Immediate rewards and the ADHD brain

A Nottingham University research team in the United Kingdom found that the brains of children with ADHD appear to respond to immediate rewards in the same way as they do to medication. Their research was published in the journal Biological Psychiatry.

“Our study suggests that both types of intervention [medicine and immediate reward/reinforcement] may have much in common in terms of their effect on the brain,” said Professor Chris Hollis, the lead investigator of  the study.

The research team used an EEG (electroencephalograph) to measure the brain activity of children as they played a computer game that provided extra points for less impulsive behavior.

The researchers devised a computer space game which rewarded the ADHD children when they caught aliens of specific colors  while avoiding aliens of designated colors. The game design actually tested the children’s ability to resist the impulse to grab the wrong colored aliens.

To test whether immediate reward/reinforcement made a difference, one iteration of the game rewarded the children fivefold for catching the right alien and penalized them fivefold for catching the wrong one.  All of this was done while activity in different parts of their brains was monitored with an EEG.

Hollis found that the immediate rewards helped the children perform better at the game. This was verified by the EEG which  revealed that both medication and immediate reward/reinforcement were "normalizing" brain activity in the same regions.

Many parents of ADHD children are aware that giving a reward to an ADHD child a week after their good behavior is insignificant to that child. ADHD children respond better to immediate reward, not delayed reward.

"Although medication and behavior therapy appear to be two very different approaches of treating ADHD, our study suggests that both types of intervention may have much in common in terms of their effect on the brain. Both help normalize similar components of brain function and improve performance,"  said Hollis.

"We know that children with ADHD respond disproportionately less well to delayed rewards – this could mean that in the ‘real world’ of the classroom or home, the neural effects of behavioral approaches using reinforcement and rewards may be less effective."

It’s obvious that providing immediate rewards/reinforcement 24 hours a day and 7 days a week would be impractical and impossible. But what does this research tell us? It tells us that if we are to train an ADHD student, feedback, reward, and reinforcement need to be immediate if we are to get their brain to rewire.

We at Play Attention have known this for many years. This is why we integrated immediate feedback/reinforcement for attention training, cognitive training, memory training, and behavioral shaping by using feedback technology. We patented this method years ago because of its inherent strength. While we knew this was the best way to achieve success, we feel research like this rather reinforces our approach. It’s about time the world caught up!

Neurofeedback, ADHD and Medication

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

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

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

For the purpose of full disclosure when writing this entry:

Play Attention

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

Dr. David Rabiner

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

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

CHADD & Neurofeedback

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

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

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

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

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

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

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

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

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

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

Here, bulleted, are some incredible results with comments:

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

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

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

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

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

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

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

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

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

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

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

Standards of Research, Dr. Rabiner, & CHADD

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

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

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

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

    Random Assignment

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

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

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

National Institutes of Mental Health Multi-Modal Treatment Study

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

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

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

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

Neurofeedback

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

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

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

Current Neuroscience & Neuroplasticity vs. Current ADHD Interventions

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

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

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

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

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

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

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

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

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

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

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

Neurofeedback Controversy

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

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

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

Summary

Neither medication nor neurofeedback are solutions unto themselves.

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

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

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

Neurofeedback training in ADHD children

Neurofeedback training in ADHD children

A study using neurofeedback to control ADHD symptoms was published in the journal Behavioral and Brain Functions (2007 Jul 26;3(1):35, Controlled evaluation of a neurofeedback training of slow cortical potentials in children with Attention Deficit/Hyperactivity Disorder (ADHD). ) The researchers compared a group therapy program to a neurofeedback regimen.

Neurofeedback (“NF”) is a form of biofeedback in which only brain wave activity is monitored and regulated through sensors, a computer, and EEG (electroencephalogram). This is opposed to general biofeedback which may monitor and attempt to regulate EKG (electrocardiogram), respiration, galvanic skin response, etc.

