Category — ADHD: Treatment

A study published in the June 14 edition of the Journal of Developmental and Behavioral Pediatrics has sparked controversy regarding ADHD medication and the brain’s power to regulate itself.

The study was funded by the National Institutes of Health and conducted by Dr. Adrian Sandler, a developmental-behavioral pediatrician and medical director of the Olson Huff Center for Child Development at Mission Children’s Hospital in Asheville, North Carolina.  The research was performed over the course of eight years using 99 patients from Western North Carolina.

Sandler found that children with ADHD can do just as well on half their medication when the medication is combined with a placebo. They performed as well even when parents and children had full knowledge they were taking a placebo.

[Placebo --  A substance containing no medication and prescribed or given to reinforce a patient's expectation to get well. The placebo in this research was akin to a harmless inert pill].

Previous studies have shown that common stimulant medication causes side-effects like tics, weight loss, stunted growth, and even heart complications in some instances. This often causes trepidation in parents afraid of the possible side-effects on their children.

Sandler compared fully medicated children, children on reduced medication, and children on reduced medication with a known placebo. The results were quite intriguing.  Both the fully medicated and reduced medication groups had increased side-effects while the reduced medication with placebo demonstrated decreased side-effects. Furthermore, the reduced medication group reported decreased control of their ADHD symptoms. However, the control of ADHD symptoms was no different in the reduced medication with placebo group than in the full dose group, i.e. the reduced medication with placebo performed as well as the fully medicated group with less side-effects as well.

“I’ve been getting a lot of calls and e-mails,” said Sandler,, who conducted the research with James Bodfish, a professor in the departments of psychiatry and pediatrics at UNC Chapel Hill School of Medicine, and study coordinator Corrine Glesne.

“Medications work,” Bodfish said in a statement. “The question is whether we always need to use them at the highest dose. Many parents are concerned about placing their child on medication. Some choose not to treat their child because of concerns about side effects.”

While the research doesn’t address it, the obvious question is, Why? Parents and children in this study knew they were taking a placebo. Why then did they perform as well as their peers without the side-effects — at essentially half the dose as their peers? While the placebo effect has been studied widely, the exact mechanisms are unknown. We do know that the mechanism is governed by the brain. This clearly tells us that having ADHD or not, our brain is still a powerful weapon in our arsenal.

We also cannot exclude the influence of the parents during this research. Did they expect their child to do better? The authors suggest that this was so. This dynamic cannot be overlooked in your family either.

The bottom line is that we likely have far more control over our behaviors and cognitive processes than we are given credit for. Modern medicine, as this research suggests, is just beginning to understand the brain’s role in shaping our lives. We’ve known this for years at Play Attention. Cognitive training. Memory training. Motor skills. Attention training. Behavioral shaping. It’s time to take control over our lives. We’ve all got the power to do it. It lies right behind our eyes.

A Nottingham University research team in the United Kingdom found that the brains of children with ADHD appear to respond to immediate rewards in the same way as they do to medication. Their research was published in the journal Biological Psychiatry.

“Our study suggests that both types of intervention [medicine and immediate reward/reinforcement] may have much in common in terms of their effect on the brain,” said Professor Chris Hollis, the lead investigator of  the study.

The research team used an EEG (electroencephalograph) to measure the brain activity of children as they played a computer game that provided extra points for less impulsive behavior.

The researchers devised a computer space game which rewarded the ADHD children when they caught aliens of specific colors  while avoiding aliens of designated colors. The game design actually tested the children’s ability to resist the impulse to grab the wrong colored aliens.

To test whether immediate reward/reinforcement made a difference, one iteration of the game rewarded the children fivefold for catching the right alien and penalized them fivefold for catching the wrong one.  All of this was done while activity in different parts of their brains was monitored with an EEG.

Hollis found that the immediate rewards helped the children perform better at the game. This was verified by the EEG which  revealed that both medication and immediate reward/reinforcement were "normalizing" brain activity in the same regions.

