Attachment and Neurofeedback

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A Case Study

On a raw November morning, Judy and Rob had to make a quick decision. Sam, Judy's three year-old student in daycare, needed emergency foster care. Although they had never planned to be foster parents and were waiting to start their own family until finances improved, they could not resist this boy. Sam first came to the attention of Child Welfare when he fell out of a third floor window at age two. When they investigated they learned that Sam was profoundly neglected, that he had been hospitalized four times, that both parents had been foster kids, both had seizure disorders, both had serious psychiatric histories and both were substance abusers. They placed Sam with his grandmother who had been diagnosed with Multiple Personality Disorder and he stayed with her for nearly a year.

Child Welfare became re-involved with him only after the grandmother returned him to his parents. There was now a baby brother. Again, due to profound neglect and Sam's severe behavior problems both boys were removed from the home and placed in foster care. Sam was nearly uncontrollable. He slept only four hours a night. He stole and hoarded food, attempted to hurt if not kill his brother, was cruel to the family pets, displayed almost constant masturbatory behavior, defecated on the floor, refused to obey the foster parents, never stopped moving, tantrumed constantly and showed no sign of regret or remorse. He was, also, unable to make a sentence of longer than three words, responding when he chose to, only with one word and with gestures. This foster family relinquished him because they feared he would kill his baby brother. The next foster family made him eat his stool when he defecated on the floor and when he started a fire by putting a cloth over a lamp, burned him on the lip with the light bulb. It was the fire that precipitated the emergency placement.

The 'honeymoon' with Judy and Rob was short. Sam was voraciously hungry, slept only 3-5 hours a night, was severely hyperactive, did not listen or obey, and generally acted 'like a punk.' He made sexual gestures when he was diapered at night and when bedtime came he would begin to scream, a bout that could go on for three to four hours. It was, as Judy humbly put it, "not easy." The demands of this child strained Judy and Rob's relationship. They had lived a quiet and gentle life before Sam, the thirty pound, ceaseless tornado tore it apart. They had heard about neurofeedback and Sam began this treatment in late November. He had three to five, three to twenty minute sessions a week depending on what he could tolerate. (It does require, to some extent, sitting still). At home they instituted regular holding sessions, often many times a day. They also gave him a bottle, which at first he did not know how to use but which he immediately wanted. They let him eat as much as he wanted. He consumed gallons of yogurt in the first few weeks. There is also-and this may be significant in terms of outcome-no TV in the home and he was fed no sugar or wheat. Within six weeks Judy noted the following changes. "Sam is eating normally, not trying to grab our food and not overeating. He is no longer preoccupied with food. He is slowly gaining weight. He's sleeping twelve hours a night. He still needs frequent holding sessions but has also begun to ask for them.

He seems surprised at himself when he does. He is more cooperative and less clingy. (For weeks he would not let Judy out of his sight.) He has many fewer episodes of rage and with prompting will make eye contact. He has remorse and he's not so selfish. He seems to be getting cause and effect. And he is able to play calmly and he asks us to read books!" Judy reported the following episode about four weeks after his placement. "We'd had a long and rough day. I asked him why he thought it was so tough. He started to cry, real, wet tears and said 'I want you!'"

After three months, Sam has become an emotionally expressive child. He can, at sad moments, still go dark behind the eyes but he does not go blank. He is increasingly, spontaneously, relational. All sexual gesturing has stopped. He still has holding frequently but increasingly on request. His new parents tuck him in at night, he falls asleep on his own and sleeps for twelve hours. His night terrors have disappeared. He listens and does what he's told. His speech is still seriously delayed but that too is improving. He is using simple sentence structure and is working with his parents on his articulation. Judy and Rob are delighted with Sam and they have begun the adoption process. This is a dramatic but not unique case and it is, of course, still a case in progress. The contribution of neurofeedback seems to be that it facilitates and potentiates all the other indispensable aspects of therapy for children with Reactive Attachment Disorder: holding; talk therapy, therapeutic re-parenting, deep parental commitment, and parental support.

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