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Neural Feedback Training as Therapy for ADHD?
"If you haven't heard of it, the idea is that by attaching sensors to the head, brainwaves can be measured, and by providing visual feedback, you can actually train your brain to regulate its activity. An ADHD person supposedly has a brain which isn't very good at keeping itself in 'concentration' mode. In a child, the feedback takes the form of a game or in the case of an infant, a pleasing pattern on the screen (an infant would probably be treated for sleep disorders, not ADHD, in case you were wondering). When the brainwaves are in the 'right' state, the game proceeds or the patterns get prettier. When the brainwaves are erratic, it all slows down.
Because it is a trendy new thing, it's been put forward as a possible treatment for many other things including sleeplessness, epilepsy and other disorders, but one of the better successes has been in the treatment of ADHD.
The whole thing sounds quite plausible, but it is also quite expensive. All of the stuff I've read has been either from the suppliers of the treatment, or from people trying to discredit it."
I am borderline ADHD, and I only found out several years ago afte I began having trouble with class and general management of time while in college.
/. to research it.
My mom had a friend who had recently gotten certified in using this type of therapy on her daughter (who was severely ADHD), and they arranged for me to show up at their house knowing that because I was a computer science major and a geek, that I would be extremely interested in the whole setup. I walk in, express interest, and they offer to hook me up, and while they're explaining what's going on, they run a quick diagnostic which shows I could use some work on the machine (and that my brain waves are "sloppy").
To make a long story short, I went through three months of training using the machine, the whole time believing it was a placebo, but my entire family noticed the difference. I also began noticing that I was sleeping better and could work for periods of time longer than 30 minutes without feeling like i HAD to take a break.
To sum up, this is a very groundbreaking type of therapy that does work, and I encourage anyone on
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Procedure in which very large quantities of liquids are infused into the colon via the rectum through a tube, a few pints at a time, in an effort to wash away and remove its contents. CI differs from an ordinary enema which involves infusing a lesser amount of liquid into the rectum only. A "high colonic" may involve the use of twenty or more gallons pumped by a machine or transmitted with an apparatus that relies upon gravity to achieve its purpose. Liquids used in colonics may include coffee, herbs, enzymes, wheat grass extract, or many other substances. Proponents of the procedure advertise that "all disease and death begin in the colon," that colonics "detoxifies" the body, and that regular "cleansing" is necessary to maintain one's health. None of these claims are true.
I am a psychology undergrad, and though I have no serious experience with the study or treatment of ADHD, I can recommend some starting points for gaining the facts on this condition. Where I in your position, I would head to the nearest university, put some cash on a copy card, and start using their online article databases. In particular, MedLine and PsycInfo have the most expansive databases on psychology research. Start simple - run some basic searches using keywords like ADHD and Neural Feedback Training. When you find an article or two that nail the topic you're exploring, move from those databses to the ISI (Web of Science) database. The most powerful feature of this database is its reverse-searching feature, where you can enter in an article, and retrieve a list of articles that have been published citing the one you have. This is a literature search (the first major task in designing a study). Moving back and forth between these databases, narrowing your keywords, following citations, and even searching for authors publishing pertinent studies, is going to return a massive quantity of data.
Unfortunately, links to these databases are going to be useless, because you need a subscription to search them. This is why you need to run your searches from a university library. Once you've got some promising references, start pulling articles, and educating yourself.
I hope this helps. I'm a firm believer in the power of psychology and medicine to improve the human condition. Your daughter doesn't have a disease, but she does have the physiological deck stacked against her. Being a fan of psychology over psychiatry, I'm happy to hear that you're persuing a non-drug-based treatment in addition to her medication regimine. I hope that this is where you'll find true long-term improvement.
Best of luck to you, your family, and your daughter.
First, find out which sub-type she has. There are many different subtypes that each have different treatments. Take the on-line tests at: http://www.amenclinic.com Second, check out the pioneer in non-drug therapies: http://www.drakeinstitute.com If you do have to resort to drugs, try Strattera, which is a new, non-addictive, non-stimulant treatment that looks very promising: http://www.strattera.com/index.jsp
Ritalin is a stimulant. "Speed" is used by people to basically mean anything that stimulates the brain chemicals. In the case of someone who has ADHD, they lack a certain brain chemical. Ritalin replaces that brain chemical to normalize the level in the brain and help with ADHD. In the case of a child without ADHD (they have a normal balance of the chemical) the excess amount causes stimulation in the same way that "speed" causes you to become blitzed. Perhaps you had a low-grade or nonexistant ADHD and the Ritalin was excessive, causing you to be wired when medicated as a kid. I don't know the name of this chemical, and I'm too lazy to Google for it (damn ADD.) Ooh look, a butterfly!
By the way, this is from someone who took Ritalin and Depakote for 10 years, and now takes Lithium and Effexor.
