Attention Deficit Disorder (ADD)
Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Disorder is chronic learning disability that impacts both children and adults.
Parents often ask for clear definition for this disorder as they and their children struggle with problem emotional and behavioral patterns. The Diagnostic and Statistical Manual used by Psychotherapists identifies three subtypes with identifying criteria. These criteria must be met for at least six months and a careful diagnosis process should be done to rule out other problems which may mimic ADD/ADHD.
This subtype is characterized by the some of the following:
Often fails to pay close attention to detail or making careless mistakes.
Difficulty sustaining attention to tasks.
Often does not seem to listen when spoken to directly.
Has difficulty organizing tasks and activities.
Avoids or dislikes task requiring sustained mental effort
Easily distracted by extraneous stimuli
Often forgetful in daily activities
Often Does Not follow through and fails to finish tasks.
Often loses things necessary for tasks/activities.
Often these children are missed by teachers and professionals because they may not pose the same behavioral challenges as those who are hyperactive. Inattentive children are often described as, "daydreamers," "lazy," and motivated. In contrast, they may appear hyper-focused on tasks and activities that interest them such as video games.
This subtype is most often noticed by parents and professionals because the behaviors are a problem for others. These children may be quite intelligent despite their difficulties in learning. While they may have difficulty focusing on tasks, they may, at times, become hyper-focused or transfixed by things that grab their attention. As you may notice the criteria below appears to be written predominantly with younger children in mind. In considering whether an older child or teen fits these criteria, it is very useful to consider the child's history and past behavior in contrast with the present. Again, it is important to consider the history, developmental level of the child, medical/social factors, and potential traumas when a clinician is doing a differential diagnosis.
Some of the Hyperactive/Impulsive Criteria are as follows:
Often fidgets or squirms when sitting
Has difficulty remaining seated when required to do so.
Often runs about or climbs excessively in inappropriate situations.
Has difficulty playing quietly.
Often talks excessively.
Is often "on the go" as if driven by a motor.
Often blurts out answers to questions before they are completed.
Has difficulty waiting their turn.
Often interrupts or intrudes on others.
This subtype contains a mixed clinical picture of both Inattentive and Impulsive traits over a specified period of time.
Other disorders may mimic these symptoms by presenting some or all of these symptoms. These other disorders might include depression, post-traumatic stress disorder, conduct disorder, a hyperthyroid, and some organic conditions. There is a high incidence of other associated problems such as behavior problems, obsessive-compulsive disorder, depression, substance abuse, and other learning disabilities such as dyslexia.
Causes of ADD/ADHD
There are many identified or suspected causes for these symptoms. Some research has demonstrated that one or more neurotransmitters like Dopamine may be in short supply or are not working as they should.
ADD/ADHD may be an inherited condition. However, this does not mean that other children in the same family will develop symptoms.
Problems in the brains ability to self-regulate. Individuals with these disorders may have have all or some of the following problems which contribute or cause their conditions: dysfunction in the frontal lobes, excessive low frequency brain wave activity (delta, theta, and alpha), auditory processing problems, or other learning disabilities. While there is no shortage of discussion and controversy about these conditions, there is much consensus that these symptoms often represent a condition of under arousal in the brain. This may seem counter intuitive for a child who has excessive physical activity and appears anything but calm. However, there is evidence to suggest that the excessive activity or attraction to stimulating and engaging activity is an unconscious attempt to remain focused and alert.
Some forms of birth trauma such as oxygen deprivation, head trauma, in-utero exposure to substances such as cocaine, amphetamines, or other complications.
Childhood exposure to lead
Possible reactions to food or environmental toxins
Myths About ADD and ADHD
Children grow out of it.
While first thought to be only a problem for children, it is now known that theses symptoms may persist during adulthood.
As children age and their brains mature, it may be easier for them to focus or control their behavior. However, sustaining that control may take enormous effort.
ADD/ADHD is caused by sugar or food dyes.
Studies have failed to find a consistent link between food or environmental senstivities (e.g., food dyes, refined sugar) and ADD/ADHD. However, since there may be several causes for these conditions, these factors may not be necessarily be ruled out as at least a factor in the symptomatic picture for a given child or adult. Some authors recommend trying elimination diets to see if there are any connections between foods or subtances and their identified symptoms.
My child just doesn't try hard enough!
