Category — ADHD: Parents

From Delta Sky Magazine, November 2007

Attention, not Detention

THE DOORBELL RINGS and Stacey Morrison greets the arrival: Bobby, the seventh-grade son of family friends. She offers him an after-school snack, which he declines, and they both head to the small sunroom of the Morrisons’ house in the central New Jersey town of Metuchen. As Bobby takes a seat in front of a computer, Morrison (at her request, the family name has been changed) reaches for a red bicycle helmet and a spray bottle containing a saline solution. Both bear the words “Play Attention.”

Three contact pads in the helmet receive a quick, enabling spritz. Bobby dons the helmet, which is wired through a Play Attention control unit to the computer. He’s now ready for another half-hour session of computer games and mental exercises that its creator calls a revolutionary breakthrough in treating a widespread disorder. It’s not the games themselves that are so unusual, but the way that Bobby and other players control much of the activity. For instance, players make a frog hop on a lily pad, keep a bird aloft or build a tower using only their brainwaves, by focusing intently on the task at hand. That is to say, they’re paying attention—a problem for Bobby and, according to various estimates, anywhere from 1.4 million to 3.5 million school-age children who struggle with ADHD (Attention Deficient Hyperactivity Disorder).

After a short procedure to establish a baseline attention level, Bobby selects Mind Maze for the first of his five-minute challenges. “Remember,” says Morrison, who has taken a seat beside him to serve as his Play Attention coach, “you want to get less than two errors.” Responding to brainwave patterns indicating that he’s focused, the software empowering this short-term memory challenge—something like the 1980s game Simon—sets four colored blocks in a circle blinking in a sequence. Bobby repeats each sequence, in this case using the up, down and sideways arrows on the keyboard. In his 35 hours of Play Attention sessions to date, he has gone from three-block sequences to recalling the order of as many as seven blinking boxes. He has NASA, a boy named John and a former teacher named Peter Freer to thank for his progress.

Freer, founder of a company called Unique Logic + Technology, located in Asheville, North Carolina, invented Play Attention out of frustration. In the early 1990s, teaching fourth grade in a pod-style open classroom, he was assigned a notorious student named John. John’s problems stemmed from ADHD and parents with an eighth-grade education who were even less able to cope with his behavior than the schools were. “I felt for John,” says Freer. “He was not intentionally trying to act out or misbehave. He was just not wired the same as his peers.”

Freer sat John at a desk right next to his own. Simplified instructions for him. Used behavioral shaping rewards. John made incremental progress at school, but not at home. “The parents are frustrated. Dad’s hitting him. They medicate him. Some days he comes in so sleepy he just lays his head on the desk,” Freer recalls. “Some days he’s fairly normal. But it disturbed me—disturbed me that I was totally underequipped to help him.”

Freer, whose graduate work included writing educational software programs, began what he now terms his “crusade” to devise a way to teach children with ADHD how to pay attention to classroom lessons, take tests and do homework. Also driving his quest: indications that as many as 60 percent of children with ADHD carry their condition into adulthood. Freer discovered that NASA, eager to keep pilots and astronauts focused on eye-glazing, low-stimulation control panels, had devised a brainwave biofeedback training system. So he hired an engineer and programmer, and the team made some enhancements to the apparatus to create Play Attention.

The noninvasive sensors in the helmet, he explains, “listen to what the brain is doing in real time. It’s a physiological monitor, like grabbing a bar on a treadmill at the gym that displays your heart rate. When the neurons fire in the brain, they produce small electrical bursts. That’s what’s picked up.”

“Play Attention made sense to me,” says Morrison, who’d consulted with numerous doctors and tried various treatments and mental exercises for her own son Jack, who was the same age as Bobby and suffering from ADHD. (Bobby himself has not received a formal diagnosis of ADHD.) “It’s like having a weak muscle in your body and they send you to physical therapy and you gradually strengthen that muscle. Except, when you tell a kid, ‘Pay attention. Pay attention,’ what does that mean? Attention is not something you can hold in your hand and see.”

