Attention Deficit Disorders with/without Hyperactivity

Introduction

Attention Deficit Disorder with/without Hyperactivity (ADD/ADHD) is a common disorder which affects anywhere from 5 to 15 percent of the population (depending on which study is cited and how the testing was conducted). Some experts estimate the number is closer to 20% (to include those undiagnosed and misdiagnosed). It affects four times as many males as females. It can lead to significant under achievement. Statistics show that, if left untreated, almost 80% of those with ADD will repeat one or more school years and nearly one half will fail to graduate from high school. These children are at a greater risk for psychiatric disorders, social skill deficits, and lower academic and employment status.

Unfortunately, many children with ADD/ADHD go through life undiagnosed. These children do not "outgrow" their disability. Fifty percent of children with ADD will have a decrease or loss of symptoms at puberty but the remainder will carry serious symptoms of ADD/ADHD into their adult life. This means that many of these children will need to learn to manage their symptoms. They must either learn coping mechanisms or they will be labeled for life as "troublemakers" or "stupid". It is estimated that as many as 50% of children with ADD also have a learning disability.

Although ADD is a serious disability, many of the characteristics commonly associated with ADD can be positive. Many successful people have been diagnosed with ADD.

In this article, we will look at different aspects of ADD including: The history, current theories on the causes (the influence of diet, brainwave patterns, and hearing loss), testing methods and some of the treatments available today (drug intervention, biofeedback and brainwave entrainment).

Definition of ADD

Attention Deficit Disorder is defined as a group of behaviours in children characterised by excessive motor activity, the lack of ability to concentrate for a sustained length of time, and the lack of normal inhibitions required to follow directions for rules of conduct. In short, these children display:

  • Hyperactivity
  • Impulsiveness
  • Distractibility/Inattention

Research has shown that many of the instructional strategies that enhance the social and academic functioning of normal children can be extremely ineffective when dealing with an ADD child. Schools give these children tasks that are difficult for them to do well. They are expected to be thoughtful, quiet, calm, patient and emotionally stable enough to focus on their work, to ignore distractions, to sit for long periods of time and to delay gratification. Typically, a child with ADD has problems developing the skills necessary to sustain their attention to any given task. And some children with ADD are hyper-focused and cannot move away from the task to which they are attending. The child in the classroom most likely to display significant behaviour problems is the child with ADD. These children experience a great deal of failure and correction.

Some typical behaviours teachers and parents see that may indicate a child should be tested for ADD are:

  1. Failure to complete tasks;
  2. Easily distracted;
  3. Frequently calls out in class;
  4. Difficulty in staying seated;
  5. Always moving;
  6. Lack of motivation;
  7. Difficulty processing information (cognitive learning); and/or
  8. Inappropriate responses to rewards and punishments.

It is important, however, that caution be exercised when these symptoms are observed in a child. Just because a child displays hyperactivity, impulsiveness and/or distractibility, does not necessarily mean the child has ADD. Anxiety and depression may be due to family stress, unrealistic demands on the child or frustration as a result of difficulty in understanding the parent or teacher.

If a child is having academic problems, it is important to determine if these problems are a result of family, emotional, social or ADD/ADHD. They may also have hyperkinesias, conduct disorder and/or a learning disability. The combination of these disorders confound the diagnosis and treatment of ADD particularly if there are two or more additional disorders. We believe that the added factor of stress will also cloud the diagnosis considerably.

History

Although there has been a recent growing awareness of ADD, documentation of its existence dates back as early as 1902, with the English physician, G.F. Still's reference to children with "abnormal defects in moral control ... and wanton mischievousness and destructiveness". He was not aware of any physical reason for the behaviours displayed by these children.

After a severe influenza outbreak of 1918, it was noted that antisocial behaviour and behaviour associated with decreased attentiveness, impulsiveness and hyperactivity were present in some of the children who had influenza related encephalitis (viral inflammation of the brain). In the 1930's, researchers concluded that there were a series of disorders which involved some type of slight brain dysfunction.

The concept of hyperactivity and distractibility was recorded in 1937, when Dr. Charles Bradley, a pediatrician, described these traits in children recovering from viral encephalitis. Dr. Bradley introduced the first pharmacological treatment by administering amphetamine sulphate to some of these children. He found that there was a dramatic improvement in school related behaviours and increase in attentiveness. At the time, it was believed that stimulants increased arousal through brain stem reticular activators.

Prior to 1940, if a child had trouble learning, he was considered to be mentally retarded, emotionally disturbed or socially or culturally disadvantaged.

In 1947, Strauss and Lehtinen developed the concept of Minimal Brain Dysfunction (MBD), then referred to as "Strauss syndrome". During the 1940's and 1950's, psychological tests were being developed to help differentiate MBD from the normal population. It became clear in the 1970's that several disorders existed and these subgroups of MBD needed to be isolated. They needed to test for hyperkinetic (hyperactivity) disorder, various learning disabilities, conduct disorders and attention disorders.

In 1980, the American Psychiatric Association released its Diagnosis and Statistical Manual III (DSM-III), where ADD, ADHD, conduct disorders and learning disabilities were identified. Since this time, minor changes have been observed for the most current description for ADD/ADHD. These have been updated in the recent release of the DSM-IV.

Recently educators have shown increasing concern for students whose lack of academic success is related to their inappropriate behaviour. Educational strategies designed for ADD children continue to be developed and tested in classrooms. We are learning more about how to provide maximum opportunities for success for our ADD students to experience success at school.

