Posts from — February 2005

The following press release was issued by researchers at the FPG Child Development Institute of North Carolina at Chapel Hill.

CHAPEL HILL, NC — For decades, researchers have wondered why some children from poor, at-risk families manage to perform better in school than other children raised in similar environments.

Now, researchers from the FPG Child Development Institute (FPG) at the University of North Carolina at Chapel Hill (UNC-Chapel Hill) and the University of Louisville in Kentucky find that children who have trouble paying attention exhibit different motivation patterns and temperament characteristics than children who don’t have problems paying attention.

This suggests that attention is more complicated than previously thought, according to lead researcher Dr. Florence Chang of FPG. “These findings provide evidence that helping children at risk for academic problems involves understanding more than a child’s attention and learning skills,” she said. “It also involves understanding their social and emotional make-up.”

The results of the study were published in the January/February 2005 issue of the journal Child Development.The researchers recruited 73 mothers and their preschool children, ranging in age from 3 to 5, all of whom attended a Head Start program and came from low-income backgrounds.

The children played a series of computerized games designed to measure their attention skills. The mothers completed a questionnaire that measured the temperament traits their children were born with, such as activity level and frustration.

To measure motivation, children were asked to complete a series of puzzles of varying difficulty levels. Children who preferred completing a challenging puzzle (deemed “mastery-oriented”) exhibited better attention skills than children who preferred completing an easier puzzle (deemed “performance-oriented”).

Previous research found that children who prefer more challenging tasks have more positive outcomes in school than children who avoid challenge and prefer easier tasks.

Overall, researchers found that temperament, motivation and attention are interrelated. This may indicate, said Chang, that screening tests that measure preschoolers’ school readiness, which today focus primarily on cognitive ability or developmental maturity, should be reexamined. Instead, it may also be important to consider other factors, such as how a child reacts to challenging tasks and his or her ability to adapt to new situations, she said.

“The findings from this study suggest problems that arise from attention difficulties are not limited to difficulty with concentration and sitting still, but are related to how children approach challenging or new situations,” said Chang. “Clearly, it is the case that much more needs to be understood about the nature and implications of having an attention problem.”

Perhaps the most significant statement the researchers claim is their final statement relating to a child’s response to challenging or new situations. When a child or an adult has diffused attention – attention spread over a wide area for short periods of time – their ability to command their environment is greatly reduced. Things happen out of their control. Accidents happen more frequently including traffic accidents. Indeed, there is some truth that some things are out of their control as they cannot control or manage things they do not perceive. Subsequently, the child or adult may develop a short temper as frustration easily sets in during new or challenging situations. Obviously, becoming quickly frustrated and shutting down during challenging situations may cause delays in emotional maturation and cognitive development. Adults experience organizational problems as they frequently do not manage things that are out of their immediate focus.

Generally, this research lends itself to a holistic perspective of diffused attention pointing not only at diffused attention, but at the subsequent problems it causes affecting daily function. It is not likely that medication can repair this as medication does not instruct the child how to manage challenging situations. It can place a child in a mental place where he might be able to learn to manage better, but who’s teaching management 101? This is where teaching tools like Play Attention play a major role in skill development both behaviorally and cognitively.

What are Biofeedback and Neurofeedback?

Feedback is an process which reflexively changes itself using its own forceful flow. The classic feedback device is the steam valve. As the steam causes a rotor to turn the centrifugal force of the rotation causes levers to rise, or strings to fly out, in the same way that if you rapidly turn yourself, your arms fly outward.

The levers on a steam device control the flow of steam, the faster the rotation the smaller the steam vent, the smaller the vent the slower the rotation. The size of the vent, the speed of rotation and the force of the arms closing the valve can all be adjusted so that the rotating axle maintains a consistent speed, so long as the supply of steam is constant.

Over one hundred years ago, French physiologist, Claude Bernard, who was characterized by Louis Pasteur “Physiology Itself” noted that most all of the human body’s systems are feedback regulated. In fact, they remain quite constant regardless of changes in the external environment. In 1932, Walter Cannon coined the term homeostasis to describe internal dynamic constancy.

A man eats food, his mouth fills, juices flow, his stomach fills, and his sensors send a signal, “satisfied.” He stops eating. A woman trots upstairs a bit too fast, her oxygen sensors are starved, and she starts breathing more deeply and quickly.

