Neurological studies of attention deficit disorders

Recent studies, including diagnostic tests with neuro-imaging (EEG) techniques, suggest that attention disorders have a neurological basis. Evidence from research using advanced neuro-imaging reveals significantly greater slow-wave activity in the frontal regions in the brains of diagnosed ADD/ADHD boys.

The Journal of the American Academy of Child and Adolescent Psychiatry reports that quantitative EEG results can be used to differentiate between types of attention problems. In a study of 40 seven-to-thirteen-year-old ADD children, significant differences were seen between children who exhibited hyperactivity and those who did not.

Treatments

Conventional treatments have had limited success. A review of studies using stimulant medication found that these drugs help only 60 percent to 75 percent of children taking them. Further, a large proportion of those who showed improvement with drugs also showed improvement when given a placebo. For those who do respond to medication, improvements in over-activity, inattention, impulsivity, and aggression are seen, sometimes along with an increase in the amount of schoolwork completed, but the drugs do not improve academic or social behavior in the long term.

Behavior modification helps some children but does not generalize to untrained behaviors. In addition, behavior modification programs are difficult for parents to maintain. Half of the parents in some studies fail to continue behavior modification because of the complexity and time demands of the program. Research with cognitive therapy, such as self-talk to improve coping skills, has not demonstrated any lasting positive effects.

Neurotherapy

A new approach to treatment of ADD/ADHD, neurotherapy, attempts a permanent improvement in behavior without dependence on drugs or continuous behavior management. Neurotherapy was developed because studies of brain waves showed differences between normal subjects and those with ADD.

Researchers Marianne Barabasz and Arreed Barabasz, Washington State University, Pullman, Washington, report that when a person without ADD/ADHD is presented with a task requiring attention such as reading or listening to a story, his EEG — pictures of brain-wave activity — usually show a shift to a faster frequency, with increased activity in the frontal regions of the brain.

In people with attention problems, however, EEGs typically show just the opposite — a shift to a slower frequency without any increased activity in the frontal regions. Neurotherapy is a kind of biofeedback training that appears to produce lasting EEG and behavior changes. Neurotherapy teaches children to increase time spent in the fast-wave activity required for focused attention.

Preliminary results with small numbers of children indicate that 80 percent of the children treated with neurotherapy show significant, measurable improvements on IQ tests, standardized tests of academic achievement and teacher/parent ratings of behavior.

Evidence is accumulating to support the conclusion that neurotherapy leads to a normalization of behavior, including improved long-term academic performance and social functioning. Follow-up neurological testing and behavior assessments at 1 month, 6 months and 1 year after treatment indicate that the effects of training are lasting and that maintenance treatments are not necessary. Currently, neurotherapy takes a large number of sessions (up to 80 1-hour sessions over 5 to 8 months) to achieve permanent improvement in attention. Some recent, very small-scale research suggests that the number of sessions necessary to achieve significant and permanent improvement may be considerably reduced by using hypnosis beforehand.

It is important to remember that although these recent controlled studies are promising, they involve very small numbers of children. More work is needed to document the effectiveness of neurotherapy.

These researchers warn that neurotherapy should not be undertaken on the basis of a behavioral diagnosis alone. This therapy is successful with those patients whose EEGs are abnormal, and a confirmation of EEG deficit functioning is necessary before neurotherapy is recommended.

“Attention Deficit Disorder: Diagnosis, Etiology and Treatment” Child Study Journal Volume 26, Number 1, 1996 pp. 1-38

Published in ERN September/October 1996 Volume 9 Number 4

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