The Causes of ADD

Sometimes, parents are blamed for causing ADD symptoms in a child due to poor parenting and discipline or family stress. Though family and discipline problems may be present in some homes of ADD children (because these children can be very challenging and one or both parents also have ADD), family and discipline problems can never cause ADD in a child.

Today, with the advances in neurotechnology, it is continually becoming clear that ADD is a biologically based disorder of the nervous system. There are many theories on what causes of ADD symptoms: frontal lobe malfunction, blocking effect, abnormal brainwave activity, hearing loss, food additives, and abnormal neuro-transmitter functioning.

Frontal Lobe Malfunction

In 1990, researchers at the National Institute of Mental Health studied adults with ADD/ADHD and found that the rate at which these people's brains used glucose was lower than in the normal population. This study also supports the belief that this is a biological condition, not a purely psychological response. Disorders of the prefrontal areas of the brain usually result in inattentiveness, distractibility, and an inability to inhibit undesirable responses. The premotor cortex provides the important function of suppressing automatic responses to specific sensory stimuli. This may be part of the reason why ADD/ADHD children often "call out" and act before thinking.

There is additional evidence that ADD may be the result of a malfunction of the frontal lobes of the brain. The frontal lobe of the brain mediates the inward looking avoidance of the environment by inhibiting the parietal lobe which directs an outward looking approach to the environment. Over inhibition of the parietal lobe leads to heavy focus where it is difficult to change one's focus (as often seen with autistic children). Under inhibition of the parietal lobe leads to easy distractibility from environmental stimuli (as seen with ADD/ADHD children).

Blocking Effect

In 1971 and 1973, Satterfield, Lesser, Saul and Cantwell developed the "low arousal hypothesis" which suggested that the inability to become alert was the cause of hyperactivity in children. These children acted as if they had a kind of "filter" blocking the impact of the sensory stimulation of the different senses. This means that the senses of sight, hearing, touch, taste and smell would not have the impact or reinforcement value that "normal" children experience. It was thought that children become hyperactive in an effort to experience their senses in a more fulfilling manner.

In the study, ADD/ADHD children were placed in a room with only a small number of objects. The children would put objects that could be tasted into their mouths, shake objects that would make a noise when placed near the ears, stare at objects that were visually interesting, rub other objects on their skin, and they would perform activities with objects which would stimulate their sense of balance (such as spin around). After a flurry of activity associated with sensory stimulation, the children would often fall asleep. Satterfield proposed that because of their low arousal, these children easily habituated to sensory stimulation and therefore constantly sought stimulation. Once their sensory stimulation was satisfied, the children relaxed.

Brainwave Activity

The most probable cause of ADD is abnormalities in neurological functioning, involving high levels of theta and low beta levels of brainwave activity.

Our brains produce "sweeping" electrical charges that create a rhythm known as brain wave patterns. These patterns are observable through electroencephalogram (EEG) instruments. EEGs record and measure large amounts of neurons firing in unison. Brain wave patterns are commonly grouped into four different categories:

  • Beta*(14-40 Hz) - generated when awake and alert
  • Alpha (8-13Hz) - usually eyes closed, relaxed wakefulness
  • Theta (4 - 7 Hz) - hypnagogic state, early stages of sleep. Referred to as the dream or "twilight" state.
  • Delta (1 - 4 Hz) - deep sleep.

The Sensorimotor Rhythm (SMR) brainwaves (13-16 Hz) are a special type of beta brainwaves which occur in the motor cortex in the brain (located on the top centre of the head). We produce SMR patterns when we are "quietly alert".

EEG studies have shown that as we get older the amount of beta brainwaves we produce increases and the amount of theta brainwaves decreases. EEG studies have also shown that children with ADD lack normal beta brainwave activity and produce excessive theta brainwaves in the frontal lobes of the brain (where the premotor cortex is located). ADD children produce brainwave activity similar to that found in children three or four years younger than themselves.

The theta activity, located mainly in the right frontal lobes of the brain, increased even more when the child performed a reading or drawing task. Right temporal beta activity also dropped significantly. This area of the brain handles the function of pattern recognition required for reading and drawing.

Even though ADHD children are hyperactive, more are actually functioning in a dreamlike state of mind even during these bouts of hyperactivity. They often become even more "dreamlike" when required to perform the visual task of reading or drawing.

Joel Lubar was the first researcher using EEG, to show that ADD/ADHD children have excessive production of theta or alpha and difficulty in producing beta activity above 14Hz. To date, thousands of psychologists have been using neurofeedback training with their ADD clients.

Hearing Loss

Many parents have wondered if their child had developed ADD as a result of an ear infection or temporary hearing loss. At this time, research does not exist relating hearing loss to ADD. However, a study comparing hereditary deafness to acquired deafness as a result of disease has been completed. The research published in 1993 by Desmond Kelly and his colleagues showed that males with acquired deafness through infection of bacterial meningitis or congenital rubella were more hyperactive, impulsive and had more "dreamlike" when required to perform the visual task of reading or drawing.

Joel Lubar was the first researcher using EEG, to show that ADD/ADHD children have excessive production of theta or alpha and difficulty in producing beta activity above 14Hz. To date, thousands of psychologists have been using neurofeedback training with their ADD Clients.