Critics of clinical NF maintain that its primary benefit of increased concentration is seldom transferred to environments outside of the clinic. NF clients do well in the clinic, but frequently cannot generalize the concentration techniques to the classroom or workplace where they do not have access to the clinician or NF equipment.

The researchers wanted to see if slow cortical potentials (“SCP”) would improve attention in ADHD children. SCP is a term use to describe synchronous firing of neurons (brain cells) that functionally depict the brain’s attention regulation mechanism in cortical networks where it is posited that attention is regulated. The researchers desired to see if SCP could be regulated (thus regulating attention) using NF. It has been demonstrated in the past that regulation of SCP has helped epileptics control seizures. Theoretically, if one learns to self-regulate SCP, one could redistribute the brain’s attentional resources.

Results? The researchers used parents’ and teachers’ ratings to assess results. According to the rating scales, the children of the neurofeedback training group improved more than children who had participated in a group therapy program, particularly in attention and cognition related domains. As critics have maintained for years, only about half of the NF group could apply or transfer their NF training outside of the clinic.

Here’s a Zen phrase highly related to this research: “Don’t Mistake the Finger Pointing at the Moon for the Moon.” If you stare at the finger, you miss the heavenly glory. This is also similar to phrases in the Indian Upanishads.

So, let’s examine a few problems of this research and its results. First, the general consideration that ADHD is a brain based neurological disorder that can be treated by just treating the brain is facile. Researchers and clinicians often focus solely on the NF technique and not the child. The child brings to the table an assortment of skills, strengths, weaknesses, and predilections. Furthermore, the child exists in the context of family, friends, school, etc. which directly affect/influence his behavior. In light of this, one cannot simply treat a portion of the brain and expect results to transfer to other aspects of the child’s environment.

Simply put, NF is instruction. It is a teaching technique. Thus, if transfer is minimal or nonexistent, the instructional method is poor. This is because NF is done in isolation of the child’s total context. Unfortunately, this is the same predicament that plagues pharmacological intervention. Learning difficulties like ADHD are seldom, if ever, the sole result of a brain based disorder. They exist in context and must be treated within context if a treatment method is to be efficacious.

The fact that we have labeled ADHD a neurological disorder (even without any associated pathology) has limited our perspective on its treatment and intervention. It will likely be years before the perspective changes.

Note: For more information about ADHD and neurofeedback, see – Neurofeedback and ADHD

Brain Study May Shed Light on Attention Disorders

New research shows it takes one part of the brain to start concentrating and another to be distracted.

This discovery could help scientists develop better treatments for attention deficit disorder .

The study, Top-down versus bottom-up control of attention in the prefrontal and posterior parietal cortices, performed at Massachusetts Institute of Technology (MIT) and published in of the journal Science, reveals that attention may have two forms: willful and reflexive. While this information is not new – cognitive psychologists have written about this for many years – the study finds that these two types of attention are controlled by distinct areas of the brain. Willful attention seems to be controlled by the frontal region of the brain in the prefrontal cortex while reflexive attention seems to be activated by the parietal cortex toward the back of the brain.

Put simply, if one is reading a book, then likely the prefrontal cortex is engaged in commanding attention like the conductor of an orchestra. If, while reading, a firecracker explodes nearby, your reflexive attention will activate from the parietal cortex command center shifting control away from the prefrontal cortex.

“This ability to willfully focus your attention is physically separate in the brain from distracting things grabbing your attention,” said Earl Miller, a neuroscientist at the Massachusetts Institute of Technology. “Now we know these two things are separate, it raises the possibility that we can fix them independently,” Miller said.

RESEARCH

MIT’s research sheds a little more light on the subject of attention because until now researchers have examined only one region at a time. Studying both regions allows us to examine their collaborative interactions, functions, and purposes.

Miller used EEG electrodes connected to the heads of monkeys to examine the complex interplay between the prefrontal cortex and parietal regions during tests of attention and bursts of reflexive attention.

