Tag Archives: ADHD

Reconsidering ADHD

By Laurie Meyers July 20, 2016

The stereotypical image of attention-deficit/hyperactivity disorder (ADHD) is the raucous little boy who can’t sit still in the classroom and is a discipline problem at home. But counselors who commonly work with ADHD know that it can also manifest as a young girl who is seemingly always in her own world or an adult who just can’t seem to get things done and frequently misses deadlines. Even after moving beyond the stereotypes, however, ADHD isn’t necessarily Branding-Images_ADHDeasy to spot, especially because the disorder can mimic the symptoms of mental health conditions such as depression, anxiety and schizophrenia.

Once viewed strictly as a behavioral problem, ADHD is now considered by many experts to also be a neurological and cognitive disorder that starts in childhood and presents lifelong challenges for those who have it. Although much remains to be discovered about ADHD, researchers believe that the problem lies with an impairment in the brain’s executive function that causes inattention, hyperactivity and impulsivity. In the past, ADHD was divided into two types, but the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders delineates three types of ADHD: inattentive type, hyperactive/impulsive type and combined type (a mix of symptoms from both the inattentive and the hyperactive/impulsive types). Although typically diagnosed in childhood, ADHD can go undetected until a person reaches adulthood. The difficulties adults with ADHD confront may look different than the difficulties children with the disorder face. For example, instead of failing to complete homework, adults may have problems with missing deadlines at work or forgetting appointments. Regardless, the root cause of those challenges and many of the strategies that are used to adapt and cope are the same for children and adults, according to counselors who work with ADHD.

The professional counselors interviewed for this article say that a number of interventions, including time-management strategies, cognitive behavior therapy and, if needed, prescription medications, can be helpful for those with ADHD. But they also emphasize that one of the most important things practitioners can do is to explain to clients why they experience the difficulties they do. Before showing up in a counselor’s office, many of these clients have come to believe (or have been told by others) that they are dumb, lazy or even mentally unstable.

Childhood challenges

Those who read the comic strip The Family Circus are likely familiar with the character of Billy, the family’s 7-year-old son, and his “trails,” which are often featured in the larger Sunday comic. The dashed lines in the comic trace Billy’s wanderings as he performs seemingly simple tasks such as going to the mailbox. One of Billy’s typical trails might lead to every room in the house, on and off the furniture and perhaps even around the neighborhood as he stops to investigate everything that draws his attention along the way to the mailbox.

Clay Martin, a national certified counselor who was diagnosed with ADHD as a child, says that Billy and his trails are the perfect example of a child with ADHD. It might take Billy forever to get the mail, but it’s not because he’s misbehaving, Martin says. It’s because he has a faulty filter for sensory input. Children and adults with ADHD may, in essence, have trouble distinguishing the signal from the noise, being unable to focus on one thing in a sea of sensory output, explains Martin, a member of the American Counseling Association.

Unfortunately, Martin adds, the adults in the life of a child with ADHD don’t typically understand this, or at least not initially. Instead, parents often think that their child is being disrespectful, willfully disobedient or just plain defiant, but that is usually not the case, he says. Martin explains that when children with ADHD get in trouble, they often are not even sure of what they have done wrong. That’s because they don’t usually possess a strong sense of time, may have trouble processing information and likely intended to listen to the instructions they were given but were ultimately unable to focus on what the parent, teacher or other adult said, according to Martin. He calls this circumstance “blinking” and acknowledges that it sometimes remains a challenge for him even as an adult. Even though he is intent on listening to a conversation, his mind will suddenly be seized by something else.

When providing counseling, Martin does a number of things to help ensure that he stays focused on his clients. He maintains what he calls a “spartan” work environment with few distractions. He silences his mobile phone and locks it in a cabinet until lunchtime and then again until the end of the workday. He maintains eye contact with clients through the entire session and summarizes their statements immediately rather than letting them “pile up.”

Beth Ann Dague, a licensed professional counselor in Wheeling, West Virginia, says the biggest challenge she faces when working with children with ADHD is often helping parents and teachers better understand the nature of the disorder. “I try to educate them about problems that occur with the prefrontal cortex and that [ADHD] is more than a short attention span and distractibility,” she says. In fact, children (and adults) with ADHD can also struggle with lack of perseverance, impulse control, hyperactivity, chronic lateness, poor time management, disorganization, procrastination, poor judgment, trouble learning from experience, short-term memory problems, and social and test anxiety, notes Dague, a member of ACA who has done advanced training in ADHD work.

When children are grappling with several of those issues simultaneously, academic problems are inevitable unless classroom accommodations are made, Dague asserts. She encourages parents to become their child’s best advocate, ensuring that the child gets all the services that those with ADHD are entitled to under federal law because the disorder is classified as a disability. Parents should push especially hard for an Individualized Education Program (IEP) for their child, she says. Under an IEP, a student with ADHD is given accommodations such as the ability to take tests separately, individual lessons with a teacher or tutor to go over problem material and other classroom modifications. Dague says that ADHD is in many ways a disorder of motivation. For that reason, parents may have to be motivated for their children with ADHD, encouraging them to keep trying and assisting them with homework, she adds.

Martin formerly worked with adolescents as an in-home counselor in Georgia and now counsels the same age group in a substance abuse program as part of the clinical work for his doctoral program at the College of William & Mary in Williamsburg, Virginia. He cautions that parents whose children have ADHD should always consult with the child and consider his or her input. Children with ADHD benefit from having structured schedules, Martin says. So parents might decide that, each day, the child will be allowed to play video games or play outside for an hour after school, but then homework must be completed, the family will eat dinner, the parents will check the child’s work and then the child will get to choose whatever he or she wants to do in the time remaining before bed. Rather than the parents always determining the schedule, Martin encourages what he calls “therapeutic negotiation,” in which the parents agree to try a different schedule arrangement based on the child’s desires. For example, the child might propose doing homework for an hour first, followed by video games for two hours. Before agreeing, the parents and child would reach an understanding that if schoolwork is neglected under the new schedule, the child will resume the original schedule.

