- ADHD Improperly Diagnosed in Children
- By Jason von Stietz, M.A.
- October 30, 2015
What is causing the rise in children being diagnosed with ADHD? Is it that the modern educational environment requires more of children, which makes it harder for ADHD to go unnoticed? Is it the exposure to chemicals in our environment or the processed sugar in our diet. A study by the Center for Disease Control and Prevention found that ADHD is often improperly diagnosed. The findings were discussed in an article by the Washington Post:
All sorts of theories have been proposed to explain the alarming rise -- 6.4 million in 2011, a 42 percent jump from 2004 -- in schoolchildren being diagnosed with Attention-Deficit/Hyperactivity Disorder, or ADHD, requiring therapy, medicine or both to make it through their day.
Some believe it's simply a matter of more awareness (and paranoia) -- meaning that more parents are seeking a diagnosis. Others wonder if it's schools (they're more academic now than in the past, requiring kids to sit still for longer periods of time making those who have ADHD more obvious).
Still others blame the environment (all those chemicals we use). Or diet (yet another thing to blame on processed sugar).
The CDC report takes an in-depth look at how children with ADHD came to get the label through a survey of 2,976 families. While in the majority of cases health care providers followed American Academy of Pediatrics guidelines when making a diagnosis, there was still a large number of children for whom these practices weren't followed.
In 18 percent of cases, the diagnosis was done solely on the basis of family members' reports, which is inconsistent with AAP recommendations that information be collected from individuals across multiple settings -- such as a teacher, piano instructor, or sports coach. Additionally, one out of every 10 children was diagnosed without the use of a behavior rating scale that is supposed to be administered.
The study also shows that children are getting diagnosed at an earlier age, with half being diagnosed at age 6 or below: 17.1 percent at age 6, 14.6 percent at age 5, and 16 percent at age 4 or younger.
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- Is Neurofeedback Effective? The Washington Post Reviews Clinical Work, Research, and Personal Experiences
- By Jason von Stietz
- January 30, 2015
The media shined a light on the neurofeedback field in a recent article in the Washington Post. Many clinicians have developed expertise treating a variety of psychiatric disorders. Some researchers are unsure there is enough evidence to support the claims of neurofeedback practitioners. However, leading neurofeedback researchers point to the field’s recent studies as evidence. Arlene Karadis discussed the clinical work and research of neurofeedback experts and the personal experiences of their patients in a recent article:
In September 2013, Chris Gardner went from kicking and spinning as a black belt in taekwondo to being locked in a world where he could not follow conversations — or even walk his dog. The 58-year-old Vienna, Va., resident had just had brain surgery to remove a large tumor, and the operation affected his mobility and cognition.
After nine months of physical and occupational therapy, he’d made little progress. So he tried neurofeedback, hoping this controversial treatment would improve his balance and mental processes.
Neurofeedback — a type of biofeedback — uses movies, video games, computers and other tools to help individuals regulate their brain waves. A patient might watch a movie, for example, while hooked to sensors that send data to a computer. A therapist, following the brain activity on a monitor, programs the computer to stop the movie if an abnormal number of fast or slow brain waves is detected or if the brain waves are erratic, moving rapidly from fast to slow waves.
The stop-and-start feedback, repeated over and over in numerous sessions, seems to yield more-normal brain waves. Researchers who endorse the technique say they don’t know exactly how it works but they say the changes in brain waves result in improved ability to focus and relax.
Neurofeedback, which is also used for post-traumatic stress disorder and attention-deficit hyperactivity disorder, has been around since the 1960s. Some research has found it promising. Other studies have been inconclusive, and some have shown no positive outcomes.
The most solid data concern ADHD, especially a recent trial involving 104 children published in March in the Journal of Pediatrics. Those who received neurofeedback had improvements in attention and impulse control, while those who did not receive the therapy did not. These improvements persisted after six months. The authors concluded that neurofeedback may be a “promising attention training treatment for children with ADHD.”