Although I sympathize with your bad experience, I tend to want to stay away from generalizations. My wife was diagnosed with ADHD about 12 years ago. She took ritalin in college and she went from a c-d student to a b student. Much of this has to do with concentration and focus. She describes her thoughts as a flashing from one subject to another all with equal/high priority, and she is able to focus on one task, one though with the help of ritalin. She does not take it currently, because she is nursing our third daughter, but she wishes she could because of the focus and clarity if gives to her. Our oldest daughter likely has ADHD. She is struggling in school. We remind her that school is not the most important thing in life. I agree that mindless conformity is bad. It reminds me of how some Native American tribes "honored" androgenous people as a special type of person. Where our society has in the past and currently doesn't know what to do with such people. We tried to "make" them one sex or another just so they could conform. I think ritalin can help some people. As with any narcotic substance, caution surely is advised.
It is dangerous to be right on a subject on which the established authorities are wrong. - Voltaire
Let me begin by pointing out that there is a correlation between ADD/ADHD and Tourette's. In other words, having one increases your chances of having the other.
... we'll never get a chance to perform that experiment, since now I'm all grown up. But I know from firsthand experience that it's possible to reign one's body in using only the power of one's concentration. So give it a shot. If it doesn't work, there's always the drugs.
I was diagnosed with mild Tourette's Syndrome when I was in sixth grade. It manifested itself similarly to your daughter's symptoms -- minor vocal and muscular tics. It wasn't a significant bother, but it impaired me enough that I sought medication for it. I began taking Clonidine transdermally (through a skin patch) to help ease my Tourette's symptoms.
A year after starting the Tourette's medication, I was diagnosed with ADD. This was ~1990, before ADD was a "trendy" disease. At the time, none of my family had ever heard of it before. So I began a regimen of Dexedrine, to help with the ADD.
I stayed on both medications for a further year, until I developed an allergy to the skin patch. At that time, my doctor recommended I try neural feedback therapy to help control the Tourette's. I went in for an hour of therapy every two weeks for a year. Over the course of the year I became better able to control my tics, but only with great concentration. If I became flustered or anxious or nervous or just plain stopped paying attention, I would lose control and the tics would come back. But, at the end of the year, I decided I was able to control the Tourette's well enough to stop therapy and medication.
I continued with Dexedrine throughout my junior-high and high school years, and gradually stopped taking it when I got to college. I firmly believe that the Dexedrine was a great help in high school; even though it exacerbated my Tourette's symptoms, it allowed me to finish high school having learned what I needed in order to get into college. Could I have used some other means to achieve the same ends? Probably. But the medication worked.
Today I'm a slightly disorganized, nervous and fidgety young man living a normal life and working a full-time job in software development. My duties expand every day and I find myself diverting more and more of my attention toward organization and self-management. But I can manage.
Will neural feedback therapy help your daughter? I'd say, give it a try. It could be that the techniques I learned to help control my Tourette's also gave me an edge in studying
P.S. I would recommend looking at alternatives to Ritalin. Dexedrine and Desoxyn , AFAIK, achieve the same thing but with fewer side effects (less of a methamphetamine-like effect on the human body).
As a previous poster mentioned, this kind of stuff works by "training" your brain. It does this through biofeedback.
Biofeedback works by presenting data of interest from some sort of sensor array (EKG, or in this case an EEG) in a way your brain interprets on various levels (ex: colors, shapes, etc).
These guys usually do it (afaik) in the context of some sort of non-interactive game (well, it is interactive in that it's driven by your brain, not by a joystick/keyboard/mouse, etc).
Anyways, I don't want to say too much because I'm sure most of it was under some sort of NDA, but here's their sites:
- EEG Spectrum International
- NeuroCybernetics
This stuff is pretty amazing, you can actually feel it working, as potent (or more) than any medication I've ever popped. But it should only be done by a trained therapist (I tried it on myself a few times because I was sick of playing back the same old recordings and it gave me a bit of a headache, but under the control of a trained tech it doesn't cause much (any afaik) discomfort. Also, unlike another poster mentioned, I was never irritated by the connections, maybe they've improved over time).It's pretty cool stuff and I hope I have an opportunity to contribute more in the near future.
Disclaimer: I'm just a code monkey that developed some "front-end" stuff (the game side shown to the patient, not the nuts & bolts on the therapist's side). So, take my info in context of just a guy who coded from a spec and attended one of their conferences.
DONT PANIC
Be sure to check out Dr Hallowell. He is the coauthor of "Driven to Distraction" as well as their recent followup "Answers to Distraction".
I would recommend emailing him if there's nothing on this site about this particular therapy.
I spent three years in my graduate school days (which was now a decade ago... yikes!) administering the hardware/software for the Autogenics system in our community mental health center at Nova Southeastern University under Doil Montgomery, Ph.D. Neural feedback is also referred to as EEG biofeedback. Not only is there some good research in this area, but it's a nice, non-invasive and non-drug way to treat this disorder (which should be especially interesting to teens and children, where medications are less tested and proven).
Some basic positive empricial results supporting the use of EEG biofeedback in the treatment of ADHD from MEDLINE:
Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: a comparison with methylphenidate. in Appl Psychophysiol Biofeedback. 2003 Mar;28(1):1-12.
Fuchs T, Birbaumer N, Lutzenberger W, Gruzelier JH, Kaiser J.
Institute of Medical Psychology and Behavioral Neurobiology, Eberhard-Karls-University, Gartenstr. 29, 72074 Tubingen, Germany.
