Traditional solutions are not enough. Learn how Play Attention can help increase focus and concentration.

Virtually anyone that knows, teaches, counsels, or works with an ADHD person is aware that ADHD is not a simple matter of attention deficit. That’s just the tip of a very large iceberg.

As a matter of fact, the term ‘attention deficit’ is actually a misnomer of sorts. ADHD people have diffused attention, not a deficit or lack of attention. Ask them. I often asked ADHD students what was happening in my classroom. They could tell me about the bird outside the window, the cobwebs in the corner of the room, a little about my lesson, a little about the whispering around them, and a little about when the air conditioner was turning on and off. That’s actually a great amount of attention. It’s just scattered or diffused over a wide area all day long.

A true hallmark of ADHD is the brain’s inability to direct attention for long periods without becoming distracted. So, it’s not a deficit at all; ADHD is an inability to direct attention. But there’s more.

ADHD is also a matter of difficulty in multiple domains of cognition. These domains are also labeled “Executive Functions.” Aside from diffused attention, ADHD also encompasses difficulty in organization of thought and tasks; sustaining effort while filtering out distractions; memory (both short-term and working memory); managing behavior/emotion; and visually directing attention and actions.

How does one cope with all these areas? It seems a monumental task. Of course, the primary medical intervention is medication. Does medication actually address all of these cognitive domains? No, it does not. Medication has limitations. That’s a fact. That’s why many parents do not see academic, behavioral, or social improvements [see the MTA study] over time. Another fact is that many of these cognitive domains can be strengthened by direct instruction.

Several small and large software companies have introduced themselves recently into the brain fitness category. Each company tends to address a specific domain like memory or focus. So, to satisfy the cognitive and behavioral needs of an ADHD person, one would need to purchase many of these games.

As the original pioneer and developer back in the late 1980s,  I saw that there was a vast gap in the needs of the ADHD person and what was being delivered. By 1994, I developed Play Attention to teach sustained attention, visual tracking with attention (like watching a teacher move about the classroom), organizing and finishing tasks, memory, filtering out distractions, and motor skills. I even included behavioral shaping. Later this year we’ll deliver social skills, more working memory & short-term memory modules, and more.  We’ve received 3 patents for this pioneering effort.

Play Attention is a careful collaboration between you, the Play Attention software, and the Play Attention professional support staff. It’s provided us with a 92% satisfaction rating.

Of course, to get results, you need to use it. Next week I’ll address how Play Attention transcends being useful to being compelling.

In late 2009, the University of Hertfordshire in the United Kingdom performed a study on Play Attention. Children in the school system near the university used Play Attention 3 days per week for twelve weeks.  Also see: http://www.sciencedaily.com/releases/2010/01/100107083904.htm

We’ll discuss this study at our free webinar on January 13th. Please register here to attend.

These students were compared to a control group of students who did not use the system.  Play Attention students showed significant improvement in behavior and attention. One of the authors of the study said:

“Children with a diagnosis of ADHD find it hard to control their impulses and inhibit inappropriate behaviour,” said Professor Pine, “This can lead to educational and behavioural difficulties. The Play Attention method may prevent long-term problems by helping the children to be less impulsive and more self-controlled.”

The study will be published in a peer reviewed journal shortly.  The full press release from the University of Hertfordshire:

New Treatment for Hyperactivity in Children

07 January 2010 Hertfordshire, University of

A new thought-operated computer system which can reduce the symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in children will be rolled out across the UK this month.

Professor Karen Pine at the University of Hertfordshire’s School of Psychology and assistant Farjana Nasrin investigated the effects of EEG (Electroencephalography) biofeedback, a learning strategy that detects brain waves, on ten children with an attention deficit from Hertfordshire schools

They used a system called Play Attention, supplied by not-for-profit community interest company, Games for Life, three times a week for twelve weeks.

The system involves the child playing a fun educational computer game whilst wearing a helmet similar to a bicycle helmet. The helmet picks up their brain activity in the form of EEG waves related to attention. As long as the child concentrates they control the games, but as soon as their attention waivers the game stops.

The researchers found at the end of the study that the children’s impulsive behaviour was reduced, compared to a control group who had not used the system.

