Mental Health Practitioners Comments

Matt Fleischman, Ph.D.
Child Psychologist
Eugene, OR

Matt Fleischman received his Ph.D. in 1976 from the University of Oregon. Upon graduation he served as the principal investigator for a large-scale multi-site outcome study related to the treatment of aggressive children. He’s been in private practice as a Licensed Psychologist and a Licensed Marriage and Family Therapist for over 15 years. He has used EEG Biofeedback for the last seven years. He’s a specialist in attention and behavior disorders in children and is the author of a book and producer of several video tapes on those subjects.

From an interview with Mike Cohen,
Southern Institute of Psycho-Physiology, August 1996.

Reflections on the mechanisms underlying Neurofeedback
It seems to me that Neurofeedback has a lot of similarities to recent developments in psychiatry that involve modifying serotonin. Serotonin is the neurotransmitter of self-regulation. Prozac, among other SSRI class of drugs increases the available supply of serotonin thereby improving the self-regulation of dopamine and epinephrine, other regulators of our mood and behavior. The SSRI drugs involve direct modification of the chemical composition of the brain. Neurofeedback comes at it from a different angle, from changing the brains own self- regulation of its electrical system. If you think of the brain as a electro-chemical system, then it should be possible to get the same effect from entering from either direction. What is different about neurotherapy is that it draws upon the brain’s very essence, its ability to modify its own performance.

Has Neurofeedback changed what you do for clients?
For ADD/ADHD, Neurofeedback has provided me with another treatment alternative or option. Prior to neurotherapy my work typically involved three aspects.

1. To appropriately diagnose the conditions and to educate the client as to what that means.

2. To provide behavioral and environmental management training to the parents of these children. As I explain to the parents, for most kids, being a ‘good enough’ parent is good enough. With these kids, being a ‘good enough parent’ is not good enough, you have to be a better parent. In school, the teacher has to be a more effective teacher. At both home and school, you have to learn to structure the environment to help.

3. The third thing is working with the physician around medication. Being able to titrate medication on an objective basis is very helpful. I have found the TOVA very helpful for fine tuning the dosage, and determining how often you need it. One can run a full ADD practice with these three approaches.

Neurofeedback has given me a fourth option. With some kids, it permits treatment without medication. For others it enables the meds to work better or at a lower dose. For kids who are already medicated, it is a way to get them off it. Even kids who respond well to medication eventually want to get off it, particularly as they reach adolescence. I was much less successful at getting kids off the meds before I introduced Neurofeedback.

For many children, I get better results with Neurotherapy than I did with medication. There is a clearer improvement in mood, less angry, less over-reaction to frustration, better emotional self-control. You also get improved cognitive ability.

I won’t say I get 100% results, but it does help most kids. Where medication is better is that it gets an immediate effect and the time and costs involved are considerably less especially as medical insurance will almost always pay for medication and only occasionally pay for Neurofeedback. Neurofeedback is time consuming and for a child (and the parents who have to bring them in, six months can seem like a lifetime. Hopefully in time we can learn to make it go much faster. We are starting to see a faster response and a higher hit rate from newer protocols but we have a lot of room for improvement.

How has Neurofeedback impacted your practice?

It has impacted my practice even though I don’t run the sessions, only oversee the work. Neurotherapy is one of the more interesting things I’m currently doing. It is a challenge. At this point I’m not sure you can divorce neurotherapy from the larger clinical practice, one that looks at the child and his or her problems as part of a larger system. Most of my families benefit from some behavioral management training. Others need to have marital or other psychological problems resolved. ADD can be very complicated. Biofeedback is effective for 85-90% based on the TOVA test. Behaviorally, probably 70% of the children are reported to be markedly better in the time the parents are willing to devote to it. Partly that may be because some children need more extended neurotherapy, perhaps as many as 100 sessions. For others I think it’s because if their environment doesn’t change, the Neurofeedback may not be enough. From the perspective of just doing neurotherapy, it is easier to treat problems like PMS, pain, migraines and sleep problems where other factors beside physiological self- regulation may be less important.

Some interesting cases
We had a set of 8 year old twins with ADD who were mildly developmentally delayed. ADD. They had few friends, and their language was poor. Neurofeedback helped improve their IQ by 22 points. The changes in their behavior, social skills and language matched the measured gains in intelligence. The one who was brighter to start with is now fully mainstreamed and is at the appropriate grade level. Biofeedback, in effect, normalized this child. That was pretty profound. The other one is still more noticeably impaired, but she started out further behind her sister and still has made dramatic strides. Incidentally an 18 month follow-up showed that the results are maintaining.

Another child, an adolescent boy comes to mind – his affect was flat and somehow odd or strange. He had poor relations with his peers and was not doing well in school. As Neurofeedback progressed, he began to make friends, doing better in school and getting along better with his parents. On follow-up, his mother reports that he has friends and fits in at the local high school.

With another child, his mom told me that her child often used to totally ‘lose it’. After a doing Neurofeedback training, they were having an intense argument, and the child said “this isn’t going anywhere. I’ll be back in a few minutes.” His mother commented that she should show as much self-control as he did.

How did you get into EEG biofeedback?
I consider myself a mainstream psychologist yet I tend to be an early adopter of innovations. While working part-time in a program for adolescents with substance abuse problems, I got a mailer on a seminar at the Menninger Institute to hear Dr. Gene Peniston. His published work on substance abuse was really impressive, and I wanted to check it out.

While at Menninger, one of the biofeedback machine used for treating substance abuse, had a switch labeled ‘SMR’. They said it was something that was being used for ADD. Following one lead to another, I eventually got in contact with Michael Tansey, Les Fehmi, Len Ochs, Joel Lubar, and Siegfried Othmer among others (all pioneers in the field). They were all gracious with their time and willing to talk with me. Eventually I bought a system.

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