Development of Attention.
Many techniques have been developed to address Attention Deficit/Hyperactivity Disorder (ADHD) symptoms. Whole models have been developed with multiple techniques (e.g., medical model, nutritional model, behavioral model). Parents have a wide variety of resources but the main one being pushed today is the medical model.
Few will deny that medicine is very effective in treating ADHD symptoms with many children. It can successfully be argued that the medical model offers the best approach to treat the majority of children and adults with ADHD symptoms. However, the medical model does have its limitations. The main limitation being that when the medicine wears off, the problems with ADHD continue to remain. However, some children will outgrown many of their symptoms as they are older. Some of them will not.
The Neuro-developmental model addresses this limitation in the medical model. If Neuro-development is successful, children outgrow many of their symptoms early or they are able to learn how to concentrate with or without the medicine. The goal of neuro-development is to be able to focus and attend and sit still without the need of medication. Unlike medication, there are no serious side effects of neuro-development. Neuro-development is relatively costly in terms of time when compared with medicine. Neuro-development requires time to complete repeated exercises in order to be effective. Exercises are designed to develop neuro-pathways that may be lacking or underdeveloped. The same principles are used in physical rehabilitation, developmental vision therapy, learning to play the piano, and speech therapy. Spending the time to do the practices or exercises will strengthen skills.
There are a wide variety of neuro-developmental exercises now available to treat ADHD symptoms. The advantage of these techniques is that once the neuro-developmental pathways are developed or learning has taken place, the results are permanent (unless exposed to toxins or injury). Anyone can strengthen their abilities to focus, pay attention, concentrate and sit still by doing the right neuro-developmental exercise or group of exercises. Another plus when doing neuro-development is that results are measurable. Improvements in attention can be easily measured (e.g., the time it takes to complete homework assignments). Improvements in performing the exercise can be measured as well. All forms of neuro-development for attention skills can be easily measured.
For the purposes of this discussion, areas of neuro-development for attention skills will be divided into four categories: exercises that increase appropriate brain waves, exercises to increase visual skills, exercises to increase focus, and concentration and decrease excessive movement, and exercises related to timing or synchronicity.
Brain Waves. There is a theory that says that inattention involves the brain's production of too much theta brain waves and too little beta 1 and/or SMR brain waves. Studies suggest that when the brain has predominately beta 1 and SMR waves, the brain is more likely to be able to concentrate and attend. Neuro-feedback or EEG Biofeedback is a way to use neuro-development to increase the brain's ability to generate more beta 1 and SMR waves. The technique requires equipment that gives the participant some indication that their brain is generating increased beta 1 and/or SMR waves. This feedback reinforces or encourages the person to automatically generate even more beta1 and/or SMR brain waves. The participant may not know or understand how they are doing it, but the feedback tells them when they are doing it.
EEG biofeedback usually requires the participant to go to an office of a professional 40 to 80 times before attention skills are adequately improved (e.g., www.eegspectrum.com). There are companies that design equipment to be used by parents without having to go to a professional (e.g., www.brian-trainer.com). Some professional have equipment you can rent and take home so that you do not have to go to the office as much. If you choose to use neuro-feedback to develop attention skills, you will need to decide which approach will work best for you and your family.
Dr. Daniel Amen wrote a book that even gave what type of neuro-feedback is likely to be helpful given the type of ADHD an individual has. He noted six subtypes of ADD and each one has its own recommendation for various treatments based on the subtype. Subtypes are indentified and described in his book. The name of the book is: Healing ADD: The Breakthrough Program That Allows You to See and Heal the 6 Types of ADD, ISBN: 0425183270. In addition, Dr. Amen offers guidelines on medication and herbs that may be helpful for each of the six ADD subtypes.
In an earlier publication by this author, Dan Moore, it was emphasized that the type of treatment needed to treat ADHD can be determined by the likely cause of the ADHD symptoms. The causes probably least likely to derive benefit from EEG biofeedback may the ones caused by food intolerances or food allergies or environmental sensitivities (e.g., yellow food dye, red food coloring, chemical cleaning products, gluten). The best treatment for environmental and/or food sensitivities that cause ADHD symptoms is to discover what substances causes the ADHD symptoms and avoid those substances if possible. If this is the true cause of the ADHD symptoms, then they will automatically go away once the body is freed from the substances it is sensitive to. Results can usually be seen in just 4 days but some children can take up to two weeks before noticeable improvements are made. Some estimate that 5 % or more of ADHD children have as the main cause of their ADHD symptoms food and/or environmental sensitivities. Neuro-feedback is not the best intervention for these children.