Clinical trials have suggested that neurofeedback may be efficient in treating attention-deficit/hyperactivity disorder (ADHD). We compared the effects of a 3-month electroencephalographic feedback program providing reinforcement contingent on the production of cortical sensorimotor rhythm (12-15 Hz) and betal activity (15-18 Hz) with stimulant medication. Participants were N = 34 children aged 8-12 years, 22 of which were assigned to the neurofeedback group and 12 to the methylphenidate group according to their parents' preference. Both neurofeedback and methylphenidate were associated with improvements on all subscales of the Test of Variables of Attention, and on the speed and accuracy measures of the d2 Attention Endurance Test. Furthermore, behaviors related to the disorder were rated as significantly reduced in both groups by both teachers and parents on the IOWA-Conners Behavior Rating Scale. These findings suggest that neurofeedback was efficient in improving some of the behavioral concomitants of ADHD in children whose parents favored a nonpharmacological treatment.
The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder. in Appl Psychophysiol Biofeedback. 2002 Dec;27(4):231-49.
Monastra VJ, Monastra DM, George S.
FPI Attention Disorders Clinic, 2102 E. Main Street, Endicott, New York 13760, USA. poppidoc@aol.com
One hundred children, ages 6-19, who were diagnosed with attention-deficit/hyperactivity disorder (ADHD), either inattentive or combined types, participated in a study examining the effects of Ritalin, EEG biofeedback, and parenting style on the primary symptoms of ADHD. All of the patients participated in a 1-year, multimodal, outpatient program that included Ritalin, parent counseling, and academic support at school (either a 504 Plan or an IEP). Fifty-one of the participants also received EEG biofeedback therapy. Posttreatment assessments were conducted both with and without stimulant therapy. Significant improvement was noted on the Test of Variables of Attention (TOVA; L. M. Greenberg, 1996) and the Attention Deficit Disorders Evaluation Scale (ADDES; S. B. McCarney, 1995) when participants were tested while using Ritalin. However, only those who had received EEG biofeedback sustained these gains when tested without Ritalin. The results of a Quantitative Electroencephalographic Scanning Process (QEEG-Scan; V. J. Monastra et al., 1999) revealed significant reduction in cortical slowing only in patients who had received EEG biofeedback. Behavioral measures indicated that parenting style exerted a significant moderating effect on the expression of behavioral symptoms at home but not at school.
Treatment of attention deficit hyperactivity disorder with neurotherapy. in Clin Electroencephalogr. 2000 Jan;31(1):30-7.
Nash JK.
Behavioral Medicine Associates,
As another person who could also be considered a 'poster child for ADHD' let me disagree with you. My personal experience has been that there are times that no matter how hard I try or attempt to work around it, there are times where my brain simply refuses to focus on any single task long enough to accomplish anything - even the things I want to do. I also occassionally fall into another classic symptom - hyperfocusing on a single task to the extreme detriment of others.
I've been on adderall on and off since middle school, and it has had a definite, positive effect on these symptoms when I take it. That said, I will agree that I'm strongly opposed to what I'd call routine prescription of stimulants. IE: Take one daily, 'just in case.' The thing I feel is often overlooked is these drugs do have definite side effects. For example, while I usually have a good appetite and admittedly eat a bit more than I probably should, if I'm on a 'routine' adderall dosage, I have to force myself to eat - it's not totally unusual for me to go a day or two without eating simply because I forget otherwise.
The bigger reason why I oppose it, however, are the emotional side effects; which is the primary reason why I don't take it daily as I'm prescribed to. Not only does the medication tend to cause you to focus better, but it also tends to cause emotional swings to become more extreme. While I tend to have slight swings anyway, the medication tends to turn what might be a slightly down mood into full blown depression - especially on the off end of the drug. Having dealt with that for several years and realizing the drastic improvement in my attitude when I took myself off medication for a couple of years, I'd never put a child on medication full time.
As it stands today, for the most part I avoid medication and try my best to work around the condition on my own, but do keep my prescription filled for times when I feel it would help me. I've found it to be a fairly good compromise, allowing me to work effectively and avoid the side effects on being constantly medicated.
So I guess what I'm saying is I don't totally disagree with you, but I still feel that ADHD isn't just something that you deal with or drastically change the environment of the kid for. I know that if anything, all years of guidance counsellors giving me things 'that will help' did is piss me off. You just have to give the kid a chance to figure things out for themselves and allow them to decide when and if they need medication, accomodations, etc. I'd force neither medication nor a special environment on a kid, but feel it'd be better to give them the tools to figure it out for themselves.
EEG Spectrum is a group of practitioners and researchers. They have a page on the application of the technology for ADHD type treatments. Also a variety of other articles and links on the tech there.
The EEG Spectrum uses hardware and software from NeuroCybernetics which includes some games you play by brain wave control. I tried some of these out a few years ago while looking into EEG tech for Virtual Reality applications.
BioFeedback Home Therapy is the home page for a couple doctors using biofeedback.
I am of exactly the opposite opinion, ADD/ADHD is a disorder and not treating it (when properly diagnosed) is just cruelty plain and simple.
I have ADD and went from being last in my class in High School and failing out of college to graduating with Honors and going on to graduate school at the finest university in the country, after being prescribed Ritalin.