I glance out the window, the sun has moved to bounce off the white wall of the bank next door, my pupils contract, and I turn back toward the darkest wall of the room, or dash into my dark room. My pupils dilate.

Generally, body systems regulate through positive and negative feedback loops. The body has sensors that detect deviation from its normal internal range. This deviation activates effectors that essentially reverse the condition.

Such ordinary biological feedback of daily living can be enhanced by using mechanical transducers (devices which measure energies). I can press a piece of plastic against my palm which turns color depending on my temperature. Quickly I learn to make the color redder and redder (the color is arbitrary, it could be bluer and bluer). If I am prone to headaches I can prevent, inhibit, or relieve a headache by warming my hand. I may measure the way my skin conducts electricity and can learn to make my own skin less conductive which tends to relax me. The plastic has fed the information back to my conscious mind and my brain has learned consciously to warm my hand. My body is responding to a feedback loop. According to Merriam Webster, biofeedback is: “the technique of making unconscious or involuntary bodily processes (as heartbeats or brain waves) perceptible to the senses (as by the use of an oscilloscope) in order to manipulate them by conscious mental control.”

Early in the development of biofeedback attention was first focused on temperature (TEMP) change. Temperature is easily and cheaply monitored and learned change is markedly reliable. Muscle tension (EMG) soon came along. The techniques of measuring muscle tension are perhaps as easily done as temperature measurement; but the equipment is more costly. TEMP and EMG are the most widely practiced forms of biofeedback.

In 1970 Barry Sterman noted that he could readily train cats to strengthen the amplitude of signals at 13 pulses per second generated in the brain’s Fissure of Roland. Later he observed that cats trained to make stronger 13-14 Hz signals resisted epileptogenic drugs (specifically, injected hydrazine). D.A.Quirk, a Canadian penologist, and G.von Hilsheimer, a Florida neurofeedback specialist, applied Sterman’s 1970 method to 2776 felons imprisoned in the Ontario Correctional Institute near Toronto and to about 10,000 clients seen in hospital and in outpatient care. The recidivism in these prisoners (15% in 3 years after discharge, compared to 40 – 100% in typical prisons) reduced significantly.

Subsequently a professional movement has been created using EEG biofeedback in the treatment of ADHD (pioneered by Professor Lubar at the University of Tennessee). In Europe a significant network of practitioners has been organized by Prof. Dr. Jiri Tyl of Prague who has significantly contributed to the proof of the efficacy of EEG biofeedback (see EEG Biofeedback FAQ)

Neurofeedback is a specific type of biofeedback that makes brainwaves perceptible through the use of sensors attached to the head. The brain operates by sending minute electrical impulses to the many cells that comprise it. When the brain is excited it emits a specific frequency range of waves. The same is true if it is tired or focused. This process is similar to a radio tower that gives off radio waves. Brainwave sensors called electrodes monitor brainwaves emanating from the brain much the same way a radio receiver monitors different radio frequencies – if I change my car radio from 101.5 FM to 107 FM, I get to listen to a different station. So, the sensors pick up these signals like little radio antennae. A receiver, like a radio receiver, amplifies them and sends them to a computer where they are changed to sound and/or pictures on the computer monitor. The pictures and sounds make the current state of the brain perceptible because that information is displayed via sound and pictures on the computer screen. So, if a person is overly excited, she can see this on the screen in a graph or perhaps a screen character rapidly buzzing around. If she wishes to calm herself, she learns to slow the computer character which is reflecting the necessary relaxing brainwave pattern. By repeating this process many times, she can eventually learn to place her brain and body in a calm state without the neurofeedback equipment. This learning achieved by biofeedback is robust, stable, reliable, and readily acquired.

There is significant evidence that hyperactive boys tend to make high amplitude slow brain waves which are associated with inefficient faster brain waves. The child can be taught to reduce the amplitude of signals slower than 7 pulses per second (<7 Hz for Hertz) and to increase the strength of the signals running 13-14 Hertz. Such children tend to become more social, more effective at school work, and they perform more adroitly on IQ and other tests. One can think of this process as switching radio stations at will. Neurofeedback students learn to switch from inattentive (daydreaming) states to focused states at will.