Foods and Additives

There are some medical professionals who believe that ADD children never react to food additives. And there are also those who believe that some children and teenagers act or behave in an unacceptable manner simply because of unsuspected or undetected allergies or manner simply because of unsuspected or undetected allergies or intolerance's. They report that even the children's appearance and physical characteristics can change. There are over 4000 chemicals used in processing food (80% of these are flavours and colours). Many food colourings are derived from coal-tar products and are believed to be carcinogenic as well. Although many doctors overlook the influence of food additives on hyperactive behaviour, many parents with a hyperactive child can tell stories about their child's reaction to ingesting a glass of orange pop or some red-coloured candy.

In his book, "Why Your Child is Hyperactive" Dr. Benjamin Feingold states that half of the cases of hyperactivity are due to allergy reactions to food or chemical additives in food.

A 1994 double-blind study by Boris and Mandel showed that foods, additives and dyes can cause large swings in hyperactivity in ADD children. In the study, a group of children were tested for allergies to dogs, cats, molds, grass and other plants. Any children having an allergic reaction to two or more of these antigens were placed in the allergy group. None were tested for food allergies. During the study, the children were not allowed to have dairy products, wheat, corn, yeast, soya, citrus, egg, chocolate or peanuts. Every day, the parents rated their child using the Conners Hyperactivity Scale. On certain days, the banned foods were included into the child's diet without the parent's knowledge. On these days the parents recorded high amounts of hyperactivity with 80% of the children. Only 20% of ADD children with NO allergies showed an increase in hyperactivity on the test days. This study shows that ADD/ADHD children with common allergies react to foods, additives and food dyes.

Response of ADD Children to Elimination Diet on basis of Allergies

SubjectsHyper ResponseNon-Hyper Response
Non Allergic4 (21%)5 (71%)
Allergic15 (79%)2 (29%)
Total197

In another study, a number of ADD/ADHD children were placed into two groups. In the first group, the children ate typical party foods: cookies, ice cream, nuts, milk. The other group ate only vegetables and salads with no milk, wheat, corn, eggs or sugar in any form. Forty-five minutes after consuming the items served, many of the children from the first group began to feel ill, were unable to write their names or sketch well, created disturbances, and showed silly or aggressive behaviour. Because most tests look at behaviour and not brainwaves or neuro-transmitters (brain chemicals), some of these children may have been misdiagnosed as having ADD.

Reaction to Milk
Before Test - somber
During Test - angry, screaming irritable, whining, uncooperative
After Treatment - happier

Reaction to Egg
Before Test - quiet and calm
During Test - rocking in seat, kicking on floor, ear lobes red
After Treatment - quiet, calm, more in control

Neuro-Transmitter

The chemicals in the brain that transmit messages from nerve cell to nerve cell are called neurotransmitters. These neurotransmitters help the nerve cells store and relay information and send out billions of messages to all parts of the body to control thought and movement. Some research suggests that ADD children don't manufacture enough of these neurotransmitters, particularly dopamine and norepinephrine. MHPG and homovanillic acid are lower in ADD children. The lower the level of serotonin, the more hyperactive the child. One cluster of nerve connections, which determines various aspects of inhibition or self control, relies on a large supply of dopamine and norepinephrine. Some experts believe that ADD may be caused by breakdowns or imbalances in neurotransmitter systems. When drugs are used in treatment, they are thought to correct this chemical imbalance and allow normal functioning of the brain.

Diagnosing ADD

It is important that parents and teachers not try to diagnose children based on handouts and books about ADD (including this one). The following section is for information only and is not intended to be used as a diagnostic tool. If you suspect that your child is ADD, we encourage you to have your child diagnosed by a qualified clinician or visit your family doctor. It is also important to rule out any other physical or psychological cause for the symptoms.

The criteria used by professionals to diagnose ADD is shown in the DSM-IV (Diagnostic Statistical Manual of Mental Disorders), developed by the American Psychiatric Association. To try to diagnose ADD by using only the criteria listed in the DSM-IV, would be of no value because we are all biased about what we consider appropriate behaviour in a child (e.g.. how often we think a child should fidget with his hands or blurt out in class). One person's observations and judgments may find a certain child to appear ADD. To another person, the same child would be thought of as just a fun, active boy or girl. Too many parents and teachers try to use the DSM-IV to determine if they believe a child to be ADD. This is called a subjective assessment and may lead to an incorrect and potentially harmful diagnosis.

From the DSM-IV - Attention Deficit/Hyperactivity Disorder

  1. Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level.

    Inattention

    1. Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
    2. Often has difficulty sustaining attention in tasks or play activities.
    3. Often does not seem to listen when spoken to directly.
    4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behaviour or failure to understand instructions).
    5. Often has difficulty organising tasks and activities.
    6. Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork).
    7. Often loses things necessary for tasks or activities (e.g.. toys, school assignments, pencils, books or tools).
    8. Is often easily distracted by extraneous stimuli.
    9. Is often forgetful in daily activities.
  2. Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level.

Hyperactivity

  1. Often fidgets with hands or feet or squirms in seat.
  2. Often leaves seat in classroom or in other situations in which remaining seated is expected.
  3. Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feeling or restlessness).
  4. Often has difficulty playing or engaging in leisure activities quietly.
  5. Is often "on the go" or often acts as if "driven by a motor".
  6. Often talks excessively.

