Parenting Children's Talents

Placebo Effects In Caregivers May Change Behavior Of Children With ADHD

According to a recent article in ScienceDaily, the perception that children are taking medication for ADHD impacts the behavior of teachers and parents.

Stimulant medications such as Ritalin and Adderall are accepted treatments to stem hyperactivity in children with attention deficit-hyperactive disorder (ADHD) and improve their behavior.  Now a recent review of research by University at Buffalo pediatric psychologists suggests that such medication, or the assumption of medication, may produce a placebo effect -- not in the children, but in their teachers, parents or other adults who evaluate them.

A placebo effect is a positive change in symptoms or behavior after a patient receives a "fake" medication or procedure; in other words, the belief can become the medicine.  In this case, the review suggested that when caregivers believed their ADHD patients were receiving ADHD medication, they tended to view those children more favorably and treat them more positively, whether or not medication was actually involved.

"The act of administering medication, or thinking a child has received medication, may induce positive expectancies in parents and teachers about the effects of that medication, which may, in turn, influence how parents and teachers evaluate and behave toward children with ADHD," said UB researcher Daniel A. Waschbusch, Ph.D., lead author of the review.

"We speculate that the perception that a child is receiving ADHD medication may bring about a shift in attitude in a teacher or caregiver. They may have a more positive view of the child, which could create a better relationship. They may praise the child more, which may induce better behavior."

The analysis supported the hypothesis that producing changes in how caregivers behave toward children with ADHD who they think are on medication produces changes in the child.

Read the full article at ScienceDaily.  As a parent, please comment to this post and share how your perceptions of and actions toward your ADHD child may change as a result of your child taking ADHD medication.

ADHD and HeartMath: Methods To Improve Attention Deficit

When working with children, adolescents and adults with Attention Deficit Hyperactivity Disorder, I use methods that help them strengthen the underlying mental processes that impact and cause ADHD.  If you are a parent with an ADHD child, you know that one mental process that often needs strengthening is the ability to "self-monitor" behavior, thoughts, and feelings so his or her energy level and actions are appropriate to the task at hand.

There are two basic abilities needed for children to effectively self-monitor.  First, they need to develop the ability to be more "self-aware" of how they are feeling mentally and physically.  Second, to have good self-awareness, they need to slow-down, relax, and notice.  These are the foundations needed in order for ADHD children to do basic and advanced self-monitoring.  If these foundations are not mastered, children cannot develop the self-monitoring needed to consistently evaluate how they interact with the world around them.

One technique that has been very effective helping my ADHD clients learn how to be more aware of themselves mentally and physically is HeartMath.  It is a series of techniques and tools for noticing and controlling the heart in order to monitor and adjust energy, stay relaxed, and reduce stress.  HeartMath has been successful in research and practice for helping children better self-manage their ADHD and attention.  I have listed below information from HeartMath about ADHD and links to research studies about how HeartMath has been successful in improving attention. 

For more information about other ADHD services that can improve the underlying mental processes that cause ADHD, please visit the ADHD Intensive section of my website.

ADHD and HeartMath

An estimated 2 million children in the United States have ADHD, attention deficit hyperactivity disorder, according to the National Institute of Mental Health, which also reports that 20% to 30% of those have been diagnosed with learning disabilities.

The core symptoms of ADHD include inattention, hyperactivity and impulsivity. All children may at times have difficulty sitting still, paying attention or controlling impulsive behavior, but symptoms such as these often are indicative of ADHD when they persistently disrupt a child’s daily life. If you suspect that a child may have ADHD, you should seek medical diagnosis from a trained health-care professional or assistance through school personnel. Read more about recognizing this disorder and other related information at ADHD Education Application.

HeartMath’s United Kingdom representative, Hunter Kane, along with Plessington Technical College and CDR Ltd, conducted a recent study on the effects of a HeartMath program with 100 students, ages 10-12, who were, as the British legally term it, "statemented" with ADHD. Key among the findings was "a 24% increase in immediate word recall and a 45% improvement in delayed word recall. Particularly significant was a 32% reduction in difficult behaviors after six weeks." Read the Hunter Kane study.

In another investigation, referred to as the Garden of the Heart study, Dr. Shari St. Martin’s use of HeartMath techniques and the emWave^® PC with ADHD children resulted in almost 400 children in Mexico eliminating their need for medication. Download a PDF of the study here: Garden of the Heart.

Share Your Experience

How have you helped your ADHD child be more aware of his or her behavior, thoughts and feelings?  Please share your best and worst experiences.  We can all learn from you.

ADHD De-stress During the Holidays

The holidays can be very stressful for children with ADHD and their families.  The hustle and bustle of preparing meals and presents and the constant flow of guests can overstimulate ADHD children and stress out the whole family.  The following is an article by Larry Silver M.D. about how to manage stress with your ADHD child during family gatherings.  In short, the best solution is to prepare ahead of time.


Keeping the Peace at Family Gatherings
Sometimes having a child with ADHD can make get-togethers stressful. Follow these strategies for peaceful celebrations.

by Larry Silver, M.D., ADDitude Magazine

Think of the last celebratory meal you shared with your extended family — and your child with attention deficit disorder (ADD ADHD). Was it a dream or a nightmare? If your answer is the latter, and your child played a part, here’s my advice:

• If your child takes medication, don’t stop it. Your child will likely need it to cope with the increased noise, activity, and excitement of the season.

• Plan behavioral strategies to deal with your child’s individual ADHD behaviors, particularly because medication may work less well when there is more stimulation.

• Is he hyperactive? Then be sure he has room to run around when he needs to. During those endlessly long, seated dinners, let him get up frequently to walk or even to help serve the meal.

• Is he impulsive? Cousins running around and the high pace of activity might lead him to do and say things without thinking. You might need to provide increased supervision during the least structured times.

• Is she easily distracted with a short attention span? Sit next to her to help her refocus if necessary.

• Avoid sensory overload. Some ADHD kids become overwhelmed by the stimuli of sounds, sights and activities they can’t filter out. They might become more irritable and tearful, or could just as easily become overly active and wild. Many will complain that it is too noisy or busy and that their head hurts.

If your child has experienced sensory overload in the past, it might be better to pass up family gatherings that involve a large or boisterous crowd, like a Fourth of July barbecue or an afternoon picnic in the church parking lot. If your child becomes overloaded on site, take a walk outside or to a quiet part of the house. Hold her and help her calm down and regroup. Perhaps another child could play a game with her in a quiet room.

Remember, ADHD is a neurological disorder that never takes a vacation. Your child goes through a lot every time his ADHD behavior lands him in hot water. If your child takes medication, be sure he or she is covered for special holiday events. If a dinner is expected to go late into the evening, plan the dosage to cover these hours. If you have family visiting and your child likes to get up early with the cousins, make sure early morning hours are covered too.  In fact, it’s usually OK to use medication more frequently than usual during holidays. Discuss this issue with your child’s doctor to decide what’s best.

Attention Training for ADHD: Positive Results In Addressing Attention Deficit

For over ten years, the Attention Process Training (APT) system has been an effective methods to improve the attention of patients with brain injuries, and of children and adults with ADHD.  This system is designed to address the different aspects of attention such as: lower level abilities like being able to focus and sustain attention over time and higher level ones like the ability to allocate attention between different tasks.

The following article summarizes research of Attention Process Training with ADHD children, and outlines its positive impact on ADHD students.  The article appeared in Attention Research Update, an online newsletter written by Dr. David Rabiner, a Duke University psychologist and former member of CHADD's Professional Advisory Board. You can learn more about Attention Research Update and sign up for a free subscription at www.helpforadd.com.

Dr. Rabiner's Overview of Attention Process Training Research

In a prior issue of Attention Research Update, I reviewed the results of an interesting study in which children with ADHD received an intervention designed to teach them how to improve their ability to sustain attention. This was one of very few studies to test whether systematic procedures to directly train attention skills in children with ADHD (other than attention training via neurofeedback) could be successful. Results from this study appeared to be promising.

