Attention Deficit Disorder

Attention Deficit Disorder is a collection of traits that reflect a child’s inborn, neurologically based temperament.  These traits include things like selective attention, distractibility, impulsivity and sometimes hyperactivity, as well as more positive traits like spontaneity and creativity. 

Attention Deficit Disorder does not reflect intelligence.  Many children with ADD are very intelligent.  ADD does, however, make it more difficult for a child to succeed in school.  Appropriate assessment and treatment can help these children to focus their attention so that they do better in school. 

Many parents believe, or are told by others, that their child has ADD.  We are offering a brief, focused assessment that will help determine whether a child has Attention Deficit Disorder.  The assessment consists of: 

·       A background interview with the parents and child 

·       The Conners Continuous Performance Test:  In this test the child must remain focused on a computer task that lasts about 15 minutes.  At the end of the test, the child’s performance is compared to that of children with and without ADD. 

·       Neurofeedback Assessment:  Research has shown that people with ADD produce more low-frequency brainwaves and have a harder time shifting into high frequencies when they are presented with a task.  This assessment measures the strength of different types of brainwaves. 

When the assessment is complete, we will provide a written report and also meet with the parents to explain the results.  At that time, if it is appropriate, you may decide to use neurofeedback therapy to help your child learn to control and focus his attention.  In this treatment, children learn how to sustain attention by using computer games that reward them for producing the higher frequency brainwaves. 

For further information on neurofeedback and attention deficit disorder, please see:

http://www.newideas.net/p0000429.htm

 http://www.neurofeedback.org/articles.htm

 www.theaddcentre.com

Jim Robbins:  “A Symphony in the Brain”, Grove Press, 2000

Treatment of attention deficit hyperactivity disorder with neurotherapy. Nash JK. Behavioral Medicine Associates, Inc., MN 55434, USA. Significant public health concerns exist regarding our current level of success in treating ADHD.  Medication management is very helpful in 60-70%of patients. Side effects, lack of compliance and the fact that stimulant medications cannot be given late in the day limit the benefits largely to school hours. While stimulants improve behavior and attention, less of an effect has been noted on academic and social performance. Continuing concerns exist about long-term safety, and studies on long-term cardiovascular and neurophysiological effects have not been carried out.  Neurotherapy for ADHD offers an effective alternate for patients whose treatment is limited by side effects, poor medication response and in cases in which the patients and/or their parents refuse to consider medications.  Studies indicate clinical improvement is largely related to measurable improvements in the EEG signature, evidenced by declining theta/beta ratios over frontal/central cortex and/or reduced theta/alpha band amplitudes.

Gaming To Train The Brain, Lara Bradley, The Sudbury Star, September 9, 2005

Video games in which your mind functions like a joy stick controlling the action the action may sound futuristic, but technology using neurofeedback is already here.

Thought therapy instead of drug therapy is a new alternative for treating a diroder affecting more than 200, 000 Canadian children - attention deficit hyperactivity disorder (ADHD).

Wednesday is National Attention Deficit/Hyperactivity Disorder Awareness Day and the treatment of the disorder is a growing concern for Canadian families.

Often, the treatment offered is medication.  In Sudbury, Dr. Edward Bassis, a psychologist, has been using neurofeedback therapy for about five years to treat everything from children with attention deficit disorders to adults with obsessive compulsive and anxiety disorders.

The philosophy behind the training is the brain can be taught, by using computer programs that reward the user, how to speed up or slow down its waves.

"Kids love it", Bassis said.  "When they hear they're going to play a video game with their brains they can't wait to come in and try it.  The problem is their brothers and sisters also want to play the video game with their minds.... It's an incredible thing really".

While the brainwave training does work well in some cases, Bassis cautions it is not a magic bullet to treat the disorder.  "Most kids benefit some.  Within that some, some kids respond terrifically, but with others it has minimal effect," Bassis said.

He doesn't employ the technique solely to treat children.  He also uses a behaviour modification program with most kids.