When the monkeys voluntarily concentrated, the so-called executive center in the front of the brain – the prefrontal cortex – was in charge. But when something distracting grabbed the monkeys’ attention, that signal originated in the parietal cortex, toward the back of the brain.

ADHD IMPLICATIONS

Miller concluded that once the prefrontal and parietal regions signaled each other (see my blogs on neural networks), the electrical activity in these two areas began vibrating in synchrony. However, as EEG specialists have known for quite some time, willful concentration involved lower-frequency neuron activity. Distraction occurred at higher frequencies. This again lends credence to EEG training to produce better attention.

While the study sheds a little more light on the subject of concentration, it examined only two portions of the brain. I contend that the entire brain is involved in concentration. The brain seems to work as an orchestra works. While the conductor is not in command, the players tune and rehearse each of their own will. When the conductor steps to the stage, taps his baton, all the individual players each snap to attention and begin to play in synchrony. It is a metaphor for brain function – our brains are formed of many different parts that perform jobs independently of each other. When necessary, a conductor taps his baton and attention is achieved as the individual parts work in synchrony.

For a person with an attention problem or AD/HD, the conductor is not controllable at-will unless the object of attention is highly stimulating like a three ring circus. A little attention may be sustained if the object of attention is only moderately stimulating, but the other conductor responsible for reflexive attention quickly takes command and distraction ensues.

ADHD persons don’t have at-will command over either conductor responsible for willful attention or reflexive attention. Do we know why this is so? No, it may be caused by a variety of factors. Can they be taught to control these conductors? Absolutely. The brain is very flexible and can compensate. All educational systems are built upon this foundation. So, let’s take this out of the realm of medical mystery and dysfunction. Let’s place it back in the realm where it is a skill that can be improved like any other.

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

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

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

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

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

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

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

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

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

9/8/2005 New Video Game Shows Promise In Treatment of Attention Deficit Disorder (ADHD)

As many as three million children in the United States are being treated for Attention Deficit Disorder. And they’re not the only ones. 4.4 percent of the adult population have A.D.D. or a related disorder, making it the second most common psychological problem in adults after depression. VOA’s Paige Kollock reports on a new ‘game’ that might be able to help them.

New Video Game Shows Promise In Treatment of Attention Deficit Disorder

By Paige Kollock
Washington, DC
29 August 2005

Medical studies have shown that television and video games may contribute to the rise in Attention Deficit Disorder, especially in children.

Doctor Stephen Hinshaw of the University of California researches children with attention deficit hyperactivity disorder. He says, “Very fast paced media are in some ways overwhelming the young brains.”

Now a company called Unique Logic and Technology has created a video game that helps re-train those young brains. It’s called “Play Attention,” and the company claims it can teach your brain how to pay attention. It works by using a helmet that has sensors.

The sensors can tell whether or not the user is paying attention. In conjunction with computer software, the sensors teach the user what it feels like to pay attention and reward them for paying attention for longer periods. Over time, the user acquires the skill of concentration.

Former Principal Pat Faulkner says the $1,795 program is worth the money. “I think Play Attention was worth every penny they ever spent on it, and all the time that was spent on it, because it has the power to change a child’s life. When a child can learn to participate in class, then he can learn, and that’s a life changing experience.”

Adults are using Play Attention too. While the U.S. Women’s Olympic bobsled team may not have A.D.D, using Play Attention helps them increase their focus, which gives them a competitive edge.

Educators say the game takes between eight and 12 months to become permanently effective. From that point on, they say, users can fall back on the skill for the rest of their lives.

ADHD: Biofeedback and Neurofeedback: An Introduction

What are Biofeedback and Neurofeedback?

Feedback is an process which reflexively changes itself using its own forceful flow. The classic feedback device is the steam valve. As the steam causes a rotor to turn the centrifugal force of the rotation causes levers to rise, or strings to fly out, in the same way that if you rapidly turn yourself, your arms fly outward.