I hold more than a dozen patents and have had research papers published at world class conferences, so as the poster says, I am a very insightful, creative, and interesting folk. And this is only enhanced not suppressed by medication.
I still suffer the effects of going so late in life before being diagnosed, I can't spell for beans having learned all the wrong spellings when I was young. Its all very nice to talk about not trying to harm her "very special mind", but failing to treat her WILL damage her intellect forever, while treating her will allow her intellect to develop.
-jon
This is from one of JamesH's previous /. postings.
5 5602
It provides some supporting evidence that they have higher priorities in their life than their child.
Mhttp://slashdot.org/comments.pl?sid=91154&cid=78
" Me to wife: How the heck could you spend $400 on clothes?
Wife to me: Don't worry, I got about $1000 worth."
Take care of her! Do not use her for fucking medical experiments.
You must realize that everyone is different. You discount ADHD because you don't have ADHD, and can't understand how someone could have ADHD. As someone who has lived with ADHD for years, I can tell you that it does exist. Fortunately, my parents did not get me all hopped up on drugs to "cure" me, but I have had to live being "different" from most people. When I was younger, I thought that everyone thought like me. Once I started doing some reading on ADHD, I realized that there are many marked differences between people with ADHD and "normal" people. I always thought that other people must be able to sit still because they had practiced more, or trained their bodies to ignore the thousands of impulses to move that I felt every second. I thought it was normal to transpose letters, or even entire words, when reading and writing. I was a fast reader and writer, so when I read words out of order, I was able to go back, re-read the words, and figure out what the sentence was saying. This slowed me down to the same speed as everyone else. I always wrote fast and sloppily, and thought that my writing was sloppy because I was fast. However, I *cannot* write slowly without a tremendous amount of concentration. Most daily tasks require such effort. Where most people have little trouble with simple tasks such as remembering to take out the garbage or pay the bills, I always have had trouble. I will even think to myself "OK, now I am going to balance my checkbook and pay my bills on time." Then I will sit down with the checkbook and stare at it, unable to even bring up the will to open it up and write a single check. I have had to get friends to force me to pay bills before. Definately not normal behavior, and something I strive to overcome on a daily basis. I have been close to being kicked out of school before, and am on the verge of being kicked out of college for some impulsive decisions.
Now, I've since been looking into neural feedback as a potential treatment - more from the geek-side of things though, than as a patient. (I'm looking at building a home-made EEG-like device with input to my computer via either a serial or parrallel device.)
I'm sure that you're aware of all the technical information on EEG's and biofeedback, but for the benefit of the other readers:
A typical electroencephalogram (EEG) is where the electrical activity in your brain is recorded over generally a 1.5 to 2 hour session. During the test, the brain can be applied with different stimuli to see how the brainwaves react. Uses for this include detection of epilepsy, and determination of clinical brain death.
Neurofeedback is an extension of typical brainwave monitoring wherein the brainwaves are represented to the patient in a way that facilitates learning how to control them, i.e via a game of some description. Current methods include controlling the doppler effect on a virtual pool, or cloud generation/manipulation.
The brainwaves are approximately:
People with ADHD can exhibit brainwaves that have an unproportionally high period of time spent in the Theta state - essentially daydreaming. So if the patient is taught how to modify his brainwaves to between mid-Alpha and mid-Beta, then a lot of the symptoms can be reduced.
For instance, with the doppler effect method, more ripples could indicate a more higher-cycle brainwaves, and can thus be observed and trained.
There is also strong clinical evidence that shows that neurofeedback is an effective tool for people with ADHD, with a lot less of the harmful side-affects of the drugs, such as Ritalin.
For me personally, I had an EEG performed when I was 12 for suspected epilepsy. An EEG is non-invasive, and non-painful. No icky injections, nothing that felt really weird. Particularly for children this can be a very important point.
I would recommend following this path highly, as it shows a lot of promise, and there is little to show it being harmful in any way.
I wish you, your daughter and your entire family the best through this, and I think that you'll be very happy with the results you'll find.
Just FYI, I'm still on Ritalin, but I do intend to go down the path of neurofeedback, but I'd rather do it via my home-made one. I'm a geek, after all.
My son is also ADHD and we had him try bio feedback for a year. He is attention deficit and not hyperactive. We stopped the bio feedback because after a year we had seen absolutely no change. However, our best friends son is also ADHD, and also not hyperactive, and he has been using bio feedback for about a year and a half with some good results. My suspicion is that the difference may be mostly how hard the person tries at it. The rub here is, of course, that staying focused and "on task" is exactly what ADHD kids have a problem with. We did get results by switching him to Adderall XR. If you haven't, you may want to try out a few different medicines with your kid and see which ones she responds to. It's worth a try. The down side of trying is that she may not be treated for a week or two, if one meds fails, and the up side is that you find a medicine that works much better. Keep her on the bio feedback, it can't harm and it may do some good. Give her every chance there is! Don't forget to take care of your self too. I used to think I was a patient person until I had an ADHD kid. Now I know that I'll never have enough. Best of luck to you!!!
I have a list for adults with ADHD (AADD @ yahoogroups) that any polite adult with ADHD is allowed to join (newbies are moderated until they've shown they won't try to enlarge our penises).