“Children with a diagnosis of ADHD find it hard to control their impulses and inhibit inappropriate behaviour,” said Professor Pine, “This can lead to educational and behavioural difficulties. The Play Attention method may prevent long-term problems by helping the children to be less impulsive and more self-controlled.”

Professor Pine and Dr Rob Sharp a senior specialist educational psychologist are continuing to work on futuristic projects with Ian Glasscock, Managing Director of Games for Life. A means of assessing learning in children with
severe communication and physical difficulties by a thought-controlled computer game method is likely to have considerable potential for these children who cannot operate a computer manually.

“Attention-related difficulties including ADHD affects many children, young people and adults and has a significant impact on their lives,” said Mr Glasscock. "Mind-controlled educational computer games technology is the only intervention shown to reduce the core symptoms of ADHD, historically medication may have been prescribed for the child.”

Games for Life plans to roll out this new system across the UK this month.

The November issue of the medical journal Pediatrics published research from Dr. Robert Kahn et al regarding the relationship between tobacco smoke, lead concentrations, and ADHD.

Kahn, a physician and researcher at Cincinnati Children’s Hospital Medical Center, Ohio, found that two risk factors: 1) exposure to tobacco in the womb and 2) exposure to lead in childhood significantly increased the likelihood of ADHD developing  in children.

The researchers used data from the National Health and Nutrition Examination Survey. Tobacco exposure in the womb was measured by reports of cigarette use during pregnancy, and childhood lead exposure was assessed by blood levels. Of the 2588 cases they reviewed, the researchers determined that children aged 8 – 15 who were exposed to tobacco smoke in the womb were 2.4 times more likely to have ADHD. Children with lead blood levels in the top third of the population had a 2.3-fold increased likelihood of ADHD diagnosis.

Lead researcher, Tanya E. Froehlich, MD, cited that the combination from both lead and tobacco smoke created a synergistic effect, an even greater effect than smoke or lead alone. Children who were exposed to  both tobacco smoke in the womb and higher lead levels had a more than eightfold increased chance of having ADHD compared to children who weren’t exposed to either.

The study does have limitations; the researchers analyzed data on smoking that was derived from the mothers’ answers on a questionnaire. The data did not include the number of cigarettes smoked. And while the researchers found a link between tobacco, lead and ADHD, they did not prove that these factors actually caused the disorder. This is similar to previously published research on prenatal tobacco smoke and lead levels.

Curiously, smoking tobacco is twice as popular in the adult ADHD population compared to the non-ADHD adult population.  Columbia University researchers established a study to determine if smoking ameliorated ADHD symptoms in adults back in 2006.  If tobacco smoke truly increases the risk of developing ADHD, the popularity of smoking among ADHD adults may create a cycle of producing more ADHD children if smoking is done prenatally.

While a strong genetic link is still the likely cause of ADHD, environment still plays a significant role in brain development. The researchers assert that perhaps up to 35 per cent of cases of ADHD in youngsters aged between 8 and 15 could be reduced by getting rid of both prenatal exposure to tobacco and childhood exposure to lead.

Attention-deficit hyperactivity disorder (ADHD) is conservatively estimated to affect anywhere between 5-7% of the world’s school-children. Is it possible that ADHD is the result of a brain that just develops slower than the brain of a child that doesn’t have ADHD?

Research has shown that the ADHD brain may develop differently than one without ADHD. However, no conclusive pathology (diseased or damaged location in the brain) exists; we don’t know what causes it.

What we do know: As a child’s brain develops, his experiences and environment help shape the connections in the brain. This development is also connected to genetic endowment. Thus, the brain develops dependent upon a complex interplay between nature (genetic endowment) and nurture (experience/environment). These connections form networks which help us process language, calculate math, feel, see, smell, think, and all else the brain is responsible to perform.

The part of the brain that is crucial to a child’s development is the cerebral cortex, the brain’s outer layer. The brain’s most complex functions like attention, consciousness, memory, and language are believed to be regulated in the cerebral cortex. As a child develops, gains experiences, and is subjected to his/her environment, the connections between the neurons (nerve cells in the brain) increase causing the cortex to thicken. The brain acts much like a muscle during adolescence; it’s a use it or lose it proposition. Connections which are frequently used are strengthened while unused connections are pruned away.