See www.drbiofeedback.com, www.aapb.com, www.isnr.org, www.pocket-neurobics.com

George von Hilsheimer, Ph.D., F.R.S.H., and Peter Freer, MAEd

Company Cites Declining Sales for the Decision

March 25, 2005 –  Cylert, a stimulant drug for attention deficit hyperactivity disorder (ADHD), is being discontinued by its maker, Abbott Laboratories. Abbott began selling the drug in 1975.

Abbott Labs, the maker of Cylert also available generically as pemoline, says it is pulling the drug because sales have steadily declining with revenues less than one million dollars this year.

The nonprofit group Public Citizen petitioned the FDA yesterday to remove Cylert – including all generic versions of the drug – citing an increased risk of serious liver problems and death from liver failure.

The petition says that as of May 1996, Cylert had caused 13 cases of acute liver failure, resulting in death or liver transplantation in 11 cases. The petition also says that from 1975-1996, there were 193 “adverse drug reactions involving the liver in patients younger than 20 years old.

In a small but startling preliminary new study, Texas researchers have found that after just three months, every one of a dozen children treated for attention deficit/hyperactivity disorder (ADHD) with the drug methylphenidate experienced a threefold increase in levels of chromosome abnormalities-occurrences associated with increased risks of cancer and other adverse health effects.

The researchers say that to their knowledge this is the first study addressing the potential chromosome-breaking effects associated with treatment of children with methylphenidate, the generic name for a group of drugs that includes Ritalin, Concerta, Metadate CD and others.

Methylphenidate is the most widely prescribed of a class of amphetamine-like drugs used to treat ADHD, with more than 10 million prescriptions written for it in 1996 alone. Between 1991 and 1999, United States sales of methylphenidate increased more than 500 percent.

Researchers at The University of Texas M.D. Anderson Cancer Center in Houston and the University of Texas Medical Branch at Galveston (UTMB) reported their detection of the chromosome abnormalities in the journal Cancer Letters. Their peer-reviewed paper is to be published several months hence, but the journal editors have made it available online in the journal’s “articles in press” section.

The authors said they undertook the study because, even though methylphenidate has been approved for human use for more than 50 years, “there are surprisingly few studies” in either animals or human beings “on the potential for serious side effects,” such as causing mutations and cancer. In 1996, a report discussing several two-year-long animal studies showed that the highest levels of methylphenidate tested caused liver tumors in male and female mice. However, similar studies in rats showed no such tumors.

The new Texas study involved researchers drawing blood from children diagnosed with ADHD before they began taking methylphenidate in order to get a baseline level of chromosomal abnormalities. Three months after the children had begun taking the drug, the researchers drew the children’s blood and tested it a second time. Chromosomes are the bodies within cells that carry the genes and genetic information. All 12 of the children whose before-and-after blood cells were studied were treated with normal therapeutic doses of methylphenidate.

Most of the abnormalities found in the studied blood cells consisted of chromosome breaks “and a higher frequency of aberrations is reported to be associated with an increased risk of cancer down the line,” said lead author Randa A. El-Zein, M.D., Ph.D., an assistant professor of epidemiology at M.D. Anderson who performed the blood studies using several techniques.

“It was pretty surprising that all of the children taking methylphenidate showed an increase in chromosome abnormalities in a relatively short period of time,” El-Zein said.

UTMB Professor of Environmental Toxicology Marvin Legator, the study’s principal investigator and senior author, cautioned, “This study doesn’t mean that these kids are going to get cancer, but it does mean they are exposed to an additional risk factor, assuming that this study holds up.” Of the 53 known human carcinogens, Legator said 48 could be detected using the chromosome analysis methods employed in this study.

El-Zein stressed that much larger studies at several medical centers are needed to confirm the results of this study and to answer other questions not addressed by it. One of these issues is the question of what happens when patients stop taking methylphenidate. “Do the levels of chromosome abnormalities go back to normal?” El-Zein said. “We don’t know.”

This will be a long post as it seems that researchers can find numerous parts of the ADHD brain that seem dysfunctional. A major flaw in virtually all of this research is that they use very small groups that cannot depict the vast spectrum brain variability among the human species. This published research confuses many people as it seems the brains of those with ADHD are smaller, have damage in the basal ganglia, putamen, frontal lobes, cerebellum, and brain stem. This amounts to little more than neophrenology.

Small Brains

“It’s strong support for a very strong biological contribution to what causes ADHD.” Dr. Judith Rapoport, National Institute of Mental Health

(AP) Hyperactive children and teens have slightly smaller brains than those without the disorder, a study shows.