We do have one specialist on board who has ADHD herself and is quite knowledgable about treatments. You're apt to get much more helpful advice than querying /. where so many people have obvious impulse control disorders...
Bioneurofeedback has been helpful for many people and several of them are on my list. Meds just don't work for everyone, and I'm one of those people. I hope to try feedback some time in the future.
The last four months of my life have been, literally, a living hell. Panic attacks to the point of screaming and shaking in fear, tranquilizers by the tubfull. Welcome to the world of [what was diagnosed as] Generalized Anxiety Disorder and it's fun big brother, Acute Panic Disorder.
The reason I mention them is because they have many of the same physical symptoms as ADHD: Trouble sleeping, racing thoughts, inability to focus, irritability/easy to upset, etc.
It was only when that connection was made, in the last week or so, that I appear to be finding my way out of it...
You see, I had what most people would call ADHD when I was a kid. Pretty much every symptom, which are pretty much the same symptoms as anxiety disorder and panic disorder in adults, I had.
Then, it being the 70s in England and Ritalin not being as popular, my mother looked around for other remedies and found the reports on Yellow 5 allergies. She took me off Yellow 5 (tartrazine) and I started to chill out. The scientists may be divided on whether it's a factor but the emprical evidence suggests it was for me at least.
It's only been in the last week or so that we put two and two together. I was ordered off caffeine the moment I got ill. I swapped to Minute Maid lemonade from diet Coke. The stuff is full of Yellow 5 - the problems snowballed.
Since Sunday I've been off anything with Yellow 5 (or Blue 1). What do you know? The physical symptoms are getting better by the day.
The point of all of this is that Yellow 5 and ADHD may or may not be related, who cares. What does seem to be the case though is that a Yellow 5 allergy can manifest with the same symptoms as ADHD or Anxiety Disorder.
All the tranquilizers in the world, SSRIs, you name it, weren't going to help when I had the equivalent of someone slipping me speed or an acid tab in every can of soda. Ditching the soda (and other things that have Yellow 5) has already had a profound affect in, what, 72 hours?
My advice would be - try cutting out Yellow 5. It might not make a difference but it will only take two weeks to find out so it doesn't really cost you anything much and you can try it in conjunction with her other treatments. But can you really afford not to try it? Imagine if the ADHD was a misdiagnosis and you'd put her through all the Ritalin and everything else when just changing out the lemonade and Sunny Delight she drinks could cure it?
Yeah, it's an unproven theory at the moment (then again, people once argued smoking wasn't bad for you too). But it risks nothing to try it and there's one person who'll serve as empirical evidence right here.
Actually, speaking as someone with Tourette's Syndrome, that's a misconception. As it happens, TS and ADD have a high rate of comorbidity. As far as I am aware this is due to the genetic factors that contribute to them. Many people have noticed TS symptoms in kids given Ritalin, and concluded that this means Ritalin causes those symptoms.
See here.
Most modern thinking in ADHD is that AAD ( Attention Abnormality Disorder ) would have been a better term. The point is that people with ADHD ( myself being one of them ) can't choose for themselves what they will concentrate on. In fact, when something like a video-game gets my concentration it is almost impossible for me to let it go. Even if I shut the game off my brain will keep trying to play. It's hard to describe and very frustrating. At least ADHD is better than MBD ( Minimal Brain Dysfunction ) which is what they used to call it.
XML is the best data format; unless your data needs to be read or written by a human or a computer.
I pasted a few abstracts below. The first is a neuroimaging study that shows anatomical differences between ADHD and normal patients. The second describes a genetic mechanism form ADHD. The third is another neuroimaging study. It shows that different areas of ADHD patients brains light up compared to normal patients when asked to perform a task that requires attention. You could do a lit search on Pub Med to find more:
Am J Psychiatry. 1994 Dec;151(12):1791-6.
Quantitative morphology of the caudate nucleus in attention deficit hyperactivity disorder.
Castellanos FX, Giedd JN, Eckburg P, Marsh WL, Vaituzis AC, Kaysen D, Hamburger SD, Rapoport JL.
Child Psychiatry Branch, NIMH, Bethesda, MD 20892.
OBJECTIVE: Because the caudate nuclei receive inputs from cortical regions implicated in executive functioning and attentional tasks, caudate and total brain volumes were examined in boys with attention deficit hyperactivity disorder (ADHD) and normal comparison subjects. To gain developmental perspective, a wide age range was sampled for both groups. METHOD: The brains of 50 male ADHD patients (aged 6-19) and 48 matched comparison subjects were scanned by magnetic resonance imaging (MRI). Volumetric measures of the head and body of the caudate nucleus were obtained from T1-weighted coronal images. Interrater reliabilities (intraclass correlations) were 0.89 or greater. RESULTS: The normal pattern of slight but significantly greater right caudate volume across all ages was not seen in ADHD. Mean right caudate volume was slightly but significantly smaller in the ADHD patients than in the comparison subjects, while there was no significant difference for the left. Together these facts accounted for the highly significant lack of normal asymmetry in caudate volume in the ADHD boys. Total brain volume was 5% smaller in the ADHD boys, and this was not accounted for by age, height, weight, or IQ. Smaller brain volume in ADHD did not account for the caudate volume or symmetry differences. For the normal boys, caudate volume decreased substantially (13%) and significantly with age, while in ADHD there was no age-related change. CONCLUSIONS: Along with previous MRI findings of low volumes in corpus callosum regions, these results support developmental abnormalities of frontal-striatal circuits in ADHD.