Many parents of ADHD children are aware that giving a reward to an ADHD child a week after their good behavior is insignificant to that child. ADHD children respond better to immediate reward, not delayed reward.

"Although medication and behavior therapy appear to be two very different approaches of treating ADHD, our study suggests that both types of intervention may have much in common in terms of their effect on the brain. Both help normalize similar components of brain function and improve performance,"  said Hollis.

"We know that children with ADHD respond disproportionately less well to delayed rewards – this could mean that in the ‘real world’ of the classroom or home, the neural effects of behavioral approaches using reinforcement and rewards may be less effective."

It’s obvious that providing immediate rewards/reinforcement 24 hours a day and 7 days a week would be impractical and impossible. But what does this research tell us? It tells us that if we are to train an ADHD student, feedback, reward, and reinforcement need to be immediate if we are to get their brain to rewire.

We at Play Attention have known this for many years. This is why we integrated immediate feedback/reinforcement for attention training, cognitive training, memory training, and behavioral shaping by using feedback technology. We patented this method years ago because of its inherent strength. While we knew this was the best way to achieve success, we feel research like this rather reinforces our approach. It’s about time the world caught up!

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.

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.

As I reported earlier (Do ADHD Adults Really Lose 3 Weeks of Work Each Year?), a study published in the journal Occupational and Environmental Medicine, found that ADHD adults worked 22.1 days less than other workers each year. Furthermore, the study found that they were unable to carry out normal work activities an average of 8.4 days per year, 21.7 days of reduced work quantity and 13.6 days of reduced work quality.

However the study actually begs the question of what is adult ADHD. If you’ve found that it’s difficult to concentrate because you may be hyperactive, have trouble remembering appointments or finishing a project once the challenge is gone, are easily distracted, or avoid tasks that require concentration the World Health Organization (“WHO”) says that you may have adult ADHD! The WHO also thinks that many adults do not know they have the condition.

Who (no pun) hasn’t felt easily distracted or avoids boring tasks? I wonder if the shaky diagnosis of adult ADHD – which by the way, is totally subjective – is being exaggerated so that more people can be ‘treated’ i.e. prescribed medication.

The researchers (World Health Organization (“WHO”) research consortium at Harvard Medical School in Boston Medicine) formed their conclusions by evaluating data from 7,075 adult workers in several countries. The workers ranged in ages from 18 to 44 and were screened for ADHD as part of the World Health Organization World Mental Health Survey Initiative. The researchers surveyed the workers about their performance at work in the last month.

Both the media and the pharmaceutical industries have helped spur the diagnosis of ADHD by clinicians. However it will remain a controversial diagnosis shrouded by concerns about context; we are now required to sit and perform focused and organizational tasks more now than ever before in history. This has changed greatly from work at standard manual labor and assembly lines of the past. Is it natural for us to become distracted at tedious or boring jobs? Do we need medication to improve our work? For whose benefit? Furthermore, an ADHD diagnosis can be symptomatic of personal learning problems or family dysfunction among many other scenarios that comprise the human situation.

Adult ADHD is caught in the midst of a tug-of-war between pharmaceutical marketing, changes in the workplace, and a very loose, subjective diagnosis. Buyer beware.

Massachusetts General Hospital (MGH) issued a press release regarding a study performed by Joseph Biederman, MD and colleagues. Biederman is a professor of Psychiatry at Harvard Medical School.  The study finds that the use of stimulant drugs to treat children with ADHD has no effect on their future risk of substance abuse.

This study directly contradicts previous studies which indicate stimulant treatment could increase substance abuse risk.  The authors of the current study (Biederman, et al) maintain that previous studies produced conflicting results because they had several limitations; some only looked at adolescents, although young adults are at the highest risk of substance abuse. The authors argue that other studies did not control for conditions such as conduct disorder that are known to be associated with substance abuse. This is commonly referred to as co-morbidity and is truly the norm for ADHD as ADHD virtually never presents by itself. It is commonly associated with conduct disorder, learning disabilities, dyslexia, etc. The authors also maintain that other studies may have examined the impact on use of only a particular substance.

