Is it Anxiety, a Phobia or just Life in Twenty-first Century?
By Ari Goldstein, Ph.D.
According to the National Institute of Mental Health (NIMH) Generalized Anxiety Disorder (GAD) is one of the most prevalent mental health issues in the United States. It affects over 18% of the adult population with 22% suffering from a severe form. Anxiety Disorder often starts in childhood, with 11 years old being the average age of its onset. The symptoms differ from individual to individual, but they include a host of physical maladies from migraine headaches and nausea to thumping hearts and twitching muscles. (1)
Perhaps one of the reasons so many people in our society are suffering from anxiety today is that we live in a time of profound change. Technology is transforming the way we go about our daily activities – the way we communicate, access information, bank, shop and even amuse ourselves. Even the climate is changing, affecting the very planet we live on. These changes can all be stressors whatever your level of education or self-confidence. No wonder we’re anxious!
But 21st century angst isn’t the same as an Anxiety Disorder.
People who suffer from an Anxiety Disorder may experience a sense of danger that is completely unwarranted by the actual situation. Furthermore, the feeling can last so long and be so intense, normal life becomes impossible. Anxiety Disorders come in several forms including phobias where a feeling of overwhelming anxiety is set off by a particular thing such as spiders or snakes and situations such as flying or having blood drawn. Like GAD, panic attacks, social anxiety, Obsessive-Compulsive Disorders (OCD) and Post Traumatic Stress Disorder (PTSD) are all forms of Anxiety Disorder. (2)
Here’s a short list of situations common among those suffering from Anxiety Disorder
1. A constant sense of tension, worry and edginess.
2. Anxiety so severe it interferes with work, school, or family responsibilities.
3. Feeling fear that you know is irrational, but still can’t seem to overcome.
4. A belief that something bad will happen if certain things aren’t done a certain way.
5. A need to avoid everyday situations or activities because they provoke overwhelming anxiety.
6. Sudden, unexpected attacks of heart-pounding panic.
7. A feeling that danger and catastrophe are around every corner.
What causes anxiety?
We’re still discovering just why all of us experience the symptoms of anxiety from time to time and others are more adversely affected. We do know that the emotion of fear is part of our hardwiring and produces instinctive behavior that helps ensure our physical survival. No one knows if a tendency to suffer from anxiety is inherited or whether our upbringing is the primary factor. However, according to Daniel Pine MD, Director of the research program on mood and anxiety disorders of children and adolescents at the National Institute of Mental Health in Bethesda, Md, “We’re beginning to understand how all of these things go together. We know that it’s rarely one thing that gives rise to a mental disorder, and we know that different mental disorders have different mixes of genetic and environmental influences.” (4)
Genetics plays a role.
While we still don’t fully understand why two people exposed to the same stressful situation will have very different reactions – one that would be described as normal and the other as an example of Anxiety Disorder – we do know genetics plays a part. Certain forms of anxiety such as panic disorder, GAD and OCD seem to run in families, indicating there’s a genetic link. Neurotransmitters or the chemical messengers that transmit information from one part of our brain to another may also influence why some people develop anxiety and some don’t. (4)
Early research indicates that the Amygdalae does, too.
The Amygdalae are two almond-shaped organs located in the middle of each side of our brain and that of other animals. We know that they are involved with instructing the body to take action in the presence of a perceived danger. (5) In the 1930s, researchers conducted a series of animal experiments to discover the function of the amygdala. When they removed or damaged this part of the limbic system in rats and monkeys, they found that these animals no longer seem to be afraid of snakes and other threats that would have normally terrified them. Some humans seem to have the same type of response. An article in the New York Times reported that Justin Feinstein, a clinical neuropsychologist at the University of Iowa, discovered that a patient with a compromised amygdala experienced a similar lack of fear. (6) This case, and others like it, have led some to speculate that it is the Amygdala that produces fear – warranted and unwarranted – in the brain.
How is Anxiety Disorder different from normal anxiety?
Dr. Pine explains the difference between normal anxiety and GAD, this way. “Let’s think about the person who is extremely shy in social situations. They may go to work or go to a party or order in a restaurant or talk to the librarian. But they will be absolutely miserable while doing it. They will have a great number of physiological symptoms — rapid heartbeat, sweating, butterflies in their stomach — and extreme stress in anticipation of doing any of these things. The diagnosis of abnormal anxiety rests on a mental health professional’s judgment that the level of distress experienced by the individual, relative to all other people in that situation, is extreme.” (4)
Are there differences in the amygdala of normal people and those with Anxiety Disorder?
In Pine’s research he found that, “when presented with subtle signs of danger, the amygdala of kids with anxiety and kids with depression react similarly to the amygdala of currently healthy kids who are at risk for anxiety and depression.” Thus, even though a high-risk child may not exhibit an Anxiety Disorder, their amygdala still reacts differently to anticipated danger than those of normal children.(4)
In the past, Pine claims, Anxiety Disorders were seen as a reactivity disorders. “Research seemed to indicate that the brains of people with anxiety were unusually sensitive to danger and tended to overreact. There is some data to support this, but now… we’ve noticed that the biggest differences between anxiety patients and healthy people were not found in their response to extreme, obvious danger but rather in their brains’ reactions to subtle threats or ambiguous situations.”(4)
This finding has implications for discovering the most effective treatment.
When asked about treating cases of Anxiety Disorder, Dr, Pine, said, “This finding suggests that the root problem is one of telling the difference between a potential threat and a real one. And this, in turn, suggests that anxiety results from a learning disorder rather than a reactivity disorder. When we look at anxiety this way, we are led to a host of potential new treatments geared toward correcting a learning deficit. This has treatment implications for both children and adults. The hope is that we will eventually be able to determine which patients will benefit from therapy or from medication and which need a combination of therapy and medication.” (4)
What we’re doing now.
Currently patients suffering from GAD may be prescribed medication with or without therapy to treat the worst symptoms. The type of medication given most often is anti-depressants that seem to decrease anxiety, even for those who are not depressed. Another class of drugs geared specifically for anxiety, are benzodiazepines. (7)
Nevertheless, more and more these disorders are treated by a specific form of talk therapy – Cognitive Behavior Therapy. Conducted by a therapist especially certified in this form of treatment, it’s designed to change the patient’s thought patterns in order to modify their behavior. In the case of chronic anxiety, this would be the thoughts leading up to experiencing anxiety in reaction to certain situations. Eventually, the association of fear with these situations is lessened or eliminated completely. (7)
Neurofeedback can also produce these changes.
Neurofeedback can be used to augment medicinal therapy, talk therapy or on its own as an alternative option to them. Based on the same principals as biofeedback, neurofeedback enables patients to learn how to speed up or slow down their brain function and control their reaction to different stimuli.
Unlike medication, which offers only short-term relief by temporarily changing brain chemistry, Neurofeedback provides a long term, individualized solution that often eliminates bouts of anxiety permanently. Applying biofeedback techniques to analyze brain function, the specialist determines how the patient’s brain works differently from a normal brain. Once a therapy plan has been determined, the brain itself is able to learn what changes it must make to eliminate feelings of anxiety. This allows the patient to achieve more success regulating their anxiety in less time.
If you or someone you know is experiencing anxiety, contact us to learn more about neurofeedback and other non-medicinal treatment options.
1 Any Anxiety Disorder Among Adults, National Institute of Mental Health, Aug. 8, 2017 https://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-adults.shtml
2 Frank, C., M.D., What Is the Difference Between Anxiety And Phobia?, ABC News,
April 15, 2008 http://abcnews.go.com/Health/AnxietyOverview/story?id=4659885
3 Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D. Last updated: July 2017.Anxiety Disorders and Anxiety Attacks, helpguide,org, July, 2017 https://www.helpguide.org/articles/anxiety/anxiety-disorders-and-anxiety-attacks.htm
4 Wielawski, Irene, Evaluating Anxiety from an Early Age, New York Times, 7/11/2008 http://www.nytimes.com/ref/health/healthguide/esn-anxiety-expert.html?pagewanted=all
5 What causes anxiety? Wikipedia, https://en.wikipedia.org/wiki/Amygdala
6 Bhandoo, Sindya, “Humans, Like Animals, Behave Fearlessly Without the Amygdala,” NYT 12. 16, 2010 http://www.nytimes.com/2010/12/21/science/21obbrain.html
7 Frank, Cathy, MD, What are the most common treatments for anxiety disorders?, ABC News, April 15, 2017, http://abcnews.go.com/Health/AnxietyOverview/story?id=4660198
Is there such a thing as an ADHD diet?
Ari Goldstein, Ph.D.
“You are what you eat” is an axiom that I’m sure most healthcare and fitness experts would agree with. After all, there is no doubt that good nutrition is crucial for maintaining good health in people of all ages, especially children. Furthermore, over the last several decades, various theories have arisen claiming diet, along with other factors cited in our last blog, may play a major role in the occurrence, frequency and severity of ADHD symptoms. We thought it was time to consider the latest findings regarding some of these theories in this blog.
First, the assumption that sugar causes ADHD is simply not true.
Sugar itself probably doesn’t cause a change in behavior in children – whether they have ADHD or not. Yet for decades (perhaps centuries) parents have limited their children’s intake of sweets because it supposedly made them hyperactive. This theory has been tested in a number of scientific studies examining not only children’s reactions to sugar intake, but the attitude of their parents as well – with very interesting results.
According to Elizabeth Harstad, Developmental Behavioral Pediatrician at Boston Children’s Hospital, “In one study, all of the children given a non-sugar substitute.1 Half of the mothers were told their children has eaten real sugar. The other half were told their children had eaten the substitute.
When all of the mothers were asked to rate their children’s behavior, the moms who thought their kids had eaten real sugar rated their children as more hyperactive.”
Hyperactivity isn’t caused by what children eat but where they eat it.
As Harsted puts it, “Think about cupcakes at birthday parties. Or platters of cookies at a holiday gathering. Or a scoop of ice cream at bedtime. Kids may act up in these settings because they’re tired or overwhelmed. In other words, it may be the situation rather than the sugar that gets kids amped up.”
Of course, too much sugar isn’t good for anyone, not only because it causes tooth decay and can increase the risk of obesity, but leads to a host of metabolic imbalances. Nevertheless, unless something changes in the future, you can’t blame ADHD on candy bars or Grandma’s apple pie.
Is ADHD due to food allergies?
As mentioned above, speculation about the role diet plays in ADHD has been with us for decades but it grew considerably louder in the 1970s due to the work of Dr. Benjamin Feingold.2 Feingold was Chief of Pediatrics at Cedars of Lebanon Hospital in Los Angeles, CA until becoming Chief of Allergy at Kaiser-Permanente Medical Center in San Francisco. He worked with adults and children, trying to discover if there was any link between ADHD behaviors and allergies to certain foods. He developed the Feingold Program or Elimination Diet to find out exactly which foods, if any, were involved. In the end, Feingold’s methods and results were largely discredited or ignored. Not only was Feingold’s diet expensive and hard to follow, the quality of his research was severely criticized by various professionals, casting doubt on his findings.
Yet while Feingold’s overall approach and conclusions may have been faulty, his questioning of the effect that food additives such as salicylate, artificial food coloring, flavoring and preservatives have on ADHD patients is still being researched today in Europe as well as the United States.
For example, in Europe food with certain food dyes now must carry a cautionary label.
In 2007 a study in the United Kingdom seemed to indicate there was a connection between artificial food dyes or/and sodium benzoate, a common preservative used in processed foods, and hyperactivity in children. As a result, the European Union began to require that if a product contained one or more of six different dyes included in this study, its packaging had to include the following copy, “The product may have an adverse effect on activity and attention in children.” In the United States, the FDA considered similar research in 2011, but concluded, “there was not sufficient evidence proving that artificial colors caused hyperactivity in the general population.”3
Still, even in the US some experts seem to think, “better safe than sorry.”
According to Joel Nigg, professor of psychiatry, pediatrics and behavioral neuroscience at Oregon Health and Science University the 2011 studies do seem to show a link between dyes and hyperactivity. “The literature is so sparse that on the one hand you can sympathize with those who take a wait and see attitude,” he explains. “But on the other hand, when we do look at the literature we have, we do see effects that seem to be real. Do you want to take a chance that these initial studies are wrong and put kids at risk or do you want to take a chance that they’re right?”3
It could be that kids with ADHD are more susceptible to a reaction to these ingredients than other children. We still just don’t know. One solution that some researchers, nutritionists, doctors and parents advocate is for families to try a different approach to nutrition called the Paleo Diet.
The Paleo Diet was inspired by Charles Darwin’s theory of evolution.
It’s based on the idea that the way we eat today is actually out of sync with our physical body structure and is due to social changes rather than evolutionary ones.4 According to Paleo Diet advocates, our bodies were designed for, and still function best under Stone Age conditions. Since our life style and diet is so different from that of people living in a prehistoric environment, it causes us to suffer from many preventable diseases such as obesity, diabetes and heart disease.
Starting with the premise that early man didn’t cultivate, harvest or eat grain himself, let alone feed it to domesticated animals, the diet recommends eating only grass-fed beef and pork or wild animals like deer and elk. It is also supposed that early man didn’t drink milk or have dairy products or alcohol in his diet. If you eliminate these elements from your daily diet, you are left with lean beef, fish, free-range poultry, nuts, fruits and vegetables. In short – a diet devoid of additives, preservatives, gluten, sugar, fat and full of vitamins, minerals and antioxidants.4
Sounds great right? However, as with most diet plans, there are some drawbacks which WebMD notes in hits article on the subject. First, buying whole, unprocessed foods including grass-fed beef and free-range chicken can raise your grocery bill considerably. Moreover, you’ll probably be spending more time in the kitchen to prepare your meals. In addition, you’ll want to supplement the diet by taking folic acid, B vitamins, calcium and Vitamin D, elements you would normally get in grain and dairy products.5
But if you consider that ADHD symptoms can be caused or exasperated by additives, preservatives and so on, the Paleo diet presents an interesting alternative families may want to consider.
If a Paleo diet seems too challenging right now, here are some other options.
Even if you choose to eat food found on most supermarket shelves, you can still make choices that will create a diet rich in foods that seem to prevent and minimize ADHD symptoms.6 Here’s a shopping list to get you started:
These include lean beef, pork, poultry, fish, eggs, beans, nuts, soy and low-fat dairy products. Protein is used by the body to make the neurotransmitters that brain cells use to communicate with each other. Laura Stephens, M.S., nutritionist at Purdue University and author of 12 Effective Ways to Help Your ADD/ADHD Child, writes, “Because the body makes brain-awakening neurotransmitters when you eat protein, start your day with a breakfast that includes it.” 6
- Fresh fruits and vegetables
Ned Hallowell, M.D. advises patients with ADHD to arrange their plates as follows: Half of the plate should be taken up with fruits and vegetables, one fourth with some form of protein and one-fourth with carbohydrates.6 Faye Berger Mitchell, a registered dietician and mother of a 9-year old with ADHD, concurs completely.6 She has found when her daughter eats like this her behavior tends to stay under control more consistently.
- Foods rich in Zinc, Iron, Magnesium and vitamin B
Zinc, iron and magnesium are necessary for the production and regulation of neurotransmitters like Dopamine and are found in meat, poultry, seafood and nuts. Zinc may also make methylphenidate (Ritalin) more effective by increasing the brain’s reaction to dopamine. Magnesium is essential for the production of Neurotransmitters involved in attention and concentration and is supposed to have a calming effect.6
Iron, of course, is found in protein and some dark green vegetables like spinach. This is important because low iron levels have been associated with inattention. In fact, one study found that ferritin levels (a measure of iron stores in the body) were low in 84 percent of kids with ADHD compared to 18 percent in the control group.6 Vitamin B , found in high protein foods and green vegetables like broccoli, is also associated with increased levels of dopamine that improve alertness.6
- Foods with Omega -3 Fatty Acids
Salmon, Tuna, Sardines and other cold water fatty fish are rich in Omega – 3 and believed to be key to brain and nerve cell function.6 Perhaps this is why fish are often called “brain food.”
Until more research comes in – we suggest taking a common sense approach.
