Global Developmental Delay

Healthy life Holistic early intervention

Psychological Therapy Only internal or only behaviour

Psychological Therapy Only individual

Healthy mind Strong supportnetwork

NeurotherapistNeuroChamps Ptd LtdBA(Hon) Psychology - University at Buffalo, The StateUniversity of New York

• Occurs during developmental period betweenbirth to 18 years

• Lower intellectual functioning thanneurotypical children with at least 2 otherareas of development

• Common signs:– Delayed acquisition of milestones (sitting

up, crawling, walking, speech etc)– Limited reasoning– Limited conceptual abilities– Poor social skills and judgment– Aggressive behavior as a coping skill– Communication problems

• 10% out of the 1,304 new referrals to KKH forintervention are diagnosed with GlobalDevelopmental Delay (GDD)– Department of Child Development (KKH)– Childhood developmental and behavioural

disorders (CDABD) database funded by SingHealthCluster Research Funding 2003-2005

– Study from 2003-2004: 1,304 new referrals

Delta(Sleep)

Theta(Deeplyrelaxed,dreamy)

Alpha(Very relaxed,recharging)

Beta(Cortical cellactivity,active)

High Beta(Cortical cell activity, stress,anxiety)

• Heinrich et al. (2004) and Leins et al. (2006) reviewedclinical studies on frequency and slow corticalpotentials training and found improvement ofsymptomatology and positive effects at cognitive level

• Reduction of inattention, impulsivity, hyperactivity• Improvement in focus, attention span, information integration

• Cantor & Evans. (2013) found qEEG and Neurofeedbackto be significantly effective in diagnosing and treatingdevelopmental disorders

• Developmental disorders are not a result of discrete lesions ormalfunctions in isolated brain structures

• Training to regulate brain wave activity will effectively addressdysfunctional neural networks

• Uses real-time displays of brain activity through EEG toteach self-regulation

• Measure brain wave activity at the cerebral cortex• Feedback information to individual through games, music, or videos

– Games: Brain is controlling player to shoot/move– Music/Videos: Brain is controlling music or videos to play smoothly

• Set thresholds to guide theindividual brain wave frequencies tooptimal level

• Teach the individual how to control and regulateactivity at neural networks

• 6 years old• Diagnosed with Global Developmental Delay

at KK Hospital• Underwent EIP

– Stopped after 3 months because no progress• Undergoing Neurofeedback and Applied

Behavioral Analysis Therapy– Started Behavior Therapy after 2 months of

Neurofeedback

• Observations:– Lack of eye contact– Reluctance to respond when people are talking to him– Unable to sit still, stimming finger movements– Unable to get to sleep at night, parents usually have

to drain him until he is exhausted and falls asleep– Difficulty forming full sentences when speaking– Mirror writing– Unable to reproduce images or text while looking at

template

• Measures brain wave activity at 19 differentlocations around the whole head

• Helps us measure and observe activity whenon task versus not on task, on different tasks

qEEG: May 2014GDD Eyes Open Profile Neurotypical Eyes Open Profile

• Delta dominant at all sites• Strongest at frontal & temporal regions• Under-aroused brain may lead to

problems with executive functioning andsustaining attention

Language Areas (P3, T5) on task: GDD profile:• Slow waves increased significantly

compared with baseline• Reduced arousal• Shift to brain idling when on

task• Can lead to symptoms of

dyslexia

Neurotypical profile:• Slow waves decreased

significantly as compared withbaseline, fast waves increased

• Reduced drowsiness• Strong ability for language

expression andcomprehension

Wernicke’s Area

Visual Areas (O1, O2) on task: GDD profile:• Slow waves increased strongly

compared with baseline, fastwaves remained unchanged orincreased slightly

• Reduced arousal• Can lead to visual

processing problems

Neurotypical profile:• Slow waves remained

unchanged compared withbaseline, fast waves increasedsignificantly

• Not drowsy when on task• Reasonable visual ability

when on task

Occipital Area

Recovery Training:1. Train regulation of slow waves to help rest exhausted brain2. Training has focused on the temporal and frontal regions for

calming effectActivation Training:1. Train Beta to increase at the central region2. Train Beta to increase at occipital regions3. All activation training are done using game feedback and video feedback

• Game feedback: Motivates the child to score higher points andtraining motor skills and strategic planning while firing up the brainregion

• Video feedback: Motivates the child while also honing languagecomprehension skills

Recovery Training (Delta)

1st session: High Beta dominant,Delta was very low.• High Beta correlated to

anxiety• Was very hyper, could not

keep still or calm down

10th session: Delta was able toincrease while Beta and HighBeta decrease.• Delta is slow wave, dominant

when in deep sleep• Was able to calm down, fall

asleep and not fidget

Recovery Training (Delta)

Overall average graph (10 sessions)

Activation Training (Beta) – Central Region1st session: Delta dominant, Thetahigh. Beta very low.• Excessive slow waves indicate

under arousal.• Was unable to sit and focus at

the activity without drifting off

13th session: High Beta dominant,Beta high. Slow waves low.• Beta and High Beta indicates

cortical activity• Was able to maintain interest in

the game for whole session andsat still to focus on game.

Activation Training (Beta) – Central Region

Overall average graph (13 sessions)

Activation Training (Beta) – Occipital Region1st session: Delta dominant, Thetahigh. Beta very low.• Excessive slow waves indicate

under arousal.• Unable to process visual

information or understandingwhat he was reading

9th session: High Beta dominant,Beta high. Slow waves low.• Beta and High Beta indicates

cortical activity• More responsive, displays better

ability to comprehend whatwe’re saying, able to reproduceimages and texts

Activation Training (Beta) – Occipital Region

Overall average graph (9 sessions)

• Able to sit in chair for 40 minutes without fidgeting duringDelta training

• Fell asleep on several occasions during training• Parents report much better sleep, and able to sleep longer• Much calmer, less tantrums• More patient, able to understand delayed gratification

concepts• More responsive and aware of the surroundings• Able to answer in full sentences when therapists speak to

him• Improvement in eye contact• Improvement in ability to copy and reproduce images and

text

• Many children’s abilities are limited by theirconditions

• These difficulties in certain abilities result in lackof confidence and low self-esteem

• Lack of confidence prevents the child from tryingor attempting the task

• Neurofeedback trains personal effort which helpsbuild up confidence of the child at the same time

• Long lasting effect