The levers on a steam device control the flow of steam, the faster the rotation the smaller the steam vent, the smaller the vent the slower the rotation. The size of the vent, the speed of rotation and the force of the arms closing the valve can all be adjusted so that the rotating axle maintains a consistent speed, so long as the supply of steam is constant.

Over one hundred years ago, French physiologist, Claude Bernard, who was characterized by Louis Pasteur “Physiology Itself” noted that most all of the human body’s systems are feedback regulated. In fact, they remain quite constant regardless of changes in the external environment. In 1932, Walter Cannon coined the term homeostasis to describe internal dynamic constancy.

A man eats food, his mouth fills, juices flow, his stomach fills, and his sensors send a signal, “satisfied.” He stops eating. A woman trots upstairs a bit too fast, her oxygen sensors are starved, and she starts breathing more deeply and quickly.

I glance out the window, the sun has moved to bounce off the white wall of the bank next door, my pupils contract, and I turn back toward the darkest wall of the room, or dash into my dark room. My pupils dilate.

Generally, body systems regulate through positive and negative feedback loops. The body has sensors that detect deviation from its normal internal range. This deviation activates effectors that essentially reverse the condition.

Such ordinary biological feedback of daily living can be enhanced by using mechanical transducers (devices which measure energies). I can press a piece of plastic against my palm which turns color depending on my temperature. Quickly I learn to make the color redder and redder (the color is arbitrary, it could be bluer and bluer). If I am prone to headaches I can prevent, inhibit, or relieve a headache by warming my hand. I may measure the way my skin conducts electricity and can learn to make my own skin less conductive which tends to relax me. The plastic has fed the information back to my conscious mind and my brain has learned consciously to warm my hand. My body is responding to a feedback loop. According to Merriam Webster, biofeedback is: “the technique of making unconscious or involuntary bodily processes (as heartbeats or brain waves) perceptible to the senses (as by the use of an oscilloscope) in order to manipulate them by conscious mental control.”

Early in the development of biofeedback attention was first focused on temperature (TEMP) change. Temperature is easily and cheaply monitored and learned change is markedly reliable. Muscle tension (EMG) soon came along. The techniques of measuring muscle tension are perhaps as easily done as temperature measurement; but the equipment is more costly. TEMP and EMG are the most widely practiced forms of biofeedback.

In 1970 Barry Sterman noted that he could readily train cats to strengthen the amplitude of signals at 13 pulses per second generated in the brain’s Fissure of Roland. Later he observed that cats trained to make stronger 13-14 Hz signals resisted epileptogenic drugs (specifically, injected hydrazine). D.A.Quirk, a Canadian penologist, and G.von Hilsheimer, a Florida neurofeedback specialist, applied Sterman’s 1970 method to 2776 felons imprisoned in the Ontario Correctional Institute near Toronto and to about 10,000 clients seen in hospital and in outpatient care. The recidivism in these prisoners (15% in 3 years after discharge, compared to 40 – 100% in typical prisons) reduced significantly.

Subsequently a professional movement has been created using EEG biofeedback in the treatment of ADHD (pioneered by Professor Lubar at the University of Tennessee). In Europe a significant network of practitioners has been organized by Prof. Dr. Jiri Tyl of Prague who has significantly contributed to the proof of the efficacy of EEG biofeedback (see EEG Biofeedback FAQ)

Neurofeedback is a specific type of biofeedback that makes brainwaves perceptible through the use of sensors attached to the head. The brain operates by sending minute electrical impulses to the many cells that comprise it. When the brain is excited it emits a specific frequency range of waves. The same is true if it is tired or focused. This process is similar to a radio tower that gives off radio waves. Brainwave sensors called electrodes monitor brainwaves emanating from the brain much the same way a radio receiver monitors different radio frequencies – if I change my car radio from 101.5 FM to 107 FM, I get to listen to a different station. So, the sensors pick up these signals like little radio antennae. A receiver, like a radio receiver, amplifies them and sends them to a computer where they are changed to sound and/or pictures on the computer monitor. The pictures and sounds make the current state of the brain perceptible because that information is displayed via sound and pictures on the computer screen. So, if a person is overly excited, she can see this on the screen in a graph or perhaps a screen character rapidly buzzing around. If she wishes to calm herself, she learns to slow the computer character which is reflecting the necessary relaxing brainwave pattern. By repeating this process many times, she can eventually learn to place her brain and body in a calm state without the neurofeedback equipment. This learning achieved by biofeedback is robust, stable, reliable, and readily acquired.

