Category — Brain Plasticity

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

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

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

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

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

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

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

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

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

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.

In his Attention Research Update, September 2007, David Rabiner, Ph.D. Senior Research Scientist, Duke University, entitled his article, How Strong is the Research Support for Neurofeedback Treatment? The report is rather perfunctory and the staid course he’s followed for years. A fresh, candid review must be performed regarding research on multi-modal treatments, neurofeedback, and medication.

Therefore, my intent here is to examine multi-modal treatments, neurofeedback, medication, their accompanying controversy and myth, and research support. I’m certain you’ll find this examination both enlightening and substantially different perceptively.

I will use some of Dr. Rabiner’s statements and also attempt to make sense of the misinformation that is propagated intentionally or unintentionally through CHADD (Children and Adults with Attention Deficit /Hyperactivity Disorder).

For the purpose of full disclosure when writing this entry:

I should disclose that I developed Play Attention, a device that monitors brain activity. It is used educationally to teach cognitive skills, improve attention, and shape behavior. It is not clinical neurofeedback. To be candid, I’m not a proponent of clinical neurofeedback for reasons I’ll describe below.

Furthermore, it should also be disclosed that the Dr. Rabiner’s newsletter is funded by CogMed, a group that sells memory games to address ADHD, and Shire pharmaceuticals, the makers of Adderall and other ADHD medications.

Play Attention has paid Dr. Rabiner in the past to advertise in his newsletter. Dr. Rabiner also sat on the advisory board for Play Attention for several years. Play Attention can no longer advertise in Dr. Rabiner’s newsletter due to his contractual obligations with CogMed. CogMed will no longer allow Dr. Rabiner to sit on Play Attention’s advisory board either.

CHADD is listed as a nonprofit organization, but still receives significant financial support from the pharmaceutical industry. Historically, it has done little else other than offer tips and strategies and support the use of medicine as a primary treatment.

According to Dr. Rabiner’s newsletter, CHADD’s stance on neurofeedback is summarized in their fact sheet on alternative and complementary interventions, which includes the following statement about neurofeedback:

“It is important to emphasize, however, that although several studies of neurofeedback have yielded promising results, this treatment has not yet been tested in the rigorous manner that is required to make a clear conclusion about its effectiveness for AD/HD. The aforementioned studies can not be considered to have produced persuasive scientific evidence concerning the effectiveness of EEG biofeedback for ADHD.”

Well, if we hold EEG biofeedback (neurofeedback) to this “rigorous manner that is required to make a clear conclusion about its effectiveness for AD/HD,” it is only fair to hold every intervention including medication and multi-modal interventions to it as well.

Quite frankly, you’ll be surprised that they do not live up to this standard either. The actual research about medication is really no stronger than that for neurofeedback. It seems we have double talk here by an organization that receives funding from the pharmaceutical industry. Perhaps, given the benefit of the doubt, they just aren’t aware of it.

ADHD Medication Research
While it received little press in 2005, the Drug Effectiveness Review Project, based at Oregon State University released a 731-page report which thoroughly analyzed 2,287 studies – virtually every investigation ever done on ADHD drugs anywhere in the world – to reach its conclusions. To date, it is the most thorough and comprehensive evaluation of all research performed on ADHD drugs.

The American Association of Retired Persons (AARP) and Consumers Union, the publisher of Consumer Reports report the data to their respective audiences. Fourteen states other than Oregon are the principal financiers the Drug Effectiveness Review Project.

The prestigious Oregon Evidence-based Practice Center, Oregon Health & Science University Drug Effectiveness Review Project’s primary purpose is to provide consumers and state insurance plans trustworthy information about pharmaceuticals. The Drug Effectiveness Review Project’s physicians and pharmacists don’t just analyze ADHD medications, so this was not an attempt to subvert or smear that industry. They analyze virtually every study on a given class of pharmaceuticals to determine the best drugs in that class and present their findings to the public and insurance industry. The Project examined 27 drugs which included Adderall, Concerta, Cylert, Focalin, Provigil, Ritalin, Strattera, and others.

In its analysis of published and unpublished research data produced by six prominent ADHD medication producers, the group found that 2,107 studies were unreliable and were subsequently rejected. Now, this is telling in itself. Finding 2,107 funded yet critically poor or fundamentally flawed studies performed by universities and the pharmaceutical industry itself speaks volumes to the nature of that research and those people responsible for it.

The Project began its review of the remaining 180 studies which demonstrated good controls and methods. Its conclusions regarding ADHD medication were quite astounding.

