Most children become excited when they are around their friends, experiencing something new or playing games. Most children have the energy to run around for an hour in the schoolyard during a lunch break or a sports match. Most children will become impatient when told to wait for something they are looking forward to. Most children will become distracted from their work when something more interesting happens. On the other hand, most children are able to be in a classroom and sit still while the teacher gives a lesson. They are also able to concentrate on and complete the work they are given. They may not enjoy the process of waiting, but will still be able to control themselves. Some children cannot contain their excitement, their energy or their impulses, and also cannot sustain their attention long enough to learn and behave well in a classroom situation. These children are often diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD).
Disorders are diagnosed when the behaviour or mood of a person impairs their ability to function. Attention Deficit/Hyperactivity Disorder describes what happens when a child’s level of inattention, hyperactivity and/or impulsivity goes beyond what would reasonably be expected and interferes with their capacity to process information and adapt their behaviour to different contexts.
ADHD is indicated by a lack of concentration, impulsiveness and over-activity which usually begins before the age of seven, persists at least six months and is not due to other psychiatric disorders or environmental influences, (e.g. reaction to problems in the family environment). Behavioural problems and conduct disorders are more associated with ADHD than ADD.
The main characteristic of ADD without hyperactivity is difficulty in concentration. Studies show that children with this diagnosis often suffer from anxiety and learning difficulties. Although there are no studies conducted on adults with this disorder, it is expected that ADD without hyperactivity has a different effect than ADD with hyperactivity.
Adults with this disorder, especially those who have not been diagnosed and treated, can suffer from a number of problems, some of which are directly caused by ADHD and other compensatory behaviour associated with ADHD. These symptoms may of course also be seen in children with ADHD.
The symptoms of ADHD in adults may be constant or situation dependent. Some people with ADHD can concentrate if they are interested or excited, while others find concentration difficult. Adults with ADHD may actively seek stimulation or by contrast, avoid it as much as possible. Whilst antisocial behaviour is sometimes noticeable in adults with ADHD, the opposite may also be an indication as some may seek attention and acceptance by overtly pleasing others. Targeted Neurofeedback is a therapy technique which can help people with ADHD adapt and control these behaviours.
With the support of a professional, there are a number of treatment options available to treat ADHD. A diagnosis should be seen as a step in the right direction, providing relief for patients to know that they are on a path forward to alleviating daily personal struggles and other behavioural or relationship issues. A professional may suggest counselling and coaching for the adult or child, their family and close friends as well as asking for support from employers or educators. A professional may also prescribe medication, as well as neuromodulation therapies such as Neurofeedback or EEG biofeedback. A trained therapist will recommend one or more of these treatments depending on the severity of the disorder and how much it impacts on the daily life and well-being of the person.
Attention Deficit Disorder, with or without Hyperactivity (ADD or ADHD, hereafter ADHD), is a commonly diagnosed childhood disorder. It is a condition that arises from neurological dysfunction and runs both a chronic and pervasive course – that is, it does not disappear with time and its symptoms carry across a variety of situations. ADHD comprises three elements: inattention (ADD), hyperactivity and impulsivity (ADHD), the latter two existing together. The condition is classified according to the child’s difficulties, either as a predominantly inattentive type, a predominantly hyperactive and impulsive type, or a combination of problems in all three areas. Unfortunately it is the combined subtype that causes the greatest number of difficulties and it is the most frequently diagnosed. Clearly the qualities of inattention, hyperactivity and impulsivity are observable in most children but not to the point of being their typical behaviour.
The consequences for children with attention deficits are numerous. Attention requires the ability to select a relevant focus, maintain concentration for a set period of time and inhibit unwanted stimuli. Some of the most common problems in children with an attention deficit include carelessness with schoolwork, leaving tasks half completed, poor listening skills, forgetfulness, disorganisation and a tendency to lose things. When a diagnosis of ADHD is made, it is not enough that inattention is identified. The nature of the inattention is also important: one child with ADHD may not be susceptible to distractions but cannot read a novel for a moderate length of time in a quiet environment; other children will be easily distracted by everything in their immediate environment. The type of treatment recommended should be individualised to target specific problems. If the brain is not capable of giving adequate attention to information, learning cannot take place and the child will become frustrated and discouraged.
Hyperactivity, the ongoing need for motor stimulation, may be as overt as continuous running and activity or may appear as fidgeting, tapping and refusing to sit still in a classroom setting. Hyperactive children also talk constantly and their behaviour may be inappropriate for the situation. Impulsivity, the tendency to act quickly, is not a matter of insensitivity on the part of the child but an inability to delay gratification. This can result in frequent interruptions in conversation or impatience when asked to wait. Risk-taking behaviour is usually more common and impulsive children do not take the time to fully consider the consequences of their behaviour on themselves or others. This type of disorder makes it very difficult for children to control their desire to act immediately.