As you can see, the answer to the question in the title of this blog is still being researched and debated in many quarters. But we hope the following quote from “Diet and attention deficit hyperactivity disorder,” published by Harvard Health Publications will put things in prospective for you,
“…a sensible approach to nutrition for children with ADHD is the same recommended for all children: eat a diet that emphasizes fruits and vegetables, whole grains, healthful unsaturated fats, and good sources of protein; go easy on unhealthy saturated and trans fats, rapidly digested carbohydrates, and fast food; and balance healthy eating with plenty of physical activity.
A healthful diet may reduce symptoms of ADHD by reducing exposure to artificial colors and additives and improving intake of omega-3 fats and micronutrients. But it certainly will improve overall health and nutrition, and set the stage for a lifetime of good health.”
Hope you found this material helpful. If you have any questions, please feel free to contact us.
1 Harsted, E. Should Kids with ADHD Avoid Eating Sugar? Understood, 2017, https://www.understood.org/en/family/events-outings/holidays-celebrations/should-kids-with-adhd-avoid-eating-sugar
2 Feingold Diet, Wikipedia, 2017, https://en.wikipedia.org/wiki/Feingold_diet
3 Harrington, R., Does Artificial Food Coloring Contribute to ADHD in Children?, Scientific American, 2015 https://www.scientificamerican.com/article/does-artificial-food-coloring-contribute-to-adhd-in-children/
4 Wolf, R., “What is the Paleo Diet?,” 2016 https://robbwolf.com/what-is-the-paleo-diet/5 McMillen, “The Paleo Diet,” Webmd.com, 2016, http://www.webmd.com/diet/a-z/paleo-diet
6 Editors, “Why Sugar is Kryptonite for ADHD Brains,” Attitude Magazine, 2009
Why Sugar Is Kryptonite for ADHD Brains
7 ”Diet and attention deficit hyperactivity disorder,” Harvard Mental Health Letter, 2009
By Ari Goldstein, Ph.D.
In the course of my twenty years in the education and psychology fields, I have engaged in conversations with hundreds of colleagues and students who are new to private practice work. The question I am asked the most frequently from these individuals is, “How did you build your practice?” To put some perspective on this question, I should note that it was coming from individuals who excelled in their respective academic fields during graduate school. Many were highly skilled clinicians, with strong patient success rates. Some had published research papers and years of clinical experience. But one simple thing eluded them. How do I build my private practice?
When I first began Cognitive Solutions Learning Center, it was myself and a colleague conducting tutoring sessions out of a small office. As our reputation grew so did the size of our clinic, both in terms of staff and physical space. With this growth, I was required to ask myself a fundamental question: “How can I have a strong business model and entrepreneurial mentality when I am in a helping profession?”
This question is more complex than it first appears. Many drawn to helping professions (Mental Health, Education and Tutoring, Occupational Therapy, Speech Therapy, Music Therapy) thrive on being able to provide their patients or students with help achieving their goals. They come to these professions with a big heart and a sense of enthusiasm. Years of education and training were spent on learning their respective professions, and how to best employ their techniques or therapies with their chosen populations. Following graduate school many work within larger private practice groups or organizations, but eventually some are lured by the sense of freedom in having their own practice.
When these individuals are faced with the prospect of working outside of a larger institution or organization, they often come to realize how unprepared they are for the daily task lists associated with running a business. Someone has always done their insurance billing for them. Someone else has calculated their hours and given them a paycheck. The marketing department has always brought clients in the door and maintained the website.
Just giving extended thought to this process can be wholly overwhelming for the most organized and motivated individual. Add to that the conflict of “I want to help” vs “I need to make money” that rages in all new private practice clinicians. As this conflict arises, a shift in mindset is required. It is possible to help, and be compensated well for your help. It is possible to serve a wide population of people from varied socio-economic backgrounds without the fear of not being able to pay the mortgage each month. This does, however, require a shift in thinking and work balance. It also requires knowing your skill sets, and brining in professional help for the aspects of running a practice that seem more daunting. At times, engaging the right individuals for support can be essential.
At CliniGrow Business Solutions, LLC, we understand the small private practice. We can help you navigate the waters of “practice building”, as well as better understand how to be a clinician and a business owner. In the process, we will help you turn the goals for your business into a reality beyond your expectations.
Why Do More Children Seem to Have ADHD?
By Ari Goldstein, Ph.D.
According to a study conducted by Centers for Disease Control and Prevention (CDC) and published in Journal of the American Academy of Child and Adolescent Psychiatry, 6.4 million or 11 percent of US children between the ages of 4 and 17 have ADHD. That’s an increase of over 42 percent between 2003-2004 and 2011-2012.1
The National Human Genome Research Institute of the National Institutes of Health has found that Attention Deficit Hyperactivity Disorder (ADHD) seems to run in families. Recent studies strongly suggest that there may be a genetic component to ADHD with research indicating that this probably involves at least two genes.2 However, although ADHD has probably been part of the spectrum of human behavior since the dawn of humanity, the insistence on labeling those with this condition and trying to control or eliminate ADHD behaviors seems to be a very recent development.
Misdiagnosed or incorrectly defined?
Some educators and doctors have suggested that this jump in the number of cases is simply due to children being misdiagnosed. Currently, diagnosis of ADHD in the U.S. is based on definitions from the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.). In Europe, pediatricians have tended to use the International Classification of Diseases (ICD), which has much stricter guidelines for diagnosing ADHD.3 Over the last few years however, more and more frequently the definitions of the D.S.M. are being used in Europe as well as in the U.S. At the same time, there has been an increased diagnosis of ADHD overseas. This has caused some to speculate that the increase in diagnosed cases of ADHD is simply due to a difference in the way doctors are defining the condition.
In fact, ADHD can be hard to diagnose since many of its symptoms may be put down to normal childish behavior. Occurring three times more often in boys than girls, ADHD is generally first noticed between the age of three and six, with seven being the average age when an official diagnosis is made.4
Diagnosis occurs most often at the same age school begins.
This is when society is most insistent that children conform to the rules of a classroom setting. In the past, before educational institutions created accommodations for children designated with “learning disabilities,” these children were often described as “troublemakers” or “problem children.” When they exhibited the typical symptoms of ADHD – difficulties with sitting quietly, trouble focusing on a task or controlling their anger – they were sent to the principal’s office, put in time out or even suspended from school. Since girls with ADHD seem to internalize their symptoms, appearing withdrawn and inattentive but not disruptive, they were often able to function more successfully in the classroom.
However, in 1991 students with ADHD came under the protection of the Individuals with Disabilities Education Act.5 For the first time, the medical and educational establishments offered children and their parents help instead of punishment for this condition. In addition, an overhaul of the Food and Drug Administration in 1997 resulted in drug companies being able to market drugs to treat ADHD to parents and educators directly. These two developments helped to “normalize” the condition, making it easier for parents to admit their children were having problems and to seek treatment after diagnosis.
More demanding education standards were set soon after.
In her article for the New York Times Magazine, “The Not-So-Hidden Cause Behind the ADHD Epidemic,” Maggie Koerth-Baker sees a direct connection between changes in U.S. legislation for measuring scholastic achievement and the increase in ADHD.
Diagnosed with ADHD in adulthood herself, Koerth-Baker noticed that between fall of 2011 and the spring of 2012, ADHD medication was hard to come by. It seems that the demand for drugs like Ritalin, Adderall and others was significantly outpacing the supply as more and more schoolchildren were being prescribed medication to treat ADHD. Koerth-Baker postulated that the explosion in the rate of diagnosis might be due to sociological factors – especially ones related to education rather than medical ones.
She explains, “The No Child Left Behind Act, signed into law by President George W. Bush, was the first federal effort to link school financing to standardized-test performance.” Yet even before that, various states had been slowly rolling out similar policies on a local level. According to Koerth-Baker, in states with laws that punished or rewarded schools for standardized-test scores, an increase in ADHD diagnoses seemed to follow. This relationship between stricter standards and an increase in ADHD cases held true nationally when just four years after the No Child Left Behind act was implemented, the number of children with ADHD rose by 22 percent.
Koerth-Baker notes parents and teachers may consider a diagnosis of ADHD “a success if the medication improves kids’ ability to perform on tests and calms them down enough so that they’re not a distraction to others.” Quoting Stephen Hinshaw, a professor of psychology at University of California, Berkeley, she suggests that, “’these incentives conspire to boost the diagnosis of the disorder, regardless of its biological prevalence.’”
Yet legislative changes may be only part of the answer.
While recent changes to educational standards by the federal government and attempts of educators to conform to them, may be one of the reasons ADHD is being diagnosed more frequently, many experts feel there is far more to consider. An increase in the incidence of ADHD may also be due to overall changes in the lifestyle of families. Koerthe-Baker puts it this way, “During the same 30 years when ADHD diagnoses increased, American childhood drastically changed. Even at the grade-school level, kids now have more homework, less recess and a lot less unstructured free time to relax and play.”
Kids have too much pressure, not enough playtime.
Mack R. Hicks, Ph.D., also express this view in an article for Psychology Today.6 Hicks claims reliable data shows that children with ADHD do better when they spend more time outside. Unfortunately, he observes, “Children are spending half as much time outdoors as they were before 1992 and 8-18 year old kids spend 7 hours and 38 minutes using entertainment media in a typical day, not including computer time for schoolwork. Only 6% of kids even play outside on their own.”
Is ADHD a “disease of civilization?”
That’s how Emily Deans, MD, describes it in her article, “Sunlight and ADHD.”7 Deans seems to concur with the observations of Koerth-Baker and Hicks, writing “…our expectation that everyone from young children in school to adults working on computers sit around paying close attention all day seems entirely modern. Certainly in the distant past young children played and hunted and gathered alongside their parents, and humans got to do a variety of tasks throughout the day, a lot of it in the sunshine and fresh air.”
Sunlight, or rather the lack of it, may affect ADHD, too.
Both Hicks and Deans agree that sunlight or its absence may further influence the occurrence of ADHD. As Hicks postulates, “New research from the Journal of Biological Psychiatry …suggests that living in States with greater sunshine (solar intensity or SI) may protect against the development of ADHD. There is a wide variation of reported attention deficit disorder from a low of 5.6% in Nevada to a high of 15.6% in North Carolina. Some of this can result from differences in diagnostic practices, but something else may be going on as well.”8
Deans supports this view, citing a new study that “suggests that amount of sunshine in the environment could also play a significant role in changing the risk of having symptoms of the disorder…Genes controlling melatonin signaling and circadian rhythm clock proteins are known to be abnormal in some people with ADHD.” She goes on to observe, “…bright sunlight is known to enhance and reinforce our own natural circadian rhythms, helping us to be alert during the day and to sleep better at night.”9 Since one of the most troubling aspects of ADHD is difficulties in sleeping, the assumption that the more sunshine in your life, the easier it will be to get the rest you need, seems to hold.
A conversation to be continued.
Another cause that parents often ask about as a possible influence on ADHD behaviors is diet. Everything ranging from too much sugar and not enough vegetables to artificial additives in processed foods has been cited by various sources as a factor in either causing ADHD directly or exacerbating it. Since this is such a complex issue, we’ll be dealing with it as a topic on its own in a future blog.
Until then, I hope you’ll use the links to the URLs sited below to learn more about this fascinating subject. If you have any questions or concerns about yourself or family members regarding ADHD, please feel free to contact us.
Whatever the causes of ADHD, the success of neurofeedback in helping patients of all ages deal successfully with this condition is gaining greater recognition every day. If you’d like to learn more about our practice and treatment for ADHD please contact us at (773) 755-1775.
1 “ADHD: By the Numbers: Facts, Statistics and You,” Healthline, http://www.healthline.com/health/adhd/facts-statistics-infographic (2014): Accessed April 22, 2017
2 “Introduction,” National Human Genome Research Institute, https://www.genome.gov/10004297/the-adhd-genetic-research-study-at-nih/ (2014): Accessed April 22, 2017
3 M. Koerth-Baker, “The Not-So-Hidden Cause Behind the ADHD,” The New York Time Magazine, http://www.nytimes.com/2013/10/20/magazine/the-not-so-hidden-cause-behind-the-adhd-epidemic.html (2013): Accessed April 22, 2017
4“ADHD: By the Numbers: Facts, Statistics and You,” Healthline, http://www.healthline.com/health/adhd/facts-statistics-infographic (2014): Accessed April 22, 2017
5 M. Koerth-Baker, “The Not-So-Hidden Cause Behind the ADHD,” The New York Time Magazine, http://www.nytimes.com/2013/10/20/magazine/the-not-so-hidden-cause-behind-the-adhd-epidemic.html (2013): Accessed April 22, 2017
6 M. Hicks, Ph.D., “Why the Increase in ADHD?,” Psychology Today https://www.psychologytoday.com/blog/digital-pandemic/201308/why-the-increase-in-adhd (2013): Accessed April 22, 2017
7 E. Deans, M.D, “Sunlight and ADHD,” Psychology Today, https://www.psychologytoday.com/blog/evolutionary-psychiatry/201304/sunlight-and-adhd (2013): Accessed April 22, 2017
8 M.Hicks, Ph.D., “Why the Increase in ADHD?,” Psychology Today https://www.psychologytoday.com/blog/digital-pandemic/201308/why-the-increase-in-adhd (2013): Accessed April 22, 2017
9 E. Deans, M.D, “Sunlight and ADHD,” Psychology Today, https://www.psychologytoday.com/blog/evolutionary-psychiatry/201304/sunlight-and-adhd (2013): Accessed April 22, 2017
The Parents Dilemma – Choosing the Right Therapy When Your Child Has ADHD
Ari Goldstein, Ph.D.
Educational Psychologist, Chicago Illinois
According to the American Psychiatric Association (APA) 5 percent of American children have Attention Deficit Hyperactivity Disorder (ADHD). The Centers for Disease Control and Prevention (CDC) puts it at 11 percent – over twice that number. Whatever the number, ADHD affects many children and those who love them. Although ADHD is usually regarded as a childhood condition, the symptoms affect people of all ages. Perhaps by the time some sufferers reach adulthood, they’ve built enough compensatory mechanisms to function “normally”. Unfortunately, for many others the challenges this condition presents affects them negatively all their lives.
ADHD diagnoses fall into three primary categories: inattentive, hyperactive/impulsive, and combined type
Children presenting with symptoms of ADHD inattentive type (Formerly known as ADD) can’t seem to follow directions, no matter how often they’re given and explained. They have trouble listening to the teacher or other students in class. Any activity that demands organization and planning, like cleaning a room or prioritizing schoolwork is just beyond them. Often, so is following conversations or lecture format classroom environments.
Children presenting with hyperactivity on the other hand, find it almost impossible to just sit still. (In Yiddish, the technical term is “shpilkes” or acting as if you’ve got “ants in your pants.”) They are always in motion and they seem to talk incessantly. (If your child is nicknamed, “Motor mouth” you probably know what we mean.) These children crave sensory input, often seeking it in the most inappropriate of settings.
A major presentation across categories of ADHD can be impulsivity. This may be demonstrated when a child calls out answers in class inappropriately and just seems to be completely unable to wait their turn for anything. Most children with ADHD symptoms also present with a range of executive functioning deficiencies.
When kids with ADHD grow up, these behaviors may be masked through the development of compensatory mechanisms or various forms of self-medication, including nicotine, caffeine, alcohol, and other drugs. These individuals may also have low esteem and feel chronic anxiety due to difficulty concentrating, relating to others, coping with depression, mood swings and anger management.
So, what can parents do to help their family?
Everyone in the family and immediate social circle feels the impact when a child has ADHD. The truth is, no matter how sympathetic and understanding parents and siblings may be, living with someone who is constantly active, vocal and impulsive, or highly forgetful is exhausting. Of course, it’s even harder for the child who is constantly trying not to upset his/her parents, relatives, and teachers.
Sometimes well-meaning relatives and friends offer suggestions that may do more harm than good, particularly because they may make parents feel guilty or inadequate. Here’s what you need to know. ADHD is not caused by listening to loud music, playing video games, eating fast foods, being vaccinated, having a bad teacher or being parented by a mother with a job outside the home. No, it is not because Johnny ran into a parked car and bumped his head when he was three years old. ADHD is not something that can be prevented or cured. However, people can learn to minimize the impact on their functioning if they can successfully build a personal “toolbelt” of skills to do so.
ADHD, in my opinion, is not a modern disability.
