Training Tips for Children and Adolescents

Doing neurofeedback with people under age 18 can be very different from brain-training adults. The following information may make your work go more smoothly.

Assessments and Young Children

The first step in neurofeedback is usually a Trainers’ QEEG. However, I generally wouldn’t even try to do an assessment on someone as young as five years old. Five or six or younger are ages whose brains are VERY immature and disorganized–even the relatively functional ones–so trying to identify patterns in them can be very frustrating.

In addition, their ability to sit quietly even for 15-20 minutes is very limited. Instead, have the parents complete the Client Report. You can load that into the TQ8 without loading any EEG data, and it will still give you a plan.

If the parents report that their child is very calm, and you believe you can gather accurate data, go ahead and do the assessment, but just do eyes-closed and eyes-open recordings. Perhaps you can also skip the 5th step of the assessment (Fp1 and Fp2, O1 and O2). That should give you enough information.

Assessment Tasks for a Very Young Person

If you ARE able to conduct a full assessment for a young person, you may use the following for the task section of the brain map.

F3/F4 is not a calculation task; it is a memory task: give him a series of numbers one second apart and have him repeat them

C3/C4 is actually the reading task: have him point to letters on a page as you name them or name them as you point to them

P3/P4 counting forward or backward (probably not in a 5-year-old)

T5/T6 You can repeat the story task here, listening for comprehension

F7/F8 Say the numbers or letters aloud as you point to them

Keep in mind that in most cases, a child who’s been diagnosed early is causing problems for the adults, which often means that they aren’t controlling the impulses (emotional, social, physical or verbal) very well. Those are issues generally related to the prefrontal cortex (PFC) and the sensorimotor cortex (SMC) Train HEG and/or C3 to C4 and you’ll generally improve impulse control especially in kids who are 7-8 or older.

As a general rule, I very rarely do TQ8s even through about age eight, and I will not often do them under 10 years of age. If you start a TQ with a young person and find that it isn’t going well, stop. Gather and process what information you have, along with a client report.

Training without an Assessment

With very young (less than 7 or 8 years) ADHD, any autistic spectrum, Tourette’s kids–the ones who have precious little body control–I usually just start with training up 12-15Hz (as a starting point, bringing the frequency down until we find “SMR” for that client) at C4, reducing 2-5 Hz. I do this for up to 10 sessions until we are seeing some ability to calm and still in the chair. Then an assessment can be done.

Neurofeedback for Toddlers or Preschoolers

Training a 2-year-old is likely to be very difficult, as you can imagine. With electrodes, the chances are that, even if he is able to let you put them on his head, he’ll sweep them off fairly quickly without thinking–like you might brush away a fly. As for training EEG, the only thing I could suggest is a squash, since very little is known about what a two-year-old’s brain SHOULD look like.

If it were me, I’d start doing HEG. There’s not much of a prefrontal in a 2-year-old, but the better it works–no matter the age–the better he’s likely to be able to control his attention, impulses and emotional responses.

If there is a very compelling reason to try training a brain that is so early in its development in a person so far from self-awareness as a two-year-old, the only way I know to do is is to have the child sit on the mother’s lap in front of the screen. I’m not sure there really IS an SMR for a kid that age, so a squash might be a good option. The brain comes online from back to front and right to left, so you might start in the parietals or at P4. You could try starting with a band down around 8-11 Hz in the sensory motor strip and see if you can get a relaxation response sliding the band down. However, you are working with a pretty difficult problem of age here.

The truth is that if brain training could “cure” the terrible twos, the units would be FLYING off the shelves. Dream on! What you are dealing with now (and will be for the next 15-20 years) is development. It’s what makes us ourselves. Generally from 2-3 years is a first flowering of independence. As for training, there’s nothing to train. At two the prefrontal cortex is just a gleam in the cortical eye. There are no executive functions. Train yourself if you are the parent, or train the parent. Teach yourself the same thing your two-year-old is learning: don’t sweat what you can’t control. That’s probably the best thing you can do for yourself and your child. People do train at four or five years old, and I’ve done it a few times when situations seemed to demand at least that we try. Seven is a much better age to start.