Researchers Philip Shaw, Judith Rapaport and others from the National Institute of Mental Health have proposed that ADHD may be the result of  lagging brain development resulting in an average 3 year delay. This theory is supported by earlier studies which found that children with ADHD have similar brain activity to slightly younger children without the condition. 

Shaw and Rapaport used MRI (magnetic resonance imaging) to measure the brains of 447 children of different ages. They frequently noticed that the volume of the brain in the prefrontal cortex was thinner in ADHD children than other children of the same age. The cortex developed correctly over time, but the ADHD brain’s  development lagged behind about 3 years before it reached maturity. Among other things, the prefrontal cortex has the responsibility of governing attention, short-term memory,  and controlling inappropriate thoughts and actions. The researchers theorized that ADHD is a lack of control over these tasks, so it was logical to suggest that ADHD is a matter of developmental delay.

Significantly, Shaw and Rapaport found that the primary motor cortex developed faster in ADHD children. As its name implies, the motor cortex helps to plan and control movements. Shaw theorized that this might explain the restlessness, fidgeting and uncontrolled hyperactivity found in ADHD children.

This research raises more questions than it answers. Currently, the cause of the delay is unknown.  If ADHD is just a developmental delay, why do approximately 70% to 80% of children carry their ADHD traits into adulthood? This fact does not rule out Shaw’s conclusions, just that developmental delay may only be present in a minority of children labeled ADHD. Other children, the 70% to 80% previously mentioned, do carry their brain differences into adulthood.

Other research points to a set of genes responsible for the ADHD trait. If either genes and/or developmental delay are the cause, then what is one to do? The brain is an incredibly flexible organ. It is shaped by a variety of factors which means that parents, teachers, and other professionals can influence outcomes. Finding a program that addresses the needs of an ADHD child, helps shape behavior, and optimizes their potential is still the best practice.

It’s suspected that nearly 25% of all cases identified as attention deficit hyperactivity disorder (ADHD) are not really ADHD at all, but are symptoms related to sleep disorders.

One of the leaders in this research is University of Michigan professor Ronald Chervin.  Chervin theorizes that very important brain development is done during sleep. Among other things, this includes the ability to regulate emotion and processing. So, if a child has chronic sleep problems, brain development may be impaired. Chervin also suspects that the brain does not receive enough oxygen if the child snores which further inhibits development.  According to Chervin’s research, children who snore are more likely to have ADHD.

He likens the ADHD-sleep connection to a child who doesn’t get a nap; he becomes restless, irritable, and acts out.

Chervin developed his theory based on a sleep/behavior survey of the parents of 866 children.  Chervin’s data exposed a sleep disorder -behavior relationship.  It was only logical to conclude that if the sleep disorder could be corrected, the ADHD symptoms would be extinguished. 

According to Newsweek: “To test this theory, Chervin then studied 79 kids (5 to13 years old) who were about to have an adenotonsillectomy. Prior to the surgery, 22 of the 79 were categorized as having ADHD, based on standard measures for such a diagnosis. One year later,  Chervin’s team tracked down the kids for a follow-up. Of the 22 identified as having ADHD, 11 kids no longer qualified as having the disorder.”

Two problems lingered: 1) New cases of ADHD cropped up and 2) 50% of the surgical patients received no benefit at all.

Before you go and get your child’s tonsils and adenoids out, let’s discuss the distinct problems in the logic associated with this research.

First, we have a problem of antecedence; does ADHD exist because of sleep problems? or does the sleep problem exist because of  ADHD? That relationship cannot be clearly identified and is a confounding problem.

Secondly, new cases of ADHD appeared and others did not benefit at all from the surgery. This would lead one to think that the outcomes may not be related at all to the procedure.

I’m reminded of an old story about researchers who taught a frog to jump upon saying, “Jump!” Many weeks were spent training the frog.  The researchers were quite happy that they had proved the frog could hear and could respond to the human voice. One of the researchers  decided they should amputate the frogs hind legs. After carefully surgically removing the frog’s legs and rehabilitating the poor frog, the researchers stood in front of the frog and yelled, “Jump!” When the frog did not respond, they all heartily nodded in agreement that the frog’s hearing was severely impaired by the removal of his hind legs.

There is little doubt that sleep problems affect brain development. Past studies have demonstrated that preschoolers with a sleep disorder are twice as prone to substance abuse by early adolescence and more likely to suffer from anxiety in their 20s. Even the American Academy of Pediatrics concurs that sleep problems are not benign.