It is an inability of the brains and bodies we evolved over hundreds of thousands of years to adapt to our current societal structures and food chain. Over the millennia, a percentage of human beings developed brain capacity which allowed them to be acutely aware of everything in their environment. This saved the social group from a host of environmental dangers. Over time, these genes were prized and these people were revered for this skill. This type of brain also tends to be very creative, good at thinking “outside the box”, and tends to be less bound by rules and structures.
Over time, the need for these qualities lessened as society evolved from that of hunter gatherers to farmers and city dwellers. Although the human genome has changed less than 1% since we lived as hunter gatherers and nomadic tribes, our social structure, food chain and the qualities needed to maintain them have completely changed. Thus, abilities that were once advantageous for survival of our species are now seen as dysfunctions of the body and brain. What we now call ADHD falls into this category.
To medicate or not to medicate.
For several decades, medication has been used as the primary way to control ADHD symptoms. The majority of these medications are stimulants under brand names like Focalin, Adderall, Dexedrine, Vyvanse, Concerta, Merthylin and, probably the best known, Ritalin. Working on the chemistry of the brain, these drugs increase slow brain activity that causes inattention and slow down brainwaves that cause hyperactivity and loss of impulse control. If these medications are ineffective and the patient is at least six years old, non-stimulates such as Strattera, Clonidine and Intuniv may be prescribed instead.
Talk therapy is used, too.
Psychotherapy or counseling is a long-term therapy that may be used alone or with medication. Using various behavior modification techniques, therapists help children deal with their emotions, focus on the moment and curb impulsive actions. While this type of therapy can be effective, it should be consistently reinforced by parents, teachers and other caregivers who may not always be able or willing to do so.
Both of these treatments have several disadvantages.
Drugs like Ritalin are “effective” with only 75 percent to 80 percent of children which means 20 percent are unable to rely on them. In addition, patients may suffer side effects that can sometimes be severe and include eating and sleeping difficulties, migraine headaches, high blood pressure, nausea and skin rashes. If patients attend school, arrangements must be made to administer medication several times a day. Usually this falls to the school nurse or other staff member, and drugs must be stored at the school so they’re available as needed. In addition, children on stimulants like Ritalin may be so “calmed down,” they seem like zombies and drained of their normal personality.
But even when medication works, it is at best a short term” band aid” solution. Pharmaceuticals do nothing to build the executive skill set necessary to function effectively in schools. All they do is allow a child to focus and better regulate their behavior and emotions in the short term. Without the development of executive function skills, the ability to improve their performance in school or society is slim to nil.
While talk therapy is a very useful intervention for many kids with ADHD, it can be difficult to find a therapist with which the child has a good rapport. Sometimes the child’s ability to engage in these sessions is hindered by their dysregulation. In addition, therapies can be expensive and are not always covered by insurance companies.
Neurofeedback provides another and often more effective option.
Although pharmaceuticals can help reduce hyperactivity and impulsive behavior work by changing the brain’s chemistry, these results only last as long as the medication is in the bloodstream. Once the patient stops taking it, the chemical imbalance returns and so does the negative behavior. Neurofeedback is based on a different premise. Its goal is to retrain the areas of the brain producing waves that are either too fast or too slow for optimum brain function. Neurofeedback enables the patient’s brain to develop new pathways producing brain waves that fall within the spectrum of typical brain function. Once learned, these patterns tend to become the brain’s new normal and are followed long after the prescribed neurofeedback therapy is completed, so negative behaviors are eliminated or reduced for a lifetime.
Neurofeedback therapy begins by diagnosing how the brain functions before treatment. In our office, for example, we use a qualitative electroencephalogram or QEEG to track and record brain wave activity in different parts of the brain, assessing the relative balance or imbalance of brain activity within them. This data and the patient’s schedule, will determine how many sessions will be prescribed per week and the length of treatment. For some clients 10 sessions may be sufficient, while others may require up to 40 or 50 sessions to reach their therapy goals. (For more details, please go to the What to Expect page on our site.)
The latest news about Neurofeedback and ADHD.
Over the last twenty years, some traditional medical and educational professionals have regarded the claims made for neurofeedback’s treatment of ADHD with a certain amount of skepticism. Still. millions of patients and their families around the world have found that neurofeedback therapy was more effective than medication or/and talk therapy. Many more have found that using neurofeedback increased the effectiveness of the more established therapies. Whether neurofeedback was the only therapy used or in conjunction with talk therapy or medication, these patients, their families and their healthcare providers found it was a significant aid in dealing with negative ADHD symptoms. Today more and more studies are being done that seem to confirm that neurofeedback indeed makes a positive difference in the lives of individuals diagnosed with ADHD.
Two recent studies demonstrate what we mean.
The first study involved three groups of children between the ages of 6 and 19 years old. The first group was given methylphenidate, the generic form of Ritalin. The second group had neurofeedback therapy for three 40-minute sessions a week for ten weeks. The third group received neurofeedback AND medication. Parents were asked to rate the children’s ADHD symptoms in each group one week before the treatment and again one week afterwards.
The children in all of these groups seemed to improve equally during the study with hyperactivity and impulsivity consistently impacted more than inattentiveness. However, there was one significant difference among the groups: The children receiving neurofeedback, unlike those in the other two groups, also showed greater improvement of inattentive symptoms.
The second study assessed educational performance as well as behavior.
Conducted in Spain, this study had teachers as well as parents record their reactions and observations. The children in the study, 11 boys and 12 girls, were between the ages of 7 and 14. All had been diagnosed as having ADHD. Half of the group were given neurofeedback therapy, consisting of 40 half hour sessions over 20 weeks. The rest of the children were prescribed a generic form of Ritalin and continued to receive medication for six months. The goal was to measure the suppression of hyperactivity and enhanced attention under these two different treatments.
Data was taken before the study began, immediately after neurofeedback therapy stopped, then two months later and yet again, six months after treatment ended. Parents and teachers assessed children’s oppositional behavior and functional impairment (the main symptoms of ADHD). In addition, teachers were asked to track and record the students’ performance in reading, writing. Math and oral expression.
According to the parental assessments, children in both groups exhibited an improvement in inattentive and hyperactive-impulsive symptoms, with inattentiveness showing the most improvement. Furthermore, both groups had maintained these gains when they were seen during the two-month and six-month follow-ups. (Remember, medication was continued for the full six months.)
The data from the teachers, however, revealed something that was unexpected. While the children on medication improved slightly more that the neurofeedback group in core ADHD symptoms, they showed no improvement academically. The group on neurofeedback, on the other hand, showed only slight improvement in inattention and hyperactivity immediately after therapy. However, their ADHD symptoms improved significantly after two months and again, six months later. The real surprise though, was that the academic performance of these students was measurably higher after therapy and these gains continued throughout the six-months leading to the final follow-up.
It’s clear that neurofeedback therapy goes well beyond medication.
The studies described above show that both medication and neurofeedback offer measurable improvements of ADHD symptoms. But neurofeedback does something far more. It changes the function of the brain permanently by developing new pathways in the brain that are maintained for the long term, The result is that children not only exhibit better, more socially acceptable behavior, but an increased ability to learn, focus, make well-reasoned decisions and act on them.
If your child is having issues with ADHD, please contact us. We’d love to have an opportunity to discuss your concerns and answer your questions in person.
Lesser Known Keys to Academic Success: Grit
There are many factors that go into determining whether a student is successful in school and on standardized tests. In this article, I’ll discuss a “lesser known” factor that parents and students should be aware of when developing a plan for improving performance in school and making educational decisions more generally: grit.
Here is a relatively long list of factors that matter (there may be others, but many other factors might be synonyms for or sub-sets a concept on the list below)
- Amount of hard work / work ethic
- Executive function skills: working memory, paying attention, etc.
- Organization skills
- Using strategies
- Interest in the subject matter
- Study skills
- Communication skills
- Interpersonal skills
- Perseverance / grit
- Positive attitude/outlook
Many people may look at the above list and find these all to be relevant, but be naturally drawn towards some traditional factors that the average person relies on when trying to understand why someone is an “A” student. Why does my oldest son have an “A” average and my younger son a “B-?” Well, he seems to work harder. Or, he is just naturally brighter and “gets” things (i.e., IQ). Or, he has better study skills and is more organized. But in fact, there is evidence that one factor on the list plays an important, underappreciated and outsized role in determining academic success: grit.
The #1 predictor of academic success
Angela Duckworth, an Associate Professor of Psychology at the University of Pennsylvania, defines grit as the “tendency to sustain interest in and effort toward very long-term goals.” Grit is related to self-control, but is more of a “long term” concept than self-control, which is about resisting momentary temptation. Duckworth describes her research in this TED talk.
Simply put, grittier people simply stick with things longer than less gritty people. When they experience problems or road blocks, they, driven by a passion for accomplishing their goal, stick with the initiative and find solutions to problems instead of giving up or redefining their goals. They are more likely to persevere in the face of obstacles. The insight here, however, is not that the above is true. It seems quite logical and intuitive, at least to me, that all else equal, someone with more grit would accomplish more in many walks of life, academic or otherwise. The insight is that grit is more important than one might expect.
You might be surprised to realize that Duckworth’s research on grit suggests that it is a better predictor of report card grades and improvement in report card grades than IQ. In fact, grit was the best predictor of academic performance. She also showed grit to be the best predictor of success in the Scripps National Spelling Bee, perseverance at West Point Military Academy and graduation from Chicago public schools. The implications for students of the importance of grit are profound.
How and why grit it matters
Imagine you are an 11th grade student in a calculus class struggling with the night’s homework. You have a friend who is getting an A in the class, but you’ve been struggling so far. You know you’ve put in some hard work, but the first test didn’t treat you very well. Once you believe or think you understand that your friend is just “more of a math person”, and may not even be trying as hard as you are, it’s easy to “let yourself off the hook,” close the book, and begin to get comfortable with the idea of a C or B in the class. This way of thinking places relatively little weight on the importance of grit, and more on IQ or natural ability.
Now, imagine that you believe in the importance of grit. You’ll probably be far more likely to find a way to stay after school to ask the teacher questions, or at least muster the courage to ask a question in class. Perhaps you’ll go even farther and ask your parents for a tutor. Once you believe that grit matters, your approach and actions will almost certainly change and you will become more likely to succeed. Now, it’s not all about simply believing in grit. Some people really are more naturally grittier than others, but that doesn’t mean a naturally less gritty person can’t train themselves to become grittier. And even if you over index in grit, your interests, study skills, planning, IQ, etc. will interact to determine how well you do. But the point is that grit is important, and a lot can be gained from simply realizing that this is the case.
Grit is far more important to academic success than most people realize. Don’t be too quick to assume that success is driven primarily by natural gifts in any given area. Success may just be a matter of sticking with a goal over the long run and overcoming obstacles to reach it.
About the Author
Mark Skoskiewicz is the founder of MyGuru, a 1-1 tutoring and test prep company. He earned a B.S. from Indiana University and an MBA from Northwestern University. He recently earned a certificate from UC San Diego for completing Learning How to Learn: Powerful Mental Tools to Help you Master Tough Subjects.
By Ari Goldstein, Ph.D.
For the past few months, we’ve been discussing the symptoms, causes and various treatment options for depression. Currently, it’s estimated that 13% of men and 21% of women in America will experience some level of clinical depression in their lives. In the past, treatment of depression usually involved long term psychoanalysis to uncover if any past emotional experiences might have been the cause of the depression.
Later, treatment often involved taking pharmaceuticals to alter body chemistry.
Today, many, if not most, people seeking relief from their depression will be prescribed some kind of anti-depressant pharmaceutical. While these drugs may address the immediate issue of a depressed mood, they also have significant drawbacks. These include loss of sexual desire, weight gain and even, in some cases, causing the patient’s condition to deepen to the point where they’re in danger of committing suicide. (Talk about the cure being worse than the disease!)
Fortunately, neurofeedback offers a treatment alternative with few if any negative side effects and some distinct advantages. Yet there are many in the medical community that still are skeptical about suggesting neurofeedback for patients suffering from depression. One of the criticisms heard most often regarding neurofeedback therapy is that no definitive studies have been done proving its efficacy for conditions such as ADHD, post-traumatic stress disorder and depression.
In considering the case to be made for Neurofeedback, I came across this quote from the great 19th Century biologist Thomas Huxley that struck me as an appropriate way to begin. Huxley, one of the great Darwin’s fieriest defenders once observed, “It is a popular delusion that the scientific enquirer is under an obligation not to go beyond generalization of observed facts…but anyone who is practically acquainted with scientific work is aware that those who refuse to go beyond the facts, rarely get as far.”
Although there’s never been the type of definitive scientific study cited by traditional institutions like the Mayo Clinic or John Hopkins, the effectiveness of neurofeedback has been studied and tested many times and by many different groups over the years. These studies, however, have not been conducted on the same level as those for pharmaceuticals for several reasons. First, neurofeedback is not the product of a multi-billion dollar company that can spend millions of dollars on a single study. Consequently, double blind research studies involving control groups have not been run to test the efficacy of neurofeedback for different conditions. But even more problematic, the very nature of neurofeedback therapy means it is constantly being adjusted to fit the individual patient. This makes any form of control group study very difficult.
Neurofeedback therapy begins by first analyzing the activity of an individual patient’s brain wave patterns. “Listening” to the brain’s electrical activity through sensors, the neurofeedback provider can determine and record just how the patient’s brain waves are functioning at that moment. Studies have shown that when the left frontal area of the brain is more active than the right frontal area, you’re optimistic and positive. Conversely, when more activity is shown in the right frontal area than the left, you’re apt to feel more negatively toward life. This is not a small thing. Because the difference between emotional comfort and discomfort can effect everything we do, including our ability to think clearly, make decisions and take decisive action to carry them out.
Within the last decade, neurofeedback and other brain assessment technologies have become much more sophisticated allowing scientists to learn more about exactly how the brain functions. Functional magnetic resonance imaging (fMRI), for example has been able to measure blood flow to specific areas of the brain during certain activities. This information allows physicians to determine the risk of brain surgery or other invasive treatments for a patient. They can also identify regions of the brain linked to critical functions such as speaking, moving, sensing, or planning. This knowledge is crucial for creating productive strategies for surgery and radiation therapy. While fMRI scans are too expensive for regular use, disorders like anxiety and depression can still be treated effectively with less advanced equipment. Quantitative electroencephalography (qEEG), for example, is used to analyze electrical activity in certain brain areas of depressed patients as compared to the brain activity of patients who typically enjoy good mental health. Using this information, neurofeedback programs are set up to teach patients how to achieve these typical states of brain wave activity.
During a neurofeedback session, the patient sits in a chair or a recliner and plays a video game or alters presentations on a computer screen by changing the state of his/her brain waves. The brain soon learns that going from one state into another will win the race, drive the train or achieve whatever the system has been set up to register as a positive outcome.
Once a patient becomes aware of how to produce waves at a typical level they can eradicate their depressed mood – in some cases for the rest of their lives. This level of control is accomplished by continuing therapy until the lesson has been sufficiently reinforced. I read about two recent studies that seem to demonstrate this. These studies were cited by Andrea Petersen in an article for the Wall Street Journal, “Brain Training for Anxiety, Depression and other Mental Conditions.” They were conducted by Dr. Kymberly Young, an associate at the Laureate Institute for Brain Research in Tulsa, Oklahoma and published in the scientific journal, Plos One in 2014. The first involved giving 23 patient suffering from depression a neurofeedback session and comparing how it affected their self-evaluation of their condition. It was found that patients who had neurofeedback scored themselves as 20% happier after treatment compared to those in a control group who scored 2%. Measures of depression and anxiety also dropped after treatment. And yet, Peterson notes, “… depression also dropped among those in the control group and the difference in the drop between the groups wasn’t statistically significant.” However, in a follow-up study by Dr. Young, presented at the annual meeting of the Society of Biological Psychiatry in 2015, the results seemed to show that the number of therapy sessions a patient undergoes plays a significant role in the success of the treatment. In this study, one group received twenty sessions of neurofeedbck before any results were measured. After these sessions, the neurofeedback group felt that their depression had dropped 50% while those in the control group said they felt only 10% improvement. This seems to indicate that while neurofeedback is about teaching the brain to act differently, it is not an instant cure. The number of sessions needed to make a significant improvement depends on the patient’s needs and is usually determined by the patient and their provider once therapy begins. Most people require a minimum of 20 sessions to see real change, however that number can vary wildly from patient to patient.