Both Martin and Dague say it is important to encourage children with ADHD to find and pursue their passions, and both counselors highly recommend extracurricular activities for these children. These outside interests are significant not just as an outlet for excess energy, but as a place where young people with ADHD can excel and experience success, especially if academics prove challenging to them. Dague talks to parents and children about trying out various sports and other activities at school and also informs them about low-cost programs such as a fine arts institute and music programs in the local area. She urges parents not to let their child simply “give up,” which is common among those with ADHD, Dague says. Instead, parents can encourage their child to try a different activity or to stay in a current program or activity a little while longer in hopes that it will spark the child’s interest.

Extracurricular activities can also teach valuable life skills, Martin notes. He credits participating in drama club in high school with helping him learn social skills, how to communicate with others and how to make friends. It was also a place where he was surrounded by individuals who accepted and supported him.

Dague is particularly in favor of sports or other physical activities for children with ADHD because she believes that movement is helpful for activating their brains. She notes that movement increases blood flow, oxygen and neurotransmitters such as serotonin, norepinephrine and dopamine.

But Dague also likes to teach yoga and diaphragmatic breathing for relaxation to child clients with ADHD. Martin finds meditation personally helpful for focus and stress relief and often suggests that clients with ADHD try it too.

Dague encourages parents to look for cognitive training resources to work on with their children. Among those she mentions are Nintendo’s Brain Age and workbooks that include exercises for increasing attention and focus. She also engages in exercises with clients in her office that are meant to enhance their attention levels. For example, she might play Simon Says, Jenga or checkers with them. Dague says that checkers is particularly difficult for children with ADHD because they are thinking too fast to strategize. In her sessions with these clients, she slows things down and helps them think about what moves they could make to beat her. She also encourages older children with ADHD to try out cooking under parental supervision. She believes that following a recipe step by step can help to increase their focus.

In cases of children with ADHD who are acting out, Dague talks with the child and parents about setting up a behavior plan. For example, the family might pick a week and say that if the child can go consecutive evenings without yelling, stomping, refusing to do homework or engaging in other disruptive behavior, he or she can earn some type of reward. Dague also teaches children with ADHD and behavior issues to visualize a stop sign or stoplight every time they feel themselves getting angry or feel the urge to grab or touch things they aren’t supposed to.

Martin and Dague stress that amid all of the possible tips and techniques for managing a child’s behavior, it is important for counselors to remember that ADHD still carries a stigma and that the struggles these children face can leave a mark.

Dague and those she supervises have used multiple methods in school or in the counseling office to help children with ADHD work on their self-esteem. She says it is common for these children to struggle to identify their positive personal aspects, so counselors in school might use worksheets and ask the children to mark their “good traits” or to write down good things that others have said to them. Dague also likes to have children make a “self-esteem box.” The shoebox, personalized with pictures or drawings on the outside, is used as a place to store positive comments from teachers, parents or peers.

Martin is also familiar with the self-esteem issues that those with ADHD often face. When he sought counseling for himself as an adult, it wasn’t to learn time-management or relaxation techniques. It was to learn self-acceptance. Beginning when Martin was a child, he had wondered why he was so different from everyone else. Over time, with the help of a counselor, he learned that he wasn’t inferior to those who didn’t face the same challenges that he faced. Eventually, he even came to appreciate his differences and, in fact, no longer considers ADHD a disorder but rather a different way of seeing the world. He encourages counselors to let their clients know that ADHD is neither an indictment nor a life sentence. Instead, their unique perspectives and passions might lead them to feats of creativity and accomplishment that many others may only dream of, Martin concludes.

College bound

The transition from high school to college can prove challenging for any adolescent, but that can hold especially true for students with ADHD. Some of these students may have grown reliant in high school on receiving assistance from their parents with remembering deadlines, organizing their assignments and managing their time, says Deborah Ebener, an associate professor and coordinator of counselor education at Florida State University (FSU) in Tallahassee. These students most likely also had an IEP in high school that guaranteed them specific accommodations that may not be available to them in college.

“In addition, [students with ADHD] must deal with changes in how disability services are delivered,” continues Ebener, a certified rehabilitation counselor, national certified counselor and licensed psychologist. “College may be the first time the student is solely responsible for requesting and managing [his or her] own academic accommodations.”

The stakes are high. Research has shown that college students with ADHD generally have poorer academic results and are less likely to graduate than their peers who do not have ADHD. Those who do graduate are likely to take longer than their peers to finish college, says Ebener, a member of ACA. College students with ADHD also tend to have poorer psychosocial and emotional outcomes, higher levels of psychological distress and higher rates of depressive symptoms, says Ebener, noting that the research is borne out by what she has seen in her private practice.

“The existing services that are available to college students with ADHD may not be adequate to help them meet the rigorous academic and psychosocial demands that come with going to college,” says Susan Smedema, who collaborated with Ebener to create a group counseling program for students with ADHD at FSU. “For example, academic support services provided by campus-based disability centers provide students with specific course-related assistance, such as extended testing time, but typically don’t address psychosocial concerns, such as helping them to make friends or navigate the dating scene.”

“Individual counseling addresses psychosocial issues and skill development, but it may be difficult to find a counselor with ADHD expertise, and counseling is often expensive and time-limited,” Smedema continues. “Individual ADHD coaching helps students develop skills and self-confidence, but it is also expensive and does not provide emotional support or address a student’s specific problems. Group counseling, however, is a cost-effective way to help students with ADHD cope more effectively with college life.”

FSU’s student disability resource center asked Ebener to develop group counseling services for college students with disabilities. She created the Coping With ADHD project and, with Smedema, developed it into a service, teaching and research project. Ebener describes the group program as a combination of cognitive behavioral and individual coaching interventions.

“We utilize a psychoeducational approach to coaching the students in such areas as time management, organizational skills, test preparation, problem-solving and goal setting,” she says. “In addition, cognitive behavioral interventions are used to address psychosocial issues related to adaption to their ADHD and other life areas. This psychosocial adaptation to disability component is what makes this intervention unique.”

The group curriculum that Ebener and Smedema created consists of eight 90-minute sessions co-led by two advanced graduate students. Topics include understanding and coping with ADHD symptoms, medication issues (such as dealing with side effects), stress reduction, self-advocacy (including how to ask for accommodations from professors), social skills (dating, in particular, is a very popular topic, Smedema says), goal setting, time management and memory strategies.