Gardner had read that the technique could aid in recovery from brain injuries.
“I was skeptical. But I was desperate. I felt like I was wrapped in miles of cotton and could not reach through it to touch or feel anything,” said Gardner, an electronic technology consultant. His doctor was projecting a two-to-three-year recovery period, based on Gardner’s slow progress nine months after surgery.
By his ninth neurofeedback session, he was driving, taking power walks and working from home.
Neurofeedback treatments vary. In Gardner’s case, he sat in a chair while tiny, pulsed signals were sent to his brain. Research suggests that these signals enable the brain to revive its communication channels, which can become impaired after a brain injury.
“I couldn’t feel anything” while the treatments were underway, Gardner said. “I just sat there with my eyes closed. My therapist explained that the pulses basically reboot the brain.”
Better focus and relaxation can seemingly help improve or eliminate such conditions as migraines (imbalanced brain waves are associated with certain symptoms like pain) and anxiety.
He has just completed the last of 10 treatments. “I am not 100 percent. I probably won’t stand on my head or get on a roller coaster. But I can do almost everything I couldn’t do before,” said Gardner, who’s back to his martial arts.
“Do most people become totally normal? No. But they improve,” said Michael Sitar, a Bethesda psychologist certified in neurofeedback. He uses it to treat depression, ADHD, chronic pain and some other conditions.
“I find [that] people with focus problems can switch tasks easier. Kids who repeat themselves and who are emotionally labile become calmer and don’t repeat as much,” Sitar said. “With some complicated cases, like bipolar disorder, people may get by on less medication. Though less common, there are documented cases of nonverbal people who become verbal.”
Like riding a bike
Deborah Stokes, an Alexandria psychologist, compares neurofeedback to riding a bike: It’s non-conscious learning, based on the feedback, that, with repetition, can be long-lasting, she said.
“We don’t know exactly how neurofeedback works,” she said. “It’s a process where if clients get out of their own way, they relax. Over time, they get the desired brain pattern, feel calm and function better. This encourages them to stay with it.” Her team sees 30 patients a week.
Thomas Nicklin, whose family was living in Alexandria, saw Stokes for debilitating migraines. A year and a half after beginning a drug regimen prescribed by a neurologist, he was not getting better.
Nicklin, a teenager who was in boarding school, did 45 neurofeedback sessions over three months last year.
“Over time, Thomas went from three or four blinding migraines a week, vomiting and daily pain, to no symptoms,” said his mother, Pat Nicklin.
Silver Spring psychologist Robb Mapou is among the skeptics.
“I have not seen enough well-controlled, rigorous studies in most conditions for which it is recommended to show, definitively, that neurofeedback is effective. I also think there are other therapeutic factors that can contribute to an individual’s outcome, such as discussing their problems with a therapist.”
Michelle Harris-Love, a neuroscience researcher at the MedStar National Rehabilitation Network in Washington, agrees.
“I believe it is applied in some situations where we do not have enough information on the cause of a disorder or how recovery happens,” she said.
But Rex Cannon, past president of the International Society for Neurofeedback and Research, based in McLean, Va., cited nearly 200 peer-reviewed published articles that indicate neurofeedback’s effectiveness. This includes a meta-analysis of 10 studies on epilepsy patients: Although they had not responded to medications, they had a significant reduction in seizures after neurofeedback treatment. And a study on migraine patientsreported, “Neurofeedback appears to be dramatically effective in abolishing or significantly reducing migraine frequency in the great majority of patients.”
Patients usually have sessions two or three times a week, for a total of 10 to 40. Most sessions are 30 to 60 minutes long. They can be expensive — from $50 to $130 each. Some insurance policies cover neurofeedback, depending on the diagnosis.
Practitioners who use neurofeedback for medical and psychological disorders must have health-care degrees and are regulated by state agencies.