That, she stresses, is the beauty of Play Attention. It shows you instantly when your attention begins to waver. “You have to pay attention,” Morrison says. “You can’t just stare at what’s on the screen. It knows the difference. You really have to be concentrating on that bird [to make it fly]. If you stop concentrating, the bird starts to drop.”

Morrison started her son Jack on Play Attention at the very end of his fifth-grade year, continuing his twice-weekly sessions throughout the summer. (Full-featured, professionally supported home versions of the program start at $100 a month. Open-site licenses for schools and organizations are also available.) In early September, Jack’s sixth-grade math teacher, who’d taught him the year before, called Morrison. “He’s like a different kid,” said the teacher. “He’s participating. He’s taking notes. He’s paying attention.”

One strength of Play Attention, explains Morrison, is its ability to target unwanted behaviors. Sitting beside Jack, she noticed that his eyes wandered all over when he first started playing Play Attention. “There’s chair-tipping or, like we’re working with Bobby now, fiddling with things on the desk,” she says. Now, with visible manifestations of behavioral drags on performance appearing on-screen, and with cues from the coach as well, Play Attention users can more easily understand the roots of inattention and begin to rewire their brains. “I know I’m just a mom, and I sound like an infomercial,” says Morrison, “but I’d like to see Play Attention in the school system.”

According to Freer (whose small business received a badly needed $100,000 in 1998 from an “angel” investor who herself suffered from ADHD), Play Attention is being used by some 450 American school systems and in various learning centers in England, Saudi Arabia, China and other countries. It’s also being used to address attention issues beyond ADHD.

While looking on with interest, some professionals remain cautious about Play Attention’s claims. “I think the jury is still out,” says Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Schneider Children’s Hospital in New Hyde Park, New York, who notes that the promise of Play Attention still awaits the critical eye of scientifically designed studies.

One such study is being conducted under Dr. Ellen Perrin and Dr. Naomi Steiner at The Floating Hospital for Children at Tufts–New England Medical Center in Boston. “We’re intrigued that [Play Attention] could be a helpful treatment for children with ADHD, either by itself or in conjunction with medication,” says Perrin, director of the hospital’s Division of Developmental-Behavioral Pediatrics and The Center for Children with Special Needs. The pilot study, which followed about 50 Boston area middle-school students through the 2006-07 school year, randomly assigned each child to one of three groups: those attending Play Attention sessions in school, those using another computer-based program and those receiving no special in-school program. The data collected laid the groundwork for the second phase of the study, now in progress.

By the time you read this, Bobby will have been weaned off his twice-weekly sessions at the Morrison house. Stacey Morrison, who is not being paid to coach Bobby, describes him as a bright kid who was getting B’s in his accelerated math class when he could have earned A’s: “His mother told me whenever he’d take a test, he’d always get the first problem wrong even though it was invariably the easiest question. I said, ‘Aha!’ Because when he first sat down to do Play Attention, whatever game he chose to do, at first he would always have trouble. But once he got started, he was fine.

“When Bobby started with me and I asked him for his goals, he told me, ‘I don’t want to spend so much time doing homework and getting yelled at all the time.’ He’s now getting A’s in that math class, stopped getting those first problems wrong, and his mother tells me, ‘You know what, Bobby is doing his homework on his own. He’s getting it done, and he’s having more free time.’”

Bobby’s mother has noticed something else, too—something that would please Peter Freer just as much, and an added benefit of Play Attention. “Bobby now looks people in the eye when he talks to them,” Morrison says. “He never used to do that before.”

Not Just for Kids

Other groups and individuals with interests beyond ADHD (Attention Deficient Hyperactivity Disorder) are also getting good results from Play Attention (800-788-6786 or 828-225-5522; www.playattention.com).

Harriet Eskildsen, director of the High Tech Center for the Disabled at the College of Marin, in Kentfield, California, has found it has helped adult stroke victims regain lost quality of life. “My students tell me it’s helped them remain focused for a longer period of time,” she says. “They can go to the movies again and follow a story line. They can return to reading books, and can again take part in conversations, which requires listening skills we take for granted.”

