Setting the Scene
Nothing feels more natural and fulfilling to us humans than creating a family. Imagine a beautiful baby boy being born to two healthy parents. Imagine being the parent of this baby boy, watching him grow from a tiny dependent infant to a curious developing toddler. For the purposes of this article, let’s refer to this little boy as Nick.
However, as Nick approaches his second year of life, concerning patterns begin to emerge.
- His small vocabulary bank doesn’t seem to be expanding at the rate of other children his age
- His ability to engage with others and in cognitive tasks appears limited in both depth and timespan
- The expression of love and connection between parent and child feels, to some degree, hindered
As time progresses, Nick’s parents grow increasingly concerned about their son’s behavior; and like any concerned parent, they set up an appointment with their pediatrician to learn more about what was going on. Upon further investigation of his developmental stage and behavioral performance, Nick is diagnosed with Autism at the age of two and a half years old.
This is little Nick’s story, and unfortunately, he is not alone.
Autism in America
According to the CDC’s Autism and Developmental Disabilities Monitoring Network, about 1 in 68 children has been diagnosed with Autism Spectrum Disorder (ASD) as of 2016. While ASD does not appear to discriminate among race, ethnicity, or socioeconomic status, it has been found that it has a higher prevalence among boys than it does girls, 4.5 times higher to be exact. This means that while 1 in every 189 girls presents symptoms of ASD, 1 in only 46 boys is diagnosed with ASD every year.
Although some correlations have been found among certain genetic and chromosomal conditions and the occurrence of ASD, any type of singular cause has yet to be determined. Instead, NCBI research data suggests it is a complex combination of both genetic and modern environmental factors that has lead to the development of the autism spectrum.
Symptoms and Challenges
Autism spectrum disorder is a neurodevelopmental disorder that encompasses a wide range, or “spectrum” of developmental symptoms, combination of presenting symptoms, and levels of disability. In other words, the disorder does not present itself identically in any two people. There are, however, a set of core issues that arise to some degree or another in the majority of all ASD individuals. These include difficulties with bonding and social interaction, language challenges resulting in limited speech and reading, and a tendency to engage in repetitive behaviors.
Research on the earliest signs and symptoms of ASD has shown that parents of severely autistic children can notice a developmental problem even before the child’s first birthday. In this first year, some of the most commonly reported concerns are issues with basic sensory perception of sights and sounds. Even the more complex issues such as differences in social, communication, and fine motor skills can be evident as early as six months of age. The emergence of symptoms during this early diagnostic window often corresponds with a more severe manifestation of the disorder.
If symptoms are more mild in their presentation, a second diagnostic window typically occurs during the school-age years. Teachers are soon able to detect the discrepancies between the innate skills and behaviors of autistic children versus those not on the spectrum. These children are often considered to have “high-functioning” autism, a subtype of ASD that has come to be referred to as Asperger’s syndrome.
In addition to the symptoms mentioned above, children with ASD often display a tendency to
- Engage in solitary (independent) play
- Difficulty interpreting social cues such as facial expressions, nonverbal communication and tone of voice
- Difficulty taking instruction or engaging in groups
- Hyper-focus and/or hyperactivity
- Resistance to transitioning between activities and daily routines
- Repetitive behaviors, tics or movements (referred to as stimming)
- Emotional instability and loud outbursts.
It is important to keep in mind that symptoms of ASD are bidirectional, meaning behaviors can present as deficient (lack of emotional expression) or excessive (stereotypic movements). It is also important to note that while children on the spectrum may display significant deficits in some skill sets, they can have amazing, prodigious capacities in other ways, such as computational, musical, artistic, or memory talents.
In Nick’s case, he was limited to solitary and parallel (adjacent but independent) play even through to the first grade. He displayed difficulties initiating social interaction, joining another person’s ideas or train of thought, and staying engaged. Nick’s language was patterned, concrete, and rote. However, he was at grade level (proficient) in math and word decoding. Nick’s parents described his emotional expression as limited, as he was not one to show much physical or verbal affection even towards them. Nick was a hyperactive boy, attracted to fans and other spinning things. He had a nose-picking tic, and ‘stimmed’ or flapped his arms routinely when he was excited. He loved to memorize maps and road routes, play with blocks and his Thomas the Tank Engine toy set. Nick also enjoyed art, and drawing with pencils, crayons, markers, and sometimes water colors.
The Autistic Brain
While the science behind the cause of ASD remains a top unsolved priority, brain imaging research has aimed to at least understand what is going on in the brains of ASD individuals.
Early functional magnetic resonance imaging (fMRI) studies found that the functional connectivity between brain regions in ASD participants was weaker compared to that of developmentally healthy participants, leading to the theory of “under-connectivity”. However, recent fMRI studies have found that there can also be an excess of connectivity throughout certain regions of the autistic brain. Although these findings may appear contradictory at first, when taken together, they suggest that abnormal brain connectivity is a primary symptom of ASD. Furthermore, abnormal brain connectivity may to some degree mirror the various behavioral profiles of autism in that symptoms can occur bidirectionally (deficient in some areas and excessive in others). It may be abnormal brain connectivity, rather than abnormal brain chemistry, that is the primary determinant behind ASD brain states and symptom presentation.
