Posts from — December 2007

PRE-SCHOOL PROGRAM SHOWN TO IMPROVE KEY COGNITIVE FUNCTIONS, SELF-CONTROL

The following press release from the University of British Columbia maintains that a research study has demonstrated that cognitive training can improve attentional control, impulse control, and other executive functions.

Furthermore, the study’s authors cite that practice of cognitive skills in early development years may decrease incidence of ADHD. I have insisted that this was possible for nearly a decade.

Complicating this matter is the No Child Left Behind act (“NCLB”). It is my belief that the NCLB has added to the ADHD problem due in part to the program’s rigid adherence to test scores based on a watered down curriculum that forces teachers to teach the test. Subjects are taught quickly requiring rote memorization rather than significant reasoning or logical application. Additionally, teachers seldom have time to individualize curriculum or nurture students with learning disabilities like ADHD. Thus, rather than encouraging cognitive skills and the development of attention, NCLB has helped promote diffused attention while simultaneously discouraging the development of cognitive skills.

NCLB has also decreased recess time, children’s access to the arts like music and drama, and even physical education. Research has clearly demonstrated increased abilities in mathematics and other academic subjects when students are involved in music and the arts.

The press release:

Program Promises Improvement in Academic Achievement for Children of Poor Families

An innovative curriculum for preschoolers may improve academic performance, reduce diagnoses of attention deficient hyperactivity disorder (ADHD), and close the achievement gap between children from poor families and those from wealthier homes, according to research led by a Vancouver neuroscientist who is an expert on the development of the cognitive functions that depend on the prefrontal cortex area of the brain, called executive functions (EFs).

University of British Columbia Psychiatry Prof. Adele Diamond, who is Canada Research Chair in Developmental Cognitive Neuroscience, led the first evaluation of a curriculum called Tools of the Mind (Tools) that focuses on EFs. These functions include resisting distraction, giving a more considered response instead of your first impulse, working with information you are holding in mind, and the mental flexibility to think “outside the box.”

The program was developed over the last 12 years by educational psychologists Deborah Leong and Elena Bodrova and has been used in several U.S. states. Its value in improving EFs has not been determined until now.

The study is published in this week’s issue of Science.

“EFs are critical for success in school and life. These skills are rarely taught, but can be, even to preschoolers. It could make a huge difference, especially for disadvantaged children,” says Diamond, who is a member of the Brain Research Centre at UBC Hospital; the Child and Adolescent Psychiatry Dept. at BC Children’s Hospital; the Child & Family Research Institute (CFRI); and the Human Early Learning Partnership (HELP). Her work is also supported by Vancouver Coastal Health Research Institute and BC Mental Health and Addiction Services.

“The recent explosion in diagnoses of ADHD may be partly due to some children never learning to exercise attentional control and self-discipline,” says Diamond.

“Although some children are strongly biologically predisposed to hyperactivity and wouldn’t benefit from training, others may be misdiagnosed because what they actually need are skills in self-regulation.”

Previous research has shown that EFs are stronger predictors of academic performance than IQ, she adds. Children from lower-income families enter school with disproportionately poor EF skills and fall progressively farther behind in school each year – facts which Diamond says are related and correctible.

“Helping at-risk children improve EF skills early might be critical to closing the achievement gap and reducing societal inequalities. We showed EFs can be improved in preschoolers without fancy equipment and by regular teachers in regular public school classrooms.”

Most interventions target consequences of poor self-control rather than seeking prevention at an early age, as does Tools. “Early intervention – heading off problems before they develop – costs far less and achieves far better results than trying to correct problems once they have developed,” Diamond says.

“If throughout the school-day EFs are supported and progressively challenged, benefits generalize and transfer to new activities. Daily EF ‘exercise’ appears to enhance and accelerate brain development much as physical exercise improves our bodies,” she adds.

The research team, which includes investigators from the National Institute for Early Education Research at Rutgers University in New Jersey, evaluated 147 five-year-olds in a low-income, urban U.S. school district. Researchers compared Tools with a balanced literacy curriculum (dBL) that covered the same academic content as Tools but without a focus on EF.

Both programs were new, instituted at the same time and used identical resources. Children and teachers in Tools and dBL were randomly assigned and teachers had equivalent levels of education and teaching experience. The children in both curricula were from the same neighborhood and ethnic group, and from families with very similar levels of income and parental education. Children received either Tools or dBL for one to two years.

Evaluation involved two computerized tests that measured EF. These tasks were different from anything any of the children had done before. Better performance by children in Tools shows that they were able to generalize and transfer their EF skills to new situations.

Tools encourages out-loud self-instruction and dramatic play. “Preschool teachers are under pressure to limit play and spend more time on instruction but social pretend play may be more critical to academic success,” says Diamond.

The Multimodal Treatment Study of Children With ADHD has been one of the longest studies performed on a select group of ADHD children. Recently published in the journal of the American Academy of Child and Adolescent Psychiatry, the data are somewhat alarming.

Data from the study were used to evaluate whether stimulant medication effects physical growth in children. The data collected over three years indicates that both height and weight are decreased in children using stimulant medication.