Among those looking to Play Attention for an edge in athletic performance is Bill Tavares, coach of the U.S. Women’s Olympic Bobsled Team. Not only is Tavares impressed by the early improvements made by some of his bobsled drivers, for whom focus on the proper line down the course is paramount, he’s also enthusiastic about what his own Play Attention sessions have done for his golf game—helping him lower his handicap from 9 to a 4 or 5.—J.G.

ADHD does not seem to be a condition like pregnancy where one is either pregnant or one is not. Rather it is a matter of degree. Some children and adults range from mildly inattentive to profoundly inattentive. The degree seems to be directly affected by a variety of environmental factors including divorce, parenting skills, etc. More frequently than not, drugs are prescribed to allay the symptoms. Obviously, they do not affect core issues that affect the child like divorce, marital discord, or learning disabilities.

Study finds divorce increases Ritalin use in children

HELEN BRANSWELL
Canadian Press
June 4, 2007 at 8:46 PM EDT

TORONTO — Children whose parents divorce are nearly twice as likely to be prescribed Ritalin in the aftermath of the split, a Canadian study reports.

But the author, a sociologist from the University of Alberta, cautioned against concluding that children of divorce are over-prescribed the drug, which is used to treat Attention Deficit and Hyperactivity Disorder, or ADHD.

Lisa Strohschein said the data she used can only identify the phenomenon and cannot reveal why Ritalin use rates are double when children of divorced parents are compared to children whose parents stay married.

“I’ve got the what, but not the why,” Ms. Strohschein said from Edmonton.

Ms. Strohschein suggests there may be a variety of answers. Some kids may need the drug to cope with the stress of the split, some kids may have ADHD and some kids may be getting a drug they don’t really need.

“The problem is I can’t be clear about it,” she said.

“I mean, I would love to be able to say ‘Yes, it’s divorce. That’s the problem,’ But it’s not necessarily so. It could just be our perceptions about divorce — and that’s the thing that makes me really cautious here.”

“(But) I don’t want to come out on the other side, either and say ‘Ritalin is bad’ because I think it clearly does help some kids.”

The psychiatrist-in-chief of the Hospital for Sick Children in Toronto said the study should serve as a reminder to doctors to move cautiously when prescribing Ritalin or other methylphenidate-based drugs to children in these circumstances.

“What we need is a deeper understanding of this issue, at the level of the primary care practitioners,” said Dr. Abel Ickowicz.

“Because . . . if we are going too quick to prescribe medication, like Ritalin, like methylphenidate, we may not only be masking the normal process of adaptation to divorce, but we may be contributing to the degree of distress the children of divorce are experiencing.”

The study, published in the Canadian Medical Association Journal, used data gathered by Statistics Canada through its National Longitudinal Survey of Children and Youth. The survey, which was first conducted in 1994, is completed every two years; Ms. Strohschein used data collected between 1994 and 2000.

Previous researchers had identified the fact that children who live in a household with only one parent or with a parent-step-parent combination were more likely to be on Ritalin than children growing up in households with both parents.

But it wasn’t clear whether the increased use was among all children in a single-parent household — in other words, children whose parents had divorced, children who had lost a parent to death and children born to a single mother — or whether some subset of these children was more heavily prescribed the drug.

Ms. Strohschein compared prescription rates among 4,151 children whose parents hadn’t divorced and 633 children who had. She found that 3.3 per cent of children in the two-parent families were prescribed Ritalin; among the children whose parents had divorced, that figure rose to 6.1 per cent.

The study notes a number of potential explanations for the doubling of the usage rate.

One possibility is that the stress of the divorce aggravated a child’s existing behavioural problems to the point where Ritalin would actually be helpful, she hypothesized.

It is known that ADHD can run in families. In addition to passing on the condition to their children, parents with ADHD-type behaviour might be more likely to divorce — a theory that points towards appropriate use of the drug.

Another possibility is that in divorce, the natural emotions children experience — anxiety, sadness, anger — may manifest themselves in behaviour that is mislabeled as ADHD-like, or that parents and doctors may be anticipating problematic behaviour because of the stress of divorce. The study suggested this type of rationale would reflect inappropriate use.