Exactly why this is so is not clear, but the researchers said the smaller brain volume does not appear to be related to the use of hyperactivity drugs such as Ritalin, as some parents had feared.

The finding could be reassuring to parents in another respect as well: It suggests that hyperactivity is biological in origin, not a product of bad parenting.

The researchers said it appears that that the brains of hyperactive children develop at a normal pace but never entirely catch up in size with the brains of other youngsters. However, they said that people with smaller brains are not necessarily less intelligent.

The findings were reported in Wednesday’s Journal of the American Medical Association.

Other studies also have suggested biological differences in the brains of people with attention deficit hyperactivity disorder.

“It’s strong support for a very strong biological contribution to what causes ADHD,” said one of the researchers, Dr. Judith Rapoport, chief of child psychiatry at the National Institute of Mental Health in Bethesda, Md.

The 10-year study used MRIs to look at 152 patients ages 5 to 18 who had the disorder, and 139 people in about the same age range who did not. It also compared patients who were on medication and those who were not.

The study found the disorder is associated with about a 3 percent to 4 percent decrease in volume throughout the brain. The smaller their brains, the greater their symptoms.

“The first thought people have is that this is a product of bad parenting” or that it is environmental, said Dr. Daniel Coury, a professor of clinical pediatrics at the Ohio State University College of Medicine who was not involved in the research. “Having clear biological findings that this is something beyond the control of parents or the child themselves helps to remove that stigma.”

Dr. Bennett Leventhal, professor of psychiatry and pediatrics at the University of Chicago, said the findings regarding the effects of medication “should be reassuring to parents that you can treat your kids and not hurt their brains.”

The research was conducted between 1991 and 2001 at the National Institute of Mental Health, which funded it.

ADHD is one of the most common childhood psychiatric disorders. Its symptoms include short attention span, impulsive behavior, difficulty focusing and fidgetiness. The American Academy of Pediatrics estimates 4 percent to 12 percent of school-age children are affected.

Bad Basal Ganglia

Reading and attention disorders both seem to stem from the same primitive part of the brain that governs thinking and muscle control, Yale researchers have found.

A study of 27 people ages 18 to 24 revealed that participants with attention deficit and hyperactivity disorder, and those with reading disorders, displayed low activity in their basal ganglia.

The study, which was published in the November issue of the American Journal of Psychiatry, is the first to use sophisticated functional magnetic resonance imaging to identify the neural circuits involved with ADHD.

When both groups were given the drug methyl-phenidate (brand name Ritalin) activity in the basal ganglia was normal, said Keith Shafritz, lead author.

Shafritz performed the work as a Yale graduate student and is now a research associate at the Duke University Medical Center.

Shafritz said the results suggest that Ritalin does not produce a unique effect in people with ADHD and that ADHD and reading disorders are in some way equivalent.

Nationally about 5 percent of children have reading disorders, characterized by reading at a lower level than expected.

About 3 to 5 percent of children show symptoms of ADHD. These include inattention, impulsiveness, and hyperactivity.

Participants were placed in a functional magnetic resonance imaging unit where they saw and heard a mixture of real and nonsense words.

The normal control group was about 80 percent accurate. People with ADHD and people with reading disorders both scored about 70 percent, Shafritz said.

Basal ganglia activity was higher in the control group.

When participants with ADHD or reading disorders were given methylphenidate and repeated the test their basal ganglia function rose to normal levels.

Shafritz said the basal ganglion is an inhibitory organ that can also activate areas of the brain. The neurotransmitter dopamine regulates the basal ganglion.

Ritalin apparently increases the inhibitory effect, dropping people with ADHD to a calmer and more attentive state.

The drug blocks the dopamine transporter, a system that clears away dopamine. With the transporter turned down dopamine accumulates.

“One driving question was, ‘Were the effects of Ritalin on the brain unique to kids with ADHD?’” Shafritz said. “The results suggest that Ritalin has similar effects in ADHD and other conditions. The idea that Ritalin is acting in a certain way in ADHD appears not to be the case.”

“The study also suggests that ADHD brains are not that different from everyone else’s brains,” Shafritz said.

Shafritz said the study was not designed to measure classroom behavior or reading skills. Also, medical ethics prevented giving Ritalin to the control group.

