How many sessions will I need?

While the absolute number of sessions necessary to produce the maximum possible benefits from neuro therapy cannot be accurately predicted in advance, estimates are possible predicated on the results of the baseline quantitative EEG (q-EEG), the evaluation which will direct your (or your child's) training experience. The qEEG is used to identify areas of the brain where activity is statistically different from that observed in the context of the typically developmental norm. Identification of such discrepancies is accomplished by virtue of comparison of your results to a FDA approved database. These areas of abnormal activity are then 'targeted' for intervention utilizing the technology.

At any given training site an average of 30 to 40 sessions is necessary to achieve a "plateau" of effect. Keep in mind however an "average" is a mathematically derived estimate around which a great deal of variation may commonly occur. In our work so far, we have seen patients plateau as early as 12 to 15 sessions and as late as 60 or more sessions. Further, when more than one brain region/area/network is identified for treatment, training at subsequent locations may be necessary in order to achieve the full benefit. And while our experience suggests both "downstream benefits" to training the primary site as well as increased efficiency of training may occur, shortening the overall time to plateau at secondary (or tertiary, or quaternary sites) this too is not predictable with precision.

How many sessions before I see results?

The first 10 to 12 sessions will allow us to assess your ability to learn the technique of training. We do not expect to see results during this time, but certainly welcome them if they occur! The therapeutic benefits of neuro therapy accrue very gradually over time and customarily are most readily evident when all areas identified on the baseline qEEG had been trained to a "plateau". The basic premise is simple: restoring healthy cerebral metabolism in affected areas will often produce symptomatic relief.

How many sessions will I need in total?

Please see above. It is also important to consider that once the acute phase of training is completed, a gradual taper of the intervention may help to sustain the results over long periods of time. Unlike medication, where therapeutic benefits are often observed to "simply melt away" upon discontinuation of the treatment, neuro training offers the possibility of sustained long-term benefits. However in our experience occasional reinforcement can be tremendously helpful in ensuring durability of effect. A common example might be a patient who trained 2 to 3 times weekly at first and saw excellent results gradually tapering his or her treatment to include monthly or even bimonthly sessions.

The principle underlying the therapeutic mechanism of neurofeedback is operant conditioning. The distinguished neuroscientist Eric Kandel, Ph.D. earned the Nobel Prize in 2000 for demonstrating the manner in which operant condition affects change in the nervous system by stimulating neurons to 'bud'

and form new neuronal connections/networks in response to environmental input. As such this technology holds promise by virtue of its ability to target areas of the brain with abnormal activity (as identified by the baseline qEEG-see above) with an intervention designed to restore healthy functioning. In our practice this goal is accomplished primarily (though not always) by utilizing "Z score protocols", which train an individual's deviant activity patterns towards the healthy, developmental norm. Convergent evidence from multiple sources suggests the restoration of healthy activity often (BUT NOT ALWAYS) is associated with symptomatic improvement. As such NFB has quite broad applications in a wide variety of neuropsychiatric syndromes. However the best evidence exists to support its efficacy in ADHD, executive function difficulties, anxiety, and various neurologically based learning/processing

Do I need to speak with Dr. Clark about the qEEG prior to scheduling?

Dr. Clark will provide you with a summary of your (or your child's) baseline qEEG findings in advance of scheduling any training appointments. In the interest of efficiency, this will usually be first provided by e-mail. However a 30 min. appointment with Dr. Clark to review the results in detail and discuss their implications for neuro therapy is included in the cost of the baseline qEEG. It is NOT however necessary to meet in person prior to commencing training, though some families prefer to do so.

Prior to beginning neuro therapy it is important to identify the specific symptoms from which one seeks relief and to the degree possible quantify their severity. During the course of your initial assessment Dr. Clark often utilizes standardized measures to quantify the severity of ADHD symptoms, (MMAT; ADHD- RS; etc) disturbances in mood (CDI; BDI; PHQ9) or levels of manifest anxiety (RCMAS; BAI; YBOCDS; etc As such comparisons can be made post treatment utilizing these instruments with good reliability. There are also numerous smart phone applications which allow each individual patient to create blogs of their own experience. MoodTracker is one such app with which we have had good experience. There are many others available.

How often do I need to come for NFB?