About 1,850 professionals have been certified through the Biofeedback Certification International Alliance. To earn that credential, they must undergo 36 hours of study in neurophysiology and related topics, complete a mentoring program to learn clinical skills and pass a standardized exam.
Mary Lee Esty, a Bethesda clinical social worker, has a small study underway treating veterans with PTSD. In an earlier study of seven veteranswho used neurofeedback, she reported, the results were promising.
“These people [in the early study] initially had minimal function. They could not work, and many attempted suicide,” she said. “One is getting a PhD now. One has a full scholarship when he could not read after his head injury. All of them are doing well.”
Other studies describe results of the therapy in a similar way, as promising but requiring further examination.
Esty, who received a National Institutes of Health grant for an earlier study of brain-injured patients, has used neurofeedback to treat more than 2,500 people, mainly with brain injuries or PTSD. In her most recent and still ongoing study, she collaborates with the Uniformed Services University of the Health Sciences, which gives participants in her program post-treatment evaluations.
“I am in this collaboration because I want to get the hard data out there,” Esty said.
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- EEG Patterns Can Inform Effective Use of ADHD Medications
- By Jason von Stietz
- August 15, 2014
Jay Gunkelman, QEEG Diplomate and Chief Science Officer of Brain Science International, was recently interviewed regarding EEG patterns and the effective use of ADHD medications. Gunkelman discussed how a patient's raw EEG and QEEG could give physicians valuable insight into the possible effectiveness of different ADHD medications. Gunkelman's discussion of medication usage was covered in an article in HCP Live:
While medication is usually the first-line choice, Gunkleman said other treatment options like neurofeedback and neuromodulation are often overlooked. Presently, some of the most popular options include stimulants, amphetamine-related norepinephrine (NE) agonists, or “nonstimulant” NE-reuptake inhibitors, he continued.
“The medication intervention is hypothesized to operate through an increased engagement of the mirror neuron system, as reflected in the related EEG rhythm: Mu,” Gunkelman noted. “Mu is a normal EEG variant in the alpha frequency band, which can be seen in the EEG bicentrally in the absence of movement, intention to move, or even ‘engagement.’ ”
With so many available options, Gunkleman said it can be difficult for doctors to find the right treatment for a particular ADHD patient. Nevertheless, “the real trick is picking the right one the first time, or at least avoiding the obvious contraindications,” he noted.
During that long and tenuous process, Gunkleman said physicians might try to mix a variety of medications; however, that method increases the risk of side effects, which he said is “especially true if drugs are mismatched with the client’s underlying neurophysiological profile.”
In describing the risks of the “try one” method, Gunkleman cited statistics from the Star-D study that showed only a 38.6% initial trial efficacy for depression in a field of more than 3,000 patients. After a fourth set of trials, 33% of participants still complained of clinical depression, he said.
“Don’t dive into the water unless you know what is under the surface,” Gunkleman warned. “If clinical practitioners wish to ‘look’ before they just try one of this long list of medications, then they should look at the brain’s function prior to prescribing a medication to treat a client.”
Examining EEG results can be a key factor in anticipating how patients will respond to prescribed medications, Gunkleman noted. Potential observations can include excessive frontal theta, frontal slower frequency alpha, and frontal age-appropriate frequency alpha, in addition to beta spindles and paroxysmal or epileptiform discharges.
“All of these patterns can disturb the frontal lobe’s function, resulting in the same behavioral manifestation of the multiple physiological patterns, each representing a very different pathophysiology and predicting very different pharmacotheraputic approaches,” Gunkleman explained.
Gunkleman also demonstrated a “lock and key” system for matching proper medications with EEG readings. Among various situations, he suggested prescribing methylpheneidate for patients who have a frontal theta pattern, as well as those with slower-frequency alpha readings who need more NE released in their prescriptions. However, when that method is not used or is unsuccessful, the author warned of rapid withdrawal symptoms in patients that could cause significant side effects such as dizziness, nausea, insomnia, anxiety, and even paresthesias. Depending on the type of medication, other possible side effects include stomach issues, mood instability, and sleep disturbances.