“The ultimate goals are to help students minimize their functional limitations, reduce psychological distress, gain social support, develop self-advocacy skills and effectively adjust to college,” says Smedema, who has since left FSU to become an assistant professor of rehabilitation psychology and special education at the University of Wisconsin-Madison. She continues to be a co-investigator with Ebener on the research aspects of what is now called the Disability Counseling Project.

Smedema, a member of ACA, says that each session generally consists of 10 minutes of group member check-in, a 15-minute presentation of content related to the day’s topic, 15 minutes of member response to the presentation, a 10-minute break and 40 minutes of general group process.

The eight sessions are:

1) About my disability: Self-assessment and understanding resources

2) Coping with my disability: Self-monitoring and stress management

3) Career decision-making and exploration: Obtaining and maintaining employment; reducing commitment anxiety and external conflict

4) Awareness of self and environment and learning to work well with others: Self-advocacy and social skills; students with disabilities’ rights and responsibilities

5) Learning to manage myself: Aggressive vs. assertive responses; developing memory skills and effective work habits

6) Who’s in control: Time management; solution-focused/forward thinking

7) How do I remember all of this: Memory strategies (e.g. calendars)

8) Wrapup: Debriefing

The group facilitators use psychoeducation to cover topics such as time management. But for other topics, such as stress reduction, they demonstrate effective techniques (for example, diaphragmatic breathing or progressive muscle relations) and lead the group in performing the exercises.

In the reaction portion of the sessions, students talk about their responses to the presentation topic or the technique being demonstrated. For example, they might discuss questions such as how particular relaxation strategies made them feel, how they might be able to implement the techniques in their lives, what barriers they might encounter in using a particular strategy or technique and what impact they think a particular strategy or technique might have on them overall.

The general group process portion of the sessions allows members to absorb what they’ve learned together while providing one another with emotional support, Smedema says.

“According to our research, students who participate in the group demonstrate significant increases in quality of life and college self-efficacy and significant decreases in psychological distress,” Smedema notes. “These results show incredible promise for the efficacy of this type of intervention in college students with ADHD.”

Recognizing ADHD in adults

Stacey Chadwick Brown, a licensed mental health counselor and private practitioner in Fort Myers, Florida, recently started working with an adult client who had formerly been diagnosed with depression. She told Brown that her anxiety and depression weren’t improving. Some of the woman’s current symptoms, such as trouble focusing and a lack of motivation, resembled depression, but as Brown listened to her story over several sessions, she noticed that the client reported long-term attention problems.

When discussing the client’s lack of motivation, Brown discovered that the woman actually was motivated, but only to do things that she found enjoyable. The client also reported feeling anxiety, which Brown definitely sensed. But Brown still didn’t feel that she was getting the full picture of the client, so she did something that she likes to do with all of her cases (with clients’ permission) — get the perspective of at least one other person in the client’s life.

“I had her roommate come in,” recounts Brown, a member of ACA, “and she said, ‘Did she tell you about how she won’t pay bills on time, gets stuck [pulled in] if she walks by the TV and has trouble getting up in the morning?’”

The client had also tried various exercises for depression and anxiety in the past but never kept up with them. Brown considered the lack of follow-up a red flag that possibly indicated the presence of ADHD.

Brown had also asked the woman to journal (another technique that Brown likes to use with most of her clients). The client showed up at the next session proudly displaying her brand-new journal, complete with an intricate self-portrait but no writing or observations. She had also neglected to complete some homework that Brown had assigned.

When Brown delved into the client’s history, the woman reported that teachers used to tell her parents that they couldn’t get through to her and that she wasn’t listening. She also remembered not liking to do her school assignments. In fact, the client told Brown that sometimes her mother had done her homework for her to keep her out of trouble.

Brown finally talked to the client about the symptoms of ADHD and asked her to think about whether she recognized any of those symptoms in herself. Brown believes that educating adult clients about the possible presence of ADHD is very important. She has asked certain clients to watch TED talks and short videos on ADHD and has also recommended that clients read You Mean I’m Not Lazy, Stupid or Crazy?! a self-help book for adults with ADHD by Kate Kelly and Peggy Ramundo. She also gives certain clients ADHD symptom scales to fill out. “It’s all about education and getting [certain clients] to see if [they] think it applies,” Brown says.

When presenting any client with an ADHD diagnosis, Brown tries to ensure that the person leaves her office understanding that the disorder is neurological, not an implied behavioral or character defect. To help in this understanding, she typically draws a picture of a brain, explaining the importance of dopamine for executive function and how those with ADHD have a shortage of this important neurotransmitter. Brown tells clients that executive function is akin to an administrative assistant who keeps the CEO (the brain) organized. When someone has untreated ADHD, it’s like the administrative assistant is on vacation, making it more difficult for the CEO to function efficiently. Brown also tells her clients that medication can sometimes help with executive function. If they are interested in exploring prescription treatment, she gives them the name of a psychiatrist who specializes in ADHD.

Brown says that providing psychoeducation is particularly important because clients grappling with ADHD often internalize a significant amount of shame. She recalls a recent client who constantly beat herself up and had a distorted self-image because of her struggles with ADHD. “She called herself fat, lazy, unmotivated, and kept comparing herself to her ‘successful’ brother,” Brown says. “She hadn’t noticed what she was doing. I kept count in one session, and she called herself lazy 12 times.”

Brown focused on making the client more aware of her negative self-talk and how to use cognitive reframing to challenge it. She had the woman take note of when she was feeling guilty or blaming herself and then fill out a spreadsheet with three columns: the activating event, its consequence and the resulting behavior. For example, an activating event might be that the client failed to pay her power bill on time. The consequence was that she felt guilty. Brown explained to the client that not paying the power bill was not an event that automatically triggered guilt on its own; instead, there was a negative self-narrative of blame that caused the guilt. And that guilt (the consequence) caused the client to overeat, stay in bed and give up on the rest of the day (resultant behavior).