Dr. Daniel Amen's research using SPECT brain scans has shown that the frontal lobes fire slower rather than faster when challenged by difficult or boring tasks. What this means as that as the child/adult tries harder, it may actually become more difficult to perform the task. It may be helpful to use the analogy of a trying to starting in car or bike from a higher rather than lower gear. Anyone who tries to start out on a bike from tenth gear, quickly learns that it takes an enormous amount of physical effort just to get going. It may also explain why such children often seem to provoke parental discipline and intervention. It is during such moments of adult intervention that their brains may focus and suddenly become more attentive. In this way, negative patterns of behavior become unwittingly reinforced. Over the long-term, the child may develop an increasingly negative self-identity.
What can we do?
In addition to behavioral interventions, Neurofeedback can help people with these conditions by training them to reduce the over abundance of lower frequency (slow and inattentive) and increase the prevalence of mid-range beta waves (calm, focused, and alert mental state). Over time, Neurofeedback trains the brain to function in a more optimal and functional way by resetting the baseline and allowing it to better self-regulate. Neurofeedback offers a safe, cutting edge treatment to an often baffling and frustrating condition. Like any therapeutic treatment, it is not successful in every case but can be help most clients presenting these symptoms. While more severe conditions may require ongoing Neurofeedback training, many can retain the benefits with little or no further treatment within 20-40 sessions. Unlike other treatment options, it produces long-term changes that can often be retained for years to come.
Traditionally, the other corrective method has been to utilize psychostimulants such as Ritalin, Cylert, Dexedrine, Adderal to stimulate the nervous system into a more alert state. Also, some 30% if children do not respond to psychostimulants or shows a worsening of their ability to function. Some adults and children may show improvement with other medications such as antidepressants, anti-convulsants, or even some hypertensive medications. However, these medications can, at best, control the symptoms without bringing about a fundamental long-term change. With discontinuance of the medications, the symptoms return within a short time. Medications may also have a number of side effects that also need be considered and discussed with your doctor.
Some advocate the use of more easily absorbed vitamins and minerals together with herbal remedies. However, advise on such matters are best discussed with your doctor.
Especially younger children, behavioral modification techniques may be helpful to reshape the dynamics and encourage more positive behavior. Family therapy and parenting classes can also help equip parents with a bigger "bag o' tricks. One thing is clear. Spanking, yelling, and pleading do not work effectively but instead leave all involved very frustrated. For a simple, effective parenting technique, consider the book or video, "123 Magic." You will find it listed on my web page on recommended books under, "parenting."
We are reluctant to consider medication because we don't our child to become "hooked" on drugs.
Neurofeedback provides a wonderful and safe alternative therapy that often helps reduce or eliminate the need for psychotropic medication.
If psychotropic medications are necessary, please be mindful that these stimulants are far safer than the stimulants sold on the street. Ritalin and other medications lack the euphoric high that characterizes popular street drugs. Bear in mind also that many who later develop addictions to street stimulants such as cocaine and amphetamines may have been trying to remedy undiagnosed ADD/ADHD. Many addicts I have worked with demonstrated undiagnosed symptoms of attention deficit and remarked to me that they were intrigued with the drug's ability to help them focus and be more productive. If Ritalin and other psychostimulants were truly addictive, parents would not have the power struggles that sometimes happen in keeping their children compliant with dosages. Put more simply, some addictions might have been prevented with Neurofeedback or psychotropic medications. It is these untreated conditions that teens and adults try to "self-medicate" using street drugs and alcohol.
Will Neurofeedback Cure This Problem?
Neurofeedback cannot be assured to help everyone. However some studies have documented that up to 80% of participants who complete training between 20-40 sessions will show measurable benefits. These benefits tend to endure for most conditions. Some adults and children may continue to require psychotropic medication but may be able to function one significantly reduced levels. Reduction or titration of medication must be done under your doctors care.
Many clients with non-severe conditions maybe show lasting improvement or require only periodic booster retraining. Some severe conditions such as Epilepsy, Developmental Disorders, Brain Injury, etc. may require ongoing maintenance to retain the achieved progress. However, it is usually the exception rather than the rule.
Because each persons genetic composition and biological factors are unique, it is not possible to predict the time-frames or extent of improvements. Some clients may show a plateau during the mid point of treatment especially with ADD/ADHD. This may occur when the novelty of the technique wears off and the child becomes bored and less attentive as they would normally do in other environments like school. Some biofeedback professionals like Professor Joel Lubar have written that such temporary regressions are common and may be a good opportunity to train further.
For more information and links related to this condition please see: