Attention Problems and Behavior Problems

Attention Problems and Behavior Problems
What’s the connection and can they be fixed?

For an ADHD child who’s experienced failure or frustration at school, has a difficult time making friends, cannot process multiple step instructions, and who likely has poor self-esteem, defiance or misbehavior seem inevitable.

The off switch or filtering in their brains works differently, so they often have impulse control issues and a frequent lack of control over what they blurt out. Couple that with failure and frustration, and you have the perfect storm. No matter what you do; punishment, coaxing, bribing, yelling, pleading etc. don’t seem to work.

Play Attention not only teaches attention by making it concrete and controllable — Play Attention students can move screen characters by mind alone via BodyWave technology — but also teaches a variety of skills that make them successful at school or work. These successes greatly improve behavior.

Additionally, and this is important, since they can see their attention in real time, Play Attention makes it readily apparent that misbehavior negatively affects their success during game play. Success is predicated on their ability to stay in control and attentive. It’s simple to correlate this to being a classroom superstar. Play Attention students learn to self regulate or control their own behavior. This is the basis of the behavior shaping program built into Play Attention (it took us over 5 years to develop it).

The scientists and doctors of the prestigious Tufts School of Medicine researched Play Attention in Boston area schools over five years. They sent independent observers into the classroom to monitor students in their study of Play Attention. The observers were blinded to the students; they didn’t know anything about them but were required to monitor their behavior. Even though the students had been labeled ADHD with behavioral problems, the Play Attention students showed significant self-control — even 6 months after the study was completed! Never underestimate what your child can learn. We at Play Attention know there is an intelligent person hiding behind the defiance and frustration. Our goal is to set him free.

800.788.6786

Attention Problems: What Can Be Fixed?

Attention Problems: What Can Be Fixed?
You can do far more than you’d think.

Can’t pay attention. Can’t finish homework. Trouble with social skills. Intelligent, but doing poorly at school or work. Struggling with behavior.

Our brain is our greatest asset, but what do we do when it doesn’t function optimally? Are we stuck? No.

The brain is incredibly moldable. Scientists refer to this as neuroplasticity. It constantly rewires itself based on its exposure to the environment. Learn multiplication tables? The brain rewires itself. Learn a new word? The brain rewires itself. Learn karate or to play the piano? The brain rewires itself. We’ve known this for many years. We know how this works even down to the molecular level. Do we apply it to attention problems? No. Odd isn’t it?

Attention is a skill. So, how do we teach it? It’s relatively easy to teach multiplication tables; you can use things like flashcards, blocks, and other tangible things. Attention is intangible; we cannot see it or touch it. That’s what makes it difficult to teach as a skill. It’s almost impossible to improve attention unless it becomes tangible.

But what if you could see attention? What if attention were concrete and controllable right in front of you? You could learn it quite easily — attention problems or not. That’s what Play Attention does; it uses brain sensing technology that allows you to control the computer by mind alone. You can move objects on the screen by your attention and learn other skills that make you successful.

Three incredible randomized, controlled studies done by Tufts University School of Medicine demonstrated that we can improve attention, behavior, social skills, and even homework skills. Play Attention is the 400 pound gorilla of attention training. It’s been around for over twenty years now. That’s an old gorilla with a heck of an attention span. You should come to a webinar and see it in action. There’s one tonight at 8:30 EST. See you there.

http://www.playattention.com/seminars/

ADHD and Driving

Is it really more dangerous?
Meta-analysis by: the National Institutes of Health (NIH)

For more information: http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/adhd_booklet.pdf

Many studies have attempted to correlate ADHD and driving habits. While outcomes have been varied, a trend clearly emerges: ADHD drivers are at greater risk for accidents. This seems especially true for young ADHD drivers.

According to a meta-analysis by the National Institutes of Health (NIH), “In high income countries [such as the United States and many European countries], MVCs [motor vehicle collisions] are the leading cause of death among children, adolescents and young adults (ages 4–29) (WHO, 2002b) and therefore, are considered a major cause of premature death and long-term disability. In the United States in 2004, there were close to 6.2 million MVCs that resulted in 42,636 deaths and close to three million injuries (National Highway Traffic Safety Administration [NHTSA], 2004). The economic burden of MVCs is extremely high and in the year 2004, traffic collisions alone cost the United States 230.6 billion dollars (NHTSA, 2004).”

