Neurofeedback, PTSD and its impact on Refugee Youth’s Academic Achievement

Introduction

The rampant worldwide refugee crisis is implicitly asking the clinical and therapeutic communities to find effective ways to deal with newly resettled people’s trauma and often consequent PTSD symptoms. The experience of Posttraumatic Stress Disorder can have a detrimental impact on a person’s wellbeing and their effectiveness in society. This is particularly true of refugee youth, who not only have had to deal with layers of traumatic experience, but also may struggle with integrating into a new school system, and may have difficulty achieving academically. Research has shown that academic achievement is impacted by PTSD in the general population, and it is particularly true for refugee population, although studies are still scarce, new and forthcoming.

Refugees and PTSD

There is evidence that trauma and PTSD experienced in children of elementary school age (6-10) has distinct impact on the child’s academic achievement (Kira, I., Lewandowski, L., Somers, C. L., Yoon, J. S., & Chiodo, L. 2012). Refugee children experience a variety of traumas, which, in turn, impacts their school performance. Some of the symptoms experienced are decreased attention, decreased memory, hyperarousal, and avoidance (Kira, I., Lewandowski, L., Somers, C. L., Yoon, J. S., & Chiodo, L. 2012). Mental health intervention is needed to treat the symptoms and the root cause (i.e. trauma) of their distress that is impacting academic performance. The traumatic conditions that refugees are exposed to can have impacts lasting beyond the immediateness of the trauma: their effect can bleed into the life of a resettled refugee.

Therefore, it is important to explore the link between Posttraumatic stress disorder (PTSD) and the refugee condition (Kirmayer et al., 2011; Young & Chan, 2015).

Life as a refugee can take a tremendous toll on a human being’s health, and its consequences can have detrimental, long-lasting effects. Refugees are exposed to extremely stressful events during the multiple stages of migration (Kirmayer et al., 2011; Teodorescu et al., 2012; Young & Chan, 2015). Beyond the trauma of experiencing war, and witnessing the deaths of neighbors and loved ones, refugees are ulteriorly stressed during their time spent on refugee camps, which are often overcrowded with people and have scarce supplies of water and food. It’s been reported that many women and children experience sexual abuse during their time in the camps (Young & Chan, 2015). In In addition, refugees seeking safety in a non-native country are often discriminated against and do not have access to legal counsel or interpreters (Kirmayer et al., 2011).

Research conducted on a large scale, looking at over 64,000 refugees from 40 different countries, has shown that up to 30% will likely show signs of PTSD (Steel et al., 2009). Refugees, who have experienced these traumatic events and exhibit PTSD are more likely to have poor adjustment and severe impacts on emotional well-being (Kirmayer et al., 2011; Young & Chan, 2015). It is important to notice that, although the burden of trauma has a deleterious effect on the refugees’ well being, one study has found that social support is the most important predictor of Posttraumatic Growth (PTG) to occur (Calhoun & Tedeschi, 2014; Tedeschi & Calhoun, 2004). Support can take many forms, including family, friends, and community elationships (Hasson-Ohayon et al., 2016; Prati & Pietrantoni, 2009). PTSD can have lasting impacts on a refugee's ability to function and thrive in society long after migration.

Academic Achievement

Posttraumatic Stress Disorder

Numerous studies have drawn a link between the trauma, violence and abuse and their negative impact in altering emotion, cognition and behavior (Cook, Blaustein, Spinazzola, van der Kolk, 2003; De Bellis, Hooper, Spratt, & Woolley, 2009), which in turn has an impact of the traumatized person’s ability to learn effectively and perform academically(Pechtel & Pizzagalli, 2011; Pinson, Arnot, & Candappa, 2010; Wilson, Hansen, & Li, 2011). In children, studies have demonstrated a link between early traumatic experience and negative impact on “memory, attention, executive skills, and abstract reasoning”(Beers & De Bellis, 2002; Pynoos, Steinberg, & Wraith, 1995; Toth & Cicchetti, 1998). Additionally, evidence that has shown that witnessing or suffering through community violence has direct negative effect on academics, overall functioning, reading and grade point average (GPA) (Delaney-Black et al., 2002; Janosz et al., 2008). The correlation between community violence and poor academic achievement is shown in high psychological stress (Schwartz & Gorman, 2003) and problems with concentration (Pynoos & Nader, 1988).

Consequent symptoms as a result of exposure to trauma are depression, anxiety and PTSD which have an decreasing impact on the children’s ability to focus and concentrate on their academic pursuits (Beers & De Bellis, 2002; Eth & Pynoos, 1985; Rousseau, Drapeau, & Corin, 1996), and even on their ability to acquire new skills, information and could have direct adverse effects on both the acquisition of new information and cognitive skills, and achievement (Streeck-Fischer & van der Kolk, 2000).