Here, bulleted, are some incredible results with comments:

• “No evidence on long-term safety of drugs used to treat ADHD in young children” or adolescents. Now, if you ask any physician, or the pharmaceutical industry, they will tell you the drugs are completely safe for long-term use based on research. That research doesn’t exist.

• The research providing any evidence of safety is of “poor quality.” This includes research regarding the possibility that some ADHD drugs could cause heart or liver conditions, tics, or stunt growth.

• “Good quality evidence … is lacking” that ADHD drugs demonstrate improvement in “global academic performance, consequences of risky behaviors, social achievements,” and other measures. The common perception is that ADHD drugs do improve academic performance and social skills. Many drug makers use ads depicting this. However, evidence for long-term improvement in academics, social skills, or behavior is virtually non-existent.

• Drug makers have found that they can expand their market by inducing adults into the ADHD experience. However, the Project found that evidence “is not compelling” demonstrating that ADHD drugs actually help adults, nor is there evidence that one drug “is more tolerable than another.”

Furthermore, the Project found that the U.S. Food and Drug Administration doesn’t require pharmaceutical manufacturers to compare newly developed medications with medications currently on the shelf. Most companies simply use a placebo or sugar pill given instead of their medication as a control. Therefore the Project found that “good quality” studies are lacking that pit one drug against another to provide evidence of effectiveness. It also could not find comparative data which might help determine which ADHD medications are less likely to produce detrimental side effects like heart and liver problems, depression, decreased appetite, tics, or seizures.

The Project could not find research that clearly provided an understanding of way that ADHD drugs work. It is not well understood for most ADHD drugs.

Even the research on ADHD performed by the respected Dr. Russell Barkley, a critic of neurofeedback studies, ranked only “fair” in the Project’s analysis of research and he’s had significant funding from the pharmaceutical industry, federal government, and universities. Noting that he’s cited most neurofeedback research as lacking, wouldn’t we expect at least a “good” or even a “superior” on his report card?

So, if one chooses ADHD medication, how does one know which drug is safer? Works better? Has fewer side effects? The research isn’t there, so we don’t know. In light of this, the Project suggested that one may do just as well on methylphenidate (generic Ritalin) which is far less expensive than newer options such as Concerta or Adderall. Incidentally, when the Project reviewed research on Concerta, it concluded that Concerta “did not show overall difference in outcomes” compared to generic good old cheap generic methylphenidate. Is Adderall any better? The Project found evidence to be “lacking.”

Do ADHD drugs provide long-term improvement for academic performance? Social interaction? Better behavior? The research just isn’t there.

The Project made clear that its findings do not mean ADHD drugs are unsafe. They may be safe and sometimes useful, but the Project found scientific proof is lacking.

While I’m not a clinical neurofeedback proponent, I think it’s clear that if pundits like Dr. Rabiner and organizations like CHADD are going to talk about good research, then let’s level the playing field and have the same requirements for everyone.

Standards of Research, Dr. Rabiner, & CHADD

Let’s go back to CHADD for a moment and its warnings about neurofeedback.

“Controlled randomized trials are required before conclusions can be reached. Until then, buyers should beware of the limitations in the published science. Parents are advised to proceed cautiously as it can be expensive – a typical course of neurofeedback treatment may require 40 or more sessions – and because other AD/HD treatments (i.e., multi-modal treatment) currently enjoy substantially greater research support.”

Now, let’s examine the 3-Year Follow-up of the NIMH MTA (multi-modal treatment) Study. CHADD states studies such as this most recent one and most thorough one “enjoy substantially greater research support.” :

According to Dr. Rabiner, neurofeedback studies, while often producing good results, often lack random assignment. Here’s what he states in his current newsletter:

Random Assignment

Imagine that you are testing a new medication treatment for ADHD with 50 children who have been carefully diagnosed. In a random assignment study, whether each child is assigned to the treatment or control condition is determined by chance – you could flip a coin and give the medicine to the ‘heads’ and nothing to the ‘tails’. This insures that any differences that might exist between children who get the medication and those who don’t are purely chance differences. At the end of the study, if those who received the medicine are doing better, you could feel confident that this is probably due to the medicine itself, and not to differences that may have been there before the treatment even started.

What if you didn’t use random assignment, but let each child’s parents choose whether their child is in the treatment or control group? In this case, it is possible that children in the 2 groups differed in important ways before the treatment began. If children who received the medication were doing better at the end of the study, it might be because of differences that were there to start with.