Is it more than just distraction? Yes. According to available research, ADHD drivers also experience negative driving outcomes for a variety of reasons:

*Poor risk perception; they don’t perceive risky situations as being risky.

* Impaired judgment or failure to make good decisions and use reasoning while driving.

* Inattention and impulsivity were found to be higher in ADHD drivers.

* Longer reaction times and a reduced capacity for flexible response to changing road conditions.

* Decreased neural motor control over the vehicle — motor skills are brain functions that allow us to control the response of our bodies.

* Increased aggressiveness and anger were identified in some ADHD drivers.

* Deficits in cognitive abilities were associated with inattentiveness, particularly visual inattentiveness and impulsiveness correlating with problem driving outcomes.

All of these findings indicate that a variety of factors make ADHD drivers less safe. It’s important to start a program where cognitive performance, behavioral shaping, and motor skills performance are increased.

Play Attention. 800.788.6786.

Managing Horrible Behavior ~ Tip 4

Tip #4 Ask Bruce Lee

Almost every parent has noticed that their ADHD child behaves just like an average child when their interest is engaged. At times, it can seem surreal or transformational. So, you should seek out activities that hold your child’s attention. Good first options include karate, tennis, dance, skiing, etc. These activities teach your child to focus attention. Even more importantly, they can teach self-control, tolerance, self-discipline, and cooperation.

Team sports are often not the best first option; being surrounded by teammates and opposing teams can prove to be more distracting than engaging.

“Knowledge in martial arts actually means self-knowledge. A martial artist has to take responsibility for himself and accept the consequences of his own doing.”Bruce Lee

ADHD — It’s all in the hands

Can certain hand movements reveal ADHD?

Two studies, both funded by the U.S. National Institutes of Health and published in the Feb. 15 issue of the journal Neurology, reveal that ADHD children have a greater amount of unintentional hand movement than children not labeled ADHD.

Researchers from Cincinnati Children’s Hospital Medical Center and the Kennedy Krieger Institute in Baltimore performed joint research using sequential finger-tapping experiments on children with ADHD. The researchers found that ADHD children exhibited more than twice the amount of unintentional movements than typical children on one of the two tests used.

Additionally, the researchers measured cortical inhibition with magnetic pulses (transcranial magnetic stimulation or TMS) and compared the results to children without ADHD.

Let’s do a little brain anatomy here to make things clearer. The cortex is a layer or sheet of neural tissue that is outermost to the cerebrum. The cortex is responsible for attention, memory, consciousness, thinking, perceptual awareness, and language. The motor cortex is a term that describes regions of the cerebral cortex. The motor cortex plays a key role in the planning, control, and execution of voluntary motor functions (like hand movement).

Cortical inhibition is a term used to describe the cortex’s ability to control these functions.  By using magnetic pulses directed across the cortex, the researchers discovered that children with ADHD were less able to inhibit their hand movements than children without ADHD. ADHD children presented unintentional hand movements about 40 percent more of the time than children without ADHD.

“We now have a real, quantifiable measure of a problem with controlling behavior in these children,” said Dr. Stewart Mostofsky, primary author of the study performed at the Kennedy Krieger Institute.

“From a clinical standpoint, the critical issue is … they do have differences with these aspects of normal motor control,” Mostofsky said. “We have to recognize that and account for that in considering how to work with children with ADHD.”

Notably, ADHD children that presented the greatest inability to inhibit their hand movement usually received more severe parental reports of hyperactivity and impulsivity.

The question obviously missing is, “What is the significance of these two studies?” They do not provide any direct applications for either diagnosis or treatment of ADHD. Could any parent with an ADHD child tell the researchers that their ADHD child could not control himself like other children his age? The answer is likely a resounding, YES!

The studies do identify patterns of inhibition control. This has been documented in previous studies and is a known factor in ADHD. Could the researchers develop a diagnostic tool based on inhibition control? Yes. As a matter of fact, this type of measurement is commonly obtained in a Computerized Performance Test or “CPT.”