HEG for Children

HEG is a good choice for children. I use HEG literally with everyone, since I can’t think of a good reason NOT to strengthen prefrontal capacity.

One of the keys I’ve always found to working with kids is to have them realize that they are actually controlling the screen with the way they pay attention. I like to start with HEG. With nIR I begin with the nIR AI design and start with the client just looking at the graph. In the beginning I ask them if they really believe they’ll be able to make things happen on the screen just by how they pay attention, then we try. Most of them are amazed to realize that when they are really concentrating on a single point, the graph goes up. When they start thinking about something else, the graph goes down.

Filtering and Processing

Most kids are some combination of Filtering and Processing. Problems with impulse control, emotional regulation, social regulation and (almost certainly, though they didn’t mention it) distractibility are related to prefrontal function.

Certainly training C3/C4 or Cz/A2/g/C4/A2, inhibiting slow and fast frequencies and rewarding SMR (though this is unlikely to be anywhere near 12-15 Hz) are the most likely EEG approaches. For an 8-year-old, alpha peak is expected around 8 Hz instead of 10 Hz for adults., so SMR is probably closer to 9-12, though you’ll likely have to adjust the band to find something calming.

(For ADD) With young or very active children, I would start with SMR training and find the effective SMR frequency and do the assessment with adjusted frequency bands after there is some control.

Training Techniques for Working with Children

I like to explain to the kid (parents can be there, but I always talk to the kid, not to them) that they will be making things move on the computer without their hands–just with their brains. I tell them I will explain a little about their brains, so they can do better on the computer, then I explain a little about slow (daydreamy) waves and fast (concentration waves). I tell them both are good, but if their brain can’t make the fast waves very well, then it doesn’t help them in school as much as some other kids’ brains help them.

I always tell them that I can’t change the way their brain makes those waves. Only one person can do that–them! I tell them that kids who got very good at moving things on the computer with their brains also found that their brains helped them get their homework done faster, get seatwork done in class, get along better in birthday parties, etc. Whatever seems to motivate them (we’ve already talked about what they like doing and what they find hard to do). Then I ask them what they think their brain makes: lots of slow or lots of fast. After they tell me, we go into the training room (usually with the family coming along.)

There I explain about the electrodes, that they are like the joystick for their brain to be able to move things on the screen. When they are hooked up I open screen one, which is only a power spectrum. I show them where the slow waves are and where the fast waves are. We talk about whether their brain has a lot of slow or fast and how that might explain the things they find difficult. I may tell them, “you see: the problems you are having are not because you aren’t smart, not because you are lazy or don’t care. Your brain is not helping you do those things!” I may tell them, “your brain is like a car. Intelligence would be the horsepower of the engine. But what we are working on is the transmission. You can have a very powerful engine, but if you only have first gear, you can’t drive very well on the highway! When your brain works better in the other gears, you’ll be able to show how smart you are in other ways, like at school.”

We go to screen 2 then: a single bar graph. I usually hook up at Cz (or with really wiggly kids, maybe at C4) and train to reduce 2-5 hz. That’s what’s showing in the bar graph. I watch it for maybe 10-15 seconds while they are watching it, and I note where are the low points that the brain reaches in its normal fluctuation. Then, when the graph is high, I put my finger alongside the bar graph at what is their normal point and say, “bring the bar down to here just by paying attention.” Nearly 100% of the clients do exactly that to the astonishment of their families and themselves. “Good!” I say, “Now keep it there,” but of course in a matter of seconds it pops back up to the higher end of their range. “That’s the problem,” I explain to them: “It’s not that you can’t pay attention; it’s that you can’t KEEP paying attention for very long. You listen to the teacher or start working on your homework, and then you are gone. The better you get at controlling the computer, the longer your brain will pay attention without you having to work so hard.” Then we turn on the scoring.

I believe that the key to successful training is for the client to recognize–to have that visceral “aha!” moment–that he or she is actually controlling what’s on the screen with attention. That is an amazing discovery. In the first trial, I want them to see that there is a state they get into, however briefly, that causes them to score more points, to make the bar go down below the target, and that when they lose that state, they lose the control.