Brown encourages clients struggling with ADHD to think about how they can change that cycle. For instance, instead of engaging in self-blame, this client could say to herself, “I’m human. I forgot. Next time I will put a reminder on my phone, or maybe not keep the bill by the bedside but on the fridge, or maybe try electronic billing. I’m not a terrible person because I did this,” Brown says.

Reframing can pull clients out of the shame cycle and simultaneously encourage them to become more action oriented by coming up with possible solutions, Brown says. One of her clients is a manager who is accustomed to meeting daily deadlines, but outside of the structure that work provides, she struggles to function efficiently. Brown and the client have discussed how the client functions better when kept to a tight schedule, so they are working together to develop a schedule for all the tasks the client needs to complete in her daily life and assign regular deadlines to those tasks. Brown has also encouraged the client to maintain to-do lists and reward herself in some way for every task she crosses off.

Brown has also suggested ways that the client might strategize to avoid scheduling pitfalls. For example, the client acknowledges getting pulled in to television wherever she is, even if she is out somewhere. She turns it on first thing in the morning and often ends up sidetracked instead of getting things accomplished. Brown has encouraged
her to turn on the radio instead, especially when she knows that she has tasks to complete.

Another area Brown and the client are working on is organization. The client often misplaces things, including in the kitchen, so they have talked about organizing in a simple, systematic way — cereal goes with cereal, soup goes with soup, vegetables go with vegetables and so on.

As she does with any client showing signs of a mental health disorder, Brown has also asked this client to visit her doctor and have bloodwork done to rule out thyroid problems, a hormonal imbalance or other possible medical issues that might be causing or exacerbating the problems she is experiencing.

Like Martin, Brown doesn’t think of ADHD in purely negative terms. Those with ADHD have problems with attention in general, but when they are interested in something, they tend to focus tightly on it and even develop a passion for it that can propel them to greater mastery and success, say Brown and Martin. Both counselors believe that there is joy to be gained from these passions and from the unique way that those with ADHD see the world. Martin says that at times, this alternate worldview can even lead to creative problem-solving that might not be possible without the frame of ADHD.

 

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To contact the people interviewed for this article, email:

 

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Additional resources

For those who would like to learn more about the topics addressed in this article, the American Counseling Association offers the following resources:

Books and therapeutic games (counseling.org/bookstore)

  • ADHD Game (therapeutic card set to be used with Dinosaur Game Board, sold separately), Bradley Erford
  • Group Work and Outreach Plans for College Counselors, edited by Trey Fitch & Jennifer L. Marshall

Webinars (counseling.org/continuing-education/webinars)

  • “Adult ADHD: Help Your Clients to Thrive if They Have ADHD (or Think They Might), Tim Bilkey

Practice Briefs (counseling.org/knowledge-center/practice-briefs)

  • “Attention Deficit Hyperactivity Disorder (ADHD): Treating Adults,” John S. Wadsworth & Laura Gallo

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org

 

Gut health and healthy brain function in children with ADHD and ASD

By Michelle Harrell February 8, 2016

With the awareness being brought forward regarding gut health and neurocounseling, the future looks bright for our children with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Although all the tools that are available for neurocounseling are excellent for improving cognitive, emotional and social skills, we now have additional research to support the addition of nutritional therapy to our toolboxes as counselors.

Although I am a new counselor, I have spent more than 25 years researching and applying nutritional therapy in my own life after being diagnosed with chronic fatigue syndrome in my early 20s. I have WatermelonTummyseen firsthand the benefits of nutritional therapy and how it affects emotional, mental and physical well-being, especially as I reversed the symptoms of ADHD with both of my two children. As a teacher, I have also witnessed the increase in children with ADHD, ASD, and other mood and anxiety disorders that could be greatly combatted with supportive counseling and nutritional therapy protocols. As I begin my journey as a counselor in the schools and private practice, I can’t imagine not grasping the opportunity to add nutritional therapy for my clients.

Improving gut health can have a dramatic effect upon mood and cognitive functioning because of its healing nature within the immune and nervous systems. The use of nutritional therapy to support gut health in children and adults builds resilience and supports the bottom-up aspect of neurocounseling that understands and recognizes the bidirectional connection between our gut and our brain, as discussed by Allen Ivey and Mary Bradford Ivey.

 

Current statistics

According to the Centers for Disease Control and Prevention (CDC), ADHD currently affects approximately 11 percent of children ages 4-17. ADHD is a chronic mental health and neurological condition that has been increasing at a rate of 5 percent per year since 2006.

ASD is also on the rise. According to the CDC, ASD affects approximately 1 in 68 children in the United States. That rate is expected to increase to an estimated 1 in 25 children by 2025. ASD is currently five times more likely to occur in boys than in girls.

The fact that both of these conditions are on the rise at these current rates in our children should be cause for serious concern. As a parent and a teacher, I have observed the increasing demand that these chronic health conditions are putting on caregivers and professionals. Many counselors are responding by offering neurocounseling and other proven therapies to assist with behavioral issues, emotional regulation and cognitive needs. Neurofeedback, along with cognitive behavior therapy, is also proving to offer improved brain function that is sustained after treatment ends. Because nutritional therapy supports brain function, the two work in synchronicity for a client’s well-being.

Much has been discussed and debated about the issue of diet with children who have ADHD or ASD. Many parents have noted that removing certain foods appears to reduce symptoms of the disorders, and there is general recognition that gluten, sugar and other allergens have had a negative effect on these children. Even though these irritants seem to cause increased symptoms in many children, the underlying gut health situation might be the actual culprit here.

The gut ecosystem is a system that needs to be in balance. The gut is balanced when good bacteria and yeast exist in a healthy ratio within the digestive tract. When this balance is disturbed, food sensitivities and allergies can be noticed. According to Donna Gates (the author of The Body Ecology Diet) and Natasha Campbell-McBride (a medical doctor who wrote Gut and Psychology Syndrome), when gut health is restored, it results in a reduction in food allergens, allowing children to once again consume gluten and other supposed no-nos in a moderate amount.

Children with ADHD and ASD have shown remarkable improvement and overall symptom reversal by using food-healing protocols that increase healthy gut microbes, according to Gates and McBride. This can be a great relief and blessing for families that have been following a strict gluten- and casein-free diet. Imagine the joy of parents who can once again allow their child to attend birthday parties to enjoy cake and ice cream.