The CPT typically flashes a letter, number, or symbol on a computer screen. The student is tasked to press the space bar or mouse when a preselected number, letter, or symbol appears on the screen. The computer will measure how many times the student clicks correctly, incorrectly, unnecessarily, or impulsively. A wide variety of data are obtained from a CPT. Yet they can only be part of a comprehensive evaluation for evidence of ADHD as so many variables are involved that may mimic ADHD.

So, while studies like the finger tapping study are interesting, they do not provide significant insight into the field nor do they provide basis for a single method of diagnosis. One may wonder why we fund such studies given what is already known in the field.

Training the ADHD Brain

For years, we at Play Attention, have trained thousands and thousands of people to better pay attention, learn the cognitive skills they need to succeed, and change their behavior. Our results have spoken clearly for us since 1994. Now science is catching up.

Two recent distinct studies validate the brain’s ability to change. While a vast plethora of research confirms these studies’ findings, they are noteworthy. The first study demonstrates the efficacy of skill training, and the second demonstrates how teaching skills rewires the living brain.

The first study, published in the August 25 Journal of the American Medical Association, was performed by researchers from Massachusetts General Hospital (MGH). They utilized cognitive behavioral therapy as a direct intervention for ADHD adults. Cognitive therapy teaches skills for managing life challenges.

The researchers at  MGH found that while medications were the first line of treatment, many patients still persist with underlying symptoms.  While previous studies on cognitive behavioral therapy for ADHD were small and short term, the researchers at MGH claim their study to be the first to conduct full-scale randomized, controlled trial of the efficiency of an individually-delivered, non-medication treatment of ADHD among adults.

“Medications are very effective in ‘turning down the volume’ on ADHD symptoms, but they do not teach people skills,” commented Steven Safren, PhD, ABPP, director of Behavioral Medicine in the MGH Department of Psychiatry, who led the study. “This study shows that a skills-based approach can help patients learn how to cope with their attention problems and better manage this significant and impairing disorder.”

“Sessions were designed specifically to meet the needs of ADHD patients and included things like starting and maintaining calendar and task list systems, breaking large tasks into manageable steps, and shaping tasks to be as long as your attention span will permit,” commented Safren, an associate professor of Psychology in the Harvard Medical School Department of Psychiatry. “The treatment is half like taking a course and half like being in traditional psychotherapy.”

Like Play Attention has been doing since 1994, the researchers provided training sessions mainly that included skills training in filtering of distractions, organization, problem solving, and planning.

Safren’s group receiving cognitive and behavioral training demonstrated advanced control of their symptoms over their control group.  This benefit had persisted when measured three and nine months after the training.

The second study, published in The Journal of Neuroscience (August 25, 2010, 30 34 11493-11500 doi 10.1523 JNEUROSCI.1550-10.2010), examined the brains of rats when they learned to control their impulses.  The researchers documented synaptic changes in the medial prefrontal cortex. They concluded that the rat’s brains rewired themselves to produce the impulse controls necessary to be successful in the tasks the scientists had established for them.

Other past studies have confirmed that the brain will rewire to make changes for skills, impulse control, organization, etc. We’re glad that science is catching up to an learning process that we’ve done at Play Attention for sixteen years now.  That’s beyond cutting edge; it’s leading the way for others.

What Lurks Below the ADHD Iceberg?

Virtually anyone that knows, teaches, counsels, or works with an ADHD person is aware that ADHD is not a simple matter of attention deficit. That’s just the tip of a very large iceberg.

As a matter of fact, the term ‘attention deficit’ is actually a misnomer of sorts. ADHD people have diffused attention, not a deficit or lack of attention. Ask them. I often asked ADHD students what was happening in my classroom. They could tell me about the bird outside the window, the cobwebs in the corner of the room, a little about my lesson, a little about the whispering around them, and a little about when the air conditioner was turning on and off. That’s actually a great amount of attention. It’s just scattered or diffused over a wide area all day long.

A true hallmark of ADHD is the brain’s inability to direct attention for long periods without becoming distracted. So, it’s not a deficit at all; ADHD is an inability to direct attention. But there’s more.