Bad Putamen

An inverse index of regional cerebral blood flow, T2 relaxometry (an fMRI procedure), was used to indirectly assess blood volume in the striatum (caudate and putamen) of boys ages 6 to 12 in steady-state conditions (Teicher et al., 2000). Boys with ADHD had higher T2 relaxation times bilaterally in the putamen than controls. Relaxation times strongly correlated with both the individual’s capacity to sit still and error performance on an attentional task. Daily treatment with methylphenidate significantly changed T2 relaxation times in the putamen of boys with ADHD, although the magnitude and direction of the effect was strongly dependent on unmedicated baseline activity.

Bad Frontal Lobes

Investigators at UCLA used magnetic resonance imaging (MRI) to compare the brains of 27 children with ADHD to those of 46 children without the disorder. They found that the region of the brain associated with attention and impulse control, located on the bottom of the frontal lobes of the brain, was smaller in the ADHD kids than in the other children.

“We would expect that the abnormalities would be in this region, and this is what we found,” lead investigator Elizabeth Sowell, PhD, tells WebMD.

The researchers also found that children with ADHD had larger areas of the outer layers of the brain.

Previous research has indicated that the differences were limited to the right side of the brain, but Sowell and colleagues found that they occurred on both sides.

Bad Cerebellum

Symptoms of ADHD in adults may include reading difficulties, poor concentration, clumsiness, and low self-esteem. Our research has shown that a medical condition we refer to as Cerebellar Developmental Delay (CDD) is a likely culprit of ADHD in adults. In CDD, the cerebellum is under-developed and not able to process information going to and coming from the cerebrum (often known as the “thinking brain”) efficiently. DORE has developed specific exercises that stimulate the cerebellum, thus allowing it to process information faster.

Bad Brain Stem and Other Parts

U.S. researchers reported brain scans of children with attention deficit hyperactivity disorder show anatomical abnormalities beyond a chemical imbalance.

The study by North Shore-Long Island Jewish Health Center was presented at the annual meeting of the Radiological Society of North America.

A second study by the same authors showed stimulant medications prescribed to balance brain chemistry appear to normalize some of these brain irregularities.

“We found abnormality of the fiber pathways in the frontal cortex, basal ganglia, brain stem and cerebellum,” said lead author Manzar Ashtari.

“These areas are involved in the processes that regulate attention, impulsive behavior, motor activity and inhibition – the key symptoms in ADHD children.”

The study used diffusion tensor imaging to compare 18 children with diagnosed ADHD with 15 control children to evaluate the brain’s white-matter fiber development. Researchers found differences in the brain fiber pathways that transmit and receive information among brain areas.

Bad Reticular Formation

Usefulness of QEEG neurometrics in a clinical setting.

Chabot and colleagues found that generalized or focal theta/alpha excess was present in 76.2% of their sample of ADD, ADHD, and children with attentional problems. These theta and alpha excess children can be divided into two distinct neurophysiological subgroups .

The first and most common group consisting of 46.4% of the sample was characterised by theta and/or alpha excess, mostly at frontal and/or central regions with normal alpha mean frequency.

Excessively high output of thalamocortical alpha generators can result from (a) overactivation of the thalamus. The primary dopamine pathways originate in the substantia nigra in the brainstem and innervate the caudate nucleus and putamen and are largely responsible for sensorimotor integration. Down-regulation of nigrostriatal dopaminergic neurons results in overstimulation of the midbrain reticular formation and the production of excess alpha (b) underactivation of the prefrontal cortex resulting from disinhibition from nucleus reticularis.

Bad Cerebrum

The authors report a study to compare regional brain volumes at initial scan and their change over time in medicated and previously unmedicated male and female patients with ADHD and healthy controls. The case-control study was conducted from 1991-2001 at the National Institute of Mental Health, Bethesda, Md, of 152 children and adolescents with ADHD (age range, 5-18 years) and 139 age- and sex-matched controls (age range, 4.5-19 years) recruited from the local community, who contributed 544 anatomic magnetic resonance images. Using completely automated methods, the main outcome measures were initial volumes and prospective age-related changes of total cerebrum, cerebellum, gray and white matter for the 4 major lobes, and caudate nucleus of the brain were compared in patients and controls.

Summary

It’s both significant and tragic to note that one can use a search engine and type in ‘ADHD’ and virtually any particular portion of the brain and find clinically controlled research that indicates related brain damage or abnormality.

