the Neurofeedback program. In addition, since Anxiety and other co-morbid conditions often exist with Migraine and Tension Headaches, we also utilize Galvanic Stimulation and Heart Rate Variability among other interventions to better treat this condition in a more holistic manner. You can learn more about all of these treatment methods in the Related Therapy section of this website. We see children as well as adults and have had good success with our treatment orientation. Migraines are not a simple condition to treat but improvements have consistently occurred with our treatment methods and in many instances medications have been reduced in number as well as dosage under the direct supervision of the primary physician.
back to top
Sensory Integration Disorder / Sensory Processing Disorder
Sensory integration disorder or what is now commonly referred to as Sensory Processing Disorder (SPD) is a neurological disorder that results from the brain's inability to integrate certain information received from the body's five basic sensory systems. These sensory systems are responsible for detecting the position and movement of the body as well as visual, sounds, smell, tastes, pain and temperature sensations. The brain then forms a combined picture of this information in order for the body to make sense of its surroundings and react to them appropriately. The ongoing relationship between behavior and brain functioning is called sensory integration (SI), a theory that was first pioneered by A. Jean Ayres, Ph.D., OTR in the 1960s.
Sensory experiences include touch, movement, body awareness, sight, sound, smell, taste, and the pull of gravity. Distinguishing between these is the process of sensory integration (SI). While the process of SI occurs automatically and without effort for most, for some the process is inefficient. Extensive effort and attention are required in these individuals for SI to occur, without a guarantee of it being accomplished. When this happens, goals are not easily completed, resulting in sensory integration disorder (SPD).
The normal process of SI begins before birth and continues throughout life, with the majority of SI development occurring before the early teenage years. The ability for SI to become more refined and effective coincides with the aging process as it determines how well motor and speech skills, and emotional stability develop. The beginnings of the SI theory by Ayres instigated ongoing research that looks at the crucial foundation it provides for complex learning and behavior throughout life.
The presence of a sensory processing disorder is typically detected in young children. Most children develop optimal sensory processing during the course of ordinary childhood activities, which helps establish such things as the ability for motor planning and adapting to incoming sensations. However, some children do not develop as efficiently. When their process is disordered, a variety of problems in learning, development, or behavior become obvious.
Those who have sensory integration dysfunction may be unable to respond to certain sensory information by planning and organizing what needs to be done in an appropriate and automatic manner. This may cause a primitive survival technique called "flight or fight," or a withdrawal response, which originates from the "primitive" brain. This response often appears extreme and inappropriate for the particular situation.
The neurological disorganization resulting in SPD occurs in three different ways: the brain does not receive messages due to a disconnection in the neuron cells; sensory messages are received inconsistently; or sensory messages are received consistently, but do not connect properly with other sensory messages. When the brain poorly processes sensory messages, inefficient motor, language, or emotional output is the result.
The following are a list of some of the common presenting symptoms that are typically seen in children with a Sensory Processing Disorder.
» oversensitivity to touch, movement, sights, or sounds
» under-reactivity to touch, movement, sights, or sounds
» tendency to be easily distracted
» social and/or emotional problems
» activity level that is unusually high or unusually low
» physical clumsiness or apparent carelessness
» impulsive, lacking in self-control
» difficulty in making transitions from one situation to another
» inability to unwind or calm self
» poor self concept
» delays in speech, language, or motor skills
» delays in academic achievement
While research indicates that sensory integrative problems are found in up to 70% of children who are considered learning disabled by schools, the problems of sensory integration are not confined to children with learning disabilities. SPD transfers through all age groups, as well as intellectual levels and socioeconomic groups. Factors that contribute to SPD include: Autism, premature birth and other developmental disorders; learning disabilities; delinquency and substance abuse due to learning disabilities; stress-related disorders; and brain injury. Two of the biggest contributing conditions are autism and attention-deficit hyperactivity disorder (ADHD). This connection between attention deficit disorder in particular has consistently been noted by Linda Kramer, OTR/L during Neurofeedback therapy.
In order to diagnose and determine the presence of SPD an evaluation should be conducted by a qualified Occupational therapist. An evaluation normally consists of both standardized testing and structured observations of responses to sensory stimulation, posture, balance, coordination, and eye movements. These test results and assessment data, along with information from other professionals and parents, are carefully analyzed by the therapist who then makes recommendations about appropriate treatment.
Occupational therapists play a key role in the conventional treatment of SPD. By providing sensory integration therapy, Occupational therapists are able to supply the vital sensory input and experiences that children with SPD need to grow and learn. Also referred to as a "sensory diet," this type of therapy involves a planned and scheduled activity program implemented by an Occupational therapist, with each "diet" being designed and developed to meet the needs of the child's nervous system. A sensory diet stimulates the "near" senses (tactile, vestibular, and proprioceptive) with a combination of alerting, organizing, and calming techniques. These techniques are utilized during the Neurofeedback session at our Clinic in order to impact upon the child’s arousal level so that the therapy session is better impacted.
The sensory integrative approach is guided by one important aspect - the child's motivation in selection of the activities. By allowing them to be actively involved, and explore activities that provide sensory experiences most beneficial to them, children become more mature and efficient at organizing sensory information. At our Clinic we actively engage the child in the therapy process but still maintain control in terms of how the activities are selected so they best meet the individual needs of the child.