Of course, neurofeedback doesn’t necessarily work for everyone. If patients can’t learn to regulate the amygdala and change their brain wave activity into a healthier range, neurofeedback may not be able to help them. But we know from our practice and from observing the work of others, that most people can be helped by neurofeedback if they just give it fair try. The rewards are literally priceless. After all, how can you put a price tag on the ability to put aside a negative and depressing outlook and fully participate in the joy of life – without medication?
If you’d like to learn more about neurofeedback for you or a family member, please feel free to contact us anytime. You may be surprised at just how far treatment for depression has come by those willing to look outside the boundaries of traditional western medicine to find new and more effective answers.
By Ari Goldstein, Ph.D.
According to Dr. Stephen Ildari, author of “The Depression Cure,” the human race is experiencing a global epidemic of depression because, “we were never designed for the sedentary, indoor, sleep-deprived, socially-isolated, fast-food-laden, frenetic pace of modern life.”
Ildari, an associate professor of clinical psychology at the University of Kansas, claims that depression is actually a form of the fight or flight response early humans developed when faced with physical dangers or predators. This condition enables the body to go through the intense physical activity required to escape a life threatening condition such as fire or an animal attack for hours or even days. However, Ildari postulates, “for many people throughout the Western world, the stress response goes on for weeks, months and even years at a time, and when it does that, it’s incredibly toxic.”
Following up on this theory, Ildari proposes that to prevent and permanently cure depression we should follow this six-step regime to create a lifestyle similar to that of depression–free, pre-historic hunter-gatherers:
-Take daily doses of 1,500 mg of omega-3 plus a multivitamin and 500 mg of Vitamin C
– Don’t dwell on negative thoughts – instead, participate in some sort of activity with others
– Exercise for 90 minutes per week
-Get 15 to 30 minutes of sunlight each morning in the summer and consider using a lightbox in the winter
– Be sociable – interact on a regular basis with other people
– Get 8 hours of sleep each night
Apparently, Ildari developed the six steps described above as an alternative to pharmaceutical therapy for depression that he regards as largely ineffective.
Where did taking drugs for depression begin anyway?
Humanity has actually been looking to “cure the blues” for Millennia. Whether it was drinking fermented beverages, smoking opium and hashish, or using stimulants like cocaine, the dream of finding an instant cure for sadness has been with us for a long, long time.
In the 1980’s pharmaceutical giant, Eli Lilly and Company introduced a new drug called Prozac to the public. Originally called Fluoxetine, the formula was intended and tested to treat high blood pressure and later obesity. When it failed to be effective in treating these conditions, it was given to a small group of people suffering from mild depression. Viola! Prozac seemed to cheer up those who were chronically sad and, perhaps just as importantly, it didn’t seem to have the same potential for dangerous side effects – addiction and overdosing – that were becoming associated with the anti-anxiety drug, Valium.
Prozac also benefited by coming along at a time when the rules were loosening for marketing pharmaceuticals. So Eli Lilly hired a branding company that scrapped “Fluoxetine” for “Prozac,” creating a name that starts with “Pro” to indicate a “positive” and “professional” outcome, followed by a “Z” suggesting strength and high technology, then ending with “ac” to convey “action.” The result of this marketing ploy was that by 2012, thirteen per cent of Americans were taking Prozac or some other antidepressant. All of these drugs generally fall into several different categories, each having its own advantages and weaknesses. Here’s a brief description and some examples of these medication types:
- Selective serotonin re-uptake inhibitors (SSRIs).
This group of drugs includes Prozac, Paxil, Zoloft, Celexa and Lexapro. They may have some side effects including upset stomach, jitteriness, insomnia and a decrease in sexual desire. Among the newest treatments for depression, SSRIs are reportedly safer than some prescriptions used in the past. The popularity of these drugs centers on their ability to increase serotonin levels in the brain. Studies done decades ago indicated depressed people have low serotonin levels and when these levels were raised, patients became more energetic and less sad.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs).
These medications include Cymbalta, Effexor and Pristiq. Their side effects resemble those caused by SSRIs and, in large doses, can also cause dizziness and excessive sweating. They also work by raising the levels of serotonin as well as norepinephrine, another neurotransmitter in the brain.
- Norepinephrine and dopamine reuptake inhibitors (NDRIs).
Wellbutrin is an example of this category and works by increasing dopamine as well as norepinephrine in the brain. In contrast to SSRIs and SNRIs, NDRIs don’t seem to lessen sexual desire or activity but if taken in high doses may increase the risk of seizures.
- Tricyclic antidepressants (TCAs).
Used for years, TCAs are often as effective as the newer SSRIs and SRNIs but have more side effects such as low blood pressure, dry mouth, blurred vision, constipation, urinary retention, fast heartbeat and confusion. They can also cause weight gain and in older patients can cause memory problems and even hallucinations. Like the newer drugs, they work by increasing the amount of serotonin and/or norepinephrine in the brain.
- Monoamine oxidase inhibitors (MAOIs).
MAOIs, such a Parnate and Nardil, also increase serotonin levels but are generally prescribed only if other medications haven’t worked. This is because the side effects of MAOIs are more serious. These drugs also require a strict adherence to a limited diet in order to avoid potentially deadly interaction with certain foods and other medications. One of the newer MAOIs – Emsam – may have fewer of these complications and is designed to work as a skin patch instead of a pill.
- Atypical antidepressants.
Medications like Desyrel and Remeron are called atypical because they can’t be put into any existing antidepressant category. Since they act as sedatives, they are usually prescribed for nighttime use and may be given along with other antidepressants to relieve insomnia.
Finding the right medication can be half the battle.
Treating depression is often a case of trial and error to find the best medicines or combination of medicines for the patient. Since antidepressants often taken several weeks before they are fully effective and side effects begin to lessen, discovering the right treatment calls for patience and good doctor patient communication. Furthermore, ceasing antidepressants abruptly can cause withdrawal symptoms which worsen depression.
Sometimes these medications are given in combinations.
Primary care physicians or psychiatrists many prescribe a number of different medications to a patient to treat different symptoms. These prescriptions may include stimulants, mood-stabilizers, anti-anxiety medications or antipsychotic drugs. In some cases, two or more antidepressants maybe prescribed along with other medications to enhance the effectiveness of the treatment. This strategy is known as augmentation.
Then there’s talk therapy or psychotherapy.
Psychotherapy, usually referred to as “therapy” is generally part of any treatment for depression. It’s probably what most people think of when considering getting help for any emotional problem. Practiced by different types of therapists, it is aimed at assisting the patient to understand what is causing their depression and how to deal with these issues. Often therapy takes place while the patient is also receiving medication to eliminate or lessen the symptoms suffered during depression such as anxiety and insomnia. Through therapy, the patient strives to regain control over his or her emotions and ability to take pleasure in day-to day-activities.
Depending on the cause of the depression, the personality of the patient and other factors, a therapist may try one or more of the following therapy approaches:
This starts with the assumption that the patient’s depression is caused by unresolved and probably unrecognized difficulties that began in childhood. During the course of therapy, the patient strives to understand these feelings and develop strategies to cope with them. Depending on the patient and the severity of the problem, the course of treatment can take a relatively short period or continue for several years.
As the name implies, this therapeutic approach centers on the interworking of relationships between the patient and their family and friends. The goal is to increase the patient’s self-esteem and improve their ability to communicate with others within a relatively short timeframe of three or four months. It is particularly well suited to treat depression caused by specific events such as a death, the end of a relationship, job loss and other major life events.
- Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy of CBT is based on the premise that by changing a person’s perception of a situation you can alter the way they react to it. So while the situation remains the same, the patient is able to overcome his or her previous feelings of anxiety or depression in response to it.
In contrast to other approaches which focus on analyzing behavior and delving into the patient’s emotional relationships, CBT concentrates on teaching the patient a different way of looking at the world and thus, reacting to it. The therapist acts as an instructor to the patient, guiding them through changing the way he or she thinks, feels, and acts within the context of a particular situation. This type of therapy is appropriate for children as well as adults. By replacing depressing or worrying thoughts, it allows the child to experience feelings that are more appropriate and exhibit more positive behaviors.
Pharmaceutical or psychotherapy – which is best?
Ever since the advent of pharmaceutical treatment for depression, there have been studies touting the benefits of medication for treating depression. Doctor frequently recommend a combination of both medication and therapy for their patients. But recent studies seem to indicate that different patients may benefit more from one of these than another, depending on the root cause of their depression and the physical structure of their brains. Here’s an example of these findings described in a New York Times article, “To Treat Depression, Drugs or Therapy?” by Dr. Richard A. Friedman.
“In a large, multicenter study, Dr. Charles Nemeroff, then a professor of psychiatry at Emory and now at the University of Miami, found that for depressed adults without a history of abuse, there was a clear ranking, order of treatment efficacy: Combined psychotherapy (using a form of cognitive behavior therapy) and an antidepressant (in this case, Serzone) was superior to either treatment alone. But for those who had a history of childhood trauma, the results were strikingly different: 48 percent of these patients achieved remission with psychotherapy alone, but only 33 percent of these patients responded to an antidepressant alone. The combination of psychotherapy and a drug was not significantly better than psychotherapy alone.”
“One explanation for the varying response is that a history of trauma early in life is strongly correlated with shrinkage of the hippocampus, a brain region critical to memory and learning. Perhaps if you are depressed with a compromised hippocampus, you need the active learning that comes with psychotherapy to beat your depression. Antidepressants alone may not suffice.”
Electroconvulsive Therapy (ECT), one of the oldest treatments, is still seen as effective.
Electroconvulsive therapy or ECT has been used to treat depression for decades. Unfortunately, in some cases the treatment was misused and ECT acquired a reputation for harming patients as much as it helped them. Today, however, the American Psychiatric Association has developed strict guidelines for using this procedure and most states require that patients grant their written consent before ECT can be used. In addition, an explanation of the procedure including all the risks involved must be given to the patient and their family before they sign the consent form. Generally, ECT is used only after psychotherapy and medication have proven to be ineffective. Since it works far quicker than medication or therapy, it is also used when there’s an immediate risk of suicide if the depressed state is not relieved.
Transcranial Magnetic Stimulation (TMS).
This is a noninvasive therapy used to treat cases of depression, psychosis, anxiety, and other disorders that seem resistant to other forms of treatment. First developed in 1985, its often referred to as rTMS standing for repetitive Transcranial Magnetic Stimulation. The treatment consists of short electromagnetic pulses administered through a coil placed against the scalp near the forehead. These magnetic pulses pass through the skull and cause small electrical currents that stimulate nerve cells in a designated area of the brain.
According to the National Institute of Mental Health, scientists theorize that because TMS focuses on specific sites in the brain, the types of side effects generally associated with ECT are largely eliminated. But opinions still vary as to which site is most effective in treating depression.
There is, of course, one therapy for depression that I have not yet mentioned – Neurofeedback.
However, neurofeedback therapy for depression is too large a topic to be reduced to just a few paragraphs and deserves a discussion all of its own. So join me for part 3 of this series where I’ll examine just why neurofeedback is often more successful than pharmaceutical and talk therapy interventions for treating depression.
Depression: Causes, Symptoms, and Treatment – Part I of III
Depression: What’s it all about?
Ari Goldstein, Ph.D. Educational Psychologist
“I have had issues with depression all my life, and it’s probably true to say there was a tendency towards it even when I was very young, during my schooldays. There was often – and this is quite common with comics – a sense of not feeling as if I belonged anywhere.”
– Jack Dee
“Every man has his secret sorrows which the world knows not; and often times we call a man cold when he is only sad.”
– Henry Wadsworth Longfellow
“If what I feel were equally distributed to the whole human family, there would not be one cheerful face on the earth. Whether I shall ever be better, I cannot tell.”
– Abraham Lincoln
“It’s so difficult to describe [depression] to someone who’s never been there, because it’s not sadness. But it’s that cold absence of feeling — that really hollowed-out feeling.”
– J.K. Rowling
If any of the feelings described above sound all too familiar, you may at some point in your life experienced a form of depression. As you can see, you’re not alone. Presidents, poets, best-selling authors and even comedians have been depressed, too.
More than 15 million Americans over the age of 18 suffer from depression every year.
According to the National Institute of Mental Health, “Depression is a common but serious illness, and most who experience it need treatment to get better.” Although 80 percent of people treated for depression experience relief within four to six weeks, two-thirds of those who need treatment never get it. This is no doubt a factor in suicide being the second leading cause of death among Americans between the ages of 15 and 44.
The American Psychiatric Association has defined three major types of depression.
In the Diagnostic and Statistical Manual of Mental Disorders (DSM), the APA describes three categories of depression all of which involve the following combination of symptoms to a greater or less degree:
– Trouble sleeping or excessive sleeping
– A dramatic change in appetite, often with weight gain or loss
– Fatigue and lack of energy
– Feelings of worthlessness, self-hate, and inappropriate guilt
– Extreme difficulty concentrating
– Agitation, restlessness, and irritability
– Inactivity and withdrawal from usual activities
– Feelings of hopelessness and helplessness
– Recurring thoughts of death or suicide
• Major Depressive Disorder or Clinical Depression – the patient feels sad and lacks interest in previously pleasurable activities. This mood lasts almost all day, every day for two
weeks or longer while the patient suffers from four or more of the symptoms mentioned above.
• Persistent Depressive Disorder (PDD) or Dysthymia – the patient experiences persistent depression for two or more years although, in some cases, sadness may seem to lift for a time.
Still, he or she is in an almost constantly depressed mood and experiences decreased appetite, low energy, lack of self-esteem, sleep problems and a feeling of hopelessness.
• Manic Depression (also called Bipolar Disorder) – the patient’s mood swings between two extremes – depression and mania. In some cases, the mania phase is dominant and felt as either
euphoria or irritability. Manic episodes may last for a week or longer during which time the patient may experience at least three of the symptoms mentioned above. If these symptoms
are severe enough or include psychotic aspects such as hallucinations and delusions, hospitalization may be necessary to prevent the patient from hurting themselves and others.
The causes of depression are as individual as the people who experience it.
Research shows that depression can be caused by genetics, environment, alterations in biochemistry or an illness of mind or body. Recent studies have discovered some structural differences between the brains of some people suffering from depression and those who do not. People who are depressed seem to have a smaller hippocampus than those who are not depressed. Depression sufferers also seem to produce an excessive amount of the stress hormone cortisol. This discovery has led some scientists to theorize that cortisol is toxic to the hippocampus and may affect the hippocampus’ ability to produce Serotonin. Whether or not this is the case, it is clear that depression is a highly complex malady that is influenced by a multitude of factors including:
• Biological Causes
Research seems to indicate people who have a close family member with depression are up to three times more likely to become depressed themselves.4 Studies using twins as subjects
found that if one identical twin was depressed, 76% of the time the other sibling also succumbed.
Medication taken for such ailments as high blood pressure, cancer and Parkinson disease can also affect the balance of serotonin in the system. This, in turn, can lead to depression in
patients already coping with these illnesses. In fact, finding out you have a serious illness can be a depression stressor by itself.
• Emotional Trauma
The death of a loved one, divorce and enduring conflict in the home or at work can also push someone over the edge into depression. So can past traumas such as sex abuse or being
assaulted in childhood. Men are particularly susceptible to depression due to a job loss or change in social status that can damage their sense of personal identity and self-worth.
• Life Changes
Even life changes that are anticipated and seemingly desired such as moving into a new home, graduating college or getting married can, in some individuals, trigger a major depression.
Depression differs between generations and genders.
Depression can strike at any age – from infancy to old age. While it is always a devastating condition, there are some differences in how it manifests itself in each sex and age groups. Statistically, depression afflicts women twice as often as men. However, this could be because the condition is often under diagnosed in men and reveals more about our social mores than our medical care. In a society that equates masculinity with self-reliance and emotional self-control, seeking treatment for depression maybe out of sync with social norms. Some men are reluctant to even talk about their emotions let alone admit to feeling overwhelmed by them. Even if a physician does diagnosis a man as depressed, that individual may refuse to accept treatment. Instead, they may try to self-medicate with alcohol and drugs, which not only masks the symptoms of clinical depression but can exacerbate the problem.