Impulsivity

  1. Often blurts out answers before questions have been completed.
  2. Often has difficulty awaiting turn.
  3. Often interrupts or intrudes on others (e.g.. butts into conversations or games).
  1. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
  2. Some impairment from the symptoms is present in two or more settings (e.g. at school (or work) and at home).

Objective measures and testing must be used to accurately determine if a child is ADD from the criteria listed in the DSM-IV. Objective measures are based on statistical evidence rather than opinion and observation. Objective ADD tests relate to the criteria in the DSM-IV above. They are developed by asking subjective questions to several hundred people and compiling the responses. For example, the number of times "normal" children fidget with their hands or blurt out would be tallied and that number would set the "true" criteria for normal children. ADD children would fall somewhere outside of that range. This would be an objective measure.

Tests used to diagnose ADD by a competent clinician will be "objectivised" tests. This means that thousands of children will have been given the same test and their responses are measured and tabulated. The results of your child's tests will be compared to the results of the tests of these "normal" children of the same age and sex as your child. The following are additional examples of tests and measures to diagnose ADD.

Wechsler Intelligence Scale for Children (WISC-R)

The Conners Teachers' Rating Scale has been used as a routine screening device for ADD/ADHD in a number of settings for many years as well as for monitoring the effects of drug therapy. It is one of the most frequently used and cited rating scales in cognitive behavioural treatment outcome studies.

ADHD Rating Scale (Berkeley 1991)

The ADHD Rating Scale reflects the conceptualisation of the disorder as described in the DSM-IIR. The 14 Symptoms currently used by professionals in diagnosing this disorder in children are listed in this rating scale.

Academic Performance Rating Scale (APRS 1991)

The APRS is a behavioural rating scale designed to be completed by teachers. It has been shown to correlate well with standardised test results.

Computerised Tests

Some tests are based on a person's interactions with a computer. The keypad or mouse movements are measured and the results are recorded and tabulated by software. Computer testing can also measure response times which can offer unique insights into a child's mental abilities. The results are not skewed by the personality or speech of the tester nor by culture of the child.

There are a few computer-based diagnostic tools available. One is called the Test of Variables of Attention (TOVA) developed by Larry Greenberg. This 22-minute test is a proven and objective standardised test of attention to a computer screen to diagnose and monitor the treatment of ADD. The TOVA test resembles a computer game. When the correct target appears or is sounded the person presses the special "firing" button. This test measures attention by evaluating hyperactivity, impulsivity, variability and response times and can test narcolepsy. It is available from Universal Attention Disorders or from Computronic Devices Ltd.

Another computer based test, developed by Joseph Sandford, is called the Intermediate Auditory Visual Attention Test (IVA). This test is similar to the TOVA but runs much shorter in time. The IVA is available from Brain Train Inc.

Some researchers believe that the TOVA's longer running time is better to assess ADD. Both of these computer tests are also helpful in determining learning disabilities.

New Understandings on "Types" of ADD

Researchers have recently come up with different categories or types of ADD. These new concepts were presented at the Future health and AAPB conferences in 1997. This new paradigm starts with the premise that people with ADD swing between extremes of under- and over-focusing without much in-between. This behaviour varies from at one moment being in a cloud to the extreme of total focus - not being able to disengage from the task. Parents often observe this watching their ADD children playing video games. Where most normal people can easily switch their focus from one task to another, those with ADD can only switch their focus from one task to another, those with grabbing stimulation. Once stimulated, they often find it quite hard to shift their attention. One form of ADD involves those who are under-focused (UF), trying to turn up their focus and those who are over-focused (OF), trying to turn it down.

The classic type of ADD involves those who have poor concentration, are prone to impulsivity and are physically hyperactive when over aroused. They basically act without much fore thought and have a tendency to roam about with no particular direction (also called roving).

On the other end of the spectrum are those who are hyper-focused and usually over aroused physically. These people easily over react to stimulation, produce excessive mental and physical energy with intense thoughts, actions and/or feelings that can be obsessive and very hard to switch off. They are not hyperactive in the sense of twitching about with no particular action in mind. These children are often relentless in their pursuit of a desired goal.

In between these two extremes are the people with ADD who are "mixed". They frequently shift between over- and under-focused several times a day. Inconsistent arousal is the primary problem for this in-between type, rather than weak or strong focusing ability. Their primary challenge is to maintain enough stimulation for follow through, but without too much stimulation. This type is hard to diagnose because their behaviours can be radically different depending on the environment. They are termed the restless type of ADD children.

Classic ADD people typically report success with Ritalin therapy. The "mixed" and "over-focused" types report paradoxical effects with Ritalin, where some report feeling too sedated and others become too agitated. The mixed- and over-focused types typically generate more alpha compared with the classic type who have excessive theta.

Susan and Zigfreid Othmer, of EEG Spectrum in Los Angeles, California, have also been evaluating ADD in terms of over- and under-arousal. Using neurofeedback, they train 14Hz. feedback followed by 10Hz. feedback on the ADD children who score impulsive on the TOVA. They train for 17Hz. on the children who show slow response times (high latency).

This new understanding to classifying or categorising ADD may help increase the likelihood of success for some therapies or treatments that seem to work for some people and not others.