Co-author, Professor William Pelham, of the University at Buffalo, says: “The children had a substantial decrease in their rate of growth so they weren’t growing as much as other kids both in terms of their height and in terms of their weight. And the second was that there were no beneficial effects – none.”

Pelham adds, “In the short run [medication] will help the child behave better, in the long run it won’t. And that information should be made very clear to parents.”

Here’s the most telling observation of the study: “I think that we exaggerated the beneficial impact of medication in the first study. We had thought that children medicated longer would have better outcomes. That didn’t happen to be the case. There’s no indication that medication’s better than nothing in the long run.”

Our good professor, Dr. Russell Barkley just spoke at a national conference citing that medication is by far the best and most trusted method. Unfortunately dinosaurs like Barkley do exist, are respected, and yet completely propagate information that has no substance in current research. Barkley is also a critic of neurofeedback.

On another front –

ADHD Drugs To Be Examined

“Two federal agencies will collaborate in the broadest study ever of prescription drugs for the treatment of attention deficit hyperactivity disorder (ADHD) and the potential for cardiovascular problems.

Over the next two years, the Agency for Healthcare Research and Quality and the Food and Drug Administration (FDA) will examine clinical data of some 500,000 adults and children who have taken such medications to determine whether they increase the risk of heart attack or stroke, the U.S. Department of Health and Human Services announced.

The FDA’s Gerald Del Pan, MD, said case reports describe “adverse cardiovascular events in adults and pediatric patients with certain underlying risk factors who receive drug treatment for ADHD, but it is unknown whether … these events are causally related to treatment.”

The study of all ADHD drugs by class will be coordinated by Vanderbilt University, with analysis by its researchers, Kaiser Permanente of California, the HMO Research Network and i3 Drug Safety, plus the FDA and AHRQ, the government said.”

Curiously, this study has already been done with results published by the University of Oregon. I’ve published the results of this study before, but it was not at all favorable for ADHD drugs. Real data on long term effects, safety, comparative analysis, and general efficacy are lacking. Let’s hope the new study treats the subject with the objectivity and professionalism of the University of Oregon.

As I’ve said in past entries, I’m not a proponent of clinical neurofeedback, and I find there are limitations to some of its research, much of the research, especially research performed over the last few years, demonstrates the possibility that the brain can and will make changes provided it is given the right stimulation. Unfortunately, clinical neurofeedback training doesn’t address other core issues like organization, memory, discriminatory processing, auditory processing, time on-task, and other cognitive skills. That’s exactly why I created Play Attention. It addresses far more than clinical neurofeedback.

Probably most importantly, neither neurofeedback or Play Attention cause any stunted growth, weight loss, tics, or any side effects like medication. From our follow-up with our clients over the last eleven years, positive training effects last as well. Far unlike medication which “In the short run will help the child behave better, in the long run it won’t. And that information should be made very clear to parents.”

Long-Term Safety Questioned of Ritalin

In research published in Pediatrics, [December 2007; vol 120: pp 1494-1501], lead author, Almut G. Winterstein, PhD, assistant professor of pharmacy health care administration, University of Florida College of Pharmacy, Jacksonville, found that common stimulants used to treat attention deficit hyperactivity disorder (ADHD) don’t often cause serious heart complications in children. However, she warns that their safety is undetermined for prolonged use.

Winterstein found that stimulants such as Ritalin, Adderall, and Concerta frequently raise blood pressure and heart rate. The researchers analyzed health records from 55,000 children and teens newly diagnosed with ADHD from 1994 to 2004 with two significant findings:

1. Children who used stimulant medication had a 20% increase in visits to hospital ERs or doctors’ offices for heart palpitations and racing heartbeat, compared with children who didn’t use stimulant medication.
2. Stimulant medications did not appear to be associated with an increase in hospitalizations or deaths due to cardiac causes.

Last year the FDA took a special interest in the matter of heart safety when it announced a special Black Box advisory to be placed on stimulant medication. This was in part due to reports of the sudden deaths of 12 children who used ADHD Drug, Adderall.

The Canadian government quickly suspended sales of Adderall XR in Canada, but later permitted sales after further investigation.

Winterstein, PhD, in an interview with WebMD, notes:

… that because serious cardiac events are so rare among children and teens, a much larger study is needed to confirm the safety of these drugs.

“We can’t really say that there is no increase in risk (for serious cardiac events) among children who take these drugs,” she says. “What we can say is that if there is an increase in risk, it will not affect a large number of children.”

ADHD Drugs and Heart Risk

The CDC estimates that 4.4 million children between the ages of 4 and 17 have been diagnosed with ADHD, and as of 2003, 2.5 million were taking medication for it.

Children are increasingly taking the drugs for longer and longer periods, but little is known about their long-term cardiovascular impact, Winterstein says.

“The average exposure in our study was two years, but we see children who are on these drugs for five years, 10 years, and even longer,” she says.

She adds that it is also not clear if the drugs are safe for children with existing heart problems or with risk factors for heart disease.