For example, parents who chose the medicine might be more willing to pursue other ways to help their child than those who didn’t. The fact that children who received the medication were doing better at the end of the study might thus have nothing to do with the medicine itself, but reflect other things their parents were doing to help them. No matter how hard you might try to rule out these other possible explanations – and I’m sure you can think of many others – you could never do this with certainty. Thus, I might reasonably doubt that your new medication is really effective.

National Institutes of Mental Health Multi-Modal Treatment Study

But if Dr. Rabiner is correct that research without random assignment is ambiguous, possibly not valid, then let’s try to evaluate data from the 3-Year Follow-up of the NIMH MTA (Multi-Modal Treatment) Study. Let’s look at the researchers said about the 14^th month:

Indeed, once the delivery of randomly assigned treatments by MTA staff stopped at 14 months, the MTA became an observational study in which subjects and families were free to choose their own treatment but in the context of availability and barriers to care existing in their communities.

So what are we to gain from the long-term evaluation done in the MTA study? Does it enjoy substantially greater research support? According to Dr. Rabiner’s standards, not if it became an observational study.

CHADD also warns that neurofeedback is expensive. How expensive is it compared to ongoing medication for a lifetime? We’ll that’s relative isn’t it? How expensive is medication to a single mom with no insurance? Heck, to any parent with or without insurance? To grandparents raising their grandchild in mom’s absence? And by taking medication, which is expensive (Concerta, AdderallXR), etc, are we guaranteed anything more than what neurofeedback might offer? According to available research, No. CHADD’s arguments lack substance but have been their common response for a long time. I am asking that this nonsense ends.

Back to neurofeedback…The primary purpose of neurofeedback is to alter brainwave patterns that are presented in real-time feedback to clients. Clients [Rabiner] “…are trained to alter their brainwave activity and taught to alter their typical EEG pattern to one that is consistent with a focused and attentive state. According to neurofeedback proponents, when this occurs, improved attention and reduced hyperactive/impulsive behavior will result.”

Thus, the fundamental premise behind neurofeedback is that brainwaves are dysregulated, especially in certain areas of the brain, and training can regulate them. Furthermore, it is proposed that this regulation improves attention and behaviors. I find this to be rather facile. Neurofeedback’s premise is surprisingly similar to medication in essence; fix these brainwaves and the person is fixed whereas proponents of drug intervention insist that if one takes a pill ADHD is fixed! Unfortunately, neither of these therapies adequately fully addresses core issues of ADHD. Neither medication or neurofeedback, by themselves teach the skills one needs to survive and thrive in the workplace or classroom. Skills like organization, improved memory, discriminatory processing, auditory processing, time-on-task, etc. are not trained through either of these interventions. The only way to attain them is to train and learn them.

I’m not saying that neurofeedback doesn’t work. It’s been field tested as has been medication for years. Could it be a worthwhile tool to be used in a multi-modal plan? Yes. Again, let’s level the playing field.

Current Neuroscience & Neuroplasticity vs. Current ADHD Interventions

The reality about neurobehavioral problems is that they exist in a context, i.e. they exist because of the brain and because of that brain’s environment. The brain is directly affected by its environment. The brain is neuroplastic; it will and does adapt according to the stimulation it receives. That is conclusive fact. No doubt about it. So, if we are speaking about a human being, then attention problems are not just brain based. They may take root there, but they are also directly related to and affected by one’s environment. Therefore, appropriate environmental factors play a great role in the treatment of ADHD including behavior shaping, consistent reward/consequences, structure, etc.

The fact that our current system doesn’t address this fact is where we fall far short of correctly treating ADHD.

Let’s say that little Jimmy demonstrates some fidgeting and inattention at school. His teacher writes a note home telling Jimmy’s parents she suspects Jimmy may have ADHD. Jimmy’s parents take heed and bring him to the pediatrician where Jimmy gets a prescription for medication within 20 minutes. This is the norm.

What’s sorely missing is where Jimmy’s parents or Jimmy’s pediatrician write a note back asking to speak to the teacher to develop a plan of action regarding Jimmy’s behavior before beginning medication. This should be our standard practice regarding ADHD. We need to change the way we view ADHD and the way we address ADHD according to current neuroscience, not how we addressed it in 1980.

Unfortunately, most pediatricians or general practitioners are quite overwhelmed and not well equipped educationally to provide a full battery of tests taking up to four or five hours for an accurate diagnosis. So, a reverse diagnosis is made; the MD writes the prescription for medication and if it works, it was ADHD!