Dr. Anton Miller, a developmental pediatrician and child health researcher at the University of British Columbia’s Centre for Community Child Health Research, said it’s possible no single answer applies across the board for these children.

“None of them is an outlandish kind of suggestion. They probably all have some validity,” he said.

“It’s certainly possible in some instances that ADHD might have been prematurely diagnosed…. But I would caution anybody (against) saying ‘Well that’s why all these children are getting medication.’ “

“But there is a possibility that in a proportion of the cases we need to try and figure out how much that does happen in the real world and try and advocate … for children to have thorough and really in-depth assessments for these kinds of behaviour and emotional problems.”

Ms. Strohschein agreed: “I think the take-home message is just to be careful not to make that broad assumption that kids must necessarily be doing poorly when their parents divorce. Some kids will do better, some kids will do worse.”

It is a myth that poor parenting causes ADHD.  This is a still a sore spot for many parents of non-ADHD children.

Our society is still firmly entrenched with the King James version of the Bible, Proverbs 13-24: He that spareth his rod hateth his son:  but he that loveth him chasteneth him betimes.

While I won’t address corporal punishment in general, it’s important to realize that it is not a good practice to spank ADHD children. ADHD children are wired differently. This is very apparent, for example, when they run through a dark living room at night and stub a toe or crack a shin on a piece of furniture. This practice inflicts serious pain, and one would think they would not repeat this again. However, they frequently repeat this behavior over and over. This is due to the fact that their impulse control overrides their ability to make good judgment – a hallmark of ADHD. So, while spanking them may relieve your frustration, it won’t help shape their behavior and may cause increased family stress. So, while poor parenting may not cause ADHD, it may exacerbate the symptoms.

Perhaps the most successful practice a parent can employ is consistency. At least two fundamental steps are necessary to be consistent; establishing a schedule and establishing a fair set of rules with consequences.

Set up a schedule beginning with a morning wake up ritual all the way to bedtime. Schedule quality time together. A chart may be employed if the child is younger than 12. Establish a fair set of rules with consequences. Typically, time-out works well with younger children. Remember not to get pushed out of your game plan, i.e. stick to your rules and schedule.

Finally, you will be far more successful if you follow this rule: Catch your child being good. Don’t just have consequences when things go wrong, have consequences when things go right! Awarding permission to stay up an hour later on the weekend, renting their own video, etc. are simple but great rewards for getting caught doing something good!

ADHD and
Behavioral Problems

According to a study published in the January 2007 issue of the American Psychological Association’s journal, Developmental Psychology, a mother’s depression predicts whether children with ADHD will develop behavioral problems.

• Maternal Depression and Early Positive Parenting Predict Future Conduct Problems in Young Children With Attention-Deficit/Hyperactivity Disorder.

Psychology professor Andrea Chronis, director of the University of Maryland ADHD Program and lead author on the paper said, “In the real world, this could have important implications, because research has suggested that children with both ADHD and conduct problems are at the greatest risk of becoming chronic criminal offenders.”

As I’ve discussed in many previous blogs, the brain is quite plastic almost to a flaw; negative stimulation, will affect the brain negatively while positive stimulation will affect the brain positively. This study seems to reflect that fact as well. The researchers found that positive parenting during preschool years predicted fewer behavioral problems as the children reached early adolescence. Children presented fewer conduct problems such as lying, fighting, bullying and stealing. Conversely, maternal depression predicted more conduct problems during adolescence.

The researchers estimate, approximately 20 to 50 percent of children and 44 to 50 percent of adolescents with ADHD experience severe conduct problems.

“Parenting an ADHD child is very difficult for many families,” Chronis says [see ADHD and Alcohol Abuse]. Chronis’ team has found in earlier research that mothers of ADHD children are at double the risk of experiencing depression than moms of non-ADHD kids. Focus was place on mothers as they are frequently the primary caregivers and are therefore subject to more stress and depression. “Often there’s a growing cycle of negativity as parents’ nerves fray and their children’s behavior escalates in response to increasingly harsh or withdrawn parenting. Maternal depression makes parenting a child with ADHD even more challenging. Now we have new evidence that praise, a warm tone of voice and use of other positive parenting techniques may help break this dangerous cycle.”