From a treatment perspective, this also implies that brain chemistry may not be the ideal target for therapy when it comes to ASD, but rather, these functional communication highways between brain regions and cortical networks; how they connect and how they communicate with each other in a given brain state. Modern neurotherapies such as infraslow fluctuation (ISF) neurofeedback address these discrepancies among electrical activity, connectivity (coherence) and processing speed (phase). As it’s evolved over the years, ISF has become one of the leading treatment options for autism in children and adults.
Brain Therapy for Autism
Neurotherapy, or neurofeedback (NFB), is a brain-based type of biofeedback where an individual learns to retrain his or her own brainwave activity. It is non-invasive, painless and can even be done while watching your favorite movie or tv-show. Brainwave activity is read using an EEG machine (electroencephalogram) and fed back to the patient in real-time through the use of audio tones. While the patient’s attention may sway from the tones to their movie, the brain remains highly attentive to this information, constantly taking in the feedback and adjusting its level of activity accordingly. Overtime, ISF neurofeedback trains the brain to better regulate, manage, and optimize its functionality and organization.
Neurofeedback research on autism uses the qEEG in order to assess the baseline levels of electrical activity across the full surface of the brain. This sample of brainwave activity is then quantified, compared to age-normed databases of developmentally healthy males or females, and used to design a patient’s NFB protocols. Recent findings from qEEG studies show that the brains of ASD individuals do in fact display distinct abnormalities related to coherence (connectivity) compared to healthy brains. Both autism and the Asperger’s subtype display coherence dysregulation, as well as hyper- and hypo-coherence in various regions of the brain, further supporting the fMRI research on the role that connectivity plays in spectrum disorders.
While ISF neurofeedback is not a cure for autism spectrum disorders, families have enjoyed a number of clinical benefits in children and adults alike. Through consistent training patients are able to engage their brains in different degrees of activity, improving neuroregulation and optimizing coherence/connectivity pathways. As a result, individuals with autism and Asperger’s have seen a range of symptom improvements including clear speech patterns, decreased hyperactivity and emotional outbursts, improved social skills, initiation of touch and physical contact, increased imagination, and more engaged responses to parental and teacher instruction.
Neurofeedback: Autism Success Stories
When Nick’s parents first brought him in for ISF neurofeedback he was about 7 years old, on his summer break following the first grade. His first qEEG revealed a congestion of hypercoherences both bilaterally (between) and ipsilaterally (within) each hemisphere of the brain. During the first sessions, Nick had a remarkable response. His father was astounded that his son sat so calmly for so long. This is frequently the case when the brain experiences something so new and unfamiliar. As expected, Nick did not exhibit this response again to the same degree until many sessions later. The reports from Nick’s parents were initially mixed. However, by the 15 session mark, his father reported very calm and “competent” behavior while doing errands, and an out of character, unsolicited expression of “I love you” towards his mother. Nick even showed me the unexpected affectiionate gesture of a hug and handshake after a training session.
Nick’s in-session responses were often gauged by certain repetitive movements such as stand-up/sit-down events, hand/arm gesticulations and verbal commentary. But following session 30, Nick began initiating social interaction, inquiring about my day while maintaining eye contact. As he continued with ISF into his 2nd year of grade school, Nick’s progress was slow but gradual: sometimes he was very active but far more related, other times he was very calm but verbally disengaged; at times his parents even disagreed about what they observed.
Through to the following year, by session 75, Nick appeared to start and complete his 3rd grade homework more easily, began having normal conversational exchange with his father about school, remaining engaged, answering questions and relating. One day at school, Nick spontaneously and without prompting, asked a fellow classmate if he would like to come and play over the weekend. In the following months Nick’s parents were told that he was more focused that year in school, showed less resistance toward instruction, and had fewer emotional outbursts.
Nick’s subsequent qEEG’s continued to show some disperse hypercoherence. This was reflected in the persistence of certain verbal stimming behaviors, such as periods of ceaseless movie narration and commentary. However, Nick’s mother observed that his imagination had become more active. Nick began calling her attention to his perceptions of different shapes and colors in his environment that reminded him of other shapes or animals.
At the 175 session mark later that spring, Nick’s parents stated that he had a good report on his social behavior at the recent PPT. Nick’s shining moments, however, came the following school year when Nick began participating in class presentations and started playing the trumpet. He performed a speech in front of the audience with confidence and played a solo at a school concert. He even participated in and won his school spelling bee and went on to take first place in the regional run-off. Nick’s latest qEEG showed significant alleviation of hypercoherences throughout the brain. In total he completed 195 sessions.
When considering neurofeedback outcomes in clients with asperger’s syndrome Nick’s journey speaks for itself. Over two years time of brain training his autism, Nick was capable of immense growth in both social and emotional capacities relating to the self and to others. For Nick’s parents, his ability to listen, engage, and focus shifted from a cause for worry to a sign of hope. As a result of his new capacities, Nick began to build a sense of autonomy, even if only on a subconscious level, leading to increases in confidence and self expression. Although some verbal stimming resisted training, Nick is able to harness his long standing aptitude for memorization so that it pays both socially and scholastically.
Infraslow neurofeedback continues to show invaluable efficiency in the treatment of autism spectrum disorders. While not a cure, neurofeedback for autism and asperger’s is a cutting-edge neuromodulation therapy that offers families struggling with ASD a not yet seen enrichment in both quality and depth of life.