The problem is that stimulant medication works for everyone. If we have two groups of children, one group diagnosed with ADHD and one group of average children, both given boring tasks, both medicated, who will do better on the boring tasks? The answer is: Both! Medication is a shotgun approach that teaches nothing. Virtually no research demonstrates long-term efficacy in social improvement, academic improvement, or behavioral improvement.

Attention is a skill like any other skill. It can be considered a cognitive skill that is measured by behavioral or performance analysis. Should strategies, known to work to improve performance on ADHD students be attempted before medication or neurofeedback? Yes. Resoundingly yes! Should Jimmy’s parents adopt a structured, consistent schedule at home? Yes. Should Jimmy’s parents develop a behavioral plan for school and home working together with Jimmy’s teacher? Yes. Should all of this be employed before neurofeedback and medication? Yes. Could it be employed while using either medication or neurofeedback? Yes. Is it far less expensive than these other interventions? Yes.

Why don’t we do this first then? While a variety of factors relate to the answer, one of the most significant ones is: It is easier to take a pill or to ask someone else to solve your problem than it is to do the work to solve it yourself. Granted, many parents are not trained to work with ADHD children, but they can learn and need to – it’s part of being a parent.

I’ll quote the respected psychologist, Dr. Abraham Maslow –

If the only tool you have is a hammer, you tend to see every problem as a nail.

Here’s how this quote relates to our current dilemma: Many parents rely on their Doctor’s opinion alone believing the physician is almost all knowing. Doctors, pediatricians included, are sparsely trained to instruct parents or educators on how to facilitate a multi-modal management plan. Instead, as they are instructed from medical school and because medicals schools rely heavily on pharmaceutical money, they are given the only answer: drugs. It is only natural that parents believe this. Unfortunately, neither the medical industry, pundits, or CHADD are familiar with research regarding medication or either choose to ignore it.

Back to Dr. Rabiner’s newsletter, this segment entitled, Controversy Surrounding Neurofeedback Research.

Neurofeedback treatment for ADHD has been a source of substantial controversy in the field for many years and remains so today. Although there are a number of published studies in which positive results have been reported, many prominent ADHD researchers feel that given significant limitations to the design and implementation of these studies, neurofeedback should be considered a promising, but unproven treatment.

I think it’s quite reasonable to say that the ‘controversy’ surrounding neurofeedback is constantly stirred up by articles such as Dr. Rabiner’s. He also says that neurofeedback studies sometimes suffer from smaller populations, etc. It does make good press, but given significant limitations to the design and implementation of studies on multi-modal treatments and pharmaceuticals, they should all be considered promising, but unproven treatments. Neurofeedback research seems to suffer the same dilemma as that of multi-modal and pharmaceutical interventions – all could be far stronger. All have considerable weaknesses. All have some strengths because they’ve been field tested for many years. So, either they are all controversial, or none of them is controversial. It’s far past time to stop double talking.

Neither medication nor neurofeedback are solutions unto themselves.

Without hidden agendas or profit motives they are on the same playing field. Now, let’s play fair and develop strategies based on our knowledge of the ADHD problem. It’s in the best interest of our children and their outcomes to find workable, manageable solutions.

Obviously, no one intervention is best, proven, or more reliable even if marketing people would like to make it seem so. It takes a whole village to raise a child. It takes a group of interventions to raise an ADHD child. Let’s find the best interventions, based on honest available research, use them in concert, and see if it works. And understand this caveat clearly, just because research, no matter how high a grade it’s given, demonstrates efficacy, it doesn’t mean that it will work successfully for you or your child. That’s just because we’re human. We learn differently, respond differently, and are wired differently based on our years of exposure to the world and our genetic makeup. That’s not theory. That’s fact.

Given that no intervention is sufficient by itself, it will always be a matter of trail and error to determine what course of actions will succeed for the long-term. Even though we desire or wish it, none are guaranteed, but that’s life, isn’t it?

Research shows a gene link to ADHD

The head of child psychiatry at the Royal Children’s Hospital (University of Melbourne, Australia), Professor Alasdair Vance, thinks that children with ADHD have impaired brain function most likely linked to a genetic condition occurring during pregnancy.

Dr. Vance believes he has conclusive evidence that key areas of the brain do not develop as quickly in children with ADHD. These areas, he posits, are linked to a child’s understanding of time and space as well as the ability to use working memory.

“So their ability to read other people’s body language, to pick up on the nuances of what their peer group are up to, would clearly be affected by the sort of developmental delays in brain development that we’ve identified,” he said.