Chronis’ research is part of an ongoing longitudinal study funded by the NIH that follows ADHD children through their 18th birthdays. Collaborating with research teams at the Universities of Chicago and Pittsburgh, the study evaluated the behavior and development of 108 children whose ages ranged from four to seven at the study’s beginning. Parenting techniques were assessed by observation, and data on the mother’s mental health were analyzed annually.

Neuroplasticity at work: the researchers found that children with mothers who displayed the highest levels of positive parenting during preschool had significantly lower levels of conduct problems over time while children of previously depressed mothers had significantly higher levels of conduct problems over time.

As I mentioned in ADHD and Alcohol Abuse, the problems of depression and alcohol abuse may be parental coping mechanisms in response to an ADHD child. They are also quite likely cyclic; the child is more likely to be depressed or abuse alcohol later in life.

This does give us a background to develop a methodology to prevent the cycle from recurring.

For ADHD Children, Mother’s Depression, Early Parenting Predict Conduct Problems

COLLEGE PARK, Md., March 22 (AScribe Newswire) – A mother’s depression predicts whether children with ADHD (Attention Deficit Hyperactivity Disorder) will develop conduct problems such as lying, fighting, bullying and stealing, according to a new study from a University of Maryland researcher.

The study, published in the January 2007 issue of the American Psychological Association’s journal, “Developmental Psychology,” also found that early positive parenting during the preschool years predicted fewer conduct problems as the children grew to early adolescence. The strength of the findings led the researchers to conclude that maternal depression may be a risk factor, whereas positive parenting may be a protective factor.

“This research gives us clear targets for early intervention to prevent conduct problems in children with ADHD,” says Andrea Chronis, director of the University of Maryland ADHD Program and professor of psychology who served as lead author on the paper. “In the real world, this could have important implications, because research has suggested that children with both ADHD and conduct problems are at the greatest risk of becoming chronic criminal offenders.”

The researchers say their study is the first to focus directly on the role of parent mental health and early parenting in the development of conduct problems among children with ADHD. Moreover, they point to previous research that shows the development of conduct problems to be quite common in children with ADHD. By one estimate, approximately 20 to 50 percent of children and 44 to 50 percent of adolescents with ADHD experience severe conduct problems.

“Parenting an ADHD child is very difficult for many families,” Chronis says. “Often there’s a growing cycle of negativity as parents’ nerves fray and their children’s behavior escalates in response to increasingly harsh or withdrawn parenting. Maternal depression makes parenting a child with ADHD even more challenging. Now we have new evidence that praise, a warm tone of voice and use of other positive parenting techniques may help break this dangerous cycle.”

Findings and Method

Specifically, the researchers found that children with mothers who displayed the highest levels of positive parenting during preschool had significantly lower levels of conduct problems over time, when other possible contributing factors were controlled. Also, children of previously depressed mothers had significantly higher levels of conduct problems over time compared to children whose mothers had never been depressed.

This research is part of an ongoing longitudinal study funded by the National Institutes of Health that follows ADHD children through their 18th birthday. Conducted by members of the research team at the Universities of Chicago and Pittsburgh, it consisted of a series of annual assessments of 108 children’s behavior and development. Children ranged in age from four to seven at the start of the research. The parenting techniques were assessed using observational methodology during the first year of the study. Information on the mother’s mental health was also collected annually.

The study focused on the mothers’ health and parenting since they are most often the primary caretakers and are more likely to be depressed than men. Also, an earlier study by Chronis and the research team found that mothers of ADHD children are at double the risk of experiencing depression than moms of non-ADHD kids.

With a grant from the National Institute of Mental Health, Chronis and her research team at the University of Maryland are now developing and evaluating a 14-week behavioral intervention for depressed mothers of children with ADHD that targets effective parenting and reducing maternal depression.

An electronic copy of the research paper is available to journalists. Please email Neil Tickner: ntickner@umd.edu.

