Neurofeedback Treatment for Reactive Attachment Disorder

Sixteen years ago, a twelve year-old boy was sent to the adolescent treatment center where I was the new Clinical Director. He was small, blonde, appealing, and murderous. At our first meeting, almost by way of introduction and without evident affect, he said, "I was 'disadopted'". He could not tell me why. Reports had it that he had seriously assaulted his adoptive mother twice. I'd been hired in part because of my reputation for reaching very difficult kids and I took this case. I used everything I knew and he didn't get it. He was, even more importantly, not 'getting' me. After hearing Foster Cline speak, I was able to name the confounding clinical phenomenon that I was encountering. I'd never heard of attachment disorder. I started to read Bowlby, Ainsworth and others. I was able to take this boy, now fourteen, with two male staff to Evergreen for two weeks of intensive holding therapy for him and two weeks of training for me. On our return, we instituted holding therapy at the treatment center but he still made no significant improvement. He now calls me from the county jail where he spends a good deal of his time for offenses like stealing agency vans, high speed chases when drunk, and fist fights. He might be considered a partial treatment success in that he has remained somewhat attached to me and he has made no assaults against women since leaving the treatment center. We were able to name the problem, assess and diagnose accurately, watch more and more of these kids arrive and, essentially, do little more of substance than to continue to watch them until they left. The only approach with any hope of helping these kids, holding, was not sanctioned by the larger mental health community. I refused, however, to believe that anyone is untreatable, particularly a kid, while acknowledging, simultaneously, that we couldn't treat them. It was this belief and this frustration that brought me to neurofeedback. Neurofeedback, which is also called EEG biofeedback or brainwave training, is a process of operant conditioning through which the trainee is able to slowly and cumulatively alter the patterns of the brain's bioelectrical activity, as reflected in the EEG. The results of such change are often, even routinely, dramatic. There are no studies on the use of neurofeedback with Reactive Attachment Disorder, but there are on Attention Deficit Hyperactivity Disorder (ADHD). One is a study of 351 kids all given the diagnosis of ADD/ADHD, many of whom were on Ritalin or other medications for the disorder. After 20 to 40 sessions of neurofeedback, 80% of this population had significant improvement in both impulsivity and inattention (as measured by the TOVA, a continuous performance test, and by observation) and many of these children had to reduce or even eliminate their medication for best functioning. In another study of fifteen children with ADD/ADHD who were trained with neurofeedback, every child's IQ improved with the average improvement being 23 points (WISC-R) along with improvements in the other measures cited above. Such a large improvement in IQ was difficult to attribute entirely to heightened intellectual function. In fact, it became apparent during testing that most of these kids were more engaged with the task and the tester. They now cared, where previously they had not. The training had helped them to normalize affect as well as improve cognitive function.

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Needless to say, this got my attention. Talking with Susan Othmer, I mentioned attachment disorder and holding therapy. She commented that when a person is held, struggles and then surrenders, he/she is probably producing the sensorimotor rhythm (also called SMR), the idling rhythm associated with motor activity. It wasn't a risky speculation since she knew that monkeys who were used in Sterman's early research on controlling epilepsy with neurofeedback and who were given to pulling the electrodes off their heads were restrained and that in the process of struggle and surrender, they would generate the very brainwave frequency that calms the brain and the body, SMR. There is also some relationship to the squeeze box developed by Temple Grandin, who has Asperger's Syndrome, a form of autism. She used the squeeze box to calm and soothe herself. The implications of what Sue was saying were profound. It was suggested that you could use computers to teach kids (and adults) how to generate the brain waves and the state associated with post-holding. Further, that once they learned to do it, the state could endure allowing them to pursue attachment.

Neurofeedback probably works by promoting the neural plasticity of the brain, by changing firing patterns and by increasing blood flow. The process allows for the optimization of brain function. As I have read of and witnessed the results of brainwave training, it has become evident to me that Reactive Attachment Disorder must be understood from the neurophysiological perspective as well as the psychological. Reactive Attachment Disorder is the manifestation of brain damage, specifically damage to the right hemisphere. Neurofeedback can, it appears, remediate this damage by, we think, helping to forge new neural pathways and calming the limbic brain. Kids and adults with Reactive Attachment Disorder live in constant flight or fight, in a terror so fundamental and so pervasive that it is no longer recognizable as terror. By capitalizing on the well documented connection between calmness in body and calmness in mind, training the brain toward motor stillness seems to have a profoundly stabilizing effect, particularly on the neglected right hemisphere. Holding therapy gives us a glimpse into the power of this relationship. However, when we appeal to the brain more directly with neurofeedback, the effect is apparently more pervasive and more enduring. The state of quiet (and not so quiet) terror is slowly but surely calmed. When patients with Reactive Attachment Disorder are no longer starkly over aroused, you begin to see the emergence of empathy, of cause and effect thinking and remorse. You watch, like you would a film speeded up, the emergence of the capacity for attachment. There is much more to be said about what we know already and what we have still to learn about this compelling process. I no longer view neurofeedback as an adjunctive therapy but rather as the first stage, primary therapy which allows for productive holding and talk therapies. All are needed. For more information go to www.eegspectrum.com on the internet. You will find a few case studies, listings of practitioners, and professional training seminars. For those who do not have internet access, contact EEG Spectrum at 800-789-3456 or 818-789-3456.