“The most exciting part of this research is the opportunity to understand in detail the brain dysfunction in this group of children so we can better understand how, by changing the child’s environment, facilitated by medication treatments, we can maximize their learning.”

Vance used fMRI on an unmedicated group of boys aged eight to 12 who were diagnosed with ADHD. The fMRI enabled Vance to examine their brains while performing mental tasks. This data was compared to a group of healthy children. Vance said the data demonstrated that ADHD was not just a behavioral issue.

“If it was, one would expect the child’s brain would be functioning normally and that at some level they are making choices to behave in this way. This suggests they are actually activating their brain differently when they are doing the same task as a healthy kid.”

In an interview with the Brisbane Times, Vance, “…believes the research strongly suggests ADHD is a genetic condition occurring most probably during the second trimester of a woman’s pregnancy, but which can be modified through medication and by adapting the child’s environment.”

“I’m not saying that because you have such brain changes the only treatment is medication. Environmental cueing can help those compensatory brain networks to develop.”

“Helping teachers and parents understand how to more frequently cue a child with ADHD through such means as positive reinforcement when the child exhibits desired behavior and through emotional connections that reward the child for better attitudes, are just some of the ways in which the condition can be helped, Professor Vance says.”

“The number and quality of empathic, confiding, nurturing, flexible and adaptive human relationships can build resilience, build compensation or, if absent, make ADHD symptoms worse,” he said.

Vance’s results are preliminary. Furthermore, one cannot forget that ADHD is diagnosed from subjective analysis; it is one of the few diagnoses that can be made over the telephone since it involves acknowledging a series of characteristics or behaviors performed over time. So, we have a problem of antecedence; Vance examined boys that were subjectively diagnosed with ADHD to compare them with boys that were not diagnosed. Does the subjective diagnosis present a problem in this research? I would think so. Could it also be possible that the brain changes in the fMRI could occur as a result of conditioning, environmental toxins, etc? Possibly. Is it equally possible that Vance’s data only accounts for one possible cause out of many? Likely. That’s why I would contend the results are preliminary. We’ll see if the future proves me wrong on this one.

On a positive note Vance does seem to understand neuroplasticity. He does see value in behavioral shaping, compensatory training, etc. While his research is NOT the Holy Grail of ADHD, there is light at the end of the tunnel if we are forging ahead in our understanding of neuroplasticity from research like this.

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.

An article from the October 6, 2005 issue of  MONiTOR TODAY!, Ottawa’s Technology Information portal:

Technology Showing Promise in Treating Attention and Behavioral Problems in Children and Adults.

Asheville, North Carolina – It’s a patented technology that is similar to that used by NASA astronauts and U.S. Air Force pilots to stay attentive in the cockpit. An innovative product called the Play Attention Learning System is using similar space-age technology that can now be used on home/school computers to help minimize attention, concentration and focus challenges in children and adults. Through the use of new computer technology, unique one-on-one support and a dynamic training program, Play Attention’s innovative learning system actually trains the brain to pay attention and focus better.

“NASA has proven that attention can be improved through feedback training. Play Attention is actually an enhancement to their technology which is successfully impacting the lives of children and adults worldwide,” says Peter Freer, Play Attention Founder and CEO. The results have been powerful throughout the United States, Europe, China, Canada, Singapore, Puerto Rico, South America, Taiwan, and Australia.

What is Play Attention? The Play Attention Learning System consists of a unique computer software program, a sensor-lined helmet similar to one used for bicycling and an interface unit that connects the helmet sensors to the computer. These sensors monitor the user’s attentive state and cognitive process while he/she interacts with the characters on the computer screen. Users complete a series of video game-like exercises that are controlled, not by joysticks or controllers, but by the brain alone. Through a process called Edufeedback, Play Attention users can see and hear real-time feedback of how they’re progressing in focusing, finishing tasks, increasing memory, and filtering out distractions.

Within a short time of using Play Attention, behavior can be modified to reduce or eliminate disruptive calling out, fidgeting, and impulsivity, all while improving time-on-task, focus, comprehension and more. The system helps reduce the effects of distraction at! home, school and the workplace, bringing life into focus. Play Attention encourages practice of key cognitive and attention skills that, in a relatively short amount of time, retrains the brain how to think more clearly, more attentively and with more focus.