Biol Psychiatry. 1999 Nov 1;46(9):1234-42
Attention-deficit/hyperactivity disorder (ADHD) as a noradrenergic disorder.
Biederman J, Spencer T.
Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA.
This review revisits the thesis that a dysregulation of the central noradrenergic networks may underlie the pathophysiology of ADHD. We review the pertinent neurobiological and pharmacological literature on ADHD. The noradrenergic system has been intimately associated with the modulation of higher cortical functions including attention, alertness, vigilance and executive function. Noradrenergic activation is known to profoundly affect the performance of attention, especially the maintenance of arousal, a cognitive function known to be deficient in ADHD. Data from family, adoption, twin, and segregation analysis strongly support a genetic hypothesis for this disorder. Although molecular genetic studies of ADHD are relatively new and far from definitive, several replicated reports have found associations between ADHD with DAT and D4 receptor genes. Brain imaging studies fit well with the idea that dysfunction in fronto-subcortical pathways occurs in ADHD with its underlying dysregulation of noradrenergic function. A wealth of pharmacological data (within and without the stimulant literature) provides strong evidence for selective clinical activity in ADHD for drugs with noradrenergic and dopaminergic pharmacological profiles. Available research provides compelling theoretic, basic biologic and clinical support for the notion that ADHD is a brain disorder of likely genetic etiology with etiologic and pathophysiologic heterogeneity. Neurobio
With my daughter, it's not just the schooling. It's everything. There is no planning going on in her brain, and without Ritalin, almost no independant thought.
The morning routine is a bit like this:
Daughter wakes up.
daughter: Can I get dressed now.
me: yes, of course you can.
daughter: what can I wear?
me: there's a dress on the couch there for you, and some knickers in your drawers.
daughter: (picks up dress) this dress?
me: yes.
daughter: is it going to be warm today?
me: i think so. it should be just right for wearing that dress.
daughter: so can I wear this dress?
me: yes (I won't pretend not to be frustrated at this point)
daughter: where are my knickers?
me: in your drawers. (if, in fact, they are none in there afterall a major panic attack is had by daughter).
breakfast also is along the same lines:
me: (puts daughters bowl of cereal at the dining table, in exactly the same place as it has been put every morning since we moved into this house 2 years ago) , come and eat your breakfast
daughter: which one is mine? (hers is often only bowl at the table at that point)
me: (points to bowl) that one.
daughter: (sits down at table in her normal spot) so is this one mine?
and so on.
Up until she was 3 or 4, she would never get out of bed in the morning by herself. If she woke up early she would lie in bed and chat to herself until she heard one of us moving around and could ask us if it was okay to get up now. She had been told repeatedly that it was okay to get up at any time past 7 o'clock but just couldn't think for herself. (and yes, she could tell the time enough to know when 7 o'clock was)
Diary writing is the whole thing over again. 'What do I write?'.
With ritalin, it's a whole lot better. She actually thinks for herself rather than being a robot that needs constant instruction.
The schooling thing was (before ritalin) a problem with things like the diary writing. She would not be able to think about what to do next, and would just start annoying the other kids, or if the teacher was lucky, just hide under the table out of the way.
We have (at home) learnt to cope with this to some extent, although I can't imagine it's a good way to conduct home life. But no teacher can be expected to devote almost all their time to one child. It's not fair on anyone else.
On the one hand, i agree with you that it's just a way of thinking that's different to 'normal', but so is autism, and to stretch your line of reasoning way beyond breaking point, so was the way of thinking of anyone whose grabbed a gun and started putting holes in anyone who's ever pissed them off. At some point you have to say 'this is a problem, either for this person or for everyone around them', and i believe that is where we are at with my daughter.
2) It has a genetic component. It's trackable in the genome. Hey, it even shows up on a PET scan, for those of you non-believers. "It's just something they're making up" does not show up on a PET scan.
3) ADHD can be easily overdiagnosed. I tend not to trust diagnoses made without the use of a CPT (Continuous Performance Test) or a TOVA (Test Of Variables of Attention). These are real performance tests, not answering some questions.
4) I know a guy who did some large project on the way to his Ph.D. in psychology on using biofeedback for ADHD. He had ADHD and the subject was of interest to him. Basically, he found that people with ADHD couldn't maintain the focus to make biofeedback work. Biofeedback can be very useful, but, to use a loose analogy, in this instance it is like having someone try to build up their biceps through weightlifting if they are paralyzed from the neck down.
I find myself tuning out people at times. It's like they talk too slow. I've noticed this problem especially with the older generation. They feel they must talk in very precise terms and verbally illustrate their ideas. Problem is, I often get their point long before they've finished babbling. So I find myself drifting in and out of attentiveness with them.
That isn't ADD/ADHD. That's getting bored with someone who belabours a point. ADD/ADHD is when you CANNOT, despite your best efforts, concentrate on anything for a long period of time. This is really bad in a classroom environment when you need to pay attention to new material (especially in Calculus courses) and you keep drifting out every five minutes regardless of the effort that you put into paying attention.