Depressed men are more prone to rage and violence than women and may display various uncharacteristic behaviors such as taking risks in their sexual partners or driving too fast. They may use work or sports as an escape from their feelings, becoming overly involved in these activities. Studies also indicate that men seem to think about suicide more frequently than women do.
Women, on the other hand, may be more prone to depression because of biological differences.
At various stages in a woman’s life, her hormones undergo significant changes – preparing for pregnancy, going through pregnancy and finally, facing the end of fertility during menopause. In fact, during every monthly menstrual cycle, most women go through several days of moodiness and physical discomfort often referred to as Premenstrual Syndrome or PMS. A small percentage of women have Premenstrual Dysphoric Disorder (PMDD) in which these symptoms are so excessive they affect the sufferer’s ability to function at work and at home. Of course, not all women become depressed when they menstruate, even if they suffer from PMDD, so these hormonal changes do not necessarily cause depression by themselves. However, research still remains to be done on just what effect estrogen, progesterone and other hormones involved with menstruation have on brain function.
Below is a summary of how women may experience depression during the various phases of their lives:
Hormonal changes can contribute to overwhelming sadness even at a time when feelings of happiness are supposed to be the norm. The fact is, pregnancy can be a mixed blessing for many
women in our society. The mother-to-be may fear the pain of delivery or, worse, having a miscarriage. She may lack a support system to help her raise the baby or be dealing with a
failing relationship with the baby’s father. Moreover, even in the best of circumstances, the increased and ongoing responsibilities a woman faces in raising a baby can be a major
• Postpartum Depression
Half of all new mothers experience feelings of sadness, anger, and irritability shortly after giving birth. For most women these negative feelings usually dissipate in a week or two
but for some they can become extremely intense and even lead to thoughts of hurting the baby and suicide. This condition is called postpartum depression and it may be due to excessive
fluctuation of hormones along with a genetic tendency to depression. Whatever its cause, it is very serious and needs immediate treatment.
Hormones also play a part in causing depression later in life. In addition to enduring the physical discomfort of hot flashes, older women may feel they are less desirable sexually to
their husbands just as their children are growing up and leaving to start families of their own. These life changes coupled with a fluctuation and drop in estrogen levels can put some
women at greater risk for clinical depression.
Social Pressures may also be why women seem to suffer from depression more than men do.
In our society women are the ultimate multi-taskers and frequently hold down full time jobs while being the primary – sometimes the only – caregiver for young children and/or senior family members. In addition, a woman may have to cope with sexual and physical abuse, not to mention the very real issues of inequality of power, status and compensation in the workplace. Any one of these situations could trigger a depression. Yet all too frequently, a woman may have to deal with two or more of these stressors simultaneously.
Even young children can experience depression.
In the very young, symptoms of depression include crying for no reason and restlessness, while in preschoolers, they may be manifested as irritability and aggression. As children mature, they may experience a sense of apathy, low energy and listlessness at school and even during activities, they usually love. Once adolescence is reached, symptoms tend to resemble those in adults more closely.
Depressed kids aren’t just “acting up.”
In our culture, children are the very symbols of hope and joy so the idea that they experience the hopelessness and alienation of depression seems counter-intuitive. Consequently, parents and teachers may overlook the signs of this illness putting the symptoms down to “kids being kids.” Yet children who are “act outing” and showing anger and aggressiveness may be as depressed as an adult who is acting sad and blue.
There are no special tests to identify depression in youngsters.
If a child exhibits the systems of depression for two weeks or more he or she should be taken to a doctor to make sure they’re not suffering from a physical ailment requiring medication. Once physical causes have been ruled out, a mental health evaluation can be made based on interviews with the child and information from parents, teachers, friends and classmates.
Research continues on the symptoms and causes of depression.
For example, just recently, a research team led by Professor Bernhard Baune, Head of Psychiatry at University of Adelaide reviewed a growing body of evidence indicating that certain types of genes effect the working of the brain and surrounding tissues during depression.5 Their recently published findings not only support multiple theories of the underlying genetic causes of depression, but highlight one gene in particular – PXMP2. PXMP2, which plays a role in breaking down fatty acids in the body and converting them to energy, seems to be expressed during depression. Baune’s team is investigating the link between PXMP2, its function in the metabolism and depression.
“Depression is much more complex than most people think, and it includes dysfunction at multiple biological levels, from genes to brain regions, and blood circulating through the body,” says Professor Baune. “The state of depression can also change over time, it goes through various phases and it may present with a large range of symptoms.” Baune’s research shows support for the wide range of theories that different genes may play a role in depression, including those that regulate serotonin, melatonin and the immune system, among many others. “But,” he claims, “PXMP2 still represents a very strong, new target for future research programs.”
This is, no doubt, just one of many discoveries that will lead us to a better understanding of depression and why it debilitates so many. Next month, we’ll explore the treatment options for depression past, present and future.
1 Facts, National Network of Depression Centers, http://www.nndc.org/the-facts/ (2014)
2 “Depression: What You Need to Know,” National Institute of Mental Health, http://www.nimh.nih.gov/health/publications/depression-what-you-need-to-know-12-2015/index.shtml (2016)
3 ”Stressing the Hippocampus: Why It Matters,” http://blogs.scientificamerican.com/news-blog/stressing-the-hippocampus-why-it-ma/ (2008)
4 Katherine Kam, “Depression When it’s all in the Family,” WebMD, http://www.webmd.com/depression/features/depression-when-its-all-in-the-family (2016)
5 “Faulty Gene Linked to Depression and Cardiovascular Disease,” Science Daily, https://www.sciencedaily.com/releases/2016/09/160913115633.htm (Sept. 16, 2016)
The History of Neurofeedback: Part III
By Ari Goldstein, Ph.D.
Educational Psychologist, Chicago Illinois
Ever since the 1970’s, when scientists like Dr. Barry Sterman and Dr. Joe Kamiya first demonstrated that patients with epilepsy could avoid seizures by regulating their own brain activity, quantitative electroencephalography, also called neurofeedback, has had a place in medicine. Later, when Dr. Joel Lubar and others demonstrated that neurofeedback was also effective in treating children and young adults with attention-deficit hyperactivity disorder (ADHD), pediatricians and educators took notice of it as well.
Yet traditional health care providers remained skeptical about neurofeedback.
Unlike pharmaceuticals, the effectiveness of neurofeedback therapy has been hard to prove via traditional tests that include blind studies and large groups of subjects. The result has been that psychiatrists and MDs have been slow to consider neurofeedback for their patients, relying instead on “proven” pharmaceuticals such as Vimpat, Zoloft, Ritalin and similar medications. Many seemed to feel that the anecdotal histories of patients who were helped by neurofeedback could just have been the “exceptions that prove the rule” rather than typical of a whole groups of people with similar disorders.
But in the 1990’s, research began to catch up with anecdotal findings.
In 1990, the Congress of the United States passed Joint Resolution 174, designating the period from January 1, 1990 to December 31, 2000, as the “Decade of the Brain.” This legislation, signed by President George H. Bush, signified a united effort of national resources including the Library of Congress and the National Institute of Mental Health.
Dedicated to enhancing public awareness of the benefits to be derived from brain research, this legislation provided new funding and enlisted the support of both the public and private sectors. As a result, researchers and scientists around the country were able to pursue advanced investigations of brain function, examine the causes of brain disorders more closely and develop more options for treating them.
One result was Functional Magnetic Resonance Imaging (fMRI), a new measure of brain activity.
This cutting-edge technology uses a functional neuroimaging procedure that can measure brain activity by noting changes associated with the way blood flows in the brain. Inspired by the discovery that cerebral blood flow and neuronal activation are connected, this technology was able to correlate the increase in brain activity to an increase in blood flow to certain areas of the brain. When Functional Magnetic Resonance Imaging (rtMRI) was used to measure brain activity in real time, the results seemed to support some of the claims made about the effectiveness of neurofeedback therapy.
Thus, the National Center for Biotechnology Information revealed that “several groups have reported successful application of rtfMRI to modify cognitive and behavioral processes relevant for the treatment of clinical disorders.1” The article containing this quote goes on to note that because of a small sample size and lack of critical control conditions these results could not be regarded as definitive. “Nevertheless, this important early work supports the investment in RCTs of rtfMRI for the treatment of some brain disorders. 1”
The mainstream press also took note of neurofeedback’s effectiveness.
In a piece on neurofeedback that ran in the Health Science section of the Washington Post, author Arlene Kardis declared, “Researchers who endorse the technique say they don’t know exactly how it works but they say the changes in brain waves result in improved ability to focus and relax.”2 The Kardis’ article also demonstrated that the therapy is being used to treat a wide range of conditions from PTSD in veterans to ADHD in school children and adults.
Neurofeedback has been used for several years by Homecoming for Veterans, a national outreach program composed of clinicians across the country who treat veterans suffering from PTSD and other brain conditions free of charge. Hundreds of American veterans who have enjoyed these services claim that they were able to get their lives back on track again, thanks to this therapy.3
Traditional medicine becomes more accepting of neurofeedback
After the Decade of the Brain, several professional associations which had previously been skeptical about neurofeedback, seemed more open to the possibility that it offered a potential alternative to pharmaceuticals to treat brain disorders. In a cover story from the American Psychology Association web site, the authors postulate, “Early studies indicate that feedback with real-time functional magnetic resonance imaging (fMRI) could help in treating clinical disorders including depression, schizophrenia, addiction and chronic pain.” 4
Another sign that medical professionals were more open to accepting the potential of neurofeedback recently came from the prestigious American Association of Peditricans. A website article on an AAP study of 104 children with Attention Deficit Hyperactivity Disorder (ADHD) reported, “Neurofeedback, a type of training using a computer program for children with attention-deficit/hyperactivity disorder (ADHD), can contribute to lasting improvements for these children.”5
As you can see, Neurofeedback is now being used to treat a host of conditions in patients of all ages. We’re sure that this is just the beginning as the Decade of the Brain gives way to a Millennium of Mindfulness – full of new developments, new discoveries and new solutions for patients seeking happier, healthier and more fulfilling lives.
If you’d like to learn more about how neurofeedback can help depression, anxiety, learning disabilities, Attention Deficit Disorders, post-traumatic stress disorder and more please contact us for a consultation.
1 “Optimizing real time fMRI neurofeedback for therapeutic discovery and development,”
PubMedGove, http://www.ncbi.nlm.nih.gov/pubmed/25161891, (July 10, 2014)
2 Arlene Kardis, “Therapists are Using Neurofeedback to Treat ADHD, PTSD and Other Conditions,” Washington Post, https://www.washingtonpost.com/national/health-science/therapists-are-using-neurofeedback-to-treat-adhd-ptsd-and-other-conditions/2015/01/16/b38e6cee-5ec3-11e4-91f7-5d89b5e8c251_story.html, (January 2015)
3 Rachel Weick, “Neurofeedback Treats Veterans with PTSD,” http://www.grbj.com/articles/79745-neurofeedback-treats-veterans-with-ptsd, (May 23, 2014)
4 “Positive feedback,” American Psychological Association, Monitor on Psychology http://www.apa.org/monitor/2016/03/cover-feedback.aspx, (March 2016)
5 “In-School NeurofeedbackTraining for ADHD: Sustained Improvement From a Randomized Control Trial,” American Academy of Pediatrics://www.aap.org/en-us/about-the-aap/aap-press-room/pages/computer-feedback-can-help-students-with-adhd.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR:+No+local+token, (February 17, 2014)
The History of Neurofeedback: Part II
Ari Goldstein, Ph.D.
For far too long, neurofeedback has been viewed as a therapy based more on wishful thinking than science. Perhaps this is because early in its history – in the 1960s and 70s – neurofeedback attracted the attention of those pursuing spiritual growth as well as patients seeking non-drug treatments for various brain conditions. Somehow, neurofeedback became associated with therapies outside the realm of established scientific inquiry.
Yet, as we indicated in our last blog, this incredible, drug-free therapy is the product of decades of well-documented research on brain function conducted by highly respected scientists. Starting with Hans Berger’s revelations about the existence of brain waves during the 1920s, scientists around the world have been exploring how this discovery could be used to treat disorders related to brain function.
The second chapter in this series features a member of next generation of neurofeedback innovators, Barry Sterman, PhD., at UCLA. It was Sterman who first used neurofeedback therapy to treat epilepsy. Later, Dr, Joel Lubar built on Sterman’s work to develop a new protocol for treating ADHD. Both of these gifted scientists, along with Dr. Joe Kamiya, Elmer and Alice Green and others, were continuing the work of previous groundbreaking researchers like Ivan Pavlov
In fact, Sterman’s first neurofeedback experiments were inspired by the work of Ivan Pavlov.
Pavlov was a Russian physiologist known primarily for his work in classical conditioning. In the 1880s, he discovered that salivation, an automatic response, could be triggered in a dog not only by the sight and smell of food, but also by the sight of non-edible things the animal had learned to associate with food.
Dr. Sterman tried a similar experiment on cats.
Taking a cue from Hans Berger, the pioneering scientist who discovered brain waves, Sterman restructured Pavlov’s experiment using 30 cats as subjects. During the course of the experiment he measured the brain activity of each animal with an EEG. After withholding food from the cats to stimulate their appetite, he put each one into a chamber that was empty except for a lever and an empty bowl. Whenever the cat pressed the lever, a mixture of chicken broth and milk filled the bowl. All of the cats quickly mastered pressing the lever to get food and Sterman moved on to the second phase of the experiment.
He introduced a tonal sound in the chamber as a background to the empty bowl and lever.
If the cat pressed the lever while the tone sounded, nothing happened. However, if the cat waited for the sound to stop before pressing the lever, broth would fill the bowl. Sterman discovered that all of the cats would go into a state of extreme concentration – perfectly still but extremely alert – until the sound stopped, signaling that they would earn a reward by pressing the lever. The singularity of this behavior was reflected in the cats’ EEGs taken during this period. It showed that their brains recorded a sensory motor rhythm (SMR) frequency of 12Hz to 15 Hz while they were waiting for the tone to stop. This frequency indicates a high degree of focused concentration.
The next phase of the experiment: See if the cats could enter SMR state at will.
Again, Sterman attached each cat to an EEG. This time he waited for the animal to produce the SMR frequency for at least half a second before giving it some broth and milk. Eventually, the cats learned that they would be rewarded for producing this frequency and all of them did so regularly. In 1967, Sterman published these amazing findings in medical journal Brain Research.
Working on an unrelated project led Sterman to an even more startling discovery.
As impressive as Sterman’s experiments were, their practical application to human brain therapy was only discovered after he worked on a very different research project commissioned by NASA. It seems that whenever astronauts or NASA workers were exposed to monomethyl hydrazine (MMH), the fuel need to propel rockets into space, they suffered hallucinations, bouts of nausea, epileptic fits and even death. NASA hoped that Sterman could learn something about the fuel’s effect on the brain that would help prevent or alleviate this problem.
Using 50 cats for this study, Sterman wired each one in turn to an EEG before injecting them with 10 mg of MMH and measuring their reaction to it. In every case, within a few minutes of the injection the cat vomited, salivated, panted and was clearly in distress.
After an hour, 40 of the cats suffered grand mal epileptic seizures. But ten others did not.
Apparently, the brains of these ten cats were strong and healthy enough to resist seizures. In fact, they suffered no further ill effects from the rocket fuel after their initial discomfort. Sterman quickly realized that the ten “super” cats belonged to the group of 30 whose brains produced an SMR frequency. He concluded that their previous conditioning had functionally and physically altered their brains, making them immune to the seizures suffered by the other cats.
In cats, epileptics or astronauts, EEG training can reduce seizures.
Once Sterman realized that cats could be conditioned to resist seizures, the next step was to see if the same training would work with people. He began by connecting human epileptics to neurofeedback equipment that was programmed to flash a green light when the subject’s brain produced a SMR frequency and a red light when it didn’t. After a prescribed number of sessions, patients were able to keep the green light on and the red light off most of the time. Experiments later revealed that neurofeedback training could produce up to 65% reduction in grand mal seizures. This was just the kind of result NASA had been hoping for. Over the years, NASA has used neurofeedback in training programs to improve a pilot’s ability to concentrate even in highly stressful situations.
Barry Sterman is still working in the field.