The Play Attention Learning System is much more than computers and technology. In addition to the hardware & software a user receives personalized one-on-one support, motivation and guidance with Play Attention staff members, typically holding a master’s degree or higher. A mentor program for children and adults to insure goals are set and being reached. And free access to www.playattention.net, a support site loaded with newsletters, information about the rewards program, latest software downloads, coaching resources, interactive advice from the Play Attention staff.

The entire Play Attention Learning System sells for $1,795, which includes all equipment, materials and training. Complete information is available online: www.playattention.com or by calling (800) 788-6786 for a FREE demonstration CD.

An Innovative Technology for Individuals with Autism Spectrum Disorders

By Linda Creamer Aug 1, 2005

Parents and teachers commonly encourage children to “pay attention.” But what does pay attention mean? What does it physically feel like? When you instruct a child to pay attention, typically their perception is that they are already paying attention! Obviously, attention is an abstract, subjective concept, and one that is incredibly difficult to manage for children with attention problems and autism. Its abstract and subjective nature also makes it difficult to teach. Special needs children would directly benefit from a program that would allow them to control their attention and establish a relationship between attention and behavior.

Years ago a local psychologist hired me to initiate a special program at his office. It was called Play Attention. Play Attention is a feedback-based program that enables individuals to control a series of computerized cognitive tasks by attention alone. Through a sensor loaded helmet, the student can actually control computer screen characters — make them fly, swim, etc. — simply by focusing on them. If the student loses focus because of fidgeting, being off-task, or some other self-distracting behavior, the characters go the wrong direction. This allows the student to actually see a direct correlation between behavior and attention. This program enables the individual to understand the concept of paying attention with concrete visual stimulation as well as understanding the way his/her body is physically feeling and reacting. It shifts attention from an abstract concept to a concrete, controllable reality. It is a tremendously powerful teaching tool.

The producers of Play Attention call its training technique Edufeedback, the combination of feedback with a behavior modification program that enables adults and children to improve attention and decrease their impulsive behaviors. Edufeedback is based on neuroplasticity, defined as the brain’s ability to restructure, reorganize, and rewire when properly challenged and stimulated. Play Attention uses EEG neurofeedback in the background to allow the monitoring of concentration. It couples this with five different cognitive tasks including attention stamina, visual tracking, time on-task, short-term-memory sequencing, and discriminatory processing. Impulsivity is measured as well during the tasks.

I worked with the psychologist for two years and achieved many successes using Play Attention with ADHD individuals. It increased their increased ability to focus and attend to details and it decreased their levels of impulsivity. Although Play Attention was developed for individuals with attention problems, I have helped many students with varying levels of autism achieve amazing results in an after-school tutoring program. Play Attention is also offered during schools hours to children who are diagnosed Autistic and in the full inclusion program.

Presently, some researchers and experts recognize that there is a correlation between Attention Deficit / Hyperactivity Disorder (AD/HD) and Autism Spectrum Disorders. Some believe that ADHD is closely related to Asperger’s Syndrome. Autism Spectrum Disorders and ADHD are developmental disorders that affect the areas of social skills, behavior, and communication. Sensory oversensitivity is also recognized in both developmental disorders. There are several website links to various articles and information from the PlayAttention website that further explain this relationship in detail. Every child with Autism requires different types of strategies and program interventions due to individual behaviors and level of understanding. The following are strategies and results used with different Play Attention clients with Autism and behavior difficulties. These are the findings of a teacher who is presently using the program with clients’ on the Autism Spectrum. I am not a researcher. Therefore, the following should be considered case studies and not controlled studies. The student’s names have been changed to protect their anonymity.

Summary

When combined with special strategies as well as transfer and generalization techniques, Play Attention has produced remarkable results for students with Autism and ADHD. The core Play Attention system allows the teacher to modify and adjust it curriculum to accommodate the special needs of these children.

I have used the combination of biofeedback and behavior modification, known as edufeedback, as an effective strategy to produce positive results with the performance of people with ADHD and Autism Spectrum Disorders.

The increased ability to attend, reduced impulsivity, development of cause/effect relationships, expanded communication abilities, social skills, sensory integration, and development of positive behaviors are observable and measurable with each student. Academic skills in reading comprehension and math concepts have improved due to the students’ ability to attend for longer periods of time. Again, these changes are actual and quantifiable. Please see the Case Studies below.

These results have been documented by a special educator who is tutoring her students with Play Attention and not by a research team or an employee of Play Attention.

Read the Case Studies

I have written for years that only by redefining ADHD can we address the problem through education and training. Finally, the movement is approaching mainstream as indicated in the article from Scientific American entitled, Training the Brain, Cognitive Therapy As An Alternative To ADHD Drugs.