There is significant evidence that hyperactive boys tend to make high amplitude slow brain waves which are associated with inefficient faster brain waves. The child can be taught to reduce the amplitude of signals slower than 7 pulses per second (<7 Hz for Hertz) and to increase the strength of the signals running 13-14 Hertz. Such children tend to become more social, more effective at school work, and they perform more adroitly on IQ and other tests. One can think of this process as switching radio stations at will. Neurofeedback students learn to switch from inattentive (daydreaming) states to focused states at will.

See www.drbiofeedback.com, www.aapb.com, www.isnr.org, www.pocket-neurobics.com

George von Hilsheimer, Ph.D., F.R.S.H., and Peter Freer, MAEd

Neurofeedback as a Teaching Tool

Why is Play Attention Different?

Dr. Olafur Palsson, Psy.D. Associate Professor of Medicine, University of North Carolina at Chapel Hill, and one of the NASA developers of similar technology, states, “The Play Attention system is in my opinion uniquely appealing because it simultaneously addresses three different factors that can inhibit healthy learning and concentration. It trains basic mental skills that underlie the ability to complete school-related tasks; it systematically monitors and reduces attention-incompatible behaviors; and it encourages the type of brain activity that is known from research to be associated with good concentration. This multi-faceted approach goes far beyond the scope of most brainwave biofeedback training. All of this is furthermore packaged into a training format that is self-esteem building for the learner and well suited for use in educational and home settings.”

Play Attention is a comprehensive teaching/learning system developed by a teacher for students struggling with attention problems and the cognitive deficits typically associated with focusing difficulties. In use worldwide and in over 300 school systems in the United States alone, Play Attention has quickly captured the attention of educators looking for an educational intervention.

Play Attention’s core teaching method is derived from neurofeedback. National publications like Discover, Time, and Newsweek have recently raised public awareness about neurofeedback – an exciting intervention for children and adults with attention problems. Neurofeedback is derived from the word, neuro meaning brain related, and feedback. Feedback is a teaching method used since teaching began. Feedback implies reporting information to the student to inform him if he is or is not performing as needed.  Clinical feedback using abstract games or graphs to teach control of attention and other autonomic functions has been around since the early 1970s.

The bane of the aforementioned clinical approach has been its difficulty of use and expense.  Clinical EEG equipment is complex, expensive, and directed toward changing brain wave patterns. The change in the brain wave patterns is supposed to indicate change in associated skills of concentration, improved behaviors, etc. Frequently, students practice on their own in the absence of a clinician and therefore have no behavioral guidance. Clinicians also have devised a myriad teaching methods (‘protocols’) using different frequencies and sensor locations. Most all of these ‘protocols’ have demonstrated success in training brain training. Virtually no neurofeedback programs or ‘protocols’ incorporated educational methodology and cognitive skill building which commonly resulted in a lack of transference or generalization. This meant that skills learned during the feedback training were difficult to relate to home or classroom activities. This fact greatly delayed its acceptance by the professional educational community and resulted in severe criticism of the technology by others in the field. A few significantly good practitioners like Dr. George Von Hilsheimer had the acute ability to coach well and get students to be successful at home and school.