Treatments for ADD/ADHD

There is no known "cure" for ADD. Often people with ADD simply learn to manage their symptoms. There are a variety of treatments available today for ADD:

  1. Medication
  2. Homeopathic
  3. Change the environment - parental training to help child cope, modify school and home life
  4. Learning techniques - cognitive behavioural training, social skills training, counselling, peer relationship
  5. Neurobiofeedback
  6. Brainwave Entrainment

Any one of these approaches alone is not as effective in dealing with the wide range of problems experienced with ADD as a "multi modal" approach (example, using both medication and behaviour management at home and school). A combination of parent-centered and child-centered behavioural treatments has an additional effect in improving behaviour. The parent must be educated to understand the cause and symptoms of ADD and how to incorporate positive behaviour techniques and strategies for dealing with their child.

Drug Therapy

At the present time, the most frequently used treatment for ADD is psycho stimulant medications alone. However, many parents are rightfully concerned about the contra-indications to these drugs and would prefer an alternative for their children. Of the children treated with stimulant drugs, 75% exhibit short-term behavioural, academic and social improvements. These drugs achieve their effect by increasing the arousal or alertness of the central nervous system. The most commonly used stimulants are methylphenidate (Ritalin), pemoline (Cylert) and dextamphetamine (Dexedrine). Although psycho stimulant medication is beneficial to many ADD children, it should not be the sole form of therapy, but one part of a total treatment plan. Any child who needs medication to affect behaviour also needs behaviour modification techniques so that the child and the parents can overcome the disabilities. Parents must be advised on how to adapt their responses to the child's behaviour so the child learns to control their own behaviour.

Ritalin is usually the drug of choice for stimulant therapy because it has been shown to have less effect on the child's growth hormones than other stimulants. Its effect begins one-half hour after ingestion and lasts for four to five hours. The precise action of this central nervous system stimulant is unknown but is thought to be the result of increased nerve impulse transmissions by causing the release of norepinephrine and dopamine from nerve terminals in the brain. The child experiences increased mental alertness, decreased hyperkinetic activity, enhanced ability to concentrate with less distractibility. The properly prescribed dosage of Ritalin is a delicate balance. If not enough is taken, the results are poor. However, if too much is taken, the child will become over stimulated. Extreme caution or complete avoidance of some of these medications should be exercised particularly for some children with cardiovascular disease, pre-existing tics, allergy or sensitivity, and/or psychosis. You should discuss theses possibilities with your physician. Parents should also be aware that there are some contra-indications to these drugs used in the treatment of ADD. Sometimes, children who take Ritalin show slower growth and lower weight. Other common side effects are: insomnia, headaches, dizziness, drowsiness, nausea, constipation and stomach pain.

Bio feed back

Some biofeedback therapists are performing brainwave training, sometimes referred to as Cognitive Re-regulation. The purpose of the program is to train ADD children to regulate their brain wave activity through the use of direct neurofeedback. The goal of the training is to provide the children with the skills to change their brain waves in order to improve their ability to attend and regulate behaviour. The children are trained to produce less theta brainwave activity and more beta brainwave activity, which allows them to be more alert, aware and fulfilled by their senses. In effect, they are training portions of their brain to function more effectively. There is an intensive selection process to determine each child's suitability for the program. The initial screening involves looking at a "brainmap" of the brainwaves to eliminate those children who will unlikely succeed with biofeedback training. The successful candidates are given biofeedback training of at least 40 sessions over a six-month period. They must learn to increase their SMR or Beta brainwaves while at the same time lower their Theta brainwaves (all the while trying to sit still). If, after the first several sessions, the child is unsuccessful in producing these results, the biofeedback is usually discontinued. Of the children who do learn to train their brainwaves, 70%-90% will successfully reduce their ADD symptoms.

Brainwave Entrainment

Brainwave entrainment (BWE), is a non-drug approach to treating ADD, flashes of lights and pulses of tones at specific brainwave frequencies. There is increasing research indicating BWE as a viable and effective treatment for many people with ADD. BWE is becoming a popular alternative to drug therapy because there are no harmful side effects and the results are long lasting. It is becoming increasingly more popular than biofeedback because it is convenient to use, cost effective and results are seen much quicker than with biofeedback. BWE works by stimulating the visual and audio cortex of the brain at a specific frequency which in turn causes the brain to resonate at that same frequency. It overcomes the blocking effect by producing a tremendous amount of visual and auditory stimulation, which involves most of our sensory processing. Through the principle of brainwave entrainment, the missing SMR (Sensorimotor rhythm) at 13 to 16Hz frequencies or beta frequencies can be generated within the brain easily and effortlessly. In 1993, Dr Russell demonstrated that auditory/visual stimulation increased IQ and significantly improved reading, memory and spelling in learning-impaired elementary school students. The parents and teachers also noted that the students became less anxious, less dependent, had better anger control, and improved their academic attention and interests.

An unpublished study by Dr. Norman Shealy demonstrated that 10Hz white light BWE stimulation for 30 minutes affected the following neurotransmitters:
(Average Results from 8 Subjects)

  • Melatonin - decreased 6%
  • Beta Endorphin - increase 14%
  • Serotonin - increase 23%
  • Norepinephrine - increase 18%

Dr. Shealy did not test for dopamine. However, norepinephrine which has been shown to also be low in children with ADD, increased substantially.

An added bonus to BWE is that it can be used by the entire family. The ADD child, parents and other family members can use the sessions. Parents can use the relaxation sessions. This will help them to be less reactive to the ADD child. While the ADD child entrains to the session, a cassette tape containing interesting but unusual sound effects or a desensitisation tape can be used to help the child develop associations of relaxation when exposed to new or reliving upsetting experiences. This new relaxation response will become a natural response for the child in other areas of his life while learning new concepts and exposed to change.