Refugees and school struggles

Refugees are unwilling hosts of a series of barriers to their learning potential, such as needing to interrupt their studies or not being able to attend school because of incessant war (Blommaert, 2009; Brown et al., 2006). Once the refugee child has been able to find relative safety in a camp settlement, they are often educated in temporary schooling environments with varying degrees of quality, attention, consistency and they are often taught in a diverse variety of languages differing from their own (Brown et al., 2006). A refugee child’s ability to learn effectively and achieve academically is ulteriorly impacted by the fact that their culture of provenience may have been oral instead of written, so they may display no academic writing ability, or no writing ability at all (Burgoyne & Hull, 2007). In addition, refugee coming from minority cultures may have had their language and culture oppressed and subdued (Nykiel-Herbert, 2010; Roy & Roxas, 2011). As discussed earlier, the refugee experience is often highly traumatic, and for a refugee child who may not understand the new language, may be illiterate, or may not understand the new country’s testing procedures, it is additionally difficult to adequately perform well in the academic environment (Ostrosky-Solis & Lozano, 2006).

There is currently not a lot of research on the impact of educational programs on the refugees scholastic performance and its outcome; most studies tend to center on the youth’s academic trails and their traumas (Taylor & Sidhu, 2011).

Neurofeedback

PTSD

Neurofeedback is a type of biofeedback which utilises a technology to measure brainwave patterns to retrain the brain to function correctly. This brain training is implemented by using either video or sound stimuli that reward the participant when their brainwave patterns act in accordance to the chosen intervention protocol. The EEG machine will track the participant’s brainwaves, send a feedback and, for instance, make a sound when the participant’s brain follow the chosen healing protocol. Amongst the most used types of neurofeedback, also known as EEG biofeedback, are Electroencephalography (EEG) and Low Resolution Electromagnetic Tomography (LORETA) (Nilsson, R., & Nilsson, V., 2014).

Studies have shown that Neurofeedback has helped people experiencing PTSD symptoms in learning self-regulatory skills, normalize their EEG exertion and helping them focus and concentrate better (Van der Kolk BA, Hodgdon H, Gapen M, Musicaro R, Suvak MK, Hamlin E, et al., 2016). Self regulation is a central skill for people to learn for people who have suffered from PTSD; by learning to manage one’s arousal, PTSD symptoms are highly decreased (Frewen P. A., Dozois D. J., Neufeld R. W., & Lanius R. A., 2012) Additionally, self regulation has shown to greatly diminish suicidal, self-harming and propensities, decrease illicit substance abuse and enhance the effectiveness of exposure therapy (Cloitre M., Stolbach B., Herman J.L., van der Kolk B., Pynoos R., Wang J. et al., 2009)

In their experiment using Neurofeedback (NF) on PTSD sufferers, Van Der Kolk, Hodgdon and colleagues found that NF intervention had much greater efficacy in diminishing symptoms in patients who had not been affected by undergoing six-months of psychotherapy focused on their trauma (2016). These same participants also showed marked improvements in their self regulatory skills, the ability to engage in activity to release stress and a recreation of a stronger sense of identity. Another important finding was that NF does not require the participant to relieve the horrific memories, but it affects the brain on a neural level by being a noninvasive, self-regulating procedure (Van der Kolk BA, Hodgdon H, Gapen M, Musicaro R, Suvak MK, Hamlin E, et al., 2016).

Academic Achievement and Attention

Studies have shown that the application of neurofeedback therapy on non-native english speakers can advance those who suffer from attention deficit, poor working memory and executive functioning (Shin, M., Jeon, H., Kim, M., Hwang, T., Oh, S. J., Hwangbo, M., & Kim, K. J. , 2015). For those who suffer from ADHD, beta brainwaves, fast waves which are present during waking consciousness and employed during focused tasks, are hypo-functioning, while theta waves, available to us during deep meditation or sleeping consciousness, are hyperactive. One study featuring an eight-year old boy with persistent symptoms of ADHD, a total twelve-session Neurofeedback LORETA intervention succeeded in positively transforming his symptoms across the board, and accelerating his school grades and performance (Koberda, J., Koberda, P., Moses, A., Winslow, J., Bienkiewicz, A., & Koberda, L. 2014). Another study featuring thirty-two participants with ADHD, showed improvement of academic scores, memory retention and Intelligence Quotient (IQ) (Fox, D. J., Tharp, D. F., & Fox, L. C. (2005).

Areas of further research

Further research must be conducted on the intersection of refugee trauma, PTSD symptoms and academic scores in their new country of residence. The ongoing refugee crisis has placed multiple English-speaking countries in the position of welcoming thousands of youth to their schools. Many young refugee carry with them a diversity of culture, languages and an unfortunate legacy of traumatic symptoms. Further research would seek to isolate with specificity which variables are causing lower academic performance, and specifically test to isolate trauma and/or PTSD symptomatology as potential source for their academic gap.


Neurofeedback research with refugees, and how it application specifically impacts academic performance after targeting PTSD and ADHD-like symptoms is nearly non-existent. As we have seen, there appears to be a link between the traumatic refugee experience, how trauma impacts the brain and nervous systems in the general population, and how these ones perform in a school environment. It appears that Neurofeedback treatment is currently a viable, noninvasive, culturally non discriminant tool to efficiently reduce PTSD and ADHD symptoms, both of which impact academic performance. A potential drawback to the wide diffusion of this therapy is its cost and its considerable time requirement (Ellison, K., 2010). However, due to quick advances in technology, we might see the use of this effective therapy increasing in coming years.

References


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Fabio Fina