I have to deal with ADHD. I know what it's like to suddenly get distracted by the smallest thing, and I know that -- in my case -- Ritalin helps with the concentration problems. I can't stand it when someone who does not have to deal with what I live with comes forth with an "authoratitive" position on ADHD, calling it a myth.
STOP MISUSING APOSTROPHES, YOU MORONS!!!
Is there any activity your daughter does that gives her focus?
;)
I know for me when I started doing programming that a lot of my attention problems seem to dissapear. In fact in a way that is almost TOO severe. I go from the attention span of a gnat to so focused on the task in front of me that I tune out the rest of the world too easily.
I think the idea of the Neural Therapy sounds VERY interesting, and the possibilities of it helping are immenseful, although I wonder if finding something that brings her focus, which every person with ADD I've ever met has one or two, might not be easier, and cheaper.
From my personal experiences, the drugs hurt more than they help, yeah, it let me sit down in class and pay attention in high school, but I felt empty, like a drone, and my mind slowed. Part of what I love about the way my own brain works is the fact that I easily develop tangents, and find other ways to look at things to make them more interesting. The ideal of using a EEG like machine to produce colored patterns on a screen that can be manipulated with your own mind sounds like an awesome way to train yourself to do almost anything, and a million times better than altering the natural brain chemistry.
RE School: Have you explored the idea of Homeschooling? Just don't forget that social interaction is 50% of the younger schooling ages.
I hope the therapy works out for your daughter, and would be interested in hearing any updates from you about it.
i think i may have posted on here before about this, but i'll mention it again anyway.
My little sister does neuro-feedback/bio-feedback therapy, and its improved her life a lot more than flooding her brain with amphetamines like they do to most of the poor little bastards that float through the US "education" system. Keep in mind that ADHD is a pretty subjective thing to diagnose someone with, and people are quick to medicate for it, although very few of the people diagnosed with it really need to be taking meth every day to keep it under control. Psychotropic drugs are not really designed to help anyone, just make their behaviors easier to manage for those of us in the human services field.
Anyway (sorry about that soapboxing) my little sister is supposedly bipolar, ADHD, and emotionally disturbed. She's been taking biofeedback therapy and karate lessons for a few years now, and the benefits from the therapy were apperant very quickly (i'd say a month or two, but your milage may vary). After the series of "games" that the therapy takes the form of, with "points" to be earned towards reinforcers (money, ice cream, charts with stickers on them, etc), the therapy simultaniously simplifies and complexifies into computer-aided transcendental meditation. pretty nifty.
Many insurance providers now cover this (but by no means the majority), Oxford insurance in CT comes to mind, but without insurance the therapy usually costs about 1000 a year with a mix of simple use of the machine and sessions with the therapist (which cost more per session). Its easy to learn how to calibrate the machine (its similar to polygraph calibration, but cooler), making sessions with the therapist an excellent option but by no means nessisary.
The equipment can be purchased at www.brainfingers.com for around 2000 (last i checked, maybe its lower now). The equipment they sell there even has a neuro-to-midi program and the SDK included in the package!!
Anyway, anybody considering poisoning their children just so they can deal with them easier should look into therapy like neuro-feedback that results in actual growth and change rather than homeostasis and chemical restraint.
Thats not to say that these drugs don't have their place, i have another family member who wouldn't be with us right now if not for depakote and wellbutrin, but think twice before drugging someone up just because they don't think the same way you do and give neuro-feedback a shot. its -FUN-.
Its interesting to note that the research and development that resulted in this therapy originated in the fallout of the ill-conceived and unconstitutional prohibition on the scientific research of LSD. The people who didn't get locked up moved their equipment to study people practicing yoga and found that using their equipment, the same states of mind could be reached in 2 weeks that would have taken 2 years unassisted by neuro-feedback. chew on that for a while.
My son was diagnosed with ADD late in life (he was 16). The first treatment we tried was biofeedback therapy. The first step was a brain mapping (a 16 electrode EEG), which cost $800. This was to determine how the brain was functioning in various areas and the frequency of the various waves (Alpha, Theta, Beta etc.). We then went 2 to 3 times a week for 3 1/2 months. The treatments were 1 hour each at $75 per hour. I honestly didn't see any difference at the end of 3 1/2 months, and my son was not noticing any difference either. So, we discontinued biofeedbace and went on Adderal. He noticed an immediate improvement. But, he didn't like the long term idea of being on medication, and quit taking it when he was 17 1/2. He had changed schools and is now in a less structured system where he is allowed to progress at his own pace, without drugs. He is now showing significant improvement in his grades and social interaction.
There is much more to the story. However, the bottom line is that, as you have read in the other responses to this post, there doesn't seem to be a single solution that works for everyone. You need be willing to take the responsibility for your treatment and not blindly turn yourself over to the professionals.You need to be very empirical in your approach and be willing to discard the things that don't work in favor of the ones that do. It might take a while to discover the right combination.