Biederman, like Russell Barkley, seems to get substantial funding from the pharmaceutical industry. That being disclosed, Biederman’s previous research tended to promote the use of stimulant medication [from www.Sciencedaily.com]:

“Earlier studies under the MGH Psychopharmacology group had suggested that stimulant treatment might actually reduce the risk of substance abuse in ADHD patients, who are at elevated risk to begin with…”

Imagine that! Taking stimulant medication in the same class as cocaine or speed in my early years would prevent me from desiring to use addictive drugs in my later years! Now that’s impressive, Joe. Obviously that was an untenable position, but Joe got the next best result with his try-again research methodology; it may not prevent substance abuse later on, but at least, Dr. Joe maintains, it doesn’t cause it.

“Because stimulants are controlled drugs, there has been a concern that using them to treat children would promote future drug-seeking behavior,” says Dr. Joe, the study’s lead author.

The MTA (Multimodal Treatment of ADHD) found that after three years of drug taking, they couldn’t find any difference in children medicated and children who had done nothing at all. The study’s authors said they witnessed no overall global academic improvement, behavioral improvement, or social improvement. They also found that children in their study had lower overall weight. Height was also less than peers.

What interests me greatly is the fact that when the authors of these studies have close ties to the pharmaceutical industry, their data tends to be skewed in favor of medicine. When there isn’t a close tie, we tend to get contradictory data, which is what one would expect.

I’m not an advocate of medicine, but I’m not an opponent either. It has its place and can help some children in the short-term. It must be supported with cognitive and behavioral interventions to maximize the opportunity for change. 

As far a research goes, all I want is the truth. Nothing skewed. No hidden agendas.

Florida undecided as states sue over costly drug program

By M.C. MOEWE, staff Writer

They’re powerful psychotic drugs, used to treat conditions like schizophrenia. No one knows what their effects are on children, especially infants, yet within seven years the number of children prescribed the drugs in Florida’s health insurance program for the poor has nearly doubled.

There’s no doubting one side effect, though — drug companies watched sales soar, aided by a Florida program they helped create.

Florida is far from unique. Several states also noted the costly boom of atypical antipsychotics — a new class of the drug that was touted to have fewer side effects. The states are suing drug makers, alleging the companies pushed newer, untested drugs that proved no more effective in treatments — but were far more costly.

In Florida, the taxpayers’ bill for the drugs jumped from $9 million seven years ago to nearly $30 million in 2006. Whether Florida will join states like Texas, Pennsylvania and South Carolina in trying to recoup some of those costs is unclear.

“Our office is aware of concerns with antipsychotics in Florida’s Medicaid program but we cannot acknowledge nor provide any information pertaining to ongoing criminal investigations,” said Sandi Copes, a spokeswoman with the Florida Attorney General’s office.

Florida Medicaid records show the number of children — some just months old — who were prescribed the drugs went from 9,364 seven years ago to 18,137 in 2006. No records for privately insured patients are available.

“The situation is out of control,” said David Cohen, a professor at Florida International University who has been studying the use of antipsychotics since 1983. While no long-term studies have been done on the effects the drugs have on children, there is evidence children on the drugs face greater risks of diabetes, hyperglycemia and extreme weight gain, Cohen said.

‘MOOD STABILIZERS’

Orange City child psychiatrist Manuel Mota-Castillo said age shouldn’t be a factor in determining whether the drug is needed. He has prescribed antipsychotics to children frequently, with the youngest being a 25-month-old child.

“I don’t want to use the name ‘antipsychotic.’ I use ‘mood stabilizer,’ ” said Mota-Castillo, who also worked for three years at Act Corp., the area’s main mental health facility.

The 25-month-old child had been kicked out of five day-care centers where complaints included punching other children, he said. “The child’s mother came to me in shorts so I could see the bruises and marks (on her),” he said.

