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 High-tech
Tools Focus on ADHD
by Jamie Talan, Newsday, June 1, 2004
For more articles like this
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https://www.bridges4kids.org.
The 9-year-old
girl stares at a bird on a computer screen and focuses hard to
make it fly. As her attention locks onto the bird, it wings its
way across the screen, going higher and higher. When the bird
slows or drops a few inches, the psychologist at her side makes
her aware that she is tapping her hand and fidgeting. When she
stops moving, she regains her focus on the bird and it soars
once again.
Kenneth Kaufman, a psychologist at the Institute for Behavioral
Health, a private practice in Commack, is banking on this new
technology to help patients with attention and behavior problems
learn to focus and complete a task. The program, called Play
Attention, is new technology based on work by NASA scientists to
help astronauts strengthen attention span. It comes with
hardware and software that allow the client, who wears a helmet
lined with electrodes that record brain waves, to move objects
on the screen with only the mind's eye. Better focusing
completes the task faster.
Studying the technology
Several small studies in Germany and Italy, as well as at an
attention deficit hyperactivity disorder clinic in Endicott
upstate, have tested the technology, called EEG neurofeedback.
The studies have shown it was as effective as ADHD drugs in
reducing symptoms of inattention and impulsivity. But some ADHD
experts say these studies test people waiting for nondrug
treatments who are predisposed to want the technology to work.
They say more rigorous studies are needed.
While such studies are under way, companies have started selling
machines that record and analyze brain waves to help verify a
diagnosis of ADHD. The quantitative electroencephalograph
(Q-EEG) produced is based on findings from 2,600 people with and
without ADHD.
Their brain-wave patterns differ enough that researchers can
predict with 90 percent accuracy if a given pattern indicates
ADHD, said psychologist John Drozd, clinical director of Lexicor,
a company that developed the diagnostic scan. A computer program
analyzes the brain scan and plots the child's brain response on
a curve from normal to that seen in children with ADHD.
While EEG has been around for almost 100 years, the use of this
technology for ADHD is still new and considered controversial.
Drozd said the company has recently opened 12 diagnostic centers
around the country, including one in Lake Success. Kaufman is
testing a unit in his Commack practice.
No lab tests for ADHD
There are no lab tests for ADHD, and Kaufman said many parents
have been searching for biological proof that their children
have the disorder. The $600 test is reimbursable through
insurance, he said.
The most effective means of diagnosing the attention disorder is
a detailed history, collected by both a parent and a teacher who
knows the child well, according to Dr. Ned Hallowell, author of
"Driven to Distraction" and an expert on ADHD.
Hallowell, a psychiatrist, has purchased a Q-EEG scanner for his
practice in Sudbury, Mass. "We don't have anything that beats a
detailed history," said Hallowell, "but it provides more
information to confirm or rule out a diagnosis."
He said he suspects the real benefit will be for the
pediatrician or family doctor who doesn't have the time or the
expertise to make an accurate diagnosis. There are also neuro-
psychological tests that help diagnose distractibility.
Hallowell said about one in every 20 patients requests the scan,
which takes about an hour.
The Q-EEG measures the ratio between key brain waves. A
technician fits a cap with 17 electrodes onto a patient's head.
The electrodes pick up different types of electrical activity in
many brain regions, and this information is fed into the
computer and analyzed. The so-called theta wave represents a
mental state of inattentiveness and distractibility, and delta
waves are associated with sleep. Beta waves suggest a very alert
state, and alpha waves represent alertness, relaxation and
wakefulness.
Differing brain waves
Some scientists have found that the ADHD brain pattern shows
more theta-wave activity in the frontal regions compared with
normal brain patterns. Q-EEG studies in children with ADHD have
shown an excess of slow-wave (theta) activity and decreased
fast- wave (beta) activity.
Stimulants prescribed for ADHD appear to normalize this abnormal
brain activity, according to psychologist Sandra K. Loo of the
University of California at Los Angeles' Neuropsychiatric
Institute.
Loo said it is "premature" to say Q-EEG is a valuable tool for
diagnosis of ADHD. The problem, she said, is that EEG
abnormalities are also associated with other psychiatric
conditions, and many ADHD children have neurological signs of
other psychiatric conditions.
"I am very skeptical," said Dr. Judith Rapoport, chief of the
child and adolescent psychiatry branch at the National Institute
of Mental Health. "This test doesn't tell us anything more than
a good history does."