ADHD is a developmental disorder, a broad term that encompasses many conditions that can arise when a child’s development is abnormal or interrupted. Most times it is impossible to pinpoint the cause, but most problems occur before, during or after birth in the critical stages of a child’s development. There does not appear to be an identifiable genetic component or a particular neurotransmitter responsible for the disorder, or any illness that conclusively causes ADHD. Although the observable aspects of developmental disorders are given considerable attention, these are only symptoms of an underlying neural dysfunction – that is, a problem with the way the brain processes information.
While studies have shown that some parts of the brain are used differently in children with ADHD, little is understood as to why this happens to some and not others. A recent study by Elizabeth Sowell at the University of California found that the brains of children with ADHD have a lower tissue density than children without the disorder, and that this discrepancy was observable in the parts of the brain that control attention and behaviour.
Previous research conducted at New York University by F. Xavier Castellanos also revealed that children with ADHD had 3% less brain volume than other children of the same age. Although every child’s brain grew at the same rate, the difference remained at the same ratio. Magnetic Resonance Imaging (MRI) was used to measure brain size and the areas most affected were those associated with the most obvious symptoms of the disorder. While this was unsurprising, there was much interest in the reduced size of the cerebellum which is the part of the brain responsible for integrating sensory information and coordinating movement and balance.
Children with ADHD tend to have abnormal listening patterns. This is not to say that they have problems with sound reception – in fact, the opposite is true as they are unable to screen auditory information and inhibit irrelevant sound. Every sound in the environment is accepted with equal weighting which leads to the child feeling distracted or overwhelmed. Good listening involves the ability to analyse, perceive, inhibit and differentiate sounds, a system referred to as auditory processing. Listening is essential not only for learning and language acquisition but for communication and self-awareness. In order to diagnose ADD or ADHD, the Centre utilises a range of measure including observation, Gold Standard psychological questionnaires, and continuous Performance tests. In addition an QEEG (Quantitative Electroencephalogram) which can be undertaken at the Centre can reveal abnormal brainwave patterns. While QEEGs can be employed as a diagnostic tool, this technology is not generally used in Australia for the diagnosis of ADHD.
For information on auditory processing please visit auditoryprocessing.com.au.
Brainwaves are measured as frequencies in the unit of hertz, the number of wave cycles per second. There are four types of brainwaves (or rhythms) that are focused on in EEGs – alpha, beta, theta and delta – and each type can be matched with a certain state of functioning. They are described in terms of their dominance and are measured at different points on the head; depending on where the sensors are placed different brainwaves can be examined and targeted in treatment.
Alpha waves (8–11 hertz) are most dominant when we are relaxed with our eyes closed and are less dominant when we are alert or thinking. Beta waves (12 hertz and above) are present when we are engaged in cognitive tasks or when we are anxious. Theta waves (4–7 hertz) reflect slow brainwave activity dominant in sleeping adults or children (even when awake) up to the age of 13. Delta waves (less than 3 hertz) are only dominant in deep sleep, though babies tend to experience delta activity as their dominant rhythm.
Typical brainwave patterns have been identified for various states and this is the underlying aim of EEG Biofeedback/Neurofeedback training – to restore the brain to its most efficient mode of operation for a specified task. For example, it has been found that in order to pay attention and learn something well, the brain must emit high levels of beta brainwaves and low levels of theta brainwaves as an imbalance is associated with poor concentration. Research indicates that children who suffer from ADHD appear to be less able to produce beta brainwave activity above 14 hertz and experience more slow wave activity3, especially in the theta brainwave region between 4–8 hertz.
The term ‘biofeedback’ describes using information from the body to help in self-regulation. EEG Biofeedback (or Neurofeedback) simply involves using brainwave data to identify when the brain is and is not performing at its optimum level. Children with ADHD undergo Neurofeedback to increase their beta rhythm which is essential for effective concentration. As they sit in front of a screen with sensors on their head, they are involved in a computer game whereby high beta activity is rewarded and points are scored. Children may see that lapses in concentration are reflected in a rocket decelerating, or that maintaining concentration causes the rocket to accelerate. In this way, the brain is trained and encouraged to perform at a higher level and the child learns to manage their inattention.
The sensors on the head do not cause any sensation or emit any kind of signal. They merely detect brainwaves and provide information about the trainee’s changes in neural activity. Neurofeedback training encourages a modification of brainwave patterns by using computerised graphic displays and auditory signals in the context of a game. This challenges the brain to function more effectively, and as children gains points within the game they learn to improve their attention and arousal and achieve better control over their emotions and behaviour.