Crystal Lamson of Sanford said Mota-Castillo has been treating her bipolar son for more than two years. Ryland, now 7, broke a Plexiglas window at a day-care center when he was 5.

“I get criticized all the time from family members,” Lamson said. “(But) there are some children out there who do need them.”

Another Sanford parent, Richard Davis, said he watched in horror as his daughter Ciara, then 6, gained 40 pounds, developed breasts and had uncontrollable tongue and facial movements.

“Those drugs were killing her,” Davis said.

Over his objections, he said Ciara was given antipsychotics by her mother and while in foster care. A court-appointed guardian also noted the effects in an August 2003 report, describing a visit in which Ciara “never once kept her tongue in her mouth.”

Ciara, now 11, was taken off the drugs after about a year, her father said, and she quickly dropped the added weight.

‘TAINTED’ MONEY

In Florida, even as drug makers were being told to issue warnings about risks, a Florida Legislature-directed program partly funded by pharmaceutical companies was recommending the drugs as treatment for attention deficit hyperactivity disorder (ADHD) with tics or intermittent explosive disorder, according to the program’s Web site that has since been shut down.

According to a study that looked at three years of data, about 40 percent of the antipsychotics prescribed to Florida Medicaid children were given to children diagnosed with ADHD — a use not approved by the Food and Drug Administration.

The Florida program was patterned after a Texas project that has spurred a whistle-blower lawsuit. The Florida Algorithm Project used some of the Texas-developed medical formulas that recommended drug treatments for mental diseases.

A year ago Texas joined the whistle-blower suit against Janssen Pharmaceutica and several other Johnson & Johnson subsidiaries. The suit alleges the program’s treatment guidelines — “improperly influenced” and paid for by the drug companies –increased sales of the antipsychotic Risperdal.

An official with Janssen said the company will defend its actions.

“We believe our participation in all aspects of our Texas Risperdal activities were in accordance with what the law required,” said Ambre Morley, a company spokeswoman.

Florida pilot programs using the Texas-developed guidelines began in 2001, according to state documents. Act Corp. in Volusia County was one of 15 sites that adopted the program until it was discontinued in September 2004.

James Bax, a former director of the Florida program, said the project began with funding from pharmaceutical companies.

“It did not take me long to realize that the money from the drug companies was tainted,” Bax said. “Once I got into it, I saw what I thought was very insidious.”

According to the program’s defunct Web site, Bax was director only a couple of months before a retired Johnson & Johnson employee took the title.

In 2002, the Florida Legislature permitted the Department of Children & Families to accept grants from pharmaceutical manufacturers to develop training for health care organizations serving public sector clients, according to a September 2003 Agency for Health Care letter about the Florida program.

When first interviewed, those familiar with the program said they did not recall any ADHD-related information. But archived pages from the program’s Internet site show the program had more guidelines on how to treat ADHD than any other ailment. A 2004 report about the program’s progress pointed to the development of an ADHD guideline as an accomplishment.

Rajive Tandon, chief psychiatrist for the Mental Health Program Office with Florida’s Department of Children & Families, said he’s not sure how much impact the Florida program had on the increased use of antipsychotics.

“It certainly was a contributing factor,” he said.

Doctors believed the new antipsychotics were better, Tandon said, citing “aggressive marketing.”

But the new antipsychotics proved no more effective than older drugs in two significant studies — one published in 2005 in the New England Journal of Medicine and another in the Journal of the American Medical Association published in 2003, said Cohen, the antipsychotics expert at Florida International.

Tandon said Florida should consider a lawsuit like other states.

“Should we at least look into it? Absolutely,” he said, calling for, at minimum, an investigation into the Florida program’s funding and impacts. “Then basically hold the appropriate people responsible.”

– News researcher Janice Cahill contributed to this report.

More Drugs

Atypical antipsychotics were touted to have fewer side effects than older antipsychotics, and their use increased among children in Florida’s Medicaid program under guidelines that drug companies helped create between 2000 and 2006.

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.”

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.