However, before we undertake invasive, painful surgery as an option, far more research should be performed to absolutely indicate a direct correlation. One currently does not exist and other options should be explored.

It has become obvious that adequate, restful, uninterrupted sleep is essential to our personal well being. Abnormal sleep patterns may result in behaviors that can be easily confused with ADHD.

If your child has a sleep problem, taking them to a sleep specialist may help. Getting adequate exercise, providing a consistent sleep routine/schedule, reducing stress,  and eating a proper diet may also assist in getting better sleep and better behavior. 

Articles published recently in two distinct journals, Developmental Neurobiology and Child Development, reveal links to ADHD and future sexual behavior.  The studies also reinforce the conventional wisdom that being reared by two  parents is better than being reared by only one parent. 

The German research team published in  Developmental Neurobiology studied Octodon degus, a rodent related to chinchillas and guinea pigs.  Degus were selected because they, like humans, are biparental creatures, meaning that both parents take part in raising their young. 

It’s been known from many other studies that prenatal and neonatal development are dependent upon a complex interplay between nature (genetic endowment) and nurture (environment).  For example, orphaned children from the former Soviet Union who received very little touch and too little stimulation were frequently developmentally impaired.

The German researchers’ intent was to see if the brains of degus reared without a father differed significantly from degus reared with two parents.

One set of degus was reared biparentally. The  other set was reared by the mother alone, the father having been removed the day after the pups’ births.  The pups’ mothers demonstrated similar sleeping patterns, grooming, and licking processes in both time and intensity. However, the pups reared by mother alone did not receive the extra nurturing time  given to pups who had a father present as well.

The researchers compared the neuronal development of both sets of pups at 21 days of age. They also carefully observed the behaviors between pups reared by mother alone, and those reared by both parents.

Not surprisingly, fatherless pups exhibited significantly different neuronal growth patterns in parts of the brain that control decision making, reward, and control (amygdala and the orbitofrontal cortex). Why is this important to humans? Because human brains are wired very similarly to the degus in this region – the cells serve identical functions.

As one author of this study, Dr.  Braun says,  "So on that level we can assume that what happens in the animal’s brain when it’s raised in an impoverished environment … should be very similar to what happens in our children’s brain." 

While some differences minimized over time, long-term differences endured.

Dr. Braun noted that a preliminary analysis of the degus’ behavior demonstrated that fatherless animals seemed to have a lack of impulse control. The fatherless pups  also engaged in more play-fighting or aggressive behavior when they played with siblings .  These are also hallmarks of ADHD.

The research correlates with a report by the Organization for Economic Co-operation and Development (OECD) published in September of 2009. The report cites that only 57% of US children live with both parents.  The remaining 43% that live with one parent have an increased risk of delinquency, ADHD, and poorer scholastic performance according to the report.

Researcher Dr. Jane Mendle, whose study was published in the journal Child Development, reinforces this nature/nurture aspect of brain development.

Prior research revealed that children reared in homes without a biological father have sex earlier than children raised in traditional biparental families. Mendle thinks the relationship is not just environmental, but due to the complex interplay between genetic endowment (nature) and fatherlessness (nurture/environment).

Mendle says, "While there’s clearly no such thing as a ‘father absence gene,’ there are genetic contributions to traits in both moms and dads that increase the likelihood of earlier sexual behavior in their children. These include impulsivity, substance use and abuse, argumentativeness, and sensation seeking.

"These traits get passed down from parents to children, resulting in a situation known as ‘passive gene-environment correlation,’ because the same genetic factors that influence when children first have intercourse also affect the likelihood of their growing up in a home without a dad."

Therefore, we are still not able to positively determine  whether single parenthood causes these outcomes. There remains a possibility that it is merely in some way associated with ADHD, risk of delinquency, early sexual experimentation, etc. It is likely that the probability of pure association will greatly increase as we discover more about early interaction between parents and their children.

If you are a single parent, all is not lost. The writer is the product of a single parent household; well balanced and successful. So whether a father is present or not, parents, grandparents, teachers, friends, counselors, etc. need to provide a child with positive interaction through talk, kind touch, and behavioral modeling. It is likely to be shown in further research that such interaction may even mend brain changes caused by fatherlessness.  We are not just the product of our genes. The brain rewires itself  not only due to genetic endowment, but it’s shaped by environment as well.