Before beginning BWE, we suggest that you have your child assessed using a TOVA test and brainmap. TOVA testing would be helpful to determine the child's level of arousal. A highly aroused child may improve better with a slower frequency than is typically used (under aroused with hyperactivity). A brainwave spectral analysis brainmap would help to ensure that the ADD-symptoms are actually caused by ADD and not anxiety-related.

Behaviour Training

It is extremely beneficial for ADD children to receive training in methods of self-control, learning strategies, organisational skills, attention focusing, and social skills.

In some cases it might be necessary to receive psychological therapy for the ADD child to deal with possible depression, negativity, disillusionment and other emotional troubles.

Miscellaneous Treatments

There has been limited research on giving precursors (the chemical building blocks of neurotransmitters) to ADD children. The results are somewhat encouraging but this requires further study.

Caffeine was in widespread use prior to the development of Ritalin. It has an excitatory, stimulating effect on the central nervous system. Some research indicates that caffeine stimulates the production of dopamine and norepinephrine although other studies have failed to show significant changes.

When using any stimulant therapy (stimulant medication, BWE, biofeedback training) ensure that the proper amount of stimulation is applied. Over stimulation may cause even more hyperactivity.

Whatever treatment approach you choose, it is important that you and your child receive the support needed. Consult the Yellow Pages or consult with your child's school counselor or family doctor for the names of ADD support groups in your area. Attend meetings or courses on ADD that are often offered through schools and community health clinics. There are many support groups available to provide education for parents and family members to gather helpful tips and share stories on both problems and the good aspects of ADD.

Learning Difference

An area of significant difficulty for most ADD children is academic performance and achievement. It has been estimated that anywhere from 20% to 50% of ADD children have at least one type of learning difference (LD), with up to 40% of these children placed in specialised programs. It is further estimated that 23% to 35% are retained at least once before reaching high school.

Often, a child with learning differences will develop stress reactions associated to specific situations and the learning disability puts them at a disadvantage. For instance, a child with poor motor planning doesn't run, kick balls, bat balls or handle a hockey stick as well as other children. Because of this, other children at school may make hurtful remarks toward the LD child. Soon the LD child may develop an anxiety reaction when performing the particular activity and in time, the performance becomes even worse. This response can quickly turn into a sense of hopelessness. The anxiety reaction and sense of hopelessness the child feels when receiving HURTFUL criticism (as opposed to constructive criticism) will apply to ANY activity, including math, art, piano lessons and so on.

When considering learning differences, it is important to determine which stage of the learning process the learning difference occurs. The learning process is best explained as follows:

Input-Integration-Memory-

The learning difference can be caused at any level of this learning process.

Input - Input is when data from our senses is received into the brain. This would include the senses of sight, sound, taste, smell and touch. This input might be impaired due to near-sightedness or a hearing impairment (possibly from an ear infection).

Integration - Integration is when the sensory data is processed and interpreted. Auditory and visual dyslexia, and scotopic sensitivity syndrome are examples of integration problems.

Memory - Once the child has input and processed the information, can it be remembered? An example of memory problem is when a child can remember and complete one task or instruction at a time. However, when two instructions are given at the same time, both instructions are forgotten.

Output - Once the child has completed the learning cycle to this point, is the ability to make the appropriate responses in place? Some children may have trouble with motor planning. They know how to play hockey but bump into all sorts of other players while trying to move the puck or they have trouble speaking or printing.

Some of the more common learning differences associated with ADD occurs at the integration level of learning. These are usually visual perception or auditory perception disabilities.

Visual Perception Disabilities

Depth Perception - Unable to judge distances. The child may have trouble planning movements such as walking or running. Consequently, the child will often bump into things.

Figure Ground Perception Unable to focus on the primary object other than background activity.

Scotopic Sensitivity syndrome Words on a page seen to wiggle. White paper can appear blinding to the child. In some cases, specially tinted eye glasses have been very helpful in correcting this disorder.

Auditory Perception Differences

Auditory Lag Some children cannot process sound inputs as quickly as others can. The child needs more time to focus their thoughts on the message in order to understand. While the teacher is stating a sentence, the child is still concentrating on the previous sentence, which means they will miss the new sentence entirely.

Subtle Differences Some children have trouble sorting subtle differences in sounds. They will confuse words like "ball" and "bell", "blue" and "blow", "can" and "can't", "I" and "in", "stared" and "started".

What can I do as a Parent?

An ADD child will respond better in structured one-on-one situations with an adult. Typical use of behavioural contingencies (rules and consequences) are usually ineffective with an ADD child.

As frustrating as it can be for a parent to deal with a child or teen with ADD, remember - the child is equally frustrated. They is doing the best they can. They have learned certain patterns and responses that work "best". What we want to do is help the child learn new and more effective responses and behaviours. The ADD child wants to do well and be successful. But they do not have the success in the "normal" expectations that are put upon them. So, they continue to "get into trouble". Sometimes these children are incorrectly labeled as "lazy" or "bad".

When the ADD child and the rest of the family understand that ADD is a neurological condition and not just "bad behaviour", the first steps towards improving the child's self-image and behaviour will be easier.