Background information

In mid 1980’s, Peter Freer was teaching at an elementary school in the rural mountains of Appalachia. He faced significant numbers of students with attention problems. Most of these students were also discipline problems. Being a second year teacher, he did not understand their learning differences, and he felt inadequately prepared to teach these students. There wasn’t even a label for students with attention problems at that time. Upon speaking with his university professors, he implemented a token reinforcement system, repeated instructions as needed, shortened assignments, and moved these students closer to his desk. While these interventions succeeded slightly, Freer still believed more could be done over and above simply modifying student curriculum and environment. Once these children became adults and entered the job market, no employer would move them closer to his desk and give them trinkets to motivate them.

Over the course of his graduate work, Freer was trained on educational implementation of computer software and educational programming developed at MIT in a program funded by the National Science Foundation. Computers were proving to be intrinsically motivating to students. Freer quickly realized that computers could be used to teach attention classes or instruction in focusing, if he could devise the correct program. He began studying research being performed at NASA and integrated into their flight simulator program. It was apparent that the neurofeedback technology NASA had implemented was not appropriate for students. However, significant educational modifications could be implemented that would make this technology practical and educationally efficient.

He undertook the massive effort to totally revise neurofeedback into a pure teaching tool by founding Unique Logic and Technology in 1994. Freer immediately stripped out the active brain wave reporting component as his intent was not to change brain wave patterns. He did intend to help alter cognitive skills because after researching decades of studies on attention problems, he found that children and adults with attention problems seemed to have weakened networks of attention, time on-task, visual tracking, short-term memory, and discriminatory processing. In other words, these students were deficit in the skills they needed most to succeed – the core components of the learning process. So, instead of trying to modify brain waves, Freer thought it more important to develop deficit cognitive skills that would directly affect behavioral performance and educational outcomes. The US government awarded Freer three patents and one pending based on his strategic modifications.

After two years of restructure the program was ready to be tested. Dubbed, Play Attention®, Freer negotiated an agreement with a local school system to test the learning system under the guidance of the special education director.

This special adaptation of neurofeedback only monitored brain wave activity to make the student aware of proper focus. Students can actually control screen characters by mind alone in activities that directly teach students to stay on-task, visually track the teacher during a classroom lesson, follow multiple step directions by increasing short-term memory skills, and learn to filter out distractions. This was a significant modification of existing teaching and feedback technology as it focused on performance based outcomes that were measurable as opposed to the older method of brain wave change which provide no conclusive evidence of specific behavioral change.

The results of the study so impressed the special education director, that he purchased a complete system for every school in the district. But that was only the beginning for Play Attention as Freer placed sensors in a bicycle helmet and integrated a behavior shaping program to assist students in diminishing or extinguishing behaviors not conducive to learning. The helmet was ideal for students as they could quickly prepare it for use in as little as 90 seconds with no fuss, no gels, no mess. It was familiar to them as they wore helmets for biking, roller blading, and skate boarding. The helmet could also withstand the rigors of the school environment.

If a student fidgets or calls out during his Play Attention session, the screen characters become uncontrollable. This allows students to actually see a direct correlation between their behavior and their attention. The behavior shaping module bases it goals on the fact that students want to succeed but need to know why they are being asked to make behavioral changes. Most students with attention problems are unaware that they exhibit behaviors that distract not only themselves, but others in their immediate surroundings too. Awareness of the behavior makes shaping it easier as attainable goals can be set and reinforced through positive reward. Yet another patent is pending on this process.

The overall result of the advancement of feedback technology in Play Attention is simplicity. Play Attention is a comprehensive program but is not complex. Its interface appears as a simple lesson plan. Goals are easy to set in all of the five cognitive components. Results are graphed from the internal data that are collected for each student. Students are even encouraged to work on actual homework assignments while wearing the Play Attention helmet and operating the learning system. This is a unique way to teach them to finish homework within a proper time period promoting good time on-task. When students log out, a journal asks them to reflect on what they’ve learned that session, what they are proud of, and what goals the need to develop for the next session. This information appears at the initiation of the very next session to promote continuity, transfer, and generalization.

Knowing that parents, teachers, and other professionals have tight schedules and need to implement software quickly, he established a support program that allows everyone to be trained quickly and be adeptly supported by professional staff via telephone and the Internet. Tech support is also available free of charge for the life of the product.