As Dr. Braun says, parents "are the sculptors of their children’s brains."

I would add that it’s not just parents. It’s everyone in the child’s environment. It does take a whole village to raise a child.

Obviously, being pregnant can be stressful in itself, but current research shows that stress can affect fetal development which may lead to long-term problems including ADHD.

Dr. Vivette Glover of Imperial College London, surveyed pregnant women at her hospital. Of these, nearly one quarter felt anxious and depressed due to stressors including work, money, arguing with spouse, and moving to accommodate a larger family. When compared to their non-stressed counterparts in this research, the babies of the stressed mother had lower birth weight, lower IQ, slower cognitive development, and more anxiety. Lower birth weight has been an indicator for coronary heart disease in later life.

In 2007, research in the Journal of the American Academy of Child and Adolescent Psychiatry indicated that being stressed during pregnancy is as detrimental for the baby’s development as smoking or being obese. Glover’s research reveals why and how this happens: stress produces the hormone cortisol. An abundance of stress can actually diminish the barrier enzyme that inhibits cortisol from reaching the fetus. Costisol impacts fetal brain development.

According to Glover, “People used to think that if something was congenital, apparent at birth, it had to be genetic. In fact it can be an in-vitro reaction of genes and environment.”

Glover also contends that her research shows stress greatly increases the likelihood of a child having ADHD (attention-deficit hyperactivity disorder), cognitive delay, autism , anxiety and depression. 

Glover’s research reinforces previous data from the UK where stress was shown to increase the risk for development of ADHD. In that research, the women who experienced the most stress doubled the chances of developing ADHD.

“The organs are forming during the first trimester of pregnancy, but the brain is developing all the way through,” Glover explains. “The organs are sensitive while they are forming and, once formed, they are harder to change.”

“In evolutionary terms, stress perhaps prepares the child for survival in a stressful environment. If a child is anxious and has attention deficiency, it will be very alert to danger. This may once have been adaptive, beneficial for the child, but it isn’t any more,” Glover says.

Significantly, Glover’s research implies that the changes may be on a genetic level so that it may be passed on generation to generation.

Therefore, it’s important to realize that taking care of ourselves during pregnancy is more important now than ever. Small efforts like seeking health services early, meditating, eating a balanced diet, taking pre-natal vitamins, and laughing are good practices.

Minimizing stress by maintaining a consistent schedule both at work and at home is a good idea.

Researchers, Dr. Zylowska, et al from the University of California-Los Angeles conducted a feasibility study of an 8-week mindfulness training program for adults and adolescents with ADHD. Their report was published in The Journal of Attention Disorders (2008 May;11(6):737-46. Epub 2007 Nov 19).

The researchers sought to inquire whether mindfulness meditation could improve attention, reduce stress, and improve mood. The researchers recruited 34 adults and 8 adolescents. Study participants were given a weekly training session. They were also required to practice daily starting with 5 minutes of meditation per day and gradually increasing to 15 minutes per day.

The majority of participants (after dropouts) reported improvements in self-reported ADHD symptoms. Independent tests on tasks measuring attention and cognitive inhibition also indicated improved symptom outcomes. Improvements in anxiety and depressive symptoms were also observed.

In yet another pilot study conducted by Sarina J. Grosswald, Ed.D., a George Washington University-trained cognitive learning specialist, a group of middle school students with ADHD were required to meditate twice a day in school. After three months, researchers found over 50 percent reduction in stress and anxiety and improvements in ADHD symptoms.

"The effect was much greater than we expected," said Sarina J. Grosswald, Ed.D., a George Washington University-trained cognitive learning specialist and lead researcher on the study. "The children also showed improvements in attention, working memory, organization, and behavior regulation."

Due to the neuroplasticity of the brain, better attention can be attained through meditation. Buddhist monks have been doing it for centuries. This seems to be true of ADHD persons as well. However, it is quite apparent that attention difficulties are just the tip of the ADHD iceberg. Other skills including organization, filtering out distractions, memory, time on-task, motor skills, visual tracking, etc, are typically diminished in ADHD persons. A complete program like Play Attention is required to teach these skills.

