Presented by Ronald Swatzny, PhD; Meredith Hoffman, PhD: When a child fails to respond as hoped to medication or treatment, their parents want answers. Rarely is neurofeedback their first choice, but it is often their last hope. By the time they consider neurofeedback, most have failed several medication attempts, behavior intervention, and parent training. The reason why so many children fail to get their issues resolved may be due to an inadequate diagnostic process. In the field of mental health, diagnoses are primarily based on the report of symptoms from either the patient, parents, or both, and a psychiatrist’s or therapist’s observations. A psychiatric diagnosis is currently the most widely used basis for medication and treatment selection however, the brain is seldom investigated directly as a source of those symptoms. The National Institute of Mental Health (NIMH) Research Domain Criteria Project (RDoC) was created to elicit scientific research into neurological abnormalities that can be linked to psychiatric symptoms for the purpose of predicting medication and treatment response. One such neurological abnormality that has been the focus of many studies over the last three decades is isolated epileptiform discharges (IEDs) in patients without seizures. Zimmerman and Konopka (2014) found that IEDs are associated with greater affective dysregulation and more severe psychiatric symptoms. They found high rates of IEDs have been found in specific diagnostic categories such as panic and anxiety disorders, mood disorders, schizophrenia, eating disorders, personality disorders, and violent behavior. Additionally, high rates of IEDs have been found specific to childhood disorders such as ADHD (Milichap et al. 2011; Kanazaw, 2014; Lee et al. 2015 & Swatzyna et al. 2017a) and Autism Spectrum Disorder (Reinhold et al. 2005; Chez et al. 2006; Milligan & Trauner 2013; Yasuhara 2010; Swatzyna 2017b). We present the findings of our systematic review of the literature and compare them to our cross-sectional analysis in order to determine prevalence rates of IEDs within diagnostic categories. Our study found a consistent high prevalence of IEDs specifically for ADHD (majority >25%) and ASD (majority >59%). If children and adolescents have failed multiple medication attempts, and more than one-third of them have IEDs, then an EEG would be justified within the RDoC paradigm. Identification of IEDs is critical to the success of neurofeedback in two ways. First, medications such as stimulants, antidepressants, and antipsychotics all lower seizure threshold and make these brains more unstable/pathologic () thus thwarting neurofeedback efforts. Second, IEDs are either artifacted out or averaged out in making the qEEG brain maps. The foci of the IEDs has to be known so that appropriate neurofeedback protocols can be designed. Just training the background fails to address the primary cause of the child’s symptoms. Having the EEG read by a neurologist who is a board certified encephalographer is not only justified in children and adolescents who have tried and failed past medication attempts but it is an ethical responsibility.
2020: Solving the Mystery- When Children Adolescents Fail Treatment, Parents Want Answers (Plenary)
Presented by Ronald Swatzny, PhD; Meredith Hoffman, PhD: When a child fails to respond as hoped to medication or treatment, their parents want answers. Rarely is neurofeedback their first choice, but it is often their last hope. By the time they consider neurofeedback, most have failed several medication attempts, behavior intervention, and parent training. The reason why so many children fail to get their issues resolved may be due to an inadequate diagnostic process. In the field of mental health, diagnoses are primarily based on the report of symptoms from either the patient, parents, or both, and a psychiatrist’s or therapist’s observations. A psychiatric diagnosis is currently the most widely used basis for medication and treatment selection however, the brain is seldom investigated directly as a source of those symptoms. The National Institute of Mental Health (NIMH) Research Domain Criteria Project (RDoC) was created to elicit scientific research into neurological abnormalities that can be linked to psychiatric symptoms for the purpose of predicting medication and treatment response. One such neurological abnormality that has been the focus of many studies over the last three decades is isolated epileptiform discharges (IEDs) in patients without seizures. Zimmerman and Konopka (2014) found that IEDs are associated with greater affective dysregulation and more severe psychiatric symptoms. They found high rates of IEDs have been found in specific diagnostic categories such as panic and anxiety disorders, mood disorders, schizophrenia, eating disorders, personality disorders, and violent behavior. Additionally, high rates of IEDs have been found specific to childhood disorders such as ADHD (Milichap et al. 2011; Kanazaw, 2014; Lee et al. 2015 & Swatzyna et al. 2017a) and Autism Spectrum Disorder (Reinhold et al. 2005; Chez et al. 2006; Milligan & Trauner 2013; Yasuhara 2010; Swatzyna 2017b). We present the findings of our systematic review of the literature and compare them to our cross-sectional analysis in order to determine prevalence rates of IEDs within diagnostic categories. Our study found a consistent high prevalence of IEDs specifically for ADHD (majority >25%) and ASD (majority >59%). If children and adolescents have failed multiple medication attempts, and more than one-third of them have IEDs, then an EEG would be justified within the RDoC paradigm. Identification of IEDs is critical to the success of neurofeedback in two ways. First, medications such as stimulants, antidepressants, and antipsychotics all lower seizure threshold and make these brains more unstable/pathologic () thus thwarting neurofeedback efforts. Second, IEDs are either artifacted out or averaged out in making the qEEG brain maps. The foci of the IEDs has to be known so that appropriate neurofeedback protocols can be designed. Just training the background fails to address the primary cause of the child’s symptoms. Having the EEG read by a neurologist who is a board certified encephalographer is not only justified in children and adolescents who have tried and failed past medication attempts but it is an ethical responsibility.
$30.00