The Maryland ADHD Program is a clinical research program with a strong commitment to conducting clinical research that advances knowledge of the assessment and treatment of ADHD, provides comprehensive, empirically-based assessment and treatment of ADHD and associated behavior problems, trains the next generation of child clinical psychologists in these practices and educates parents and schools in this form of assessment and treatment. More information is available online: http://www.bsos.umd.edu/psyc/clinicalpsyc/training/adhd.htm.

LONDON, UK: The Daily Telegraph reports of a highly controversial study indicating that parents of autistic children tend to be more highly educated than parents of children with other mental problems. Researchers found that 46% of parents of autistic children achieved a General Certificate of Secondary Education (GCSE) compared to 35% parents of other children in the study. A GCSE is the name of a set of British examinations, usually taken by secondary school students.

The study, conducted by the Office for National Statistics, was an attempt to closely examine children with autism as well as to determine whether mental disorders were rising.

Researchers found that autistic children were also less likely to live in poor families. However, many autistic children live in families where neither parent worked. While only nine percent of parents with autistic children earned less than £200 per week, 20 percent of other children lived in homes with a weekly income of less than £200 per week.

Researchers suggested that the unusual combination of high educational status and low economic activity among parents of autistic children “reflects their heavy caring responsibilities.”

Seven percent of US children are suspected of having ADHD while the British study indicates on two per cent had Attention Deficit Hyperactivity Disorder (ADHD), and only one per cent had a less common disorder, such as autism. As is true in the US, boys were more likely to have a mental disorder than girls.

“The prevalence of mental disorders was also greater among children and young people in certain families, such as lone parent families (16 per cent) compared with two-parent families (eight per cent) and in step-families (14 per cent) compared with those with no stepchildren (nine per cent).

Dinah Morley, deputy director of Young Minds, the children’s mental health charity, said the figures were a wake-up call to the “tremendous cost” of divorce.

“We can’t turn the clock back to a time when all children stayed with their birth families,” she said. “But we can start to be more aware that these things that adults do impact very deeply on children. I think it is a wake-up call to adults to be more aware when they decide to divorce of the tremendous cost to the children. It is important for society to think how in the future it is going to support children better.”

However, statisticians emphasised that while there was a link between divorce and mental health problems in children, it was not clear whether the divorce followed the diagnosis of the mental problem or whether it may have triggered it in some way.

They added that mental health problems in children were also more common where the parent had no educational qualifications (17 per cent) compared with those who had a degree (four per cent) and where a parent was an unskilled manual worker (15 per cent) compared to a doctor or lawyer (four per cent).

One per cent of children aged 5-16 had autistic spectrum disorder.

The majority – 82 per cent – were boys. Almost all the children had a physical complaint as well (89 per cent compared with 54 per cent of other children).

Tim Loughton, the shadow Health Minister, said: “The Government urgently needs to make it easier to identify problems early on in schools and to provide appropriate treatment. That does not mean admission to adult wards or excessive reliance on the chemical cosh of drugs.”

(Source: Daily Telegraph, September 1, 2005)

The Impact of 3-Tier Formularies on Drug Treatment of Attention-Deficit/Hyperactivity Disorder in Children, a study published in the April 2005 issue of the Archives of General Psychiatry, concludes that number of health plans that limit the cost of ADHD drugs has been increasing in recent years.

Lead researcher, Haiden A. Huskamp, Ph.D. is an Associate Professor of
Health Economics in the Department of Health Care Policy at Harvard Medical
School.

The study concludes that in an effort to save money, many health plans encourage physicians and parents to select drugs that are ‘preferred’ by the health plan. Drugs selected that are not on the preferred list mean higher out of pocket expenses or co-payments. This reduces the likelihood parents will buy ADHD medication for a child.
 
The study found for one health plan, three-tier formularies resulted in a 17 percent decrease in the probability that parents would purchase an ADHD medication for their child. In addition, with the three-tier adoption, the plan’s spending decreased 43 percent and enrollee spending increased 46 percent.”

It seems that the health of the individual should take precedence over money saving strategies. Health plans should encourage, not discourage appropriate drug use.