As for meditation, it is likely a good supplement to training in the aforementioned skill areas, but given the nature of the cited studies, a controlled clinical study is warranted.

  The Journal of the American Medical Association (JAMA. 2009;302(10):1084-1091) recently published work by Dr. Nora D. Volkow, MD, et al regarding evaluation of the biological bases that may reveal a reward/motivational deficit present in the brains of persons with ADHD.

Volkow and her colleagues theorized that ADHD may be connected to reward-motivation deficits. Volkow investigated whether lack of motivation and its relationship to reward could be traced to depression of dopamine in various areas of the brain.

To determine whether dopamine was depressed in ADHD persons, the researchers used positron emission tomography (PET scans) to measure dopamine levels in 53 nonmedicated ADHD adults and 44 healthy non ADHD adults between 2001-2009.

Since the biological mechanisms of ADHD are unknown, studies of this type have become the holy grails of research. While Volkow’s credentials are quite impressive (NIH, NIDA, etc.) this research is not new or conclusive. The theory that dopamine dysfunction/depression may be involved with ADHD symptoms has been researched for many years.

Furthermore, Volkow’s  small sample size consisted only of adults and therefore should not be extrapolated to include the child population. The small sample size alone should prevent it from being generalized to the entire adult ADHD population. One has a problem of antecedence here; is ADHD caused by dopamine depression in the brain? Or is the dopamine depression the result of ADHD that was acquired by other biological means? This research cannot answer that question.

What does the research tell us? It tells us that for some adults, dopamine may play a role in ADHD. For those adults, taking a stimulant medication may increase dopaminergic activity thus increasing reward/motivation responses and thus increasing attention to task. That might be a stretch.

On the downside, persons with depressed dopamine levels would probably greatly enjoy using stimulants. Study participants reported this. This may contribute to the frequent incidences of substance abuse among ADHD persons.

The authors write,"Despite decades of research, the specific neurobiological mechanisms underlying this disorder still remain unclear. Genetic, clinical and imaging studies point to a disruption of the brain dopamine system, which is corroborated by the clinical effectiveness of stimulant drugs (methylphenidate hydrochloride and amphetamine), which increase extracellular dopamine in the brain."

Unfortunately, the study leaves us with more questions than answers. Does it tell us what happens long term? Does it tell us of side effects?  Does it tell us if this actually applies to children? Can we conclusively determine a causal relationship between reward/motivation and ADHD? Does it solve the problem of antecedence? Do we know anything conclusively about all ADHD adults. No. There’s still a long road ahead.

The journal, Psychological Science (May, 2009 Douglas Gentile. Pathological Video Game Use among Youth 8 to 18: A National Study) sampled youth aged 8 to 18.

Iowa State University Assistant Professor of Psychology, Douglas Gentile, found that 8.5% of the gamers to be pathological players. Gentile bases his statistics on standards established for pathological gambling. So, while parents often cite that their child is ‘addicted’ to video games, Gentile’s standards necessitated that video game play actually caused family, social, school or psychological damage due to video game playing habits.

“What we mean by pathological use is that something someone is doing – in this case, playing video games – is damaging to their functioning,” Gentile said. “It’s not simply doing it a lot. It has to harm functioning in multiple ways.”

On average, the pathological gamers in the study played video games at least 24 hours per week. This is nearly twice as much as non-pathological gamers. Parents of pathological gamers also allowed their children to have video game systems in their bedrooms far more often than non-pathological gamers. 

According to Science Daily, Gentile found that pathological gamers reported having more trouble paying attention in school and thus received poorer grades in school, had more health problems, were more likely to feel “addicted,” and even stole to support their habit.

The study also found that pathological gamers were twice as likely to have been diagnosed with attention problems such as Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder.

“There is still much we do not know,” Gentile said. “We don’t know who’s most at risk, or whether this is part of a pattern of disorders. That’s important because many disorders are co-morbid with others. It may be a symptom of depression, for example. And so we would want to understand that pattern of co-morbidity because that would help us know how to treat it.”

Gentile is continuing his own research, currently conducting both longitudinal and clinical studies to determine risk factors and symptoms found in pathological youth gamers.

It is wise for parents to limit use of video games and TV. Treat them as you would dessert; limited portions used as a reward.