Dr. Sterman is now Professor Emeritus at UCLA in the Neurobiology and Biobehavioral Psychiatry departments. The work he did in over fifty years ago helped pave the way for the use of Neurofeedback to treat many brain conditions today. Dr. Sterman has produced over 100 peer-reviewed articles, contributed chapters to more than 30 books and written six books on operant conditioning in animals and humans, epileptiform and sleep brain behaviors. He also lectures frequently and is especially sought after as a lecturer on neuromodulation.
And neurofeedback is being used to treat a wide range of brain conditions today.
Over the last decade, advanced research on the brain has provided more evidence that neurofeedback is highly effective not only for treating epilepsy and ADHD, but also, post-traumatic stress disorder, traumatic brain injuries and more.
In our next chapter, we’ll cover how the latest developments in brain research have reawakened scientific interest in neurofeedback and earned it a significant amount of support from such prestigious medical organizations as the American Pediatric Association.
In the meantime, if you’d like to learn more about how neurofeedback can help depression, anxiety, Attention Deficit Disorders (ADD ADHD), post-traumatic stress disorder and more please contact us for a consultation at your earliest convenience.
The History of Neurofeedback: Part I
By Ari Goldstein, Ph.D.
Educational Psychologist, Chicago Illinois
chicago neurofeedback and eeg for ADD and ADHD
There has always been a certain air of mystery about Neurofeedback. How does it work? Why is it so effective in treating brain conditions as varied as Attention Deficit Disorder (ADD or ADHD), traumatic brain injury, seizures anxiety, depression, and learning disabilities (dyslexia, dysgraphia, dyscalculia, etc.)? In the interest of answering these and other questions, we thought we’d start with the history of this remarkable, non-medicinal treatment for the brain known as Neurotherapy.
Neurofeedback as practiced today is largely the result of work done in the 1960s by two researchers, Dr. Joe Kamiya and Dr. Barry Sterman. During this time, Kamiya was exploring the role that alpha wave activity played in consciousness at the University of Chicago, while Sterman was researching brain activity during sleep at UCLA and the Veteran’s Administration Hospital in Sepulveda, California. Both were trying to discover the role brainwaves played in all aspects of behavior. But the initial discovery that brain function involved waves of electrical pulses makes for a fascinating tale all its own.
The Strange Inspiration for the Discovery of Brainwaves
Brainwaves were discovered by a German psychiatrist named Hans Berger. In 1873, Berger enrolled in the Friedrich Schiller University of Jena to study mathematics with an eye to becoming an astronomer. He left college after only one semester however, to enlist in the cavalry. During a riding exercise while still in training, he lost control of his horse and was thrown directly in the path of a horse-drawn cannon. Fortunately, the artillery battery driver halted the horses in time, so Berger suffered only minor injuries. But the experience made a profound impression on him.
On his return home, Berger learned that at the very moment he was almost run over by galloping horses, his sister experienced a sense that he was in danger and had had their father telegram Berger to check on his well-being. According to Berger this incident was “a case of spontaneous telepathy in which at a time of mortal danger, and as I contemplated certain death, I transmitted my thoughts, while my sister, who was particularly close to me, acted as the receiver.”
And so Began a Lifelong Study to Explain the Unexplainable
After completing his military service in 1893, Berger began to study medicine in the hope of discovering how his mind could have communicated with his sister so many miles away. His goal was to find the physiological cause of the psychic energy he believed responsible for this event, or as he put it, “search for the correlation between objective activity in the brain and subjective psychic phenomena.”
He earned his MD in 1897 and became a lecturer at the University of Jena. As a staff member of the university clinic, he found numerous patients with various brain disorders and injuries who agreed to participate in his studies over the years. In 1901 he published his first paper on brain function. However, although he spent the next 20 years studying the brain, Berger had yet to make significant progress in his research on its function.
After serving in World War I, Berger came back to Jena and became the Director of the Jena Psychiatric University Clinic. Working with patients whose injuries allowed him to have direct access to their living brains, in 1924 Berger used an Edelmann string galvanometer (pictured below) to complete the first successful electroencephalogram (EEG) or biofeedback of electrical brain activity. Continuing his experiments on patients with intact as well as damaged skulls, he published a series of articles about his work between 1929 and 1938. These papers showed that not only were brainwaves caused by the activity of brain neutrons, but these oscillations of electrical current in the brain could be recorded and measured. Despite Berger’s carefully researched publications though, it wasn’t until 1934, when other researchers drew attention to the presence of brainwaves, that Berger’s work was accepted by the scientific establishment.
So What are Brainwaves, Anyway?
Brainwaves are created by synchronized electrical pulses produced by brain neurons when they communicate with each other. As Berger demonstrated, waves can be detected through sensors placed on the scalp, and their activity has been described by author Jim Robbins like “a symphony in the brain.” Robbins’ analogy was inspired by the way brainwaves operate on different frequencies, each linking and connecting to the others through harmonics and thus causing different reactions and behaviors.
Brainwaves in neurofeedback EEG treatment chicago
Here’s a brief description of the different brainwaves and how they affect us:
Slow-paced and penetrating, they occur during periods of deep sleep and meditation, when awareness of the external world is suspended. They’re the source of empathy and give us the ability to heal and regenerate after illness and injury.
These waves are experienced during sleep and meditation but they have a higher frequency than delta waves. They’re the gateway to learning and memory, producing a twilight state as we drift off or wake from sleep. It is in theta that we experience dreams and fantasies, get in touch with our intuition and access information that is beyond our conscious awareness.
Nicknamed “Berger’s Wave” in recognition of Berger’s role in discovering them, Alpha waves are experienced during states of calm contemplation and learning. They aid in the coordination of calmness, awareness and the integration of mind and body activity. They’re the resting stage of the brain. “Being in the moment” is the normal alpha state.
When we’re attentive to our tasks such as solving problems, making judgments and decisions and engaging in other productive mental activities we’re in beta mode. Beta brainwaves fall into three distinct bands: Lo-Beta, Beta and Hi-Beta. During Lo-Beta we’re often between tasks and musing. In Beta, we’re highly engaged, active and productive. While in Hi-Beta we’re dealing with complex issues, integrating new information and perhaps experiencing a certain level of anxiety and excitement in reaction to these activities.
These brainwaves have the highest frequency and are the most subtle of all. For a time Gamma waves were ignored and regarded as background noise to the brain’s “symphony.” Gamma waves are above the frequency generated by neurons so how they’re origin is still unknown. But we now know that they relate to the integration of information from different brain areas and are most active during states of love and altruism. Some speculate that Gamma rhythms may determine perception, consciousness and spiritual development. (Maybe this is what Berger was looking for all along!)
How we experiences the world depends on our positive – or negative brainwave activity.
If we can identify, measure and manipulate these waves, we can improve how we think, feel and behave. For example, conditions such as anxiety, sleep problems, inability to focus, aggressive behavior, chronic pain and depression may be due to an in balance in brainwave activity. Neurofeedback allows us to teach patients suffering from these conditions how to start or stop producing the brainwaves associated with them. And once this learning has been completed, the improved condition becomes the default mode the brain continues to go to. Naturally. Without medication.
All of this started with Hans Berger seeking to understand how he was able to communicate his anxiety instantly to his sister hundreds of miles away. Of course, the discovery of brainwaves is just the start of the Neurofeedback Story. Please stop back again to read the next Chapter in the development of this life-changing therapy.
Ari Goldstein, Ph.D. is the Executive Director of Cognitive Solutions Learning Center, Inc. in Chicago, Illinois, as well as a consulting partner at Chicago Mind Solutions in Northbrook, Illinois.
Cognitive Solutions offers one on one and group programs in the summer aimed at developing students’ processing abilities, executive functions, and academic weaknesses. Our programs are highly individualized, and designed to help our students reach their full potential. Our programming is designed for students diagnosed with Attention Deficit Disorder (ADD or ADHD), learning disabilities (dyslexia, dysgraphia, dyscalculia), or executive functioning difficulties in Chicago, Illinois. Contact us at 773-755-1775 or email@example.com for more information on our summer remediation programs.
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Screen Time: How Much Is Too Much?
Ari Goldstein, Ph.D.
Look around in any waiting room, restaurant, or public space filled with children who are required to wait for a period of time. What percentage of those children are engaged in conversation or play? How many are reading quietly to themselves? Now, how many are hyper-focused into a screen? What is it about these devices that so engages children and creates this need? To better understand this, we need to explore both the biological and the behavioral underpinnings of this ubiquitous trend.
How many of us, as adults, is guilty of constant engagement with our screen devices. Of course we deem much of it “work”, including our facebook surfing and engagement with a range of vapid entertainment. Who do our children look to as role models for their behaviors?
From the perspective of the brain, screen devices are awesome! They provide fast paced stimulation to the brain, and frequently contain a series of rewards or level development that further engage the brain. This rapid stimulation tells the brain to release more “feel good” neurochemicals such as serotonin.
Parents come in to my office on a daily basis expressing concerns over their children’s constant need to be engaged with a screen of one form or another. This is a double edged sword. Electronic communication is everywhere, and the adults of the future will need to be proficient in their usage and able to adapt with the technology. Children model their parents and friends behaviors, and everyone around us is engaged with a screen of some sort. While as parents we need to manage the amount of screen time our children have, we need to be aware of the benefits of some of the programs as well as the importance of technological literacy. The rule in my home is no screen time during the week unless it is directly related to homework. Then on the weekends we allow our kids a couple hours per day to engage in the screens of their choice. Most of the research done on the subject agrees that less than 2 hours per day of average screen time is not associated with any negative behavioral or cognitive patterns.
Certain forms of screen engagement can also be very positive, and challenge cognitive skills. There are several very good research based online programs designed to develop a range of cognitive skills, including executive functioning, memory, and attention. Many games also require a high level of strategy, planning, and visual spatial problem solving (think Minecraft). Encourage your children to engage in the types of games which require them to focus, think, and plan ahead.
By managing the amount of screen time and the content itself, this entertainment method can become a powerful tool to sharpen your child’s mind and ensure their technological proficiency as they enter adulthood.
At Cognitive Solutions Learning Center in Chicago, we work with children and adult who have been diagnosed with a range of learning disabilities (Dyslexia, Dyscalculia, Dysgraphia) and Attention Deficit/Hyperactivity Disorders. Our approach includes a range of non-medicine based treatments and interventions, and we work with parents to ensure that their children can grow to their full potential.
Learning Specialist – Isn’t that just a tutor?
By Ari Goldstein, Ph.D.
Tutors have existed for as long as man. Elders helping the younger generation learn the skill sets necessary to survive in their environment. Of course, early tutoring focused more on gathering food and creating shelter than on memorizing math tables. Fast forward to our test driven and memorization based school curriculum. Students have to absorb and repeat mountains of information on a regular basis. They have to work quickly, efficiently, and a strong competitive sense emergences in most classrooms from an early age. Most parents feel their children need to keep up, and some are concerned with even “Average” performance. As a result, Americans spend billions of dollars each year for tutoring support for their children.
A tutor is a very useful tool for many students. Tutors help their pupils learn facts, study for tests, and become more fluent and efficient with a range of academic tasks. But what happens when those academic deficiencies are driven by difficulties processing information? Does the tutoring work? My clinical experience would indicate that often it does not. When students come to Cognitive Solutions Learning Center in Chicago, many are initially assessed to better understand their processing and functioning through a comprehensive evaluation. Having information about how the brain processes information is highly useful when planning how to best help a student remediate areas of processing difficulty. Specialized interventions can be designed which are aimed at developing a student’s underlying cognitive and processing deficiencies. This makes the process of tutoring much more targeted and effective.
Tutors come in all shapes and sizes, with a wide variance in education, background, and experience. They range from high-school and college students looking to make some extra money to retired teachers who love helping children, and everywhere in between. How well a tutor can help a student often depends on their experience and their ability to develop a strong rapport. But what they can do is often limited. Without understanding of and intervention with underlying processing deficiencies, many students will not make the expected levels of progress they are working so hard to gain. This frequently leads to frustration on the part of the student, the tutor, and the teachers and parents.
A learning specialist is someone who typically possesses a minimum of a Master’s Degree in a special education related field. The have extensive experience reading and interpreting psychoeducational and neuropsychological evaluations, and are able to use these documents to create intensive and effective remediation programs. Many work as special education teachers in the school system, and develop private interventions for students in after-school hours. Learning specialists work to strengthen underlying brain processing, at the same time helping the student develop a strong academic skill base.
A student who has difficulty reading will often begin work with a tutor. They will typically work to develop stronger fluency, decoding, and compression skills. But what if the student isn’t making progress in this work? What if all the repetition and multi-sensory teaching are not working? That is where an understanding of processing can better assists a learning specialist in their work. Many students who struggle to read have some form difficulty with their their auditory, visual, or executive processing systems. A learning specialist will work to develop reading skills in a manner similar to a tutor, however they will also design and implement a targeted intervention to address any underlying processing deficiencies. This might include auditory processing work, expressive or receptive language development, visual tracking and visual motor work, or executive skills development. Strengthening how the brain processes information while at the same time developing academic skills makes for a powerful and effective remediation program. The same processing difficulties can be true for students with a range of learning disabilities, including dyslexia, dysgraphia, and dyscalculia. Often times, difficulties processing information through one of the systems mentioned is a strong underlying factor in their struggles to learn. Students diagnosed with Attention Deficit Hyperactivity Disorder (ADD/ADHD) often have executive deficiencies that can be strengthened through targeted work with a learning specialist.
While tutoring is beneficial for many students who simply require some extra practice or “brush up” on skills, it is often ineffective for students who struggle to develop learning skills. These students frequently see far better outcomes when their academic interventions are designed more broadly to target and strengthen areas of their brain that aren’t properly processing the world around them.
At Cognitive Solutions, many students come to us after multiple unsuccessful attempts at tutoring. Our learning specialists create highly individualized remediation plans, and work with students to strengthen academic functioning, processing capacities, and self-esteem. For more information on Cognitive Solutions Learning Center in Chicago, please feel free to visit us online at www.helpforld.com.
Neurofeedback: Science or Shamanistic Ritual?
By Ari Goldstein, Ph.D.
The human brain is a fascinating organ that constantly seeks to improve itself. The capacity of the brain to grow and develop in response to environmental stimuli is magnificent. From trepanation to phrenology, behaviorism to psychoanalysis, man has sought to better understand this splendid organ. As we begin the 21st century, our knowledge of the brain continues to grow and develop at a rapid pace. Technology allows us to understand and improve how the brain functions in manners never before thought to be possible. One of the ways current science allows us to understand how the brain functions is through analysis and normalization of the electrical patterns created by the brain. The process of reading and analyzing the brain’s electrical patterns is known as a Quantitative EEG. The data provided through this process helps individuals and their clinicians understand how their brain is functioning and processing information, thereby allowing for much more targeted clinical interventions.
When I was a psychology student in College, we were taught that the brain does not grow much in adulthood. As the understanding of the brain and neuronal functioning has increased, we now know that the brain is highly capable of adapting and growing even into old age if given the right stimulus. The process of EEG Neurofeedback involves teaching the brain to grow and develop more efficient patterns of functioning. Through a series of games and activities played while connecting their brain to the computer, individuals learn to better self-regulate and improve the efficiency of their brain function.
I was first introduced to EEG Neurofeedback by Dr. Sam Effarah, and my thinking around learning and the brain changed dramatically. I was able to very clearly see quantitative data on how the brain was functioning, and saw how we could gain an amazing amount of very functional and actionable knowledge from a Quantitative EEG assessment. I also began to see the tremendous value in teaching people to regulate their own functioning through neurofeedback in a much more meaningful and lasting way. Clinicians could very clearly see patterns in the brains of individuals diagnosed with ADD/ADHD, learning disabilities, anxiety, depression, and autistic spectrum disorders that were different from the average brain. Often times, the frontal lobe of the brain in individuals with attention difficulties has far too much of the slow wave known as “Theta”. This can cause a state of cognition known in scientific terms as “La La Land”. A fast spindly wave known as “High-Beta” was often seen throughout the brain of those with hyperactivity and anxiety. Disconnections between areas of the brain that process auditory and visual stimulus often become apparent through the Quantitative EEG in those diagnosed with learning disabilities.
When we began using EEG data to drive some of the work we do at Cognitive Solutions, the level of skepticism among our colleagues and patients was high. It was almost as if we were practicing some form of shamanistic ritual to help people. As time went on, more and more people began to try it out. We had patients referred to us with a range of symptoms, including attention disorders, learning disabilities, anxiety, depression, and autism spectrum disorders. Most patients reported improvement in a range of symptoms after completing only a few sessions. Some took more time to see improvement, but those who stuck with it generally reported significant improvement in their functioning over time.