I usually have them play 3 games (1-2 minutes each). Could be just trying to score points looking at the bar graph, could be pacman. I like to keep it simple. I do NOT believe in trying to seduce a kid into training with false promises that this will be like playing video games, popping them onto puzzles or Inner Tube or DVD training the first time I see them–or even early in training. Because I have seen it happen too many times that a kid who has only the bargraphs or a fast trend object (sometimes even the power spectrum) can spend several sessions just figuring out how they are doing what they are doing and getting better at it. Even then, I like to use the games as a reward. After they have scored (for example) 200 points, then they can play Inner Tube.

It’s very important how you start kids off. The more you promise entertainment, the more bored they are likely to get. It’s great if a kid is willing to do NF because he likes watching a particular DVD, but eventually it’s not hard to figure out that you could be watching that DVD without the electrodes. If the training results are happening, which they may be, then that’s fine. But if the kid is just watching the DVD’s but the things we want to change via NF aren’t really showing much improvement, then what is the benefit of not having to fight him/her to do something which is essentially not achieving anything?

At the end of the first session, I always tell kids two things:

“Tell me: was I doing any work here today? I was just sitting here watching you. And was your family doing any work? They were cheering when you scored all those points. How about the computer? Was that doing any work? It was just showing what your brain was doing. Who was the only one here who was doing any work? It was you! And so when you get better and better at controlling the screen, and your homework is getting done faster and your grades are getting better, only one person gets to take credit for that. And that’s YOU! Because YOU were the one who did it!”

And I also tell them, “You know what I want you to do? When you see your friends at school tomorrow, tell them, ‘you know what I did yesterday? I practiced changing the speed of electrical pulses in my brain!’ You know they are going to laugh and say, NO WAY! But you saw yourself doing it here today. Your family saw you and I saw you. And the better you get at controlling the screen, the better you will be at doing something that most people don’t even believe is possible! It will be like a secret power you have, and you’ll have it for the rest of your life!”

Boredom During Training

As for the problem of boredom…well, if you think that the very best video-game options available in the NF universe can stand up to what is available to the kids in the rest of their world, you will be seriously disappointed. I make it clear from the very beginning with every client that NF is NOT entertainment. It is a means that empowers THEM to make their own brain work more effectively with the boring, routine tasks (the ones they have trouble focusing on), so they can get those done quickly and accurately and THEN have time for the really cool video games (or friends, or sports or music or whatever) that IS entertainment in their lives.

I like to use video files in training–usually about 5-8 minutes later in a session after they have scored a predetermined number of points. I also like playing Naming, Dominoes and other NF games we play DURING training segments for about 3 minutes per session. And I like doing homework, reading aloud, doing math problems or other tasks that may be difficult for the client for 5-8 minutes per session. I think you wouldn’t find too many clients who have worked with me who would complain that their sessions are boring, but I think it is more MY job to keep them engaged and building a growing sense that they are changing their own brains. It’s like the difference between getting a really good baby-sitter or nanny vs plopping the kids in front of the tube and letting Barney (or whoever) take care of them.

Peak Alpha

All the band definitions change when you work with someone young. Adults–late teens and up–should have an alpha peak at or above 10 Hz in the back of the head. Eight-year-olds would be expected to have a peak closer to 8 Hz. Alpha, if it is there, is more likely 6-9 or thereabouts for, for example, a six-year-old. SMR is much lower than 12-15 (that is likely beta), etc. Beta 15-18 may actually be high-beta for a six-year-old in terms of how his brain experiences it.

SMR Training

In kids, you have to train where the brain is (e.g. adjust the frequency of SMR) rather than where it SHOULD be. If a child has 8 Hz as peak alpha, the alpha band is probably more like 6.5-9.5 Hz. That means that SMR will be 9.5-12.5. When you train to increase 12-15 Hz in that head, you are actually training up BETA at C4, which is likely to cause fidgets, irritability, or sensitivity. Starting with 9-13 as your SMR frequency should help, but you also have the ability to adjust the frequency on the fly.

In the design, adjust the filters. Choose the one you are using (12-16 or 9-13), and you’ll be able to lower or raise the band by 0.1 Hz each time you tap the left or right arrow key on your keyboard. Adjusting about .5 Hz every couple minutes until you find a band that results in the client being still and calm and maybe even drowsy lets you find the “functional” SMR for that client.

