Neurofeedback for Indigenous children with complex post-traumatic stress disorder in out of home care: A pre-post experimental trial

Neurofeedback, also known as EEG (electroencephalogram) biofeedback, is a therapeutic intervention that provides immediate feedback from a computer-based program that assesses a client’s brainwave activity. The program then uses sound or visual signals to reorganize or retrain these brain signals. By responding to this process, clients learn to regulate and improve their brain function and to alleviate symptoms of various neurological and mental health disorders. Participants will sit relaxed on a chair with back support with two EEG sensors connected to a computer with EEGer software downloaded via an A202 amplifier (Neurofeedback International Academy, Victoria, Australia). The impedance of all electrodes will be kept at under 15 kO and placed according to the international 10/20 system. A neurofeedback specific assessment will be completed including a ‘mini-map’ and initial site of training will be as per Dr Susan Othmer’s protocol guide. The mini-map will be repeated at midpoint and completion. The frequency of reward and inhibit bands will be set after assessment of the posterior dominant rhythm; this will be individualised and guided by expert supervisors’ input (co-investigators and neurofeedback clinicians from the Australian Neurofeedback Institute). The software allows for insertion of culturally appropriate images, or even the child’s own drawings. 32 sessions will be offered over 24 weeks, the first 24 sessions will be twice weekly and the final 8 sessions to be held weekly. (4 weeks grace has been built into the trial to allow for likely cancellations due to the pandemic.) Each session will be 30-45 minutes long, settling each child and attaching sensors takes a variable duration. As is standard practice in neurofeedback, if a child is outside of 40-55% reward band for longer than approximately 20 seconds the system will be re-calibrated to achieve the most ideal settings to maximise learning (40-55% of time in reward state).The neurofeedback will run for 20-30 mins dependent upon the training going towards improvements and the child not tiring. Adjustments to the protocol will be based on caregiver and child reports and clinical judgment. All foster parents will receive standard neurofeedback psychoeducation (as per training received at the course offered by the Australian Neurofeedback Institute). Foster parents will be guided to encourage their children complete regular home based relaxation practice (such as using a slow breathing app) but achieving this will be left to the discretion of the carer. If carers ring for support due to their child becoming agitated, they will be reminded of the relaxation practice. Their feedback regarding symptoms for the 48 hours after treatment will be incorporated into treatment planning as is standard for this model of care. Fidelity of treatment will be guided by expert supervisors.