 

Basic knowledge

ADHD and ASD are just two of the many mental and developmental disorders that can benefit from the application of nutritional therapy to improve gut health. Gut health is important for brain health and directly affects mood and emotions. A growing number of researchers are interested in the relationship between gut microbes and brain function. According to the California Institute of Technology (Caltech), approximately 90 percent of serotonin is made in the gut. Researchers at Caltech are also studying the benefits of gut flora and its direct contribution to reducing autism symptoms in mice and humans.

According to Lisa E. Goehler, an expert in psychoneuroimmunology and faculty at the University of Virginia School of Nursing, gut microbes are responsible for creating most of our serotonin and numerous other neurotransmitters that are essential for healthy brain function. Serotonin is necessary for the brain to experience a positive mood and be resilient to stress. Microbes in the gut also have the essential task of supporting digestion by synthesizing vitamins, fermenting things we can’t digest and producing hormones that influence our immune, endocrine and nervous systems, according to Goehler.

Not just quantity, but diversity of gut microbes is important for overall health, Goehler says. She states that lean individuals have greater diversity in their gut microbes. But even a heavy person who has a diverse and abundant good microbe count is shown to be in better health than those with limited amounts of microbes, she says. According to Goehler, heavy individuals with a greater diversity of microbes experience fewer problems with metabolic syndrome and cardio and neurovascular disorders. This can even be a factor in the health of children who are overweight.

In general, Goehler reports, when good gut microbes are limited and displaced by toxins and yeast, digestion is impaired, resulting in leaky gut syndrome. In leaky-gut syndrome, yeast begins to take over when good bacteria have been reduced due to antibiotic use and unhealthy food choices. Yeast overgrowth causes leakage in the wall of the small intestine, allowing contaminants and undigested food into the bloodstream that would otherwise not have been able to cross the intestinal wall barrier. Yeast and other pathogens can then travel to the organs and cause additional health issues.

Nutritional therapy to restore balance begins with reintroducing additional healthy gut microbes back into the system. Probiotics and cultured foods seem to be a foundational piece to any effective gut-healing protocol. More of the science that goes with this essential piece of the puzzle is outlined in programs of leading practitioners. The results of restoring healthy flora back into the gut for healing has yielded many positive results for some families with ADHD and ASD.

I was pleased to find the work of two professionals who have been having similar results with the reversal of ADHD and ASD symptoms with a diet based on consuming probiotics and cultured foods. Gates’The Body Ecology Diet and Campbell-McBride’s Gut and Psychology Syndrome were remarkably similar, even though the two developed their works separately on opposite sides of the world. Gates, of California, and Campbell-McBride, of the United Kingdom, collaborated in a video to share the similarities between their results and the importance of balancing the body’s digestive ecosystem. I highly recommend their video as a source of valuable information for anyone seeking to learn more about the advantages of cultured foods (see https://youtu.be/nLP0Ijo2CK4).

Gates and Campbell-McBride both offer straightforward steps for balancing digestion, and they both have documented multiple cases of reversal or, in some cases, complete healing of ADHD and ASD in children when their methods are combined with additional holistic therapies. They both recommend the use of coconut kefir and fermented vegetables as foundational pieces of their plan. They both also mention that, historically, all cultures had some sort of cultured food that supported gut health, but during the latter half of the 20th century, this knowledge seemed to be disregarded for our current modern diet. Introducing these foods back into people’s diets has resulted in tremendous health restorative qualities for many of their clients. Having valuable resources that are in layman’s terms for clients to use can help support clients’ wellness plans.

 

Overcoming barriers

Counselors will come up against a variety of barriers if they choose to integrate food healing into their practice.

First is the issue of counselor training and understanding. Clearly we as counselors did not set out to be certified in nutrition, and many counselors may not want to pursue the additional certification. I have found it worth the time and energy to learn because I can apply it in my own life and experience improved personal health in addition to supporting my clients’ needs. Clients may also feel more inclined to see if food-healing protocols might work for them if their counselor is applying them as well. Regardless of whether you align yourself with another professional who possesses the credentials to offer nutritional therapy or you decide to jump in and educate yourself, your clients will benefit. But the choice is obviously the counselor’s to make.

As a recent counseling program graduate who wants to move forward into practice as a neurocounselor and offer nutritional therapies, it is important to educate myself on current research-based approaches that are demonstrating positive results. Current scientific research shared by Goehler in her workshop titled “Understanding the Gut Brain: Stress Appetite Digestion and Mood” offers one such professional learning opportunity for counselors. Of course, other researchers offer additional workshops. I make it a point to include these types of workshops in my professional development plan.

Although I am knowledgeable about food therapy and plan to constantly improve my skills, I also know my limits and will refer my clients as needed to those who are experienced experts in nutritional therapy. I also know that one size does not fit all. Clients require individualized plans that are suitable for their health needs.

Even if clients begin eating a healthier diet that is right for them, barriers such as cultural resistance at school, work or home can discourage them from continuing a positive habit. Counseling strategies might include encouraging clients to build healthy communication and confrontation skills when responding to those who question their dietary preferences. These skills can especially benefit teenagers who have to address their peers at a time when peer influence is of great importance in their lives.

Barriers of child taste preferences can be a serious problem for parents who have children with ADHD or ASD. Oftentimes, these children resist the foods that will restore their gut health. In his book Conquering Any Disease (2014), Jeff Primack shares the ingenious strategy of introducing delicious fruit smoothies into a child’s diet to restore gut health in children who have health issues. His research and books on food healing and smoothies have resulted in positive outcomes for Foodchildren with ASD and ADHD. These children were soon demanding more healthy smoothies as their tastes slowly changed toward a diet that would support their goal for improved health.

Within private practice, counselors can overcome barriers by educating clients through workshops and seminars. Clients can also benefit from support groups if they feel alone or don’t receive support from their immediate family or community system. Free online forums such as the one that Gates created (see bedrokcommunity.org) can offer testimonials and encouragement for parents who hope to help their children by integrating nutritional therapy along with other holistic protocols and counseling services.