It is interesting to note that the techniques mentioned in the article have been incorporated in the Play Attention cognitive tools for about ten years.

“Recent studies support the notion that many children with ADHD have cognitive deficits, specifically in working memory–the ability to hold in mind information that guides behavior. The cognitive problem manifests behaviorally as inattention and contributes to poor academic performance. Such research not only questions the value of medicating ADHD children, it also is redefining the disorder and leading to more meaningful treatment that includes cognitive training.”

Salient issues raised by the author include:

1. The difficult decision by parents “To medicate or not? Millions of parents must decide when their child is diagnosed with attention-deficit hyperactivity disorder (ADHD)–a decision made tougher by controversy.”
2. While medication may calm a student’s outward behavior, research shows that it does not increase cognitive ability manifesting in improved academic performance, social relationships, or defiant behavior over the long-term.
3. This has led scientists to research effective means of cognitive training as a substitute.

This is really a shift in our understanding of this disorder from behavioral to biological,” states Rosemary Tannock, professor of psychiatry at the University of Toronto. Tannock has shown that although stimulant medication improves working memory, the effect is small, she says, “suggesting that medication isn’t going to be sufficient.” So she and others, such as Susan Gathercole of the University of Durham in England, now work with schools to introduce teaching methods that train working memory. In fact, working-memory deficits may underlie several disabilities, not just ADHD, highlighting the heterogeneity of the disorder.”

The article focuses on Dr. Torkel Klingberg of the Karolinska Institute in Sweden who trained around 40 kids with ADHD with a software program that addressed “working memory.” After more than 20 days of training parents reported that their children had greatly improved attention and lessened hyperactivity.

Klingberg essentially proved that cognitive retraining improved neurobiological function. This work has been underway with Play Attention since 1994. It’s good to see the paradigm shift beginning to happen.

The following research, New Cornell study suggests that mental processing is continuous, not like a computer appeared recently in a number of major publications.

Through computerized testing, the researchers essentially confirmed AND disputed work theorized by computer scientist, Marvin Minsky, in his book, The Society of Mind. Minsky theorized that the brain processes information through a variety of separate, distinct agents that work together in various capacities. Thus, according to Minsky, information processing is somewhat linear as in our working computers. The researchers seem to confirm the linear biological processing (input) of information, yet claim their findings demonstrate that the “neural activation patterns flow back and forth to produce nonlinear, self-organized, emergent properties – like a biological organism,” when processing (outputting) information.

There are many similarities between Minsky and Cornell’s group, however, they seem different possibly only by semantics. Once again, the mind seems to have a difficult time describing its own activities.

June 27, 2005

New Cornell study suggests that mental processing is continuous, not like a computer

By Susan S. Lang ITHACA, N.Y. – The theory that the mind works like a computer, in a series of distinct stages, was an important steppingstone in cognitive science, but it has outlived its usefulness, concludes a new Cornell University study. Instead, the mind should be thought of more as working the way biological organisms do: as a dynamic continuum, cascading through shades of grey.

Kevin Stearns/University Photography Cornell psycholinguist Michael Spivey asks Florencia Reali to listen for a word and then click on its picture. By studying the curvature of the trajectory of the mouse, he can analyze language comprehension processes. Copyright © Cornell University

In a new study published online this week in Proceedings of the National Academy of Sciences (June 27-July 1), Michael Spivey, a psycholinguist and associate professor of psychology at Cornell, tracked the mouse movements of undergraduate students while working at a computer. The findings provide compelling evidence that language comprehension is a continuous process.

“For decades, the cognitive and neural sciences have treated mental processes as though they involved passing discrete packets of information in a strictly feed-forward fashion from one cognitive module to the next or in a string of individuated binary symbols – like a digital computer,” said Spivey. “More recently, however, a growing number of studies, such as ours, support dynamical-systems approaches to the mind. In this model, perception and cognition are mathematically described as a continuous trajectory through a high-dimensional mental space; the neural activation patterns flow back and forth to produce nonlinear, self-organized, emergent properties – like a biological organism.”

In his study, 42 students listened to instructions to click on pictures of different objects on a computer screen. When the students heard a word, such as “candle,” and were presented with two pictures whose names did not sound alike, such as a candle and a jacket, the trajectories of their mouse movements were quite straight and directly to the candle. But when the students heard “candle” and were presented with two pictures with similar sounding names, such as candle and candy, they were slower to click on the correct object, and their mouse trajectories were much more curved. Spivey said that the listeners started processing what they heard even before the entire word was spoken.