And remember that your child will still experience normal mood swings, likes and dislikes and fluctuations in energy level. We all have "good" days and "bad" days.

There are a number of supportive actions that parents can take. We have made the following suggestions. You may want to integrate some or all of these into your home life.

  1. Give your children (and each other for that matter) a minimum of three hugs a day! We also practice "grugging" (group hug). This can be more effective than almost all other suggestions we give here. If the child won't hug you, be patient. This may be foreign in some households and it may reflect unresolved tensions (and part of the behaviour problems) or may indicate that the child is deficient in loving, physical contact that is so important for healthy development. Please don't force a child to hug you. To help encourage a young child to have fun hugging, hang up post-it notes or pieces of paper with "FREE HUG" written on them. The children will have fun collecting their "free" hugs. Encourage siblings to hug each other as well. Remember, encourage, do not force, hugging.
  2. Don't say "no" every time your child asks for something. Say "yes, after you....(e.g.. help with dishes, homework or answer me five quick questions"). The "yes" answer breeds a positive feeling for both of you. "After you help with..." develops work ethic. Rewarding the child provides incentives. Remember, often your child desires your presence while doing a chore. Even if you don't actually help with the chore, they often will just like your company.
  3. Remove ALL caffeine from your child's diet, including all coffee, some soft drinks, chocolate and some over-the counter drugs (please read labels carefully or ask your pharmacist). Caffeine may interfere with prescribed medication.
  4. Ensure that your child (and the rest of the family too!) eats a variety of fruits and vegetables every day.
  5. Eliminate foods with additives and dyes. Do not use cereals, chips or snacks with the additives BHA and BHT. These chemicals are added to the packaging of many cereals and snacks to add "freshness". Discontinue use of foods with dyes in them. This would include orange coloured cheese and fruit drinks. If the fruit drink does not say "juice", then it will likely contain sugar, food additives and artificial flavour and colour. The rest of your family will cooperate much better if you lead the example. If you suspect that your child has allergies to dust, pollen, grasses, molds or food, we suggest that you consult with an allergist for testing and guidance.
  6. Spend "one-on-one" quality time with your child every day. Engage in activities in which you both participate and where there is no judgment or performance criteria placed upon the child. For example, play games in which there is no winner/loser, draw pictures, sing songs, etc.
  7. Maintain a routine regarding daily activities and expectations. Be firm that the child conforms to these standards. Put in place both positive and negative consequences for the child.
  8. Be consistent! Do not back down from a family policy because your child is nagging you to do so.
  9. Depending on the age of the child, sending them to a 3- to 5- minute "time-out" as a consequence for inappropriate behaviour can be effective. A time-out is not a punishment. It is meant to be quiet time for the child to reflect and get "grounded". Send the child to a room with nothing of interest in it (not to their bedroom where there are usually many distractions).
  10. Focusing on rewards as consequences for desirable behaviour will be more effective than punishments for undesirable behaviour.
  11. Start a system where all privileges such as TV, snacks, video games, small toys, etc. are earned. These activities are not "rights".
  12. If your child is often fighting with other children at school, plan special events such as "video night" complete with popcorn when they bring home a classmate they have been in conflict with.
  13. Avoid using labels when speaking to your child. When disciplining your child use words directed at the behaviour, not the child. For example: "That was a bad thing to do" rather than "You are bad for doing that". When praising a child, choose concrete and specific words instead of general and abstract descriptions.

And last but not least, we tend to focus on the negative aspects of ADD. Help your child see that they are very special and unique. Some ADD traits can be viewed as a benefit. ADD children tend to be: Full of energy, willing to try new things, willing to take risks, ready to talk, able to do several things at one time, smart, in need of less sleep, spontaneous, able to think of different and new ways of doing things, happy and enthusiastic, imaginative, creative, fun to be with, inquisitive, quick to forgive, never boring, playful, honest, interested in new things.

Cognitive Exercises

Whatever treatment you choose for your child, it is beneficial to help the child learn new responses to certain situations. Some of the following exercises may be practiced with your child to help them learn to pay attention and listen for instructions. You may also practice these exercises while using the DAVID Paradise, a brainwave entrainment device available from Comptronic Devices Limited.

Five-Questions Exercise

This exercise is intended to discourage impulsive behaviour, promote thinking and reinforce a system of small rewards.

Whenever a child impulsively wants something, have the child answer five questions in order to "earn" what it is they wants. Base the questions on schoolwork or things your child has learned at home (e.g.. from the news, etc.). Include a wide variety of topics such as math, social, spelling and general interest. Make the questions challenging, but not too difficult. Do this several times a day if needed.

Auditory-Lag Exercise

Give the child a clear instruction. When the child has completed the assigned task, offer a reward. Make the instruction somewhat challenging so the child will succeed most of the time. After the child has become competent at this, get the child's attention and deliver the instruction more quickly. As the child becomes proficient make the instructions more complex. Offer rewards for their successful completion. Make this a game and practice it every day. Play this game during a Paradise session.

Subtle-Difference Exercise

Make up sentences with the incorrect word of similar sounding words in them. E.g.. "Please do not bounce the bell in the house." Teach the child to point out how the key word does not make logical sense within the context of the sentence. Make this a game and practice it everyday. Play this game while on the Paradise.