School counselors might experience the most challenging barriers within a system that does not quite understand the role they play as mental health supporters. It would be interesting to see how administrators respond to data indicating that instances of ADHD and ASD are increasing and information about the current solutions available for parents and teachers to offer. The current demand to address the needs of ADHD and ASD students is enormous and requires a significant amount of time and resource planning for all school personnel. School counselors are being called on to assist with the increasing numbers of behavior issues and learning needs related to ADHD and ASD diagnoses. In addition to their current workloads that may include extra administrative duties that keep them from being available for these students’ counseling needs, school counselors are still trying to establish their identities as counselors in schools. This is where advocating for a comprehensive school counseling program as outlined by the American School Counselor Association, a division of the American Counseling Association, can be useful. Comprehensive school counseling programs encourage school counselors to be change agents, which could include mental health efforts that integrate nutritional support for these students.

School counselors can bring this information to light in a variety of ways, including offering a professional development class on mental health for school staff, administrators and school board representatives. As a teacher, I would have appreciated learning more about many of the diagnoses that I was designing 504 plans, individualized education programs and response to intervention frameworks around. Teachers are in the trenches daily dealing with stress and anxiety issues related to ADHD, ASD and other mental health disorders but don’t know the details behind these diagnoses. They will truly need the support of school counselors and administrators in the years ahead given the projected increases for ADHD and ASD.

There are many other creative ways that school counselors could address wellness. Counselors educated on nutritional research could advocate with their school boards and county nutritionists to suggest healthy food options that would be tasty for students. According to Luise Light, the former director of dietary guidance and nutrition education research for the Department of Agriculture, the food pyramid that emerged in the early 1990s was a product of business corporations and not true science. In 2006, Light stated that all of her research was overlooked in favor of corporate interests. In her book What to Eat, she explained how this development has directly affected our society’s health and particularly our most valuable natural resource — our children. Clarifying that the food pyramid is both outdated and not based on the best scientific data could help our society understand nutrition differently.

Another opportunity for counselor advocacy is to work collaboratively with health and science teachers to design lessons that align with current research. I knew of one health teacher who taught children in an impoverished neighborhood the benefits of micronutrients by bringing in a blender and creating fruit smoothies. This exposure to practical solutions that tasted good paid off. The students couldn’t stop talking about their lessons on food and nutrition from this progressive teacher, and I even heard them discussing how they were teaching their parents about healthier food options.

With food therapy and neurocounseling working together, the future looks hopeful for children and families dealing with ADHD and ASD. Obviously, each child is his or her own unique being and will require an individualized protocol that is specific to that child. Professional counselors have been trained to offer amazing tools for improved mental health, and I believe we now have a critical missing link to add to our toolbox. We are at an exciting time in our work, with science and counseling validating the relationship between the mind and body as never before.

 

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Michelle Harrell, an educator working in the Columbia County school system, lives in Evans, Georgia. She earned her bachelor’s degree from Georgia Tech and both a Master of Arts in Teaching MichelleHarrelland a Master of Education (school counseling) degree from Augusta University. She is currently working on her specialist degree in counseling education and supervision. Michelle is also a qigong and meditation teacher in her spare time. Contact her at michelleharrellneurocounseling@gmail.com.

Diagnosing ADHD in toddlers

By Donna M. MacDonald August 27, 2015

In 2000, Dr. Steven Hyman, then director of the National Institute of Mental Health (NIMH), made a statement for the record and publicly recognized that preschoolers can have the mental health condition of attention-deficit/hyperactivity disorder (ADHD). He made this statement even though this belief was not widely accepted at the time. He further stated that preschoolers with ADHD were _toddlersunable to interact happily and healthily with friends and family members, significantly impairing their self-esteem and the stress level of the family unit. Therefore, Hyman urged a push for more studies to be conducted on medication for children as young as age 3. (It’s important to note that Hyman is not “for” or “against” medication; he is for what is right for each individual case). He was hopeful that more studies and results would give parents of young children legitimately suffering from this disorder more treatment options.

In 2011, the American Academy of Pediatrics adjusted its guidelines for the diagnosis and treatment of ADHD to include younger children. Previously, it had “allowed” ADHD to be diagnosed in children only 6 and older, but since the push from NIMH in 2000, more research studies had in fact been conducted, and those results warranted the change to include the diagnosis and treatment of preschoolers.

Some public school preschools enroll their students at age 3 (even though most children start a bit later because of where their birthdays fall on the calendar). An ADHD diagnosis requires that the symptoms be consistently intense and frequent for a period of six months, which means that most preschoolers who legitimately have the disorder are receiving the diagnosis at the end of age 3 or the beginning of age 4. According to Dr. Demitri Papolos, a recipient of an NIMH Physician/Scientist Award whose research findings have been widely published, the latest research suggests that the age of onset for ADHD is usually prior to age 4 and can occur as early as infancy. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reports that ADHD symptoms will have an onset prior to age 12 and that the observation of excessive motor activity during toddlerhood is likely. However, the DSM-5 states that these young cases of ADHD can be hard to distinguish from normative behaviors.

‘Within normal limits’

Given this information, what should counselors watch for in terms of identifying possible ADHD symptoms in these very young children? It can be challenging to discern between the typical hyperactivity, impulsivity, inattention, irritability and aggression that toddlers will inevitably display and the symptoms that are actually clinically significant and indicative of the neurodevelopmental disorder of ADHD in 1- to 5-year-olds. This is because in toddlers, as the DSM-5 states, behavior and emotional expression that is considered “within normal limits” spans a very wide range. Consider, for instance, the following scenarios:

  • What if a 1-year-old bites her sister?
  • What if a 2-year-old throws a tantrum in the store when he doesn’t get the toy he wants?
  • What if a 3-year-old runs around the minivan and won’t stay in her car seat?
  • What if a 4-year-old constantly says “NO!” and won’t follow directions?
  • What if a 5-year-old can’t sit still at the dinner table?

All of these scenarios can be associated with ADHD, but they are not necessarily indicative of the child actually having ADHD because each of the examples can fall within normal limits for the age range. This does not mean that these behaviors are always acceptable, however. Therefore, some of these behaviors will need modification.