A second investigation of this topic was published in the November 99 issue of the Journal of Learning Disabilities (Semrud-Clikeman, M., An Intervention Approach For Children With Teacher- And Parent-Identified Attentional Difficulties. Journal of Learning Disabilities, 32, 581-590). Participants in this study were 33 children in grades 2 through 6 who were diagnosed with ADHD, and 21 matched comparison children. Teachers nominated children to participate in the study, based on their difficulty completing assignments and paying attention in class. (Note: Efforts were made to screen out children who had other diagnoses in addition to ADHD, so this was not a truly representative group of ADHD children.)

Parents were informed about a program to teach their child better attention skills. Those parents expressing interest in the program were contacted so that an ADHD evaluation for their child could be completed. Interestingly, of the 33 children identified with ADHD in this study, only 50% had been previously diagnosed and very few were receiving any treatment. Although this is not the focus of the study, these data highlight the unfortunate fact that many children who struggle with ADHD are never formally identified and receive little appropriate assistance.

Attention training was conducted in after-school groups of 4 to 5 children that met twice a week for 60 minutes each time over an 18-week period. The attention training system used was based on the Attention Process Training model (APT), developed for adults over a decade ago. This system is based on the idea that there are different components to attention: lower level components such as being able to focus and sustain attention over time and higher level components that involve the ability to allocate attention between different tasks.

The training program utilized both visual and auditory attention tasks. The visual attention tasks required children to find a target stimulus embedded in an array of distracters. Tasks were relatively simple at first (i.e. the child was required to find one type of figure among widely spaced figures ranging from somewhat similar to widely dissimilar) and became increasingly difficult (i.e. the child had to find a selected number of figures from among many closely spaced figures as quickly as possible). For the auditory task, children were required to count the number of times particular targets could be heard on an audio tape. The easier tasks required children to keep track of how often they were presented with a particular letter from among a group of dissimilar options. In the more difficult tasks, children had to count the instances of words beginning with particular sounds. These are the kinds of repetitive, uninteresting tasks that children with ADHD typically have great difficulty performing accurately.

During each session, children reviewed their performance (i.e. speed and accuracy) from prior sessions and were required to set goals for their performance that day. In addition, the group discussed strategies to help each child meet his or her goals. Children attempted the task using the strategy they had selected, and then evaluated the effectiveness of the strategy based on their performance. When this evaluation indicated the strategy was not effective, the group leader helped the child revise the initial strategy and he or she would try again. Thus, the basis on which better attention skills were trained included repetitive practice in attention tasks, reviewing prior performance and setting new performance goals, and developing, monitoring, and, if necessary, revising strategies to achieve one’s performance goals. This active problem-solving approach is one that can be applied to a wide range of academic and behavioral objectives, not just the attention tasks that were the focus of this study.

Only 21 of the participants with ADHD received the intervention described above. The remaining children were unable to take part because of after-school scheduling conflicts. Prior to beginning the intervention, all 33 ADHD children and the 21 non-ADHD comparison subjects completed a test of visual and auditory attention that was different from those tasks used in the attention-training paradigm.

After the 18-week attention training intervention was completed, all children were given the visual and auditory attention tests a second time. To determine whether the attention-training program was successful, the authors compared the pre- and post-training performance of three groups: ADHD children who received the intervention (i.e. ADHD intervention group); ADHD children who did not receive the intervention (i.e. ADHD control group); and non-ADHD comparison children (non-ADHD control group).

Results

As expected, pre-test results indicated that children in both ADHD groups performed more poorly on the visual and auditory attention tests than the non-ADHD comparison children. The ADHD groups did not differ from one another, however, suggesting that their attention skills were equivalently impaired prior to the training program. In addition, parent and teacher ratings of attention problems for children in these groups were equivalent prior to the start of training.

At the post-test assessment, the ADHD control group continued to show poorer performance on both attention tasks than the non-ADHD control group. Children who received the attention-training program scored as well as the non-ADHD subjects and significantly better than the children in the ADHD control group. In fact, on the auditory attention task, children in the ADHD intervention group had slightly higher average scores, although this difference was not statistically significant.

Post-test behavior ratings from parents and teachers were not obtained.

