Country Living's Healthy Living – June 9, 1998

Calming Your Wild Child

by Sarah Hutter

Elliot had always been a wild child--overactive, inattentive, and difficult to control. But it wasn't until he turned 13 that those traits got him into serious trouble at school.

"He was constantly drumming on his desk, making noises, and not paying attention in class," says his mother, Roslyn. "He was never bad, just really disruptive." Elliot's teacher complained that he wasn't doing his work, wasn't following along, and often spoke out of turn. Even when confined to his seat, he always seemed to be in motion. Finally the teacher recommended that he be placed in a special class. Devastated, Roslyn took Elliot to a neurologist, who diagnosed him with Attention Deficit Hyperactivity Disorder (ADHD), and prescribed a stimulant called Dexedrine. By the end of the month, his fidgeting had ceased--but he had grown strangely introverted and irritable. "He had no appetite and couldn't sleep," says Roslyn. "It was like he had lost his spark."

Then she saw an ad in the paper for a clinic offering biofeedback, and with her neurologist's blessing, she met with Mary Jo Sabo, Ph.D., the director of the Pain and Scress Biofeedback Center in Spring Valley, N.Y. Using a process called brain-wave training, Sabo placed electrodes on Elliot's head and employed standard electroencephalographic (EEG) equipment to display his brain waves on a computer screen. Sabo then led Elliot through a series of exercises designed to show him how his brain reacted to stimulus--as well as teach him how to influence those reactions by taking deep breaths and redirecting his thoughts. In short, the exercises taught Elliot how to concentrate. During the course of the first 15 half-hour sessions, Elliot seemed more focused and relaxed. After 20 sessions, he was off the medication and "was a different person," says Roslyn. Recently, the 16-year-old made the honor roll at school.

Attention Deficit Disorder (ADD) is the most commonly diagnosed behavioral or psychiatric disorder of childhood, affecting an estimated 3 to 5 percent of American youngsters. Often diagnosed as early as age five, and in three times more boys than girls, symptoms include impulsivity, distractibility, and inattention--all of which can persist into adulthood. In addition, some kids, like Elliot, are also overactive and are thus diagnosed with ADHD. Stimulant drugs like Dexedrine and the more commonly prescribed Ritalin have the paradoxical effect of keeping inattentive and overactive kids calm and focused. Together, they have been the mainstay of medical treatment for both ADD and ADHD for more than 20 years. At present, there are some 1.5 million American children on Ritalin--and the number is climbing.

But while the drugs are effective at reducing symptoms for a reported 70 to 80 percent of the children who take them, they are currently the object of controversy. Ritalin prescriptions doubled in the 1990s, raising concerns that its use was sometimes inappropriate. And the drug's benefits are short lived. One dose of Ritalin lasts only four hours; it must be taken several times a day. Some parents complain of side effects, which include appetite loss, nervousness, insomnia, headaches, stomach aches, and "Ritalin rebound," a significant worsening of behavior once the drug has worn off. Another serious concern: Because the medication only addresses the disorder's symptoms, it must be taken indefinitely if symptoms persist; many of today's ADD sufferers may need to be on Kitalin for life. With these issues in mind, many parents and physicians are taking a more holistic view of the disorder and considering non-drug treatments like neurofeedback.

Neurofeedback--also known as EEG biofeedback-- differs from traditional biofeedback in that it focuses specifically on electrical activity in the brain. Using EEG assessment equipment, experts have found that children with ADD exhibit a different brainwave pattern, with too many slow, sleepy, low-frequency brain waves known as theta, and not enough alert, focused, high frequency brain waves known as beta. It is thought that with this surfeit of theta waves, ADD children suffer from low arousal, and act out as a way to keep themselves from drifting off.

Neurofeedback training can help. With guidance from a qualified practitioner and feedback from computer games, a child is asked to guide colored balloons across a screen or manipulate bars that read his brain waves like a thermometer. By focusing on these tasks, the child exercises his weaker pathways and increases beta brainwave activity. "Neurofeedback empowers the child to regulate his attention," says Lynda Thompson, Ph.D., founder of the ADD Centre in Toronto, and coauthor, with pediatrician William Sears, M.D., of The ADD Book: New Undet·standings, New Approaches to Parenting Your Child (Little Brown, 1998). "It allows him to learn what concentration feels like so that he can then replicate that state when necessary--whether it's while he's in the classroom or playing hockey."

Neurofeedback can be used in combination with drugs, though with training, many children eventually wean themselves off the medication. "We don't take children off Ritalin," says Sabo. "That's up to the parents and their physicians. But we find that kids can gradually decrease the dosage and, in some cases, go off it entirely."

Critics call the process experimental and credit the placebo effect for results. But proponents like Thompson and Sabo, who see changes in brain-wave patterns, as well as behavior patterns, disagree. "No one really knows how it works, but we don't know how Ritalin works either," says Thompson. "The theory is that both effect neurotransmitters and increase the speed with which messages are getting communicated in the brain. But with neurofeedback, we're also creating structural changes. By exercising those pathways for concentration, the connections get stronger."

Indeed, studies by Joel Lubar, Ph.D., a professor of psychology at the University of Tennessee in Knoxville and a pioneer in neurofeedback research, measure success rates of treating ADD at 80 percent. He also reports grade-point average improvements in 80 percent of the children he has worked with.

There are drawbacks, however. Neurofeedback is time consuming and expensive. Most clinics prescribe a minimum of 20 to 40 sessions, which can each cost from $60 to $250. On the plus side, neurofeedback has no side effects, and therapy is short-term: Experts claim that once a child acquires concentration skills, which takes an average of five to six months, he's got them for life.

Neurofeedback, with or without drugs, is no cure. But, children with the disorder can acquire sufficient coping skills over time to conquer the symptoms and end the need for therapy altogether. Until then, experts recommend a range of interventions:

Behavior modification therapy: Recommended by the American Academy of Pediatrics, the therapy involves practical techniques and a system of rewards that help kids monitor their behavior.

Extra help at school: Because 90 percent of children with ADD also suffer learning problems like dyslexia, talk to school administrators about having your child tested and arrange for special classes, if necessary.

A balanced diet: While junk food is often blamed for ADD, the research is inconclusive. What's most important is having the structure of three meals based on an overall good diet, says Kathi Kemper, M.D., M.P.H., author of The Holistic Pediatrician (Harper Perennial, 1996).

Security: "Have clear expectations at home," suggests Kemper, who also encourages parents to establish predictable routines, especially for homework and bedtime. Kids with ADD do better when their sleep is regulated--and plentiful. To help your child with transitions, break complex tasks down into simple steps. For example, if it's almost time for dinner, ask your child to finish his game, put it away, wash his hands, and come to the table.

A positive attitude: "Kids labeled as having ADD have gifts and abilities and ways of looking at the world that are unique and valuable," says Thomas Armstrong, Ph.D., author of The Myth of the ADD Child: 50 Ways to Improve Your Child's Behavior and Attention Span Without Drugs, Labels, or Coercion (Plume, 1997). "Because he may have low self-esteem, it's important for parents to hold a positive image of their child."

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