On the other hand, in some instances, parents really do need to lower their expectations of what a toddler can and should be able to do. After all, toddlers are not meant to be mini-adults or even mini-children. Therefore, it is important to remember that it’s normal for a toddler to say “no” because it means he is trying to gain a sense of independence. It’s normal for a toddler to throw a tantrum when she doesn’t get her way because of the need for immediate gratification, which is associated with an immature frontal lobe of the brain. It’s normal for a toddler to want to run, jump and climb because movement actually helps the brain develop properly and helps the toddler to feel well emotionally. Toddlers don’t have long attention spans, so sitting still should be difficult for them.

According to staff members who specialize in early intervention with children ages birth to 36 months at the U.S. Department of Health and Human Services, a child who is 12 to 15 months old should be able to hold attention to an activity for one minute. A child who is 16 to 19 months old should be able to hold attention for two to three minutes. Nearing age 2, a child should be able to attend for three to six minutes. By age 3, this attention span should increase to five to eight minutes, and by age 4, the child should be able to hold attention to one activity for eight to 10 minutes. This does not mean, however, that the child will necessarily be able to remain still while attending to the activity. It is important that clinicians and physicians have a thorough understanding of what is within normal range so that they do not misdiagnose ADHD.

As the child ages, the range of behaviors that is considered within normal limits diminishes significantly. For instance, if a 7-year-old engages in any of the scenarios listed above, such as biting another child or running around the minivan while the parent is driving, especially if this happens on a regular basis and the child is not responsive to consistent behavior modification techniques, it provides much more reason for concern for an actual mental health condition.

Indicators of ADHD in toddlers

So, what are the signs of actual ADHD in a toddler? For actual ADHD, the toddler’s behavior must showcase a pattern of chronicity, meaning demonstrating the behavior frequently and consistently for a period of at least six consecutive months and without responding to consistent behavior modification techniques. In addition, the behavior of a toddler with ADHD must be intense in nature — much more intense than a typical toddler who might showcase these symptoms occasionally.

There will also be a rule-out procedure for ADHD to ensure that the toddler’s behavior is not due to normal temperament, a medical issue or sleep disorder, the externalization of daily stressors or another mental health condition. If all these causes for the toddler’s behavior are ruled out, the following may serve as signs of ADHD in the toddler:

  • Putting self in danger on a regular basis. This action is due to the presence of novelty-seeking behaviors, sensory-seeking behaviors or impulsive behaviors. Examples include hanging over a second-story banister, jumping down an entire flight of stairs, climbing the bookcase or the drapes, or darting into the street.
  • Putting others in danger by impulsively becoming physically aggressive, such as ripping toys out of others’ hands or pushing another child off of a swing. These actions are the result of a strong need for immediate gratification.
  • Struggling to make friends and difficulty following social norms, such as taking turns while talking, sharing toys or waiting in line. Parents of young children with ADHD may notice that other parents routinely cancel play dates with them or are not heard from again after having one play date with their child.
  • Falling behind in preschool despite interventions in the classroom to help the child succeed.
  • Engaging in tantrums for extended periods of time (15-30 minutes) on a daily basis or, sometimes, several times per day. During these tantrums, the child loses all rational thought. These tantrums display cognitive, behavioral and emotional impulsivity. Many of these instances are triggered by events that are considered “minor.” Most typical toddlers would not react in this extreme manner to these events, so this type of reaction is considered “disproportionate to the event.”
  • Overreacting in a positive manner to minor events. An example is jumping from one piece of furniture to another out of excitement, yelling loudly and throwing his or her hands in the air because of getting to go to the park, even when visiting the park is an almost daily occurrence. This overreaction makes it especially difficult for the child to transition into actual participation in the desired activity because he or she struggles to calm down.

Behaviors must be measured not only in terms of developmental norms but also in proportion to the event. If an 18-month-old goes to the library for the first time, she may run, yell loudly and touch every book she can out of excitement. However, if the child is now 4 years old, has been to the library regularly and still struggles to use “quiet feet” or cannot maintain herself for the five minutes of story time, that is cause for concern. If a 3-year-old throws a tantrum for 20 minutes because the big trip to Legoland — a place the child has never been before — has been canceled, that’s more “normal” than if a 4-year-old engages in a tantrum for 20 minutes because it’s raining and he can’t go to the local pool that he visits almost every day. That reaction would be considered disproportionate to the event.

Children younger than 6 or 7 cannot process traditional talk therapy because of its abstract nature. Therefore, it is important to get the young child with ADHD involved in another form of interpersonal behavior therapy to work on self-awareness, self-management, social skills and decision-making skills. Play therapy, dance/movement therapy, art therapy, music therapy and animal-assisted therapy are examples of nontraditional therapy forms that may be especially appropriate for young children, as long as clinicians are incorporating all of the self-regulation skills necessary for a child to use age-appropriate behavior.

 

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Donna M. MacDonald is a licensed clinical professional counselor who has worked professionally with ADHD for 15 years as a teacher, YMCA director and, currently, licensed clinical therapist in a therapeutic day school. She is also the mother of 6-year-old twins who were diagnosed with ADHD at age 3. She is the author of the book Toddlers & ADHD under the pen name Donna Mac. Contact her through her website at toddlersandadhd.com.

Letters to the editor: ct@counseling.org

 

Related reading: See MacDonald’s Counseling Today article from earlier this year: The connection between ADHD, speech delays, motor skill delays, sensory processing disorders and sleep issues

 

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The connection between ADHD, speech delays, motor skill delays, sensory processing disorders and sleep issues

By Donna Mac January 16, 2015

To ensure the overall well-being of child clients with attention-deficit/hyperactivity disorder (ADHD), counselors frequently work in combination with other service providers such as speech therapists, physical therapists, occupational therapists and sleep specialists. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), many children with ADHD have also ADHD2experienced speech delays, gross motor delays and fine motor delays. In addition, many clients with ADHD showcase sensory issues or have a comorbid sensory processing disorder. Many children with ADHD seemingly also struggle to settle down at night, especially when parents are trying to get them into bed.