In order for neuro therapy to be effective a minimum of once weekly training/reinforcement is required. However experience has taught us clients initially scheduling for once weekly treatment frequently fall below this frequency given the degree of uncertainty inherent in all our schedules (vacations, visit from grandparents, high work/school demands, illness, etc We therefore recommend patients initiate training at least twice weekly. As the acute phase of treatment is completed and progress realized, it will be appropriate to reduce the frequency of training. This is a clinical treatment decision to be made in consultation with Dr. Clark and NOT a predetermined event based on a particular number of sessions completed, etc.

Will the changes be gradual over time?

Yes. The mechanism of action of neuro therapy involves the gradual formation of new neural pathways in the brain which (just as in typical development) which occurs gradually over time in response to

There is good evidence to suggest the therapeutic effects of neuro training may be enduring. The longest FORMAL STUDIES indicate a two year persistence of effect. However clinical experience offers of hope of even longer lasting effects, which may in part be sustained by 'auto-reinforcement' (ie, new pathways, once formed, are used and re-used thereby reinforcing the strength of their connections Maintenance therapy may also prove helpful in this regard, even when applied only infrequently after a period of successful "acute" treatment. Is this a "new-age" treatment?

There is nothing 'new' about neurofeedback. The basic idea and technology have been in use since the 1960's. What is "new" is the availability of the computing technology to collect and analyze data as complex as that contained in a routine qEEG in the office, as well as the creation of FDA approved databases which allow for reliable comparison of the patient's results to a scientifically sound standard of typically developing individuals of the same age and gender. These comparisons allow us to identify variations in frequency, phase, amplitude, and coherence which are of statistical significance and in turn are believed to reflect evidence of metabolic activity which is deviant from the norm.

What is the research backing for NFB?

NFB has been exhaustively researched with extensive documentation existent to document both its therapeutic efficacy and excellent tolerability. While NFB is NOT a panacea, it is a reliable, safe, and effective treatment. At your request a copy of a 2009 meta-analysis from Arns and colleagues can be provided you in hard copy or .pdf format. I would also encourage you to visit MindMedia.nl.

How will I know when we are done with treatment?

During the course of your training you will work with your tech and Dr. Clark to monitor your progress. Not unlike any other treatment modality, neuro therapy can be assessed both subjectively (patient/parent reports, teacher observations, information from spouses or significant others, etc) as well as objectively ("training down" both within sessions and overall between sessions as the therapy progresses; repeat MMAT or standardized inventories, etc Training is complete when:

1.Satisfactory relief of presenting symptoms has been obtained.

2.Objective data indicates maximum therapeutic benefit has occurred (no longer 'training down'

3.A limiting side effect is encountered (VERY unusual

Does my prescribed medication affect NFB?

Because all forms of treatment (including medication, psychotherapy, neuro therapy, etc. etc. etc) seek to relieve symptoms by changing neural metabolism, it may be necessary to alter the variety, dosing, or timing of psychotropic medications over the course of treatment with neuro therapy. Regular consultations with Dr. Clark will ensure the proper steps are taken as we seek to integrate the various

How do you measure my progress?

The initial qEEG is $1200. Our consultant, John Anderson MA has 40 years of experience in reading qEEGs and teaching neurofeedback. John has trained our staff for NFB. The cost of neurotherapy is $195 per session, but discounted rates are available for prepayment which minimizes the demands on our staff's time for billing and collection, allowing us to keep our overhead low. Packages consist of 10 at $1500., 20 at $2600. and 30 at $3000.

Should I pay at the window or will I be billed?

When you begin neuro training you will be provided with a billing document explaining our billing policies. Payment is due no later than the time of service. However pre-payment discounts are available for purchasing packages This discount is offered as it allows us to keep our overhead low. Payment for any unused sessions will be promptly refunded (see terms of billing document)

In our experience most (but not all!) insurance companies have declined to pay for neurotherapy, citing it as 'experimental' treatment. This is common across most commercial insurance. We do not accept insurance for our neuromodulation services (neurofeedback or transcranial magnetic stimulation We are always happy to provide documentation (cpt codes) on your behalf which you can use to file a claim with your insurance. Simple requests for the completion of brief forms, etc will be happily addressed at no additional charge. However, insurance company requests for lengthy letters, phone calls, etc will be completed and billed at Dr. Clark's customary hourly rate.