Case Studies

A Teenager with Asperger's Disorder

Brian was a 15 year old boy who had always done well in school during his grade school years, and was one of the top students in his class. When he got into the 8th grade, he started having more difficulty understanding some of the work, which required him to abstract now rather than just memorize rote facts. He had always been fascinated with trains, and he could remember the details of train schedules coming and going in his neighborhood, as well as numerous facts about the trains themselves.

Oftentimes, Brian was seen as odd by his classmates, and his mother said that he would be picked on without his even knowing it at times. He was awkward and confused in social situations, and tended to keep to himself. One boy took it upon himself to tease Brian, who was hurt by the teasing. He decided to write a threatening note to the student, thinking this would warn him to stop. The teacher got ahold of the note, and he was suspended from school and charged with terroristic threatening. The school ordered a psychological evaluation and risk assessment before they allowed him to return to school.

Brian had some awkward mannerisms. He smiled at what seemed like inappropriate times, for example, when he was talking about the teasing at school. This was interpreted as being related to intense social discomfort, and was easily misinterpreted by others as his not being concerned about others' well-being. He made very poor eye contact, and he had a difficult time staying on topic, oftentimes shifting the topic of conversation onto his interest in trains.

The Gilliam Asperger's Disorder Scale as rated by Brain and his mother together was in the clinically significant range, with his largest deficits being reflected in his social interactions scale. There were also deficits noted in pragmatic skills, restricted patterns of behavior, and cognitive patterns. Problems with reciprocal social interactions skills, communications skills, and stereotyped behaviors, interests, and activities.

Brian's QEEG results showed multiple abnormalities. His right parietal-temporal lobe showed excessive slow activity. This is an area important for facial recognition and empathy. He also had excessive mid-line frontal hi-beta, something that is oftentimes seen in those with obsessive thinking and mental rigidity. There were multiple coherence problems, reflecting a cognitive inefficiency in his processing, since coherence is a measure of communication between different brain areas. In his frontal lobes there was excessive connectivity. Between his frontal lobes and the central and back parts of his brain, there were excessive disconnections.

Since recent research has showed that connectivity training was effective in reducing symptoms of Asperger's by 20% for every 20 sessions of training, work was started there. Brian's mother did not notice any effects of this training until the 12th session. She said she noticed mainly that Brian was making more frequent eye contact, and was maintaining his gaze for longer periods of time. He seemed a little less uncomfortable when talking to him, and he was smiling less frequently at the wrong times. By the 15th session, Brian's mother confirmed her impressions from several sessions previously to state that there was now a clear, albeit modest improvement.

We decided to focus more on decreasing his anxiety, and we did this by working at both the frontal site and the right rear site at the same time. By the 25th session, Brian was no longer stuck on talking about his train interests, and could be more easily redirected to different topics. A repeat administration of the Gilliam Asperger's Disorder Scale showed 25% improvement in the social interaction scale and the restricted patterns of behavior scales.

By the 30th Session, Brian was more relaxed and made good eye contact. He was able to discuss how what he did was frightening to other people in the school something he did not grasp before starting neurofeedback. At the 46th session, Brian proudly stated that he now had a “girlfriend” at school, something which his mother confirmed. At my recommendation, his mother bought a computer program called “mind reading” that teaches people with Asperger's to recognize and identify over 300 different feelings by watching actors and taking quizzes. He had been working on the program on a nightly basis for 30 minutes. He told me during one session that he was “delighted” to see me.

Brian did 75 sessions total. At the 60th session, his GADS scores had dropped into the “Low/Not Probable Range” even thought he still was more socially uncomfortable than the average student, and he still was very much interested in trains. He was practicing his feelings game on a regular basis at home, and he no longer had his girlfriend, but said he had his eyes on a few others in his class.

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