Vision. Being able to use the muscles of the eye and to regulate eye movement is a neuro-developmental and neuro-muscular activity. Good vision is often affected by many things. Developmental optometrists attempt to measure and rehabilitate poor vision caused by developmental problems. Some types of poor vision will result in symptoms of Attention Deficit/Hyperactivity Disorders.
One theory is that whenever the eyes move or shift in gaze, the brain has a different thought. These thoughts that come from an inability to keep a gaze are believed to be distracting and the person has an inability to remain focused. The ideal professional to address vision problems that relate to attention abilities are developmental optometrists. There is a difference between a regular optometrist and a developmental optometrist. The developmental optometrist will measure at least 20 factors related to good vision. Good vision is more than just 20/20 vision. It involves depth perception, the eyes teaming with each other, convergence and much more. A resource to find a developmental optometrist can be found at the Pediatric Opthamologist website. Developmental optometrists are the ideal treatment for individuals who have ADHD symptoms that are caused by vision problems.
Vision problems are so common in children with ADHD and Dyslexia that DORE routinely checks for vision problems and prescribes visual exercises accordingly. They have found that when children compete the exercises, their attention skills significantly improve as well.
Theoretically vision exercises can be assessed and given by parents as well. Even so, it is recommended that a professional be sought out. Visual exercises may be given by a parent to augment the exercises assigned by professionals, though it is best to consult the professional before adding exercises. A couple of our favorite vision exercises are described at this link.
Focus, Sitting Still and Attention. Visual exercises appear to automatically improve focus and attention. There are other exercises that do not appear to be related directly to vision. Several computer programs have been developed to develop attention and focus skills. One example is a program to increase working memory called Cogmed. Children are able to increase their working memory (a common deficit for children with an Attention Deficit/Hyperactivity Disorder). Cogmed involves a program downloaded to a computer to be practiced an hour a day for five weeks and a therapist calling once a week to see how the neuro-devleopment is going. There is actual research on this approach and the results of the research thus far are very impressive. There are other websites that offer neuro-developmental exercises to increase focus and attention skills. Some of these include Brain Train's Captain's Log, and Lumosity.
We offer a few neuro-developmental exercises of our own. As with most of our exercises, equipment is minimal and the cost is also minimal. However, the outcomes are usually substancial. We hope you enjoy them. One of our favorite exercises to increase the ability to sit still is the Freeze Game. It is explained in two places on our website. It is included in Behavioral Interventions for Children with ADHD and Freeze Game. We consider this game a basic level for any child or adult that has a trouble being still. It is a game that should be used often for hyperactive individuals.
Another skill related to focus and attention but seems different is auditory memory. Most children with ADHD have deficits in auditory memory. Many parents know this because they have to often repeat things they say to their ADHD child. Many ADHD children only get a small portion of what is told to them. This is an easy skill to test for. Just repeat a short sentence to your child (three or four sentences for older children) and see how well they tell it back to you using the same words. If they are able to do this with 80% accuracy, then we consider this normal. If they are only 20% accurate, then this may be a problem. Can you imagine what it would be like going to school and only getting 20% of the information that the teacher says? For children with ADHD and for many adults with a Traumatic Brain Injury, this is normal. The Auditory Memory exercise is designed to allow these individuals to develop normal skills in this area. If successful, the individual will be able to understand 80% of what is said to them when the vocabulary is adjusted for their level of development or age. To experience a neuro-developmental exercise to improve auditory memory, try the Auditory Memory Game
Auditory memory is related to attention, but it is also part of another complex skill called auditory processing. Just as problems can develop with visual processing (e.g., near point vision problems), problems can develop with auditory processing. For example, one sub component of auditory processing is being able to filter out distracting noises so you can focus on a speaker or teacher. When a tape recorder records, it picks up all the noise in the room including the air conditioner phone, police sirens outside, all the noises. When we listen, our brain automatically filters out that noise so that we can pay attention to the speaker. Not everyone is able to do this. Some hear everything that a tape recorder would and it is usually very distracting. A person with auditory processing problems will appear to a teacher and almost everyone else as someone with an Attention Deficit Disorder. However, in reality their problems relate to an auditory processing problems. Address the auditory processing problems through neuro-development and the attention problems are resolved as well. Of course, it is possible that a child could have auditory processing problems as well as other causes of an attention deficit disorder. As you can see, attention deficit /hyperactivity disorder can get very complex. However, one can always test for auditory processing problems and correct for it. It takes an audiologist to diagnoses auditory processing problem. A great and relatively inexpensive neuro-developmental program for addressing auditory processing problems is called Earobics.