Brain scans and QEEG are relatively nascent technologies that are currently more art than science when used to determine the source of ADHD. Obviously, the publishing of data on small groups may assist researchers in garnering grant funds. It may even help them retain their position at university in a publish or perish world. However, publishing of such data is not only unethical, it is also highly misleading if it does not explicitly define itself as highly preliminary. Even then it is questionable.

Publication of this neophrenology allows media to portray ADHD individuals as irreparably brain damaged which is both harmful and flagrantly untrue.

From a recent news story – Drug withdrawal weighs on Shire:

Shares in Shire Pharmaceuticals have fallen 10% after its best-selling drug was withdrawn from sale in Canada amid reports linking it to 20 sudden deaths.

Regulators said data showed 14 children and six adults had died after taking the usual recommended doses of hyperactivity treatment Adderall XR.

Shire said it disagreed with the findings and remained confident in the safety and effectiveness of the drug.

The Hampshire-based firm is the UK’s third largest pharmaceutical company.

Most sales of Adderall XR come from the US.

The US FDA has also issued a Public Health Advisory to notify healthcare professionals that Health Canada, the Canadian drug regulatory agency, has suspended the sale of Adderall XR in the Canadian market.

Adderall XR (amphetamine)
Audience: Neuropsychiatric and other healthcare professionals

FDA issued a Public Health Advisory to notify healthcare professionals that Health Canada, the Canadian drug regulatory agency, has suspended the sale of Adderall XR in the Canadian market. Adderall XR is a controlled release amphetamine used to treat patients with Attention Deficit Hyperactivity Disorder (ADHD). The Canadian action was based on U.S. post-marketing reports of sudden deaths in pediatric patients. FDA is continuing to evaluate these and other post-marketing reports of serious adverse events in children, adolescents, and adults being treated with Adderall and related products. Adderall XR is approved in the United States for the treatment of adults and pediatric patients 6-12 years old with ADHD, and Adderall, the immediate release formulation of the drug, is approved for pediatric patients with ADHD.

More information can be found on the FDA Adderall and Adderall XR Information page.

FDA ALERT [2/09/2005] – Sudden Deaths in Children

Health Canada has suspended marketing of Adderall XR products from the Canadian market due to concern about reports of sudden unexplained death (SUD) in children taking Adderall and Adderall XR.  SUD has been associated with amphetamine abuse and reported in children with underlying cardiac abnormalities taking recommended doses of amphetamines, including Adderall and Adderall XR.  In addition, a very small number of cases of SUD have been reported in children without structural cardiac abnormalities taking Adderall.  At this time, FDA cannot conclude that recommended doses of Adderall can cause SUD, but is continuing to carefully evaluate these data.

More information can also be found on the FDA Patient Information Sheet: Adderall and Adderall XR Extended-Release Capsules and the Alert for Healthcare Professionals: Adderall and Adderall XR (amphetamine).

From the FDA prescribing information for Adderall:

Long-Term Use: The effectiveness of ADDERALL XR for long-term use, i.e., for more than 3 weeks in children and 4-weeks in adults, has not been systematically evaluated in controlled trials. Therefore, the physician who elects to use ADDERALL XR™ for extended periods should periodically re-evaluate the longterm usefulness of the drug for the individual patient.

From a recent Wall Street Journal story: 
What If Einstein Had Taken Ritalin? ADHD’s Impact on Creativity

In American schools these days, countless class clowns are sitting down and shutting up. In chemistry labs, students who used to mix chemicals haphazardly, out of an insatiable curiosity, now focus on their textbooks. In English classes, kids who once stared out the windows, concocting crazy life stories about passersby, now face the blackboard.

The question is whether the Ritalin Revolution will sap tomorrow’s work force of some of its potential genius. What will be the repercussions in corporations, comedy clubs, and research labs?

Some researchers now wonder if would-be Einsteins and Edisons will choose different career paths because their creativity and drive are dulled by ADHD drugs.

Too many kids, especially boys who are merely rambunctious, are being given the drugs with just cursory evaluations, says William Pollack, an assistant clinical professor at Harvard Medical School.