Summary And Implications

Results from this study indicate that children with ADHD can perform as well as non-ADHD children on visual and auditory attention tasks following training in sustained attention and problem-solving skills. This is the second study published in recent years suggesting the potential benefits of direct attention training for children with ADHD.

These are encouraging results, but there are limitations to this study that the author notes are important to consider. First, because the sample did not include any children with diagnoses in addition to ADHD, as is true for many children with ADHD, this was not truly representative of the overall ADHD population. Therefore, it cannot be determined whether similarly positive results would have been obtained for children with ADHD and co-occurring problems. Second, there were very few females included in the study, making it unclear whether the beneficial impact of the training program would generalize to girls as well.

The most important limitation is the absence of any post-test assessment of children’s actual behavior and performance in the classroom. Although it is encouraging that children who received the training performed better on specific tests of attention, it is essential to know whether the training also had positive impact on classroom behavior and academic performance. It is certainly possible that it did, but it is also possible that there was no change in these more important outcomes. It would thus be very important to repeat this study to determine whether the attention-training paradigm used actually results in classroom gains.

Move To Learn: How Perceptual Motor Development Can Improve ADHD and Learning

A program that has been effective developing the Perceptual Motor Abilities (integration of the senses, movement and the mind) to improve ADHD and learning disabilities is called Balametrics. Educators, occupational and physical therapists, and NASA have used the program for over 30 years.  According to Learning Breakthrough, “It is an exercise (or movement) regimen performed on highly specialized equipment specifically designed to better organize or ‘calibrate’ the way the brain processes the information it receives from the senses.”  This brain organization can help the mind better communicate among various brain regions and enable students to be more in control of their attention and learning.

The Balametrics program was used at the C. L. Milton Elementary School in Laredo, Texas for four months, twice daily with 83 second, third, fourth and fifth grade students all with Dyslexia, ADD/ADHD and other Non-Specific Learning Disabilities.  Because students typically need to use the program consistently and properly for 9-12 months to see lasting results, the school’s principal Mrs. Ratliff was told not to expect too much with only four months use.  However, within only four months, these students had, on average, a 75% greater amount of reading progress as compared to a control group of non-learning disabled students from the same grades.

According to Mrs. Ratliff, learning-disabled children typically progress in reading ability only 25% to 50% the amount of non-learning disabled students over the same period of time. Showing a 75% greater improvement, with everything else being equal, shows substantial and significant progress as a result of performing the Balametrics activities.  All students were tested before the program began in January 2004. After re-testing in May, the non-LD control group of students showed a 45% increase in the percentage of correct test scores compared to test results from December 2003. The LD students who participated in the Balametrics program showed a 121% increase. This is an amazing reversal.

To learn more about Balametrics for ADHD, please contact A Talented Mind at cerreto@atalentedmind.com, or www.atalentedmnd.com.

ADHD Solutions: Taking a multidisciplinary approach with your ADHD children

When parents hear the words “Your child has attention deficit hyperactivity disorder,” they have many mixed feelings.  On one hand, they are relieved to be able to put into words why their son or daughter has scattered attention but also laser focus at times, hyperactivity, inability to follow linear directions and stay on course, inability to effectively transition from one activity to another, etc.  On the other hand, they start wrestling with the best solutions to use in order to address the attention deficit.

When selecting methods, parents need to understand that attention deficit is a biological condition of the brain, and the biology influences the child’s behavior parents see.  Many parents get lulled into the belief that it is only about helping their child better manage behavior and forget that ADHD is a biological condition.  This is a natural progression for parents because our parenting knowledge and skills have been developed to deal with children’s behavior, not the biology of their brains (their mind's underlying processes).  However, the methods parents use need to address the biology and behavior together.

The first set of methods parents typically use are stimulant drugs and behavior modification techniques such as rewards and punishments.  These methods do help moderate both the biology and behavior but they do not improve the underlying mental processes that are impacted by or contribute to the attention deficit such as perceptual motor development, attention control, memory and executive function.  To improve attention deficit (not cure it), parents need to take a multidisciplinary approach that improves how the mind communicates among the different regions that influence learning, attention, and behavior control.

Starting this week, I will post tips for strengthening underlying mental processes that can improve your child’s attention deficit.