Another one of our favorite exercises to increase focus and attention skills is called self monitoring. Many children with ADHD symptoms never learn self monitoring because their teachers and parents are always doing the monitoring for them. They do not need to ask themselves if they are being appropriate or not because an adult will be there telling them when they are being inappropriate. The Nurtured Heart Approach which can be viewed as a neuro-developmental relational approach takes advantage of self monitoring by never telling the children what they are doing wrong. They simple get a consequence and they have to figure out what they did wrong in order to avoid getting consequences. The rules of correct behavior are given to the child when they are being appropriate, never when they are being inappropriate. This way the child learns to ask themselves if they are being inappropriate or not to avoid consequences. The Nurtured Heart Approach is a great parenting technique for children with ADHD.
Our self monitoring strategy allows children to stay focused on their homework by asking themselves if they are on task or not. Every 45 seconds a cue reminds them to ask themselves if they are on task or not. If they are, they check yes on a form. If they are not on task (e.g., looking away, day dreaming, talking, out of seat) they check no on the same form. With this technique, results are usually immediate but mastery takes time. Mastery is achieved when the child can independently finish 20 minutes of homework within 20 minutes. The technique starts off by having the parent make sure they are completing the form correctly and ends up towards mastery with no forms to fill out, but the children mark on their homework what time they will finish up and they watch the clock to pace themselves appropriately. We have self monitoring described in Behavioral Interventions for Children with ADHD and we sell a Self Monitoring Kit that gives you two audio files to implement the exercise.
Timing. The fourth area of neuro-development to increase relates to brain synchronicity. It was observed that some individuals with ADHD do not have good rhythm and they are poor at keeping time with a beat. The theory is that the brain has to be in synch with itself in order to concentrate and attend well. Exercises designed to increase synchronicity have been shown to increase attention skills. Probably the company with the most expertise in this area is a company called Interactive Metronome.
The Interactive Metronome is a biofeedback device that provides information about being in synch with music. Sensors are on the person's hands and feet. The feedback tells if the person was late, early or on time to the beat. As with all neuro-development, exercises are to be conducted frequently. For individuals without the resources to obtain the Interactive Metronome, synchronicity can be achieved by video games that require and score on staying in rhythm. Guitar hero and Dance Dance Revolution are two examples of popular video games that will help develop attention skills when they are mastered. When these games are mastered by individuals with ADHD who have synchronicity problems as part of their ADHD symptoms, then significant improvements in concentration and attention should be observed. In these video games, asually titles are given to participants that suggest mastery (e.g., Advanced, Expert) As a parent, you will be able to tell that synchronicity has been mastered on these game by looking at the child's level of play and their scores. Usually these children start off being so bad at these games, that they are not internally motivated to play the games. It may take some external motivation (e.g., bribes, more time on X-box, the pre-Mack principle) to get them to play these games. After they start improving, they will be more self or internally motivated. There is a free version of Dance Dance Revolution that is played with the keyboard on line called Flash Flash Revolution.
Pace Tutoring or LearningRx addresses synchronicity by having many of their exercises used in conjunction with a metronome. When doing neuro-development, you can often enhance learning and attention skills by including timing with a metronome. Some have observed that learning a musical instrument can improve attention skills. This would especially be true if a metronome was used while learning to play the instrument.
In this article, we have talked about the development of attention skills broken down in four areas. We have reviewed professionally developed interventions and providers of neuro-development as well as other exercises to develop attention skills. The kinds of exercises used should be dependent on the needs of the child. Some children who are able to sit still but not focus and pay attention will not need to do the freeze game. Likewise, children with a good since of rhythm but are still inattentive will not need to spend much time doing the Interactive Metronome. A good rule of thumb is to use interventions that address your child's weakest skills. If you picked the right intervention, in 30 days you should see some improvement. Continue the exercise until mastery has been achieved.
For more information on neuro-development, please follow the links below.
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written by Daniel T. Moore, Ph.D. copyrighted 2013