The significant changes in technology and methodology stemming from a different perspective – an educational perspective – have enabled Play Attention to become a world leader in educational attention training with homes, schools, learning centers, and professionals using Play Attention from Beijing to Brazil.

Re-wiring Your Brain, Meditation & ADHD, A Self-service Guide

In his January 3, 2005 Washington Post article, staff writer Marc Kaufman says, “Meditation Gives Brain a Charge, Study Finds

“Brain research is beginning to produce concrete evidence for something that Buddhist practitioners of meditation have maintained for centuries: Mental discipline and meditative practice can change the workings of the brain and allow people to achieve different levels of awareness.”

“What we found is that the longtime practitioners showed brain activation on a scale we have never seen before,” said Richard Davidson, a neuroscientist at the university’s new $10 million W.M. Keck Laboratory for Functional Brain Imaging and Behavior. “Their mental practice is having an effect on the brain in the same way golf or tennis practice will enhance performance.” It demonstrates,” he said, “that the brain is capable of being trained and physically modified in ways few people can imagine.”

It seems that science is finally catching up to practices that are literally thousands of years old. It is always amazing and somewhat frustrating that for centuries, millions of people have realized they can rewire their brains; however, science is just now beginning to understand the process and accept that it can actually occur.

Biofeedback and neurofeedback practitioners use equipment to undergo the same changes that the Buddhist monks undergo through training in the process of meditation. The machines used in biofeedback and neurofeedback allow the user to move into the same states as Buddhist monks. Sensors are attached to the scalp which permit the neurofeedback practitioner to view what the brain is doing, called brainwave activity, as it immediately happens via the computer screen. Repeating the practice of neurofeedback can be very similar to meditation. The Keck Laboratory verifies that physical activities or training can actually rewire the brain and this has been demonstrated for feedback practitioners too.

“The brain uses an enormous amount of the body’s energy. Even under normal circumstances it uses about 20 percent of your body’s entire energy production. When you work your brain harder, [meditate, use neurofeedback or biofeedback] you use more. The blood flow goes to the brain and it’s really like working out,” says Duke University neurobiologist Dr. Lawrence Katz.

Executive Director of the Center for Brain Health and professor of behavioral and brain sciences at the University of Texas at Dallas, Dr. Sandra Chapman says she wants to dispel the myth that the brain is “an untouchable black box. The brain is highly modifiable by everything we do.” Everything we do includes physical exercise, social interaction, meditation, prayer, or playing. Chapman says, “Whatever you spend time doing is what part of your brain is going to strengthen. Don’t do random things. Ask yourself if that’s the part of your brain you want to build. We see people who lose a lot of their ability, but the first thing to come back is the thing that they did the most.”

From our new knowledge of the working brain, it is evident that the opportunity exists to rewire the circuits that are weakest in persons with ADHD, i.e., those circuits that don’t allow attention to low-level stimuli like balancing a checkbook, cleaning your room, finishing homework, staying organized, or finishing a project at work. The object is to practice mindfulness and work on the aforementioned specific tasks. I developed Play Attention for just this purpose and science is finally catching up to us.

In referring to rewiring and strengthening the brain, research psychiatrist, Jeffrey Schwartz, of UCLA’s Neuropsychiatric Institute says, “The key really is the refocusing. When you refocus you activate alternative brain machinery… [It] really is like going to the gym; you’re strengthening your brain. When you stop doing it, you have a stronger brain.”

So, to rewire the circuits that are weak and strengthen them, we must repeatedly practice. For people with ADHD, this practice is clear: we must practice attention and those subordinate skill sets that are conspicuously missing. That’s the foundation of Play Attention. It is the only feedback based learning system that incorporates attention training with cognitive skills training. Our patents guarantee that. The scientific community IS finally catching up.

Portions of this blog were derived from Sky Magazine’s Brain’s World by Sophia Dembling (Feb. 2005)