In his ongoing research into boyhood, Dr. Pollack has found anecdotal evidence that Ritalin renders some kids less interested in pursuing creative opportunities. One boy he studied had been active in his school’s science club. After he was put on Ritalin, he felt like the spark inside him was extinguished. He lost interest in the science club and dropped out. Eventually, he stopped taking Ritalin, returned to the club, and developed a flashlight alarm system that won a major science competition.

Ten years ago, PBS ran the documentary- ATTENTION DEFICIT DISORDER- A DUBIOUS DIAGNOSIS?. The case was made that the epidemic of Attention Deficit Disorder affecting mostly white, middle class boys is to a large extent man-made, one result of a long-term, unpublicized financial relationship between the company that makes the most widely known A.D.D. medication and the nation’s largest “A.D.D. Support Group.”

No question that A.D.D. is spreading, along with the use of powerful psychostimulants. The number of children being medicated-now an estimated 2,000,000-seems to be doubling every two years.

In preparing our documentary, we heard time and again that Ritalin is “all over the schools.” Recovering drug addicts told us that Ritalin was becoming what’s called a “gateway drug,” the first drug a child tries. And addicts told us that some teenagers snort Ritalin for a quick, cheap (but dangerous) high.

Viewer reaction to the the broadcast of the ADHD diagnosis television show was generally positive.

“And did I ever tell you that ADD: A Dubious Diagnosis probably saved my son’s life? His pediatrician gave me a copy and I think it was her way of saying that perhaps you might want to reconsider accepting the diagnosis. Watching this video was undoubtedly the most pivotal point that revealed/exposed to me the collusion that’s fueling the ADHD epidemic in the US. It really changed the course of our lives in an very positive way. Thanks a million for making it.”

“It is refreshing to see someone with an objective viewpoint weigh in on this issue. The very idea that we would condone giving children drugs that can damage the brain of a child before the brain has even developed is in my opinion insane.”

Why is Play Attention Different?

Dr. Olafur Palsson, Psy.D. Associate Professor of Medicine, University of North Carolina at Chapel Hill, and one of the NASA developers of similar technology, states, “The Play Attention system is in my opinion uniquely appealing because it simultaneously addresses three different factors that can inhibit healthy learning and concentration. It trains basic mental skills that underlie the ability to complete school-related tasks; it systematically monitors and reduces attention-incompatible behaviors; and it encourages the type of brain activity that is known from research to be associated with good concentration. This multi-faceted approach goes far beyond the scope of most brainwave biofeedback training. All of this is furthermore packaged into a training format that is self-esteem building for the learner and well suited for use in educational and home settings.”

Play Attention is a comprehensive teaching/learning system developed by a teacher for students struggling with attention problems and the cognitive deficits typically associated with focusing difficulties. In use worldwide and in over 300 school systems in the United States alone, Play Attention has quickly captured the attention of educators looking for an educational intervention.

Play Attention’s core teaching method is derived from neurofeedback. National publications like Discover, Time, and Newsweek have recently raised public awareness about neurofeedback – an exciting intervention for children and adults with attention problems. Neurofeedback is derived from the word, neuro meaning brain related, and feedback. Feedback is a teaching method used since teaching began. Feedback implies reporting information to the student to inform him if he is or is not performing as needed.  Clinical feedback using abstract games or graphs to teach control of attention and other autonomic functions has been around since the early 1970s.

The bane of the aforementioned clinical approach has been its difficulty of use and expense.  Clinical EEG equipment is complex, expensive, and directed toward changing brain wave patterns. The change in the brain wave patterns is supposed to indicate change in associated skills of concentration, improved behaviors, etc. Frequently, students practice on their own in the absence of a clinician and therefore have no behavioral guidance. Clinicians also have devised a myriad teaching methods (‘protocols’) using different frequencies and sensor locations. Most all of these ‘protocols’ have demonstrated success in training brain training. Virtually no neurofeedback programs or ‘protocols’ incorporated educational methodology and cognitive skill building which commonly resulted in a lack of transference or generalization. This meant that skills learned during the feedback training were difficult to relate to home or classroom activities. This fact greatly delayed its acceptance by the professional educational community and resulted in severe criticism of the technology by others in the field. A few significantly good practitioners like Dr. George Von Hilsheimer had the acute ability to coach well and get students to be successful at home and school.