In response to Cliff's original post and questions, I have used neurofeedback in the past to support me in overcoming ADHD like symptoms. Due to a general fear in our family about psychology in general, I never was formally diagnosed with ADHD, but have been told several times by friends that are licensed psycologist that I had all of the signs of this condition. (As an example, to do my homework as a kid I turned the radio and the TV on at the same time). As an adult I continued to have problems with this. Because of my general concern about medicating this issue, I chose not to go down a medication path. I was concerned with my perception that medication seemed to cut the performance curve of what was possible for me to do... I worked for a while with neurofeedback, and was truly suprised that it helped my concentration. From there, given its expense, I was not able to afford a lot of treatments. I never was able to find a medically proven device (other than the one from EEG Spectrum that the psychologist that I worked with) that was inexpensive enough for me to buy to go forward with further treatments after my cash supply ran out for this. However, the limited number of treatments did seem to really make a difference. It is noteworthy, at least in my case, that I also dealt with some of my issues through exercise 4 days a week in a rigorous martial art class. (specifically Aikido). Moreover, after the neurofeedback, I also enrolled, and now have been a student of a meditation practice (for the last 4.5 years- zazen) that has been of continuing support for me. I still have difficulties at times from wanting to get up, go to the bathroom, look outside, read my mail, check slashdot, and then repeat in the next 20 minutes, especially when I get off of my routine of exercising in Aikido and meditation... You might look into several different directions on this, not just neurofeedback. Good luck.
I have experienced beer allowing me to concentrate more fully on something. For instance, I play pool/darts far better after a couple of drinks, as long as I don't have so much that my coordination is impaired. It seems that I become able to focus on the one task at hand, and more able to tune out distractions.
I also hear this about driving drunk. When drunk, people are usually able to maintain their speed, or follow a straight line. Not both. Considering that driving requires juggling so many different inputs, it makes sense to not drive intoxicated. Especially considering that the ability to hyperatenuate one particular thing will give the driver a false sense of confidence.
I'll never make that mistake again, reading the experts' opinions. - Feynman
My wife is a Child Psychiatrist and medical researcher. In addition to reasearch and clinical work, she works 10 hrs a week with an agency that helps foster and adoptive parents.
I have heard stories from both ends of the spectrum. One where a foster parent wanted to medicate a perfectly normal child just so they could more easily manage an inquisitive child in a boring environment.
And an other case where the parents were strongly opposed to med's but ther little boy was literally climbing the walls knocking books of the self in a 15 minute interview. After meds the boy was much, much, much better, and happier. The parents could not believe the difference and felt bad about the boy suffering so long.
True ADHD is socially very difficult on the child. Untreated, an ADHD child has an increased chance of drug abuse.
I mentioned Cliff's post to my wife and she, like an other poster, recommend Strattera. Strattera is a non stimulant ADHD drug that is as effective as Ritalin.
ADHD is both the most under-diagnosed, and over-diagnosed childhood desease. As much as 30% of ADHD children are left undiagnosed. Many times their parents think "boys will be boys" or "I was like that" (Umm there is strong genetic basis). On the over-diagnosed side, upto 15% of diagnosed children may actually be bipolar. If your child is not responding well to ADHD Meds, talk to a Child Psychiatrist. A pediatrician is not as trained to make the distinction between ADHD and Bipolar Disorder.
There is a spectrum ADHD severity. There are very severe cases where it is totally unfair and hurtful to call it "bad parenting". And there are mild cases where coping strategies alone may help.
Also confusing matters in the mild cases, sometimes "labeling" the child as ADHD can make the difference in getting extra reasources to an acedemically struggling child.
My son, however, is another matter entirely. He's a great guy, but he's got ADHD in a FAR more acute form than I do. Lesson one, not everyone diagnosed with this disorder is in the same boat. Like good parents, we took our little darling to the doctor soon after he started kindergarten, where the teacher didn't appreciate his caroming off the walls like a biological billard ball. Ritlin, of course, was prescribed immediately.
My happy little fireball turned into a mopey, depressed little jellyfish. The teachers were happy -- he was now easy to control! Back to the doctor -- adjusting dosages gave big improvements, but never was just right. The side-effects were as bad as the ADHD.
They changed drugs, Adderol(sp) and several others. The doctor was getting testy, saying we should be satisfied with "good enough". We changed doctors. Lesson two: Keep trying!
FINALLY, a doctor tried Imapramine. It's an old-style antidepressant, with some interesting side-effects (like "slowing down" the mental machinery a bit). My son never had the anger problems and antisocial behavior frequently associated with ADHD, he just couldn't concnentrate - my wife would make him literally sit on his hands while she tried to help him with school work, and he'd just vibrate with unspent energy. It was a long-shot, but the doctor thought my son's symptoms might respond to the side-effects of Imaprimamine. It worked beautifully. He's still pretty "bouncy", but he's in control of himself. His grades are, frankly, not stellar. He's happy, productive, inquisitive, and alert, not doped-up on the typical ADD drugs. Lesson three Decide what results you want, realizing that the goal isn't necessarily to make your kid "just like everyone else", but to the best version of them they can be.
Anyway, ADD/ADHD IS a serious problem, unless you have a mild case like mine, and every treament has plusses and minuses. During the years we were trying different treatments, I got to see my son put through an emotional and physical taffy-puller, but we found a treatment that seems to fit HIS situation well, reducing the symptoms that are limiting to him without impairing or redefining who he is beneath it all. Keep working at it, and you should find something that works for your daughter.