The research on Neurofeedback is strong (isnr.org). While detractors would note the lack of double blind studies, a host of solid research studies into neurofeedback show quantifiable evidence of improvement for a range of brain based dysfunctions. Anecdotal cases can be found all over the world for individuals who have seen improvement for a range of symptoms affecting their daily functioning. The American Psychological Association has consistently given higher and higher efficacy marks to this treatment as more and more solid research has been conducted.
At Cognitive Solutions Learning Center in Chicago, we have worked with thousands of patients using neurofeedback over the past fifteen years. Most have seen tremendous benefits in quality of life as a result of this treatment. As I have watched the science catch up to what I have seen personally in our clinic, I am glad to have discovered this amazing intervention tool. From shamanistic ritual to true science, it appears that neurofeedback is a viable and drug free option for many patients to treat a range of brain based symptoms.
Thoughts on Treating Attention Deficit Disorders Naturally and Without Medication
By Ari Goldstein, Ph.D.
When I was growing up in the 1970’s, there were always boys who were hyper. They couldn’t control their behaviors, responded impulsively to everything placed in front of them, and acted as if driven by little motors constantly running full speed inside their bodies. There were also boys who stared off into space on a regular basis, seeing a whole movie playing behind their eyes. There were girls who flitted around the room like social butterflies, and those who gazed out the window seeing a movie of their own. We just saw these kids as “different”. They acted a little differently, and they learned a little differently. They provided diversity to the classroom environment, a little entertainment for the other students, and certainly some stress for the teachers trying to manage their behaviors and teach at the same time.
Back then, Ritalin was something only considered for the most severe cases of diagnosed ADHD. Cases where children’s’ behavior was a danger to themselves or others. They were out of control, and there was nothing their parents or teachers could do. As time went on, the pharmaceutical companies marketed the disability of Attention Deficit (Hyperactivity) Disorder as well as they marketed their own products. By the mid 1980’s, medication management became a much more prevalent intervention for ADD/ADHD. As I graduated college and moved into teaching special education in the 1990’s, I saw an increase year after year in the diagnoses of Attention Deficit Disorders. As the diagnoses rose, so did the use of stimulant medications. Ritalin, Adderall, Vyvanse, Straterra, and the list continued to grow. I often wondered if these drugs were being prescribed to really help the kids, or to help those around them manage their behavior and learning more easily.
By the time I had entered private practice, well over 50% of the students referred to me had a diagnosis of ADD or ADHD, often in conjunction with various learning disabilities. While I saw that these medications were helping the kids to be better students, I began to develop an understanding that using the medication didn’t really change anything about the child’s functioning. It helped them focus, but it didn’t provide them with tools or a skill base for learning. It helped control hyperactivity, but it didn’t help them develop better self-regulation skills. I knew there had to be a better way, but by the same token the researcher in me read study after study about the efficacy of medication for the treatment of attention disorders. Very little research has been conducted into other methods for developing stronger focus and regulation without the use of medications.
Around the time I began to develop a toolbox of strategies for helping students develop executive skills (see Thoughts on executive functioning), I was also introduced to Dr. Sam Effarah . Dr. Effarah showed me the world of EEG functioning, and my thinking around learning and the brain changed dramatically. I was able to very clearly see quantitative data on how the brain was functioning, and saw how we could gain an amazing amount of very functional and actionable knowledge from a quantitative EEG assessment. I also began to see the tremendous value in teaching people to regulate their own functioning through neurofeedback in a much more meaningful and lasting way. Clinicians could very clearly see patterns in the brains of individuals diagnosed with ADD/ADHD that were different from the average brain. Often times, the frontal lobe of the brain in these individuals (the very “home” of executive skills) has far too much of the slow wave known as “Theta”. A fast spindly wave known as “High-Beta” was often seen throughout the brain of those with hyperactivity. This work, combined with my research into the effects of diet, supplementation, mediation, and skills training on learning and attention, led to our current philosophy of treatment at Cognitive Solutions Learning Center in Chicago.
Over the years, many of our patients have been referred to us after trying a range of psychiatric medications for disorders of attention. Some of these individuals responded well to the medications, some did not. The general consensus among both parents and children was that they would rather not be on medication. Through the regiment of changes mentioned above, combined with a solid investment on the part of the student and family, many of our patients have been able to successfully titrate off of medications and improve how their brain processes information for the long term.
Medication for the treatment of ADD/ADHD certainly has its place. Many individuals truly benefit from the medication, and it has saved the lives and futures of many bright and capable children. However our societal need for a quick fix, combined with the extreme efficacy of the medications in increasing focus, has led to an epidemic of over prescription of medications. The medication is not a panacea, and is but one small tool in the clinician’s toolbox for treating disorders of attention. Rather than a front line of treatment, these medications should be a last resort in the treatment of Attention Deficit Hyperactivity Disorder.
For more information on the Cognitive Solutions approach to treating Attention Deficits Hyperactivity disorder (ADD/ADHD) without the use of medications, please visit us online at www.helpforld.com.
Thoughts on Executive Functioning Skills
By Ari Goldstein, Ph.D.
When I first began teaching special education in the early 1990’s, the term executive functioning was unheard of. As a young teacher, I very quickly saw the importance of developing underlying cognitive skills to help my students learn more efficiently. They benefited tremendously from learning better strategy usage, time management, organization, and self-regulation skills. Over time, I developed a series of exercises and activities designed to strengthen these aspects of functioning in the classroom. What I found was that by developing their underlying cognitive skills and meta-cognition, I was able to help my students become better learners. We had no terminology or training programs for this, it was just good psychoeducational practice.
As I transitioned into private practice in the late 1990’s, I continued much of this work in a one on one fashion with the students I was tutoring. Around the year 2000, the term executive functioning began to emerge with some popularity in psychology and education circles. As I read more and more research on the subject, I began to understand that the underlying skills I had been working on with my students all along were, in fact, executive functioning skills. Good teachers have been working to develop these skills since the dawn of teaching, but finally there was a terminology and construct associated with what they had been doing in the classroom. I became so interested in the subject that I spent a good portion of my Ph.D. work investigating executive skills and their impact on learning and functioning.
Fast forward fifteen years. Executive functioning is now a buzz word heard throughout the academic community. Every parent, teacher, and school is now concerned with executive functioning. As a practitioner, I see this as a wonderful development. Unfortunately in our fast paced and testing based school system, the focus is primarily on test scores. We expect students to memorize and regurgitate information, but we do very little to develop their underlying self-monitoring, problem solving, and regulation skills. Schools are now more aware of executive functions, and their crucial impact on learning and problem solving throughout the life span. Many private tutors also work on executive functioning, however too often the focus is very heavy on organization skills and time management, with little work done to develop underlying frontal lobe functioning (Executive skills make their “home” in the frontal lobe of the brain).
Executive skills develop at different rates in different children. However, true executive difficulties do exist in many students, and tend to be even more prevalent in students with learning disabilities or disorders of attention (ADD/ADHD). Effective development of executive skills lies in not just teaching students how to organize themselves, but helping them develop into stronger problem solvers with better self-regulation skills. This can be done through a range of remediation programs, including Feuerstein’s Instrumental Enrichment, Quantitative EEG training (neurofeedback), meditation practice, and one on one skill based work designed specifically to strengthen frontal lobe functioning.
Our learning specialists at Cognitive Solutions take a very individualized approach to the development of executive skills. We work one on one with students to help strengthen their frontal lobe functioning, and help them develop a tool-belt of skills for stronger school based functioning. This differs from traditional tutoring, which tends to focus on the development of academic skills without work aimed at developing underlying areas of cognitive and information processing.
For more information on Cognitive Solutions Learning Center, please visit us online at www.helpforld.com, or feel free to contact us at 773-755-1775.
“Mens sana in corpore sano”
Exercise to Treat Depression and Improve Overall Life Satisfaction
“Mens sana in corpore sano” is well known Latin quote meaning “a sound mind in a healthy body”. Here at Cognitive Solutions, we see patients whose symptoms range from mild to severe depression, and after our evaluations with those patients, we offer a comprehensive intervention plan that includes non-invasive, non-pharmaceutical related recommendations to help ease symptoms of depression. Medications are the fastest way to improve symptoms of depression, but these can sometimes cause debilitating side effects. It seems so simple, but time and time again studies show the effectiveness of excursive in treating depression. While this may be a simple solution, it is by no means easy. The relationship between body and mind has interested experts for many years. Since physical activity is critical in sustaining life, it is generally understood that exercise functions as a form of survival. Exercising has been a strongly associated factor in maintaining a healthy lifestyle. Many researchers have explored the effects of exercise on the body, and recently psychology research has also attempted to find a correlation between exercising and mental health.
Exercise can be defined as “any type of physical activity, aerobic or anaerobic, with the means of integrating the mind, body, and spirit”. This definition alone makes apparent the association between exercise and the mind (and therefore mental health). The general thought is that exercise has physical and psychological benefits, which is why it has been so helpful in maintaining overall health. One factor which makes it difficult to compare previous research studies is the method in which exercise is measured. Some studies actively randomized a sample into exercisers and non-exercisers, while others first distinguished exercisers from non-exercisers before proceeding to ask specifically about duration and intensity of exercise. Some even used a scale to determine the amount of exercise in which one participates regularly. Some studies have reported that a lack of exercise is correlated to depression in a broad range of ages. Researchers have even found that those who are unable to exercise because of a physical illness or handicap reported higher depression scores than all others. Studies often show that physical fitness itself is a factor contributing to the mental health of regular exercisers.
In addition to the satisfaction gained from performing athletic exercise, its effects on one’s body play an obvious role in the modification of mental health. In one study, overweight subjects were found to have poor perceived mental health, high negative affect, and low optimism. The same participants were also at higher risk for future unhappiness, low positive affect, life dissatisfaction, and depression. The relationship between exercise and mental health has been a topic examined by many psychologists. However, the specific areas of mental health affected by exercise have been questioned throughout these researcher’s trials. Different aspects of mental health in relation to fitness have been examined. Some of these aspects include anxiety and, as previously mentioned, depression.
Reports that those who exercise tend to be less anxious and depressed than those who do not exercise. It seemed that in all the recent studies, exercisers were happier and more satisfied with their lives than non-exercisers, regardless of gender or age. Other studies have examined psychological factors such as rage and trust issues. Overall, studies show that people who exercised regularly experience considerably less depression, anger, cynical distrust, and tension than those who exercised less often or did not exercise at all. Health in mind and body is not a phrase to take lightly and there is evidence to back it up. Increase your endorphins the natural way – get that body moving!
Adult attention deficit hyperactivity disorder (ADD or ADHD) manifests itself through two main characteristics: inattention and hyperactivity/impulsivity. These symptoms, as well as the others that often accompany them, can cause numerous problems in a person’s day-to-day life. These problems include the inability to maintain stable relationships, poor performance at work, difficulty organizing and planning, and low self-esteem.
A person exhibiting symptoms of inattention makes careless mistakes, doesn’t listen being when directly spoken to, doesn’t follow through on instructions, fails to finish tasks, has difficulty organizing tasks and activities, is easily distracted, and is forgetful in their daily activities. That same person might exhibit symptoms of hyperactivity-impulsivity. These symptoms include: fidgeting with their hands and feet, often physically active in situations when it isn’t appropriate, and often interrupting the conversations of others.
Attention Deficit Hyperactivity Disorder always starts in childhood. This means, if an adult is just discovering they have ADHD they also had it as a child. Some people have fewer symptoms as they age and their brain develops further. It is difficult to diagnose ADD/ADHD in adults because many of the symptoms frequently stem from other conditions. It is important to note that Attention Deficit Hyperactivity Disorder does not cause other disorders. However, a number of conditions often accompany this disorder including mood, anxiety, and personality disorders.
If you feel that you or a loved one has the characteristics of adult Attention Deficit Hyperactivity Disorder, fell free to contact Cognitive Solutions Learning Center in Chicago at (773)755-1775 or online Adult ADD and ADHD for more information or to schedule a consultation.
EEG Neurofeedback For Dyslexia
Our previous blog discussed adult dyslexia, its symptoms, and how the proper testing and diagnosis is important for treatment planning. Along with the proper testing and diagnosis for a learning disability such as dyslexia, certain treatments are available that can improve brain function in a meaningful way.
Neurofeedback training or EEG Neurotherapy targets the symptoms of dyslexia at their foundation – the brain! Often visual, auditory, and/or executive processing deficiencies are present in those with learning disabilities, and neurofeedback directly targets these areas of brain function. Not only can it target the primary symptoms, but also the secondary symptoms of learning disabilities including social emotional and self esteem difficulties. Neurofeedback produces long-term changes in an individual’s functioning and mental health.
There is a great deal of research that supports EEG neurofeedback training for those with learning disabilities, cognitive deficits, and emotional dysfunction. In addition to this research, there is support for treating symptoms and deficits that are specifically related to dyslexia with neurofeedback. By examining various regions of the brain through brain imaging, including QEEGs (brainmaps), researchers have found that structural differences in the left side of the brain are present in those with Dyslexia and can be treated with neurotherapy. This makes sense given that the left side of the brain is primarily involved in the representation and comprehension of language. Breteler (2010) conducted research examining the improvements in children with dyslexia and specifically looked at reading and spelling. They were able to find a significant improvement in spelling for the children that received the neurofeedback training when compared to the control group that did not receive the neurofeedback training. Also, their findings suggest that improvement in attentional processes in the brain could be partially what is contributing to the spelling improvements (Breteler, 2010).
Attention difficulties (ADD/ADHD) are common for those of all ages with various learning disabilities. Hundreds of individuals with these diagnoses and more have seen improvements with neurofeedback training at Cognitive Solutions Learning Center in Chicago. Neurofeedback training has shown a high level of clinical success around the world, and is supported by a strong base of research in neuroscience. There is a solution to help individuals with brain based disabilities like dyslexia make changes to their brain that have a lasting impact, no matter their age.
Read more about The Cognitive Solutions Learning Center approach to Neurofeedback for Dyslexia Here
If you feel you or your child may suffer from dyslexia contact Cognitive Solutions Learning Center in Chicago at (773)755-1775, or visit us online at www.helpforld.com, to find out more about our programs.
*Breteler, M. (2010). Improvements in Spelling after QEEG-based Neurofeedback in Dyslexia: A Randomized Controlled Treatment Study. Applied Psychophysiology & Biofeedback, 35(1), 5-11.
Chicago Mind Solutions
Cognitive Solutions Learning Center-Chicago, Il.
Dyslexia is a language based learning disability whose symptoms can cause an array of difficulties. The primary difficulty experienced by those with dyslexia is word recognition. In these individuals, the brain sees words differently than a non-dyslexic brain. Reading fluency, spelling, and writing are often problem areas for a dyslexic person. Sometimes, these issue are undiagnosed during early childhood. However, as education progresses and more grammar is introduced, reading and writing become more difficult.
People suffering from dyslexia may also have difficulty with spoken language and clearly understanding what others are saying. These issues may be difficult to recognize, however it is important that they are identified as they can lead to significant difficulty in school and the workplace.
Sadly, dyslexia can also affect the way individuals feel about themselves. Dyslexic people often report feeling “dumb”.
Dyslexia is a neurobiological disorder, meaning certain regions of the brain are not processing information correctly. It is important to note that having dyslexia does not mean that one is less intelligent than other people. It simply means the individual requires different teaching methods than other people.
Adults with dyslexia are often spatially talented and excel in professions such as engineering, architecture, design, artistic endeavors, mathematics, and medical work. However, they often struggle with time management, planning, and organization. ¬
There is no cure for dyslexia. However, with a proper testing and diagnosis followed by hard work and support from family, teachers, and friends, an individual diagnosed with dyslexia can be highly successful in schooling and later on in the workplace. Read more about Dyslexia Testing and Dyslexia Tutoring at Cognitive Solutions in Chicago:
Learning Disability Testing and Assessments
If you feel you or your child may suffer from dyslexia contact Cognitive Solutions Learning Center in Chicago at (773)755-1775, or visit us online at www.helpforld.com, to discuss our Dyslexia testing and tutoring services.