“When there was ambiguity, the participants briefly didn’t know which picture was correct and so for several dozen milliseconds, they were in multiple states at once. They didn’t move all the way to one picture and then correct their movement if they realized they were wrong, but instead they traveled through an intermediate gray area,” explained Spivey. “The degree of curvature of the trajectory shows how much the other object is competing for their interpretation; the curve shows continuous competition. They sort of partially heard the word both ways, and their resolution of the ambiguity was gradual rather than discrete; it’s a dynamical system.”

The computer metaphor describes cognition as being in a particular discrete state, for example, “on or off” or in values of either zero or one, and in a static state until moving on. If there was ambiguity, the model assumed that the mind jumps the gun to one state or the other, and if it realizes it is wrong, it then makes a correction.

“In thinking of cognition as working as a biological organism does, on the other hand, you do not have to be in one state or another like a computer, but can have values in between – you can be partially in one state and another, and then eventually gravitate to a unique interpretation, as in finally recognizing a spoken word,” Spivey said.

Whereas the older models of language processing theorized that neural systems process words in a series of discrete stages, the alternative model suggests that sensory input is processed continuously so that even partial linguistic input can start “the dynamic competition between simultaneously active representations.”

Spivey’s co-authors are Marc Grosjean of the University of Dortmund, Germany, and Günther

I recently debated multitasking to task switching. Multitasking denotes attention to a variety of extraneous and internal stimuli. All research that I can find concludes that the human mind performs much less efficiently under multitasking environments–this includes the following article from Johns Hopkins University and published in The Journal of Neuroscience.

Task switching denotes shifting full attention from one activity to the next. It seems to parallel our current understanding of brain function in a high stimuli environment.

Multitasking: You can’t pay full attention to both sights and sounds Lab findings suggest reason cell phones and driving don’t mix The reason talking on a cell phone makes drivers less safe may be that the brain can’t simultaneously give full attention to both the visual task of driving and the auditory task of listening, a study by a Johns Hopkins University psychologist suggests. The study, published in a recent issue of “The Journal of Neuroscience,” reinforces earlier behavioral research on the danger of mixing mobile phones and motoring.

“Our research helps explain why talking on a cell phone can impair driving performance, even when the driver is using a hands-free device,” said Steven Yantis, a professor in the Department of Psychological and Brain Sciences in the university’s Zanvyl Krieger School of Arts and Sciences.

“The reason?” he said. “Directing attention to listening effectively ‘turns down the volume’ on input to the visual parts of the brain. The evidence we have right now strongly suggests that attention is strictly limited – a zero-sum game. When attention is deployed to one modality – say, in this case, talking on a cell phone – it necessarily extracts a cost on another modality – in this case, the visual task of driving.”

Yantis’s chief collaborator on this research project was Sarah Shomstein, who was a doctoral candidate at Johns Hopkins. Shomstein is now a post-doctoral fellow at Carnegie-Mellon University.

Though the results of Yantis’ research can be applied to the real world problem of drivers and their cell phones, that was not directly what the professor and his team studied. Instead, healthy young adults ages 19 to 35 were brought into a neuroimaging lab and asked to view a computer display while listening to voices over headphones. They watched a rapidly changing display of multiple letters and digits, while listening to three voices speaking letters and digits at the same time. The purpose was to simulate the cluttered visual and auditory input people deal with every day.

Using functional magnetic resonance imaging (fMRI), Yantis and his team recorded brain activity during each of these tasks. They found that when the subjects directed their attention to visual tasks, the auditory parts of their brain recorded decreased activity, and vice versa.

Yantis’ team also examined the parts of the brain that control shifts of attention. They discovered that when a person was instructed to move his attention from vision to hearing, for instance, the brain’s parietal cortex and the prefrontal cortex produced a burst of activity that the researchers interpreted as a signal to initiate the shift of attention. This surprised them, because it has previously been thought that those parts of the brain were involved only in visual functions.

“Ultimately, we want to understand the connection between voluntary acts of the will (for instance, a choice to shift attention from vision to hearing), changes in brain activity (reflecting both the initiation of cognitive control and the effects of that control), and resultant changes in the performance of a task, such as driving,” Yantis said. “By advancing our understanding of the connection between mind, brain and behavior, this research may help in the design of complex devices – such as airliner cockpits – and may help in the diagnosis and treatment of neurological disorders such as ADHD or schizophrenia.”