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- Exercising the Mind to Treat Attention Deficits
- By Jason von Stietz
- June 10, 2014
Medication is typically the first line of treatment in the treatment of ADHD. However, research shows that the benefits of ADHD medication wanes after 3 years. Could mindfulness meditation be used to improve cognitive control? How about specially designed video games? A recent article in The New York Times discussed mindfulness meditation and specially designed video games used in the treatment of ADHD:
Poor planning, wandering attention and trouble inhibiting impulses all signify lapses in cognitive control. Now a growing stream of research suggests that strengthening this mental muscle, usually with exercises in so-called mindfulness, may help children and adults cope with attention deficit hyperactivity disorder and its adult equivalent, attention deficit disorder.
The studies come amid growing disenchantment with the first-line treatment for these conditions: drugs.
In 2007, researchers at the University of California, Los Angeles, published a study finding that the incidence of A.D.H.D. among teenagers in Finland, along with difficulties in cognitive functioning and related emotional disorders like depression, were virtually identical to rates among teenagers in the United States. The real difference? Most adolescents with A.D.H.D. in the United States were taking medication; most in Finland were not.
“It raises questions about using medication as a first line of treatment,” said Susan Smalley, a behavior geneticist at U.C.L.A. and the lead author.
In a large study published last year in The Journal of the American Academy of Child & Adolescent Psychiatry, researchers reported that while most young people with A.D.H.D. benefit from medications in the first year, these effects generally wane by the third year, if not sooner.
“There are no long-term, lasting benefits from taking A.D.H.D. medications,” said James M. Swanson, a psychologist at the University of California, Irvine, and an author of the study. “But mindfulness seems to be training the same areas of the brain that have reduced activity in A.D.H.D.”
“That’s why mindfulness might be so important,” he added. “It seems to get at the causes.”
Depending on which scientist is speaking, cognitive control may be defined as the delay of gratification, impulse management, emotional self-regulation or self-control, the suppression of irrelevant thoughts, and paying attention or learning readiness.
This singular mental ability, researchers have found, predicts success both in school and in work life.
Cognitive control increases from about 4 to 12 years old, then plateaus, said Betty J. Casey, director of the Sackler Institute for Developmental Psychobiology at Weill Cornell Medical College. Teenagers find it difficult to suppress their impulses, as any parent knows.
But impulsivity peaks around age 16, Dr. Casey noted, and in their 20s most people achieve adult levels of cognitive control. Among healthy adults, it begins to wane noticeably in the 70s or 80s, often manifesting as an inability to remember names or words, because of distractions that the mind once would have suppressed.
Bolstering this mental ability, specialists are now suggesting, might be particularly helpful in treating A.D.H.D. and A.D.D.
To do so, researchers are testing mindfulness: teaching people to monitor their thoughts and feelings without judgments or other reactivity. Rather than simply being carried away from a chosen focus, they notice that their attention has wandered, and renew their concentration.
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- Brain Games: Move Objects with Your Mind to Find Inner Calm?
- By Jason von Stietz
- March 6, 2014
Couch potatoes everywhere, rejoice.
New commercial devices, using technology borrowed from the field of neuroscience, are making it possible to control objects with brain power alone. The idea is to help train users to become more focused — and relaxed. Read Full Article Here
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- Prevention or protection from ADHD??
- By Jay Gunkelman
- March 26, 2013
This link contains graphics showing the correlation between solar intensity and the prevalence of ADHD in the USA. The intense sunlight seen in th Southwest has a protective/prevantative effect on the prevalence of ADHD. The underlying paper was just published in Biological Psychiatry and was the topic of a recent workshop in Nijmegen, in The Netherlands. The solar factor likely influences from 25% to nearly 50% of the ADHD population.
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