Background information

In mid 1980’s, Peter Freer was teaching at an elementary school in the rural mountains of Appalachia. He faced significant numbers of students with attention problems. Most of these students were also discipline problems. Being a second year teacher, he did not understand their learning differences, and he felt inadequately prepared to teach these students. There wasn’t even a label for students with attention problems at that time. Upon speaking with his university professors, he implemented a token reinforcement system, repeated instructions as needed, shortened assignments, and moved these students closer to his desk. While these interventions succeeded slightly, Freer still believed more could be done over and above simply modifying student curriculum and environment. Once these children became adults and entered the job market, no employer would move them closer to his desk and give them trinkets to motivate them.

Over the course of his graduate work, Freer was trained on educational implementation of computer software and educational programming developed at MIT in a program funded by the National Science Foundation. Computers were proving to be intrinsically motivating to students. Freer quickly realized that computers could be used to teach attention classes or instruction in focusing, if he could devise the correct program. He began studying research being performed at NASA and integrated into their flight simulator program. It was apparent that the neurofeedback technology NASA had implemented was not appropriate for students. However, significant educational modifications could be implemented that would make this technology practical and educationally efficient.

He undertook the massive effort to totally revise neurofeedback into a pure teaching tool by founding Unique Logic and Technology in 1994. Freer immediately stripped out the active brain wave reporting component as his intent was not to change brain wave patterns. He did intend to help alter cognitive skills because after researching decades of studies on attention problems, he found that children and adults with attention problems seemed to have weakened networks of attention, time on-task, visual tracking, short-term memory, and discriminatory processing. In other words, these students were deficit in the skills they needed most to succeed – the core components of the learning process. So, instead of trying to modify brain waves, Freer thought it more important to develop deficit cognitive skills that would directly affect behavioral performance and educational outcomes. The US government awarded Freer three patents and one pending based on his strategic modifications.

After two years of restructure the program was ready to be tested. Dubbed, Play Attention®, Freer negotiated an agreement with a local school system to test the learning system under the guidance of the special education director.

This special adaptation of neurofeedback only monitored brain wave activity to make the student aware of proper focus. Students can actually control screen characters by mind alone in activities that directly teach students to stay on-task, visually track the teacher during a classroom lesson, follow multiple step directions by increasing short-term memory skills, and learn to filter out distractions. This was a significant modification of existing teaching and feedback technology as it focused on performance based outcomes that were measurable as opposed to the older method of brain wave change which provide no conclusive evidence of specific behavioral change.

The results of the study so impressed the special education director, that he purchased a complete system for every school in the district. But that was only the beginning for Play Attention as Freer placed sensors in a bicycle helmet and integrated a behavior shaping program to assist students in diminishing or extinguishing behaviors not conducive to learning. The helmet was ideal for students as they could quickly prepare it for use in as little as 90 seconds with no fuss, no gels, no mess. It was familiar to them as they wore helmets for biking, roller blading, and skate boarding. The helmet could also withstand the rigors of the school environment.

If a student fidgets or calls out during his Play Attention session, the screen characters become uncontrollable. This allows students to actually see a direct correlation between their behavior and their attention. The behavior shaping module bases it goals on the fact that students want to succeed but need to know why they are being asked to make behavioral changes. Most students with attention problems are unaware that they exhibit behaviors that distract not only themselves, but others in their immediate surroundings too. Awareness of the behavior makes shaping it easier as attainable goals can be set and reinforced through positive reward. Yet another patent is pending on this process.

The overall result of the advancement of feedback technology in Play Attention is simplicity. Play Attention is a comprehensive program but is not complex. Its interface appears as a simple lesson plan. Goals are easy to set in all of the five cognitive components. Results are graphed from the internal data that are collected for each student. Students are even encouraged to work on actual homework assignments while wearing the Play Attention helmet and operating the learning system. This is a unique way to teach them to finish homework within a proper time period promoting good time on-task. When students log out, a journal asks them to reflect on what they’ve learned that session, what they are proud of, and what goals the need to develop for the next session. This information appears at the initiation of the very next session to promote continuity, transfer, and generalization.

Knowing that parents, teachers, and other professionals have tight schedules and need to implement software quickly, he established a support program that allows everyone to be trained quickly and be adeptly supported by professional staff via telephone and the Internet. Tech support is also available free of charge for the life of the product.

The significant changes in technology and methodology stemming from a different perspective – an educational perspective – have enabled Play Attention to become a world leader in educational attention training with homes, schools, learning centers, and professionals using Play Attention from Beijing to Brazil.