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What Do You Think About NICE’s Recommendation For ‘No Change’ To ASD Guidelines ?

This is what we think …

24 May 2016

Today is the deadline for comments on the draft decision NOT to change the NICE Clinical Guidelines for ASD for Adults. Next Tuesday 1st June is the deadline for comments on the recommendation NOT to change the  Guidelines for Children.

We think this misses an opportunity to review Neurofeedback, and our comments are here:

We had to make the font very small to fit onto the form, so we have reproduced our detailed comments below. These are the comments for under 19s – the comments for adults are almost identical:

“We disagree that the guidelines should not be updated because we see no evidence that neurofeedback has been properly assessed as an intervention.

There is also evidence contrary to the statement in the current guidelines ‘Do not use neurofeedback to manage speech and language problems in children and young people with autism’.

There is a strong body of evidence that demonstrates the ability of Neurofeedback (NF) to use the brain’s inherent plasticity to change the electrical patterns in the brain in response to feedback. There is also strong evidence that differences in the electrical patterns in the brain correlate with differences in cognitive and behavioral function, including many of the symptoms associated with ASD. We can supply copies of relevant literature if the Committee is not familiar with this research. We believe this evidence alone, together with growing clinical evidence of NF being applied to ASD, merits Neurofeedback being available for ASD. In addition to this, below we have summarised some key research in this area specific to subjects who have a diagnosis of ASD.

A 2010 literature review1 assessed 5 separate studies which in total reported 180 ASD individuals receiving NF training. The authors concluded “We view neurofeedback as an intervention that may prove to be efficacious in the treatment of symptoms of autism. Presently, it should be viewed as possibly efficacious with potential and would then be in the same category as most interventions used with this challenging population.”

A 2010 RCT2 involved 20 children age 8-12 diagnosed with autism were randomly assigned to a neurofeedback group and a control group. The neurofeedback group had 40 x 21min sessions of neurofeedback. Parents of the NF group reported significant improvements in reciprocal social interactions and communication skills. EEG analysis showed 60% of those receiving neurofeedback reduced Theta waves in anterior cingulate cortex (ACC) known to be involved in social & executive dysfunctions in autism.

A 2013 study3 compared brain connectivity network analysis derived from the EEG (electroencephalogram) of 11 ASD and 12 control group children under fear, neutral and happy face stimuli.

They found Children with autism have a different modularity of such networks from typical children.

A 2007 controlled trial4 conducted 20 sessions of Neurofeedback for 37 patients with ASD. The experimental and control groups were matched for age, gender, race, handedness, other

treatments, and severity of ASD. The NF group had 89% success rate improving ASD symptoms, 40% reduction in core ASD symptomology (ATEC scores), 76% reduction in hyper-connectivity.

In a 2002 controlled trial5 twenty-four autistic children were divided into two groups, matched by sex, age, and disorder severity. One group received neurofeedback training and the second acted as a control group. The NF group had an ATEC score reduction of 26% on average compared with 3% in control group. Parents reported improvements in all behavioral categories assessed.

In a 2009 trial6 parents reported improvements in social interaction & communication skills after a group of seven autistic children diagnosed with autism spectrum disorders (ASD) received a neurofeedback treatment that aimed to improve their level of executive control. The NF group showed significant improvements in attentional control, cognitive flexibility & goal setting. This study was followed up7 12 months later and the authors found maintenance of improvement of executive functions and social behavior after 12 months.

In a 15-year clinical outcome study8 published in 2010, between 40–60 sessions of neurofeedback, combined with training in metacognitive strategies and, for most older adolescent and adult clients, biofeedback, resulted in an average 9 points IQ score increase, decrease in difficulties with attention, anxiety, social functioning plus improved academic and intellectual functioning.

1.Coben, R., & Myers, T. E. (2010). The relative efficacy of connectivity guided and symptom based EEG biofeedback for autistic disorders. Applied psychophysiology and biofeedback, 35(1), 13-23.

2.Kouijzer, M. E., van Schie, H. T., de Moor, J. M., Gerrits, B. J., & Buitelaar, J. K. (2010). Neurofeedback treatment in autism. Preliminary findings in behavioral, cognitive, and neurophysiological functioning. Research in Autism Spectrum Disorders, 4(3), 386-399.

3.Jamal, W.,et al (2013) Using brain connectivity measure of EEG synchrostates for discriminating typical and Autism Spectrum Disorder. 6th International IEEE/EMBS Conference in Neural Engineering (pp. 1402-1405).

4.Coben, R., & Padolsky, I. (2007). Assessment-guided neurofeedback for autistc spectrum disorder. Journal of Neurotherapy, 11(1), 5-23

5.Jarusiewicz, B. (2002). Efficacy of neurofeedback for children in the autistic spectrum: A pilot study. Journal of Neurotherapy, 6(4), 39-49.

6.Kouijzer, M. E., de Moor, J. M., Gerrits, B. J., Congedo, M., & van Schie, H. T. (2009). Neurofeedback improves executive functioning in children with autism spectrum disorders. Research in Autism Spectrum Disorders, 3(1), 145-162.

7.Kouijzer, M. E., de Moor, J. M., Gerrits, B. J., Buitelaar, J. K., & van Schie, H. T. (2009). Long-term effects of neurofeedback treatment in autism. Research in Autism Spectrum Disorders, 3(2), 496-501.

8.Thompson, L., Thompson, M., & Reid, A. (2010). Neurofeedback outcomes in clients with Asperger’s syndrome. Applied psychophysiology and biofeedback, 35(1), 63-81.”

If you think the Guidelines for Children should be updated you have almost a week to make your views known !

Note that you need to be a registered stakeholder to make comments – if you are not here is a list of registered stakeholders who could make comments on your behalf: https://www.nice.org.uk/guidance/CG170/documents/stakeholder-list-2

If you want to know more about Neurofeedback for ASD, see our dedicated pages.

And if you would like a personalised discussion on how Neurofeedback might can help you, with packages costing from £75 a week, call us today on 0207 118 0887.