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Article of Interest - Alternative Therapy

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Bridges4Kids LogoHigh-tech Tools Focus on ADHD
by Jamie Talan, Newsday, June 1, 2004
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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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