Figure-Ground Exercise

Similar to the "Five-Question" exercise. Using flash-cards with addition, times-tables or pictures for the child to identify (whatever is age appropriate), place yourself in between the child and a distraction (e.g. TV). Encourage the child to learn to focus on the card (figure) or yourself and not the distraction (ground). Make this a game and play it everyday.

Desensitisation

Talk to your child to determine what activities or situations cause the child to feel anxious. Write a description of this activity (include as many senses as possible) in a paragraph or two. For example, if the child feels anxious when the teacher calls upon them for an answer in class, describe what the classroom looks like, what sounds are heard, etc. Then, while the child is using the Paradise or practicing some other form of relaxation technique, read the description and have the child imagine the situation in their mind for approximately 10 seconds. Then instruct the child to take about 30 seconds to relax. Repeat this process several times during the course of a session. In later sessions, have the child visualise doing the activity feeling relaxed and confident. Repeat the visualisation process several times over several weeks or as required. Practice the activity with the child (e.g.. having fun batting a ball, showing flash cards, etc.). Actually improving the child's performance while having fun is the best medicine.

What can I do as a teacher?

The key to effective classroom management of ADD children is providing a balance between structure and flexibility. Many ADD children may be more restless and over active than other children.

  1. Provide consistent routine with intermittent changes.

  2. Reduce work load and/or shorten work periods.

  3. Make rules and directions clear, specific, and external (e.g.. word and picture cues). Review rules and directions frequently.

  4. Set time limits for work composition.

  5. Provide incentives and rewards for smaller work portions and gradually increase.

  6. Tell the student what you want to see them doing rather than what you don't want to see.

  7. Specify consequences of appropriate and inappropriate behaviour in advance.

  8. Provide opportunity for productive, legitimate movement.

  9. Provide external supports (e.g.. posters, homework sheets, monitoring forms, anagram reminders).

  10. Clearly specify or break down tasks into small units. Set requirements and time limits.

  11. Promote socialisation by creating opportunities for dyadic interaction and/or social skills training sessions.

  12. Provide a model of problem solving by modeling and teaching steps of tasks.

  13. Keep your style as dynamic as possible, use novelty and attractions.

  14. Provide a model of organisation, a designated place for everything. Help the student organise belongings and work materials.

  15. Pace work, lecture, and instructions to allow for processing time.

  16. Allow periodic self-pacing, but avoid open-ended tasks.

  17. Provide variable access to information (e.g.. hands on, lecture, reading) and ensure opportunity for over learning and peer coaching.

  18. Provide predictability in the routine (e.g.. advance warnings for transitions or changes).

  19. Give immediate feedback where possible.

  20. If you must use verbal reprimands, make them immediate, unemotional, brief, and in close proximity to the student.

  21. Increase opportunities for one-to-one contact between teacher and student.

  22. Schedule academic tasks in the morning.

  23. Provide an extra set of textbooks for the home.

  24. When evaluating performance, use various assessment strategies (e.g.. oral, written, anecdotal).

  25. Be positive, model positive self-talk and recognise the student's accomplishments and appropriate behaviours.

  26. Traditional closed classrooms are preferred over open-style classrooms (which magnify auditory and visual distractions).

  27. Seat the student at the front of the class and close to the speaker. Seat away from frequent traffic areas.

  28. All extraneous noises and visual stimuli should be minimised, especially when giving instructions and teaching new concepts.

  29. Give verbal or physical cues such as lightly touching the shoulder or desk or using a "secret" signal. It is important not to embarrass the child.

  30. Give directions in clear and simply-constructed sentences. Avoid complex or compound sentences.

  31. Talking slower and frequently restating oral information will aid in comprehension.

  32. Verbal instruction should be accompanied by visual reference (pictures, diagrams, outlines models) and demonstration.

  33. Since memory is best for real-life events or occurrences, experiential approaches to learning and concrete examples are beneficial.

  34. Periodic feedback should be required from the child to ensure that they are listening to the speech message.

  35. Instructions may need to be repeated following each class on an individual basis, if the child has not been able to comprehend the material. Encourage the child to repeat what they think was said. Assignment books are often helpful.

  36. Move into new areas of academic instruction gradually, always reviewing past material so that the child can experience some degree of success.

  37. New concepts and vocabulary should be previewed at the beginning of a lesson and highlighted at the end of a lesson. Writing them on the board may also help reinforce the student's attention to them.

  38. Involve active participation by the student, as opposed to passive listening. Reciprocal teaching techniques in which students assume the role of teacher in small groups will help maintain attention and reinforce comprehension of material.

  39. Seatwork and passive listening tasks should be punctuated with breaks or activities which provide opportunity for the student to get up and move about.

  40. You may want to record lessons or instructions for the child to review at home.

  41. Use records, tapes and other tools which have earphones to help the student develop the ability to listen and understand, while shutting out conflicting sounds in the classroom.

  42. Care must be taken that disciplinary actions are not taken against a child when their misbehaviour or lack of willingness in participating in a group activity or in completing a task may be due to confusion caused by their attention problems.

  43. Encourage the child to ask questions when they are confused. Establish a positive feeling about asking questions or asking for repetition.

  44. It may be helpful to plan more difficult lessons early in the day or alternate lessons that require greater auditory attention with those that are more visual or independent.

  45. Give the child praise and reinforcement for even minimal improvement. Encouragement and support are key factors in developing patterns of success.

  46. All requests for correction in behaviour should be made in such a way as not to draw negative attention to the student (do not call the student by name and tell them to listen).