By Ari Goldstein, Ph.D.
Most psychologists and doctors in Chicago have limited tools available for the treatment of Attention Deficit Hyperactivity Disorder (ADD and ADHD). Frequently, behavioral modifications and prescription medication are the only options presented to patients.
As an Educational Psychologist at Cognitive Solutions Learning Center in Chicago, I have noticed an alarming increase during the past decade in the number of referrals I receive for testing and treatment of disorders of attention (ADD and ADHD). What troubled me the most was that when the child received a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder), of which ADD (Attention Deficit Disorder) is a subcategory, that child would almost certainly end up on medication.
It’s estimated by the Institutes of Mental Health that over 10% of the school-aged population have the disorder. That’s over two million children. And that’s conservative. If all these kids are put on meds, that seems scary to me as a parent and as a professional
I therefore became interested in researching the availability and effectiveness of non-medicinal treatments for attention disorders for those in Chicago. Through my research, I came across methods I have put together successfully to help children and adults without medication. I have developed a multifaceted, noninvasive approach to treating what is essentially a disability of regulation. People with Attention Deficit Hyperactivity Disorder (ADD or ADHD), whether children or adults, have difficulty regulating and controlling their behaviors, actions, thoughts, and problem solving. To treat the disorder, we need to know how the problems in regulation are manifesting and then develop an individualized plan to address the deficits.
It is essential to actively treat the regulation deficits, which offers a long-term solution, What I oppose is over-use of medication, not medication itself. Pharmaceuticals are an alternative to consider where a child’s behavior is destructive to himself or others, or for patients who have shown no improvement after following a non-medicinal protocol diligently for four to six months.
After a thorough evaluation including batteries of tests, if it appears diagnosis of Attention Deficit Hyperactivity Disorder (ADD ADHD) is appropriate, I will often send the client for a metabolic screening to rule out possible underlying blood-related causes for symptoms similar to ADD ADHD, such as blood sugar regulation difficulties, under or over active thyroid or lead poisoning.
The first prong my non-medicinal approach is nutrition and supplementation. What we put into our bodies has a tremendous role in how our brain functions. Sugar exacerbates ADD ADHD symptoms. The more stable the blood sugar level, the easier to regulate attention and the less of the anxiety experience which is often a part of ADD ADHD.
Removing processed foods from one’s diet and testing for and eliminating food allergies can also make a huge difference. Food allergies are a group of auto-immune disorders: the body is attacking itself. This can cause depression, anxiety and negatively affect one’s capacity for attention and learning.
Supplementing diets with Omega 3 fish oil from fatty fish like salmon and sardines supports enhanced brain function: Many Americans are deficient in this, and this can contribute to a range of psychological and cognitive difficulties. Likewise, pro-biotic foods like live culture yogurts improve general health and cognitive functioning.
The second prong is exercise and sensory input. Exercise helps balance the chemicals in our brain. This is especially important if a child is spending lots of time in front of video games, TV and computers. From the earliest days, these devices wreak havoc on our attention span: If a child spends more than two hours a day engaged in these pursuits, there is a greater chance of developing ADHD. From my perspective, the spike in diagnosis at least in part to children getting used to such constant and rapid media stimulation that it’s hard to adjust to the real world.
I have frequently observed that young boys diagnosed with Attention Deficit Hyperactivity Disorder (ADD ADHD) are hungry for sensory stimulation. I frequently put them on a diet with crunchy foods, and suggest activities like swinging on a swing and swimming, both to work off energy and calm them down. Tae Kwon Do is recommended as an excellent vehicle for engaging in physical activity with others, while instilling discipline and focus.
The third prong of my approach is executive functions training. These functions have a number of components that are found in the frontal lobe, from cognitive planning to physical organization, from controlling emotional outflow to working memory. Developing executive functioning and cognitive organization leads to physical organization,
A thorough evaluation of these functions will show which areas need to be addressed. While medications can help the behavioral and academic aspects, it is short lived. We do a child disservice when we do not train them in specific executive function skills. Parents can support this development as well through ensuring their children have structure and routine, which are comforting, and logical consequences where behaviors require modification.
The fourth prong, which is the leading non-medicinal treatment for ADHD, is neurofeedback. The brain is an electrical matrix with different signals being sent, but the signals may not be functioning optimally. The neurofeedback process consists of a video game the child plays with their mind. Initial brain imaging [QEEG] helps to show what is functioning optimally and what is not. Neurofeedback provides training to recognize what a brain wave state feels like, so we can shift it more easily. This teaches children with ADHD how it feels to shift their brain from a relaxed to an attentive state.
Individuals who wish to remain medication free are highly encouraged to explore the four prong treatment methodology laid out in this article. For more information, or for help in the Chicago area, please contact us.
ADHD stands for Attention Deficit Hyperactivity Disorder. This disorder is common amongst children and young adults around the world, and can present with difficulties regulating focus, bodily movement, and impulsivity. Contrary to modern thinking, medications for child attention deficit disorder (ADHD) are not always the best initial treatment. Instead, parents should seek out behavioral treatments according to new research presented at the annual convention of the American Psychological Association. Medications that address ADHD symptoms such as a lack of concentration in the classroom don’t necessarily address other impairments caused by ADHD. These often include difficulties with executive skills, emotional and behavioral regulation, and development of academic functioning. At CSLC, we have a repeatable process that is proven to alleviate the need for medicines such as Concerta, Adderall, Focalyn, or Strattera. Medicines such as the ones listed are short-term treatments that do not change brain function long term. While medication can be an effective tool for some people, our approach is COMPLETLEY non-medicinal and addresses each aspect of brain function for a long-term solution. We customize our treatments for each individual, because we understand that each patient is unique. Please review our website www.Helpforld.com to see what we can do!
Looking for some simple behavioral interventions to try out in the home?
Cognitive Solutions Learning Center says:
1.Ignore mild inappropriate behaviors and praise appropriate behaviors (Catch them being good!)
2.Use appropriate commands:
o Obtain the child’s attention: say the child’s name
o Use command not question language
o Be specific
o Command is brief and appropriate to the child’s developmental level
o State consequences and follow through
3.Daily charts (e.g., School, Home Daily Report Cards). www.goalforit.com is a great resource for chart creation. Encourage ownership in the chart, and have your child help with chart creation (brainstorming of concepts to be measured with the chart, how to implement, and appropriate rewards).
4.Premack contingencies using above charts (e.g., watch TV or phone time contingent upon homework or task completion)
5.Point/token system with both reward and cost components
6.Specific times and places for homework. Environment should be clean, well lit, and free of distractions. Time management worksheets can also be a useful toll for developing better homework monitoring skills.
FOR IMMEDIATE RELEASE
(Chicago, Illinois, 17 January 2012)
A Neurofeedback session typically begins with a quantitative EEG. The EEG is done with the use
of sensors that are placed on top the head, and it is intended to measure brainwave activity.
This information will be used as a reference and an indicator of how your brainwaves are
affecting your train of thought. From then on, the professional therapist will create a therapy
that is tailored especially for your own needs. A person who is undergoing Neurofeedback
is called a “trainee,” basically since the patient is being trained by the therapist to modulate
brainwave activity and achieve certain results. These results are almost instantaneous but
more often not trainees are not aware of these changes immediately, but they certainly can
observe changes in their state of mind even outside the Neurofeedback session. The training
will specifically teach a person to maximize activity in certain frequencies while keeping down
others in a bid to regulate or balance the frequencies so the brain is not overloaded with too
With the help of Neurofeedback, a person can achieve relaxation as well as minimization of the
brainwave activity that is causing him or her to be constantly anxious, irritated or suffer lack
of calm in most situations. In fact, according to the International Society for Neurofeedback
and Research, the Neurofeedback therapy is ideal for people who are suffering from attention
disorders like Attention Deficit Hyperactive Disorder as well as Epilepsy. The Institute is also
undergoing research to determine the effects of the therapy on people who have Autism,
headaches, insomnia, anxiety, substance abuse, TBI and other pain disorders. So far, the ISNR
is saying that the results of their research into these disorders are “promising.” There are more
grounds being gained each day in research and the Cognitive Solutions approach can prove this.
One great thing about undergoing Neurofeedback therapy is the fact that it is non-invasive and
requires no medicine. The CSLC approach stresses non-medicinal in all that we do. It does not
require surgery, so you can walk out of the clinic normally and go about your business like it
did not happen at all. Of course, you will be stepping out of the therapist’s clinic feeling like a
new version of yourself thanks to the training you get from the Neurofeedback center at CSLC.
Several people who have gone through the process have seen tremendous results. (see our
about us page). Testimonials from successful trainees have shown that Neurofeedback has had
a positive effect on their lives and daily functioning, which means that Neurofeedback really
works and no matter what state your are in, it is always beneficial.
If you are interested in undergoing Neurofeedback training, contact Cognitive Solutions
Learning Center Inc. The Center is located in Chicago, Illinois. Contact the center by calling us
at phone number (773) 755-1775, or use the contact form found online at www.helpforld.com.
With Cognitive Solutions, you are sure to experience a positive change in your life.
2409 N. Clybourn Ave. Chicago, IL 60614
Phone: (773) 755-1775
Cognitive Solutions Learning Center, a Chicago based clinic, offers a specialized approach for treating Attention Deficit Hyperactivity Disorder without the use of medication.
Chicago, IL, September 02, 2011 –(PR.com)– Ari Goldstein, PhD, founder and director of the Cognitive Solutions Learning Center in Chicago, noticed an enormous spike over the past ten years in referrals he received for diagnosis of attention deficit disorders such as ADD and ADHD. Sometimes symptoms would manifest as disruptive behavior at home or at school; sometimes academics were overwhelming due to inability to focus.
What troubled Dr. Goldstein, who has a PhD from the University of Illinois in Educational Psychology and a Masters in Learning Disabilities, was that when the child received a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder), of which ADD (Attention Deficit Disorder) is a subcategory, that child would almost certainly end up on medication.
It’s estimated by the Institutes of Mental Health that 9% of the school-aged population – mostly boys – have the disorder. That’s over two million children. And that’s conservative, according to Dr. Goldstein. “If all these kids are put on meds, that seems scary to me as a parent,” he says.
Dr. Goldstein became interested in researching the availability and effectiveness of non-medicinal treatments for attention disorders. Through his research, he came across methods he has put together successfully to help children and adults without medication.
Dr. Goldstein and his Cognitive Solutions team of professionals, which includes learning specialists, speech and language pathologists, and a clinical neuropsychologist, have developed a multifaceted, noninvasive approach to treating what he calls a disability of regulation.
“People with ADHD, whether children or adults, have difficulty in regulating and controlling their behaviors, actions, thoughts, problem solving, and such,” Dr. Goldstein explains. “To treat the disorder, we need to know how the problems in regulation are manifesting and then develop an individualized plan to address the deficits.”
Emphasizing that “We’re actively treating the deficit, which offers a long-term solution,” he points out that what he opposes is over-use of medication, not medication itself. He suggests pharmaceuticals as an alternative to consider where a child’s behavior is destructive to himself or others, or to clients who have shown no improvement after following the non-medicinal protocol diligently for four to six months.
After a thorough evaluation including batteries of tests, if it appears an ADHD diagnosis is appropriate, he will send the client for a metabolic screening to rule out possible underlying blood-related causes for symptoms similar to ADHD, such as blood sugar regulation difficulties, under or over active thyroid or lead poisoning.
The first prong of Dr. Goldstein’s non-medicinal approach is nutrition and supplementation. “What we put into our bodies has a tremendous role in how our brain functions,” he declares. Sugar exacerbates ADHD symptoms. “The more stable the blood sugar level, the better their attention and the less of the anxiety experience which is often a part of ADHD,” he says.
Removing processed foods from one’s diet and testing for and eliminating food allergies can also make a huge difference. “Food allergies is an auto-immune disease: the body is attacking itself,” he explains. “This can cause depression, anxiety and negatively affect one’s capacity for attention and learning.”
Supplementing diets with Omega 3 fish oil from fatty fish like salmon and sardines supports enhanced brain function: “Many Americans are deficient in this,” he observes. Likewise, pro-biotic foods like live culture yogurts improve general health and cognitive functioning.
The second prong is exercise and sensory input. “Exercise helps balance the chemicals in our brain,” he asserts. This is especially important if a child is spending lots of time in front of video games, TV and computers. From the earliest days, these devices wreak havoc on our attention span: “If a child spends more than two hours a day engaged in these pursuits, there is a greater chance of developing ADHD,” he warns. He attributes the spike in diagnosis at least in part to children getting used to such constant and rapid media stimulation that it’s hard to adjust to the real world.
He also advises that young boys diagnosed with ADHD often are hungry for sensory stimulation. He might put them on a diet with crunchy foods, and suggest activities like swinging on a swing and swimming, both to work off energy and calm them down. Tae Kwon Do is recommended as an excellent vehicle for engaging in physical activity with others, while instilling discipline and focus.
The third prong of Dr. Goldstein’s program is executive functions training. These functions have a number of components that are found in the frontal lobe, from cognitive planning to physical organization, from controlling emotional outflow to working memory. Developing cognitive organization leads to physical organization, Dr. Goldstein says.
A thorough evaluation of these functions by a learning specialist will show which areas need to be addressed. “A pill can help the behavioral and academic aspects, but it is short lived,” he says, “so we do a child disservice when we do not train them in specific executive function skills.” Parents can support this development as well through ensuring their children have structure and routine, which are comforting, and logical consequences where behaviors require modification.
The fourth prong, which Dr. Goldstein describes as the leading non-medicinal treatment for ADHD, is neurofeedback. “We’ve consistently seen tremendous and dramatic results from this,” he enthuses. He explains that the brain is an electrical matrix with different signals being sent, but the signals may not be functioning optimally. He describes the neurofeedback process as being like a video game the child plays with their mind. Initial brain imaging [QEEG] helps to show what is functioning optimally and what is not.
“Neurofeedback provides training to recognize what a brain wave state feels like, so we can shift it more easily,” he explains. This teaches children with ADHD how it feels to shift their brain from a relaxed to an attentive state. “We’ve seen tremendous change, and not just in the behavioral and academic aspects of children with ADHD,” he says. Adults go off depression meds, athletes improve their peak performance, surgeons learn to move “into the zone” for their surgery. Clients typically undergo 20 to 40 sessions which are presented on a twice a week basis.
Dr. Goldstein’s enthusiasm for neurofeedback is echoed by Catherine Tipping, whose son Rowan has been diagnosed with ADHD and started his treatment with Dr. Goldstein a year and a half ago. At that time, six-year-old Rowan manifested focus issues that affected his schoolwork. “From the initial and intensive battery of diagnostic tests to the recommendation he get special glasses from a visual processing expert and twice-weekly neurofeedback sessions, the change has been nothing but positive,” she declares.
She credits neurofeedback for much of the improvement, but adds that minor dietary adjustments, such as yogurt shakes and fish oil supplements, and signing Rowan up for Tae Kwon Do also have helped him to be calmer and focus better. Moving from “really struggling,” his last report card was nearly all As and Bs. Now in second grade, he continues his neurofeedback sessions with neuropsychologist Dr. Sam Effarah and sees a Cognitive Solutions learning specialist weekly to help him to organize his thoughts on paper.
Tipping was so impressed with the neurofeedback portion of the treatment that she herself has undergone treatment to combat sleep issues and a family history of depression. “I do feel calmer,” she says. She has also started Rowan’s twin sister, Gemma, who is accelerated academically but “a little hyper,” as well. “The kids think it’s fun, like a computer game,” Tipping smiles.
It does take more time, expense, and intensive involvement with your kids to deal with attention deficits using this multi-pronged, non-medicinal approach, according to Dr. Goldstein. And not every client chooses to utilize all four prongs. Those who do, like Tipping, are big advocates of the approach.
“We’ve seen great changes in him,” says Tipping about son Rowan. She advocates ruling out all other options before risking side effects of pharmaceuticals that can clinically affect your child, asserting that in her family’s experience, “the Cognitive Solutions approach offers a great alternative to automatically going the medications route.
“This shows there are other options out there,” Tipping declares. “It takes more time, but it’s so worth it!”
Cognitive Solutions Learning Center is located at 2409 N. Clybourn in Chicago. The phone number is (773) 755-1775 and web address is www.helpforld.com.