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Pay attention to attention deficit disorders

As the classroom environment replaces the sun-filled days of summer, children with excessively high levels of energy or inattentiveness are soon identified as “problem” kids by their teachers and the school system.

Frequently, the terms “attention deficit disorder,” ADD or ADHD are used to describe these children, and requests for evaluation and/or medications is made. What is a parent to do? This column will briefly describe the nature of the disorder and provide some information about alternative treatments.

So, what are ADD (inattentive) and ADHD (hyperactive/impulsive) conditions? Historically, they are characterized by behavioral symptoms of inattention, impulsivity and hyperactivity. The psychiatric criteria for diagnosing the disorder are:



— Inattentive type: A child is diagnosed with the disorder if six or more of the following apply:

1) Often fails to give close attention to details or makes careless mistakes in school work; 2) often has difficulty sustaining attention in a task; 3) often does not seem to listen when talked to directly; 4) often does not follow through on instructions and fails to finish school work; 5) often has difficulty organizing tasks; 6) often avoids tasks that require sustained attention; 7) often loses things necessary for tasks; 8) is often distracted by extraneous stimuli; 9) is often forgetful in daily activities.




— Hyperactive type: A child has the problem if six or more of the following apply:

1) Often fidgets with hands or feet; 2) often leaves seat in classroom or other settings where remaining seated is expected; 3) often runs or climbs excessively in inappropriate situations; 4) often has trouble playing in leisure activities; 5) Is often “on the go”; 6) often talks excessively; 7) often blurts out answers before the question has been completed; 8) often has difficulty waiting for his or her turn; 9) often interrupts and intrudes on others.

This disorder is known to affect 5 to 15 percent of the population, and is four times more likely in boys than in girls. Behaviorally, if your child meets the above criteria, he or she more than likely has ADD. Seeking a solid clinical evaluation will help sort this out from other disorders, such as oppositional and defiant disorder or childhood depression.

From a brain point of view, ADHD has been associated with anatomical and biochemical abnormalities in the frontal lobes. From a brainwave perspective, the frontal lobes of these children show “slow-wave” activity; it is as if they are drowsy.

Inattentive types are, in fact, frequently found to be “daydreaming.” Some researchers suggest that ADHD children become hyperactive as a means to fight off this drowsiness, and soon develop behavioral repertoires that annoy their teacher.

Medical treatment of this disorder commonly involves prescribing “psycho-stimulants.” Medications such as Ritalin or Cylert are commonly used to chemically stimulate the brain and nervous system, essentially “waking” the child up so that he or she can more easily pay attention.

Some parents are reluctant to “drug” their children and seek alternative ways of treatment. One potential pathway is nutrition. Some researchers have found that children become hyperactive when they are given foods they are allergic to.

Refined sugar is a common culprit. Once all sugars are removed from the child’s diet, the inattentive or hyperactive behaviors disappear. For others, it may be wheat products. A good nutritional consult can help you figure this out.

Two behavioral treatment approaches have emerged over the last 20 years. In “neurofeedback,” the brain waves of the child are monitored using an EEG biofeedback machine, and the child is trained to wake up the brain using the EEG feedback.

Such training has been shown to be as effective as psycho -stimulants in reducing ADHD and inattentive symptom and usually takes 30 to 60 sessions. Once learned, the child retains the skill.

Another method that has emerged in the last five years is the “interactive metronome.” The child is taught 14 rhythmic-timing tasks, such as hand clapping, thigh slapping, foot tapping, etc. A pacing tone is presented to which the child must keep precise timing. We are talking very precise timing, within 18 milliseconds of the tone.

Guide tones are also presented to tell the child if their claps or taps are early or late. When they are right on, the guide tones are silent. The developers of this technique essentially state that the technique refines the planning and sequencing circuits of the brain. It is thought to wake up the frontal lobes and improve how they operate.

Clinical studies on the use of the interactive metronome have shown significant improvement in ADHD and inattentive symptoms after approximately 14 sessions. Further, research conducted at the Sierra Health Institute in Nevada City has shown that interactive metronome training speeds up the brain’s activity in the frontal lobes. (For more information on this technique, see the Web at http://www.interactivemetronome.com.)

Alternate methods of treating this disorder should be considered before psycho-stimulant medications are selected. Beware that these alternative therapies will take more time from the parent, and their clinical effectiveness may takes weeks, rather than days, to appear. Lastly, for some children, medication may ultimately be necessary to help control the problematic behavior.

Jeffrey R. Cram, Ph.D. is a holistic psychologist who offers psychotherapy, biofeedback, neurofeedback, flower essences and music therapy. He is the director of the Sierra Health Institute in Nevada City. Contact him at 478-1334.


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