Billy, whose name has been changed to protect his privacy, walked into my office agitated, ignoring his parents and looking like he was prepared to go off at the least provocation. This was our first meeting and I was unsure my office could survive his outbursts. I was told by his caseworker that he had destroyed a hospital emergency room; he would disrobe and urinate in public and was known to attack adults and other children. Billy was 10 years old and had already spent many years in a therapist’s office. Clearly, expecting him to talk about his feelings and issues; his adoption, loss and separation, or his early trauma would not do.

Fortunately, I had added neurofeedback to my services many years ago and “brain training” would be the initial focus of our work together. Neurofeedback would serve as a “low impact” intervention, which an intervention that is non-threatening and would allow a trusting relationship to develop slowly while also helping to heal Billy’s nervous system. I worked with Billy and his parents for two years and watched him transform into a kind and caring kid. I have observed this same phenomenological process with other adopted children who are also stuck in chronic trauma states. These are children who exhibit many negative attachment symptoms, are highly resistant to verbal therapies, are not learning in school, and are usually prescribed psychotropic medications for behavior management.

During the first year of my work with Billy and his parents he received two neurofeedback sessions per week. Billy’s parents also concurrently received attachment-based parent coaching as an integrated approach. Billy was encouraged to engage at whatever level he could tolerate. Initially, it was a challenge for Billy to sit for a short period of time but because he was able to watch a movie while the neurofeedback was administered, he was able to tolerate the process. During the first year, Billy’s outbursts slowly began to diminish in their intensity and Recovery from Trauma with frequency. He was increasingly able to engage in meaningful conversation about adoption issues and his capacity to connect with his adoptive parents slowly emerged. He was sleeping better and his night time bedwetting was resolving. By the end of his first year of neurofeedback Billy was improving sufficiently to reduce his sessions from twice per week to once per week.

The second year proved to bring improvements in cognitive processing. Billy began to develop the capacity for insight, to problem solve issues without becoming overwhelmed, school performance improved, and he began to develop peer friendships. His parents expressed greater satisfaction with their home life as Billy was more cooperative and emotionally available. Toward the end of the second year, Billy was able to begin the transition from a special school for behaviorally challenged children back to public school. He was behaving like a typical kid.

Throughout our work together, Billy was not forced to talk about his “issues” or to address his relationship to his adoptive parents. The therapist’s role seemed to be more of a tracker of Billy’s process as he participated in neurofeedback, giving him opportunities to address issues as his own nervous system began to settle and he developed the capacity to self-regulate his arousal states, feelings and situations that would have triggered his alarm reactions in the past.

Within this process, Billy was able to emerge out of his own trauma state holistically. He developed an increasingly connected and warm relationship with his adoptive family who shifted from complete overwhelm to expressions of pride in Billy and his growing accomplishments. Billy’s natural aptitudes began to emerge, especially a creative side that had not been previously expressed. The process of transformation was remarkable for a child that was nearly placed back into the system, could not function at home, school, had no friends, and little hope. During the two years of neurofeedback, Billy’s many psychotropic medications were either eliminated or reduced, although his parents and the psychiatrist seemed fearful to take the leap and completely eliminate the last medication.

There are important lessons for adoptive parents and therapists to learn from neurofeedback. While the first defense in our mental health system is to prescribe medication to manage behaviors, there are effective holistic technologies, such as neurofeedback, to help adopted children become whole. Until the nervous system has shifted from intense and chronic states of over arousal, a child is not available to process verbal approaches to therapy. With neurofeedback, the nervous system is presented with a renormalization process that is holistic, non-threatening and non-invasive. Once the child’s nervous system calms, the ability to self-regulate becomes the new norm and the need for behavioral control through psychotropic medications or intensive interventions are no longer necessary. A child’s growth appears so natural and seamless that parents often forget what their child was like at the beginning of neurofeedback, as if, this was the real child they had all along.

In addition to neurofeedback, here are some other pertinent factors to consider:

1. The parental relationship with the child is important throughout this process so parent participation is critical. The parents work concurrently on positive, attachment-based parenting strategies that will support the healing of the child’s nervous system. If the parents are completely burned out (their own nervous system is overloaded) they may have difficulty acknowledging and supporting the child’s progress. It would be optimal for the parents to participate in neurofeedback as well.

2. As the nervous system recovers, children who are medicated will exhibit symptoms of Being overmedicated. Symptoms may appear to be a regression in functioning and there is a tendency to want to increase medications. Instead, it is critical to decrease medications at these junctures.

3. Patience is required. Neurofeedback is not a quick fix as it takes time for the brain to learn and integrate new skills. Some parents jump ship way too quickly thinking that nothing is happening. My experience has been that for severely dysregulated children, it takes two years of neurofeedback or about 150 sessions. This is really a small investment considering the potential transformation that occurs for the children and families.

4. Since neurofeedback is diagnostically neutral, systemic improvements in such areas as sleep, attention, mood or bedwetting are also benefits.

5. The therapist needs to have the skills to manage the therapeutic process over time.

This includes parent coaching with an attachment focus, tracking the child and being sensitive to when the child is ready to participate in new levels of cognitive and emotional exchange as the nervous system recovers.

Finally, while I have seen this process of transformation many times in my practice, there needs to be a caution as neurofeedback should not be viewed as a panacea. Sometimes there are extrinsic constraints that seem to derail the process and the journey of each adoptive family is uniquely individual. There are many neurofeedback systems and it can be daunting for parents to find a good match between a particular neurofeedback approach and an experienced therapist. Regardless, neurofeedback is a treatment approach that warrants serious consideration for adopted children who have experienced developmental trauma.

Mershona Parshall, LISW-S, ATR-BC has worked with adoptive families for 18 years. She has a private practice outside of Cleveland, Ohio. To contact Parshall, write to mershona@gmail. Com or visit www.mershona.com.