A variety of factors play a role in treating ADHD in children.  Anxiety and depression may need to be addressed, as well as the child's situation at home and in school, where some adjust programming for the student.

If all these factors come together and are addressed in addition to the neurofeedback, then the child can make significant improvement, Bassis said.  If some elements are missing, then it doesn't go as well, he added.

Before seeking out treatment, families should make sure their child has ADHD.  According to a study published in the journal Psychiatric Services, the numbers of ADHD cases almost quadrupled in the 1990s.

 Why?  Some researchers believe ADHD is often diagnosed falsely, while others say it reflects a real increase because professionals are getting better at identifying it.  Bassis falls in the first camp.  "A lot of other things are being called ADHD and ADD (attention deficit disorder)," he said. 

Learning disabilities, high or low IQ and memory problems are a few of the signs that often get people labelled as having ADHD. 

Bassis said he had in his office this week who had been labelled with the disorder because he wasn't paying attention in class.  However, after administering tests for learning disabilities, as well as cognitive assessments, it turned out he was in the top one percentile for IQ and just wasn't being challenged at school.

Bassis said part of the problem is the questionnaire used to diagnose ADHD, which is filled out by teachers and parents.  It's highly subjective and situational - three people can produce vastly different profiles of the same child, he said.

People who do have the disorder often can't switch from slow brain waves - the kind you use for day dreaming - to the faster ones needed to concentrate.

Bassis' neurofeedback machine rewards the brain when it produces certain beta waves.

For instance, when the brain produces the targeted waves, butterflies will appear on the screen or a dart will go through swatches of colour to a dart board.

It usually takes between 20 to 40 sessions on the machine to train the brain to produce beta waves.  However, after about five or six sessions, there is some indication as to whether the treatment will be effective. 

The training is not about trying to take away certain brain waves, but rather "putting the child or adult in control so they're able to switch between mental activities."  he said.

Identifying and Treating ADHD

-  Some of the most common symptoms of attention deficit hyperactivity disorder include distractibility, impulsiveness, restlessness and fidgeting, all of which can seriously interfere with the ability to function in society.

-  Medication to manage the disorder is helpful in 60 to 70 per cent of patients.  However, side effects, lack of compliance and the fact stimulant medications cannot be given late in the day limit the benefits largely to school hours.  While stimulants can improve behaviour and attention, less of an effect has been noted on academic and social performance.

-  Neurotherapy for ADHD offers an effective alternative for patients whose treatment is limited by side effects, poor medication response and in cases where the patient and/or their parents refuse to consider medications.

-  Neurofeedback is biofeedback to the brain - a form of conditioning that rewards the brain for activity at desired frequencies while discouraging activity at other frequencies.

-  What are brain waves?  The brain is bioelectric.  It is able to organize its activity by constantly creating electrical waves.  When we sleep, it produces large-amplitude, slow brain waves called delta waves.  Theta waves occur in the moment before sleep.  Alpha waves are usually associated with a relaxed, meditative state of "open focus".  When a person concentrates at at task, the brain produces faster beta brain waves.

Northern Ontario Medical Journal, Fall 2008,

Biofeedback assists with anxiety-based problems

Biofeedback, a process that records brain activity and other bodily functions, while not new, is recognized more today as people look for alternatives to prescription medications.

The treatment technique prompts the patient to control or monitor his or her physiological or mental state in order to enhance learning, concentration, and relaxation, or to modify physiological responses that may accompany anxiety-related problems.

Bassis and Carter, a Sudbury-based psychotherapy and consultation service, has been using biofeedback as part of its assessment and treatment programs since the mid-’90s and has found it to be a useful tool.

Dr. Edward Bassis uses it for a variety of anxiety-related problems like depression, brain-injury and retraining, obsessive-compulsive disorders (OCD), phobias, as well as performance enhancement for competitive sports, and to treat attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD).