ADHD is also a matter of difficulty in multiple domains of cognition. These domains are also labeled “Executive Functions.” Aside from diffused attention, ADHD also encompasses difficulty in organization of thought and tasks; sustaining effort while filtering out distractions; memory (both short-term and working memory); managing behavior/emotion; and visually directing attention and actions.

How does one cope with all these areas? It seems a monumental task. Of course, the primary medical intervention is medication. Does medication actually address all of these cognitive domains? No, it does not. Medication has limitations. That’s a fact. That’s why many parents do not see academic, behavioral, or social improvements [see the MTA study] over time. Another fact is that many of these cognitive domains can be strengthened by direct instruction.

Several small and large software companies have introduced themselves recently into the brain fitness category. Each company tends to address a specific domain like memory or focus. So, to satisfy the cognitive and behavioral needs of an ADHD person, one would need to purchase many of these games.

As the original pioneer and developer back in the late 1980s,  I saw that there was a vast gap in the needs of the ADHD person and what was being delivered. By 1994, I developed Play Attention to teach sustained attention, visual tracking with attention (like watching a teacher move about the classroom), organizing and finishing tasks, memory, filtering out distractions, and motor skills. I even included behavioral shaping. Later this year we’ll deliver social skills, more working memory & short-term memory modules, and more.  We’ve received 3 patents for this pioneering effort.

Play Attention is a careful collaboration between you, the Play Attention software, and the Play Attention professional support staff. It’s provided us with a 92% satisfaction rating.

Of course, to get results, you need to use it. Next week I’ll address how Play Attention transcends being useful to being compelling.

Driving under the influence of ADHD

The University of Virginia wished to test whether ADHD medication helps young adults while facing driving distractions.

Research suggests that ADHD drivers have a greater likelihood of having or causing an accident. Obviously, hallmarks of the ‘disorder’ are inattention, distractibility, and sometimes hyperactivity. So, when their cell phone rings and they answer, bad things tend to happen.

According to Daniel Cox, Ph.D., professor of psychiatry and neurosciences at the University of Virginia Health System, as a group young ADHD drivers are two to four times more likely to have a car accident than non-ADHD drivers. Cox’ research will examine the effects of methylphenidate (MPH), a controlled-release stimulant worn as a patch, on young ADHD drivers facing real-life distractions.

This is rather clever marketing as the research is funded by Shire Pharmaceuticals, the pharmaceutical mega-giant who makes Adderall and the MPH patch. As I’ve stated before, it’s always questionable when a pharmaceutical giant funds a university study on its own medications. In this instance, it will make great marketing if the good Dr. Cox finds that young adults drive better while on meds! But, heck, since stimulant medication has the same effect on non-ADHD people, shouldn’t we all take it prior to driving? Regardless of that fact, if young ADHD people can wear a patch and drive better, that’ll sell millions of dollars worth of medicine!

The study would likely be significantly more impressive if Dr. Cox used unmedicated non-ADHD young adults and medicated non-ADHD young adults as control groups. I’d be more than eager to see those results.

Or maybe, just maybe, ADHD or not, we should put our cell phones away, put out our cigarettes, not eat in the car, put our pet in a pet carrier, and focus on driving. Shouldn’t we demand that of our ADHD teens before placing a stimulant patch on their arms? 

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.

John Ratey: “Train Your Brain”

From A User’s Guide to the Brain by Dr. John J. Ratey, M.D.

…the brain is subject to the same kinds of influences and dysfunctions as other organs. Like a set of muscles, it responds to use and disuse by either growing and remaining vital or decaying, and thus, for the first time, we are learning to see mental weaknesses as physical systems in need of training and practice. The brain is a dynamic, highly sensitive yet robust system that may adapt, for better or worse, to almost any element of its environment. If we are going to set about training our brains to succeed in the world, we certainly need to learn about the various factors that can influence brain functions.

…Neural Darwinism is the theory that explains why the brain needs to be plastic, that is, able to change as our environment and experiences change. That is why we can learn in the first place, and unlearn too, and why people with brain injuries can recover lost functions. The concept also underlies two of the mantras of this book. “Neurons that fire together wire together” means that the more we repeat the same actions and thoughts–from practicing a tennis serve to memorizing multiplication tables–the more we encourage the formation of certain connections and the more fixed the neural circuits in the brain for that activity become.