Current thinking:  When we used SMR training alone to work with a client, that’s what I taught.  Problem was that many trainers experience that they didn’t find the “sweet spot” frequency.  I myself had that experience many times.  Now, with HEG and a Whole-Brain training plan, SMR is a piece of a much larger training approach.  I don’t mess with frequencies very much.

If you really want to deal with hyperactivity, use a C4/T4 montage and reduce 19-38 while training up 2-6 Hz.  You can certainly adjust the frequencies (using Tools: Frequencies) on the fly if you want to try it.  I agree that starting with 9-13 probably makes sense for someone 8 or below, and you can reduce the frequency half a hz at a time.  I’d go down as low as even 2-6.  Sometimes you’ll get a response in terms of physical relaxation and stilling, but not always.

Unexpectedly High Alpha

When alpha drifts down out of the 8-12 range, it is problematic, and the same is true when it drifts up into the faster range–especially in a 10-year-old. That is definitely anxiety and irritability related. It would make sense to do some training to slow down the alpha–much as we would to speed it up.

Brain Development

Brains come “on-line” from the back to the front and right to left, so a client of this age will be expected to be more active in the back than the front (and likely on the right than the left).

It’s been said that God’s little joke on parents is that in adolescence the limbic system bursts into full bloom, bringing powerful emotional drives to the surface, while the prefrontal cortex, which is responsible for managing those drives, doesn’t come online, as you note, until the middle 20’s. Anyone who knows adolescents knows that some of them are a lot more effective prefrontally than others at any age, and those who are less developed in that area may be more likely to do foolish and perhaps dangerous things, squander opportunities, etc. So brain-training to improve prefrontal function makes a lot of sense–probably especially for the kinds of young people who are most likely to be brought to a trainer in the first place.

Adolescents

If you believe that every late adolescent who has difficulty with memory, study skills and performance on standardized tests has exactly the same problems, then you should go looking for a “where to put the electrodes and what to train” recipe.

I’ve worked with clients who had those issues resulting from excessive frontal alpha or alpha that didn’t block effectively. Material was not processed when coming in, so it didn’t form clear memories and wasn’t able to be used in testing or study.

Others have excessive slow activity, they keep falling back into their thoughts when trying to sustain an external focus. They also don’t use language well internally, and have problems with sequential/hierarchical tasks. Same result.

Others aren’t effective at screening outside distractions or internal impulses, so they get drawn off things they are supposed to be paying attention to or doing unless they are in a super controlled and quiet environment. Same result.

Others have high levels of anxiety about performance, so when they are trying to do a task, part of their brain is telling them that they won’t be successful, etc. Tests, of course, trigger an anxiety reaction as well. Same result.

Others have lots of obsessive thoughts and/or compulsions, they are perfectionists, driven to avoid anxiety by making sure they make no mistakes (for which they are always looking). Same result.

Dealing with Unmotivated Adolescents

I know that many of our list-mates are trained as therapists, but I would stress to you that training and therapy are different approaches in some very important ways. The best trainers I have ever worked with or known were all great coaches.

While Brain-Training often attracts psychotherapists, the best and most successful trainers are usually the best coaches. Coaches are not therapists, and most therapists are not coaches. It’s important to understand the differences.

Psychotherapy is focused on “treating psychological problems” via communication and relationship, focus on conflicts and insight, with the goal of relieving symptoms. Therapy is non-directive, oriented toward guiding the client toward discovering things about him or herself. It seeks to change patterns by changing feelings.

Coaching is focused on improving performance through a process of establishing goals and objectives for improved performance. It assesses and works to change strengths and weaknesses. Coaching is often directive, focusing on training and guidance as a means toward changing limiting habit patterns and instilling more effective ones. It changes feelings by changing patterns.

In Brain-Training, we do not focus on diagnoses or disorders. We identify, with the trainee, patterns of thought, mood, behavior, control and performance which are blocking desired outcomes, and we focus on changing the habits in the brain that underlie them.

Brain-training is built around the realization that energy patterns encode learned strategies in our brains and that our minds are our experience of our brains. Therapists seek to change the brain by changing the mind; coaches change the brain to change the mind. Therapists interpret; coaches challenge.