Biofeedback covers a range of modalities. Physiologically, it can measure heart rate, breathing, skin conduction, temperature and muscle tension. Neurologically, a process known as EEG (electroencephalographic) biofeedback, also called neurofeedback, measures brain waves, allowing patients to look at how their brains function.

“Initially, we do an assessment,” Bassis said. “We may do a combination of breathing and neurofeedback, particularly with someone who has an anxiety-based problem. That way, you know what the body is doing on a physiological level as well as what the brain is doing.”

The use of biofeedback has increased over the years because more people know about it and the centre’s familiarity with it has grown, encouraging its use in a greater variety of ways.

A person with a hand tremor can be treated by locating and hooking up the Electromyograph (EMG) to the spasming muscle or muscles. The person would then be trained to learn how to relax those muscles with continual feedback from the computer. Then, he or she would learn how to carry out simple tasks without the hand tremor and, eventually, evolve to more challenging movements.

Competitive athletes can be trained to improve attention, concentration and focus, and reduce negative emotions that get in the way of performance.

Treating ADD/ADHD

Children who have been diagnosed with ADD or ADHD by a pediatrician also come to the centre. ADD and ADHD have been described as a collection of temperamental traits and styles of thinking associated with short attention span, distractibility, difficulties organizing and completing assignments and impulsiveness, according to the ADD Centre’s website. These often lead to academic underachievement.

“We would do a variety of assessments (both on and off medication) because there are so many other things that would look like ADD or ADHD that are not,” Bassis said.

To determine if a child has ADD or ADHD, other problems that look like it have to be ruled out. This means evaluating learning abilities, including cognitive strengths and weaknesses, personality, behaviour and feelings. Neurofeedback would also be part of that assessment process.

Traditionally, behavioural rating scales for identifying ADD and ADHD are given to a parent and the child’s teacher and then returned to the pediatrician, who in turn, decides from an observational visit and the rating scales whether or not the child has ADD or ADHD. If a parent pursues this route, the child will be put on some type of stimulant drug such as Ritalin to control his or her behaviour.

Bassis disagrees with this assessment process. “If you give the same rating scale to both parents independently, we often get very different profiles. If you give the scale to three different teachers, you now have five different profiles for one child.”

Often, a child will come to the centre already diagnosed with ADD and not have it.
However, if Bassis and Carter have diagnosed a child with ADD, neurofeedback can be used to display increased brain wave activity associated with attention, concentration and focus (beta waves), and decreased brainwave activity associated with distractability (alpha or theta waves).

“The key word is ‘associated’,” Bassis points out. “You can’t say the brainwave activity we are working on is the cause of ADD; it is only correlated with it. There may be very different underlying structures responsible that we can’t see or look at.”

He added that there is no pure form of ADD because there are always other influences like school and home life that cannot be separated. However, the notable improvements in behaviour may cross over those domains.

Other strategies are also employed with the neurofeedback process. “We are always looking at what kind of behavioural interventions are required within home and school settings,” Bassis said.

Bassis said the success rate for the treatment is approximately 75 to 80 per cent, and most of the children who are on medication come off it. Unlike medications, which can cause reduced appetite, ticks or OCD behaviours, neurofeedback has no negative side effects.
Stephanie Lazure, one of two clincians who administer biofeedback, said the training allows the child to have more control.

“They can chose to concentrate or they can chose not to concentrate, whereas if they are on medication, they may be sitting quietly in their chair, but they are not necessarily concentrating the whole time.”

Bassis questions long-term retention of information acquired under stimulant medication.

“Short-term attention, memory and retention of information acquired under stimulant medication improve, but not consolidation of that memory into long-term.”

Although Bassis recommends this method over medications when treating ADD or ADHD, he stressed the importance of the experience and skill of the clinician operating the equipment because there are no real norms or standards in neurofeedback.

“The norms that are out there are very specific to the different kinds of neurofeedback equipment,” Bassis said. “So, if you’re administering neurofeedback in your office and the equipment is different from the equipment I’m using, I’m not even sure we’re measuring the same thing.”