But Kaufman sees it as a tool that makes parents feel more
comfortable in the diagnosis. "This is just one more piece to
the puzzle," he said.
Gary Lynch, a professor of psychiatry at the University of
California at Irvine, added that "doctors should be able to use
these tools to eventually help diagnose a lot of brain
diseases." Lynch is co-founder of a new company, called Thuris
Corp., that is developing and testing the use of the Q-EEG for
diagnosis of Huntington's disease, cluster headaches, depression
and mild cognitive impairment, a precursor of Alzheimer's
disease.
"The Q-EEG is promising, but we just don't know how much we can
promise," said Dr. Peter Jensen, director of Columbia
University's Center for the Advancement of Children's Mental
Health and a child psychiatry professor at New York-
Presbyterian Hospital in Manhattan. He said the testing
information is impressive, and he is debating whether to obtain
a scanning device for Columbia. He'd like to see whether it
helps pediatricians improve diagnosis and treatment. Some
studies suggest only one of every two children with ADHD has
been diagnosed and receives appropriate treatment.
If EEG waves are abnormal in ADHD, some doctors say it makes
sense that altering these brain-wave patterns may be beneficial.
That theory is the basis of neurofeedback systems like Play
Attention.
When a person is asked to focus, the computer is responding to
his or her brain-wave patterns. The subject directs attention
toward an object, which then moves in the right direction. But
distraction makes the object slow or go in the opposite
direction. It's a form of biofeedback, and, over time, people
who use the technology get better at monitoring and altering
their own brain waves. Kaufman said it could take anywhere from
30 to 60 sessions to show a benefit on attentive behavior. Like
any treatment, it won't work for everyone.
How Play Attention began
Play Attention is the brainchild of Peter Freer, a former
teacher who became intrigued by NASA's flight-simulation
training. As a fifth-grade teacher in a rural Appalachian school
in North Carolina, Freer had met the student all teachers fear.
"John was a hellion," Freer recalled. "Impulsive. Impossible to
teach. Disruptive."
He moved John's desk next to his own and shortened his
assignments. It worked for math, but at home John's frustrated
parents began to beat him in hope of reshaping his unruly
behavior. When that didn't work, they medicated him.
"We were so unprepared to teach students like John," Freer said.
Freer hired a programmer and worked three jobs to get enough
money to pay for software he wanted to build. He broke down the
learning into small increments of time, designing a program to
track how a child visually follows a teacher and how the brain
filters out distractions. His engineering degree helped. He
figured out what brain waves look like when someone is paying
close attention.
In 1994, he formed a company. By then, John, his former student,
had dropped out of school. He's since been in and out of jail
for assault and theft. Freer said he suspects that John's
impulsiveness may have contributed to his life choices.
Play Attention primarily has been used in schools and more
recently by mental health professionals. The controversy over
proving itself in the therapeutic field continues. Two rigorous
studies are under way, at SUNY Plattsburgh and at Eastern
Virginia Medical School.
A place for technology
ADHD experts like Columbia's Jensen say there is a place for
these high-tech programs. He's also been trying to understand
what nonmedication approaches are best for children with ADHD.
Most of the brain's wiring is laid down in the first four years
of life, and behavioral therapy is proving effective if it
begins during this critical period, Jensen said. He also said
that exercise is important in helping kids strengthen their
motor system, which works with thinking areas of the brain to
shape attention.
These types of programs help shape behavior and the time a child
spends on a given task. Anthony Scannella, chief operating
officer of the Foundation for Education Administration in New
Jersey, has just struck a deal with Freer to offer Play
Attention to schools throughout the state. "Teachers are
screaming for help," Scannella said. "This program has great
promise."
Dr. Lenard Adler, director of the adult ADHD program at New York
University School of Medicine, said he's been searching for ways
to test nonmedical interventions with the same scientific rigor
necessary to get a drug approved by the Food and Drug
Administration. "Some people find Q-EEG helpful, and some
don't," he said. "It's definitely an area that is evolving." He
is seeking a federal grant to conduct a controlled study of
Q-EEG neurofeedback with adults with ADHD.
He often recommends relaxation methods, a healthy diet and
limits on caffeine in addition to more traditional treatments.
"If we can find more things that work, that's great."
There is no question that medicines do help quell some of the
symptoms of ADHD, but they don't work for everyone, and many
parents still would rather not put their children on medicines
if there were other therapies that worked.
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