For me, the idea that a trainee might not want to talk about something that was limiting performance simply doesn’t compute. We would have spent time in the very first session(s) getting a clear statement of what he wanted in his life: independence, security,relationships, success, etc. and how those things would manifest. We would set objectives in each of those areas, set targets, track how they came out and adjust. The training would support the desired outcomes, and the experience of success in changing one’s own life would support the training.

If you were a coach, and a player wanted to be on your team, but he refused to practice, refused to admit areas where his performance was not effective–in short, if he refused to make the effort and respond to the challenge–you would sit down with him and tell him that he needed to make a choice. You will work with him to help him achieve his goals, but if he’s not participating fully in the process, you’re wasting your time (and someone’s money). The only person who actually has the capacity to change his life is he himself. Without his participation, nothing will happen, and that’s not acceptable to you.

I’d basically sit down with him and tell him we are at a go/no go point in his life. If he is really satisfied with the life he has at present–and even more so, if he believes his life in the next 2-3 years will be something that will satisfy him, then there is no sense continuing the training. It’s not something you are doing to him; it’s a tool you are offering him to take direction of his life at the very time when that’s the main developmental job he faces. If he chooses to make every decision to keep himself dependent, then he’s going to fall further and further behind and it will be increasingly difficult to change paths.

I don’t know if you’ve read or heard of 12 Rules for Life–an Antidote to Chaos by Jordan Peterson, but I’d suggest you read it, and for sure he read it. He is a member of a generation without direction, for whom having an excuse is as good as doing something. Obviously not all his peers are falling into that trap, but this is where he has to take the fork in the road.

Bed Wetting

I’ve probably worked with 2 dozen kids over the years who wet the bed. Many of them had tried supplements and devices and counseling, etc. All of them stopped when their brains speeded up. I can’t say that all of them had been labeled as ADD, but certainly with the slow brains they had, language processing for detail and externally focused attention would have been major issues.

When a child with a very slow brain sleeps, he does not rise into the REM state 4-5 times during the night. His brain is in a sleep state during the day, and it stays there at night. These children usually sleep very deeply and are hard to awaken in the morning. They basically slide down into a slow-theta or delta state–equivalent to a coma state–and stay there all night. Just as you would not expect a person in a coma to pop out of bed when the brain received news of the need to go to the bathroom, so you cannot expect it of children who sleep this way. And anyone who has ever tried to awaken such a child in the morning can relate to the coma analogy.

Yes, as children get older, even the slowest brains begin to speed up (they are way behind the developmental curve in this area, but it does happen eventually) and the bedwetting stops. Of course the attention and learning problems don’t, and probably the ability to awaken and pop out of bed don’t.

If the trainer can get the brain to start shifting into faster frequencies, commonly the enuresis, difficulty in awakening AND attention and learning problems get better. And in most the cases I worked with the need for all those supplements disappeared as well.

Seizures

Training a 3-year-old

You can try, but there are some obvious problems.

First, it’s not easy to place electrodes on the head of a baby that age, because she keeps pulling them off. You can try a mini-cap, but very young children aren’t likely to like those either. I’ve trained a 4-year-old (two of them) when I was much younger and more patient. We had the child sit in the mother’s lap in a rocking chair with mother’s arms around him and gently holding his hands. At that time we didn’t have adhesive electrodes, and the ear clips were a real problem. Today I would use an adhesive snap-in electrode on the back of the neck for a ground and behind the right ear for the reference. The only electrode I would place at Cz, just above the “soft spot” (the fontanelle).

Second, the infant may or may not pay attention to the feedback. If there is some kind of video or game that she likes on the computer, I would use the FRE1C BxShadow protocol with the video or game running on the client screen and place the shadow screen over it.

Third, almost nothing is known (of which I’m aware) about the energy brains of infants except that they are a lot slower than those of older children or adults. I would Inhibit 2-38 Hz which helps to activate the “brakes” on the brain. Cz is closely connected to the basal ganglia which are involved in motor control, so hopefully that will help.

Training T3/T4 in one channel or C3/C4 in one channel would ordinarily be a training for seizure disorder increasing SMR, but I would have no idea what frequency SMR would be for a 3-4 year old child, so I wouldn’t risk it.