What is the connection between ADHD and these other deficits? If we take a look at the structural and chemical makeup of the ADHD brain, we find similarities with these other areas. First, let’s take a look at what an ADHD brain can look like:

  • There can be a smaller frontal lobe with less blood flow to it. This is where the executive functions exist: planning, organization, task initiation, task completion, time estimation, time management, self-regulation, social behavior, short-term memory, working memory, motivation, impulse control, intentionality, purposefulness and the ability to transition effectively. A smaller frontal lobe will lead to emotional immaturity.
  • The overall cerebral volume is usually smaller as well.
  • The neurotransmitter systems of dopamine and norepinephrine are affected. People with ADHD do not produce enough, retain enough or transport these neurotransmitters efficiently through the brain. MRI studies show that this inefficiency can be due to less white matter and more grey matter in the brains of clients with ADHD, which slows transportation. Dopamine is the main “focus neurotransmitter,” heavily associated with the frontal lobe and the executive functions, in addition to being the “feel good” neurotransmitter. It is also heavily linked to the limbic system, which contributes to people with ADHD reacting in a manner that is disproportionate to the event, either positively or negatively. Norepinephrine is involved in focusing on tasks a person considers to be either boring or challenging. In addition, it plays a role in sleep.
  • These clients can have a smaller caudate nucleus with less blood flow to it. The caudate is heavily innervated by dopamine neurons, and it plays an important role in learning, memory, social behavior, voluntary movement and sleep.
  • Electroencephalograms (EEGs) have shown that people with ADHD have more slow waves (theta waves) present than the general population when they are in an “awake state.” The increase in slow waves is especially pronounced during reading and listening tasks, causing people to lose focus, daydream or become drowsy.

All of this simply means that the ADHD brain is less mature and has less activity than a neurotypical brain. It is important to note that a doctor will not order an EEG or MRI either to diagnose or rule out ADHD because these findings are not indicative only of ADHD. In fact, many other issues present this way, including the following.

Speech delays: As stated earlier, the frontal lobe plays a key role in ADHD, but it also plays a role in speech production. There is a significant distinction between those with ADHD who have had speech and language delays versus the general population. It is also important to understand that children with speech and language delays typically have attention spans commiserate to where they are developmentally with language. For instance, if a 7-year-old speaks at a 4-year-old level, the child’s attention span may be that of a 4-year-old. This does not mean the child has ADHD. In addition, the child with a speech delay might find it challenging to communicate needs appropriately, so the child may begin to act out, have tantrums or melt down, much as a child with ADHD might demonstrate. Therefore, if a child has a speech and language delay, a thorough investigation needs to be conducted to determine whether the child’s “ADHD types of struggles” (of both attention and behavior) are related to the language delay, or if, in fact, the child also has ADHD.

If a child does have both ADHD and a speech delay, a physical therapist can make recommendations to the speech therapist concerning how to use specific large-body movements during speech therapy sessions. This will bring blood and glucose to the frontal lobe of the brain. This can be beneficial for speech production and will help the child with ADHD to feel more emotionally regulated.

Another speech issue connected with ADHD is speaking too quickly. This will sound almost as if the child’s speech is slurred. This can be due to the cognitive impulsivity related to ADHD. It can be addressed in a psychotherapy session or a speech session by having the child draw slow, wavy lines as the child speaks.

Motor skill delays: The ADHD brain processes slower than a neurotypical brain because of the transportation difficulties with the neurotransmitters and also because of the increase in slow wave (theta wave) movement. Interestingly enough, researchers find that about half of all children with developmental gross motor coordination disorders actually suffer from varying degrees of ADHD.

Why? Possibly because slower brain processing speed is also manifested in motor skill deficiencies. These motor delays are helped by physical therapists. However, there are other techniques used as well because there are activities that can help speed processing in the brain, such as balance-based activities. Physical therapists and occupational therapists tend to work together to incorporate balance-based activities with both motor skill delays and ADHD because the act of balancing the body actually requires the use of both hemispheres of the brain. In turn, this speeds processing, increases focus and decreases impulsivity.

Other extracurricular activities such as gymnastics, yoga and martial arts involve balance and practicing controlled movement, which are crucial for both ADHD and motor skill deficiencies. Some children with ADHD will have difficulty with fine motor issues such as buttoning clothing or tying shoes, and occupational therapists can help with those concerns as well.ADHD1

Sensory processing disorders: Reward-deficiency syndrome is when the brain is asking for more dopamine. This can be witnessed in the hyperactive response of those with ADHD when they “sensory seek” (spinning around and around, for example) or “novelty seek” (such as hanging over a two-story banister). Dopamine also limits and selects the sensory information that arrives to the frontal lobe, which is one reason that children with ADHD show these sensory issues. In addition, there is a less developed frontal lobe in cases of ADHD. This poses a “double whammy” because both dopamine and frontal lobe issues are involved with sensory concerns as well.

An actual sensory processing disorder occurs when a person has difficulty with the way the brain senses, organizes and utilizes sensory input. This results in unexpected outcomes of movement, emotions, attention and adaptive behaviors. It is as if the brain is using unexpected information on the way in, so, naturally, the unexpected emotions and behaviors come out, which can create further stress and anxiety for the person. Some people with ADHD will have certain sensory concerns without having a full-blown sensory processing disorder, but other people will have both ADHD and a sensory processing disorder. Occupational therapists are skilled at helping children with these issues.

Sleep issues: Children with actual sleep disorders or inconsistent sleep patterns will showcase symptoms similar to ADHD such as irritability, less developed social skills, attention difficulties, memory impairment, lower academic output, increased internalizing and externalizing of problems, not complying with requests and aggression. Because of this particular symptomology, it is crucial to rule out a sleep disorder before diagnosing ADHD.

Can a person have both ADHD and difficulty sleeping? Yes, but not always. A study was published in The New York Times in which researchers focused on children with comorbid diagnoses of ADHD and a sleep disorder. A year after surgeries or treatments for the sleep disorders, only half of the children retained their ADHD diagnosis, meaning that the other half had been misdiagnosed with ADHD; it was only the sleep disorder causing their symptoms.

It’s important to note that “trouble sleeping” was once a symptom qualifier to secure an ADHD diagnosis. The symptom was removed from the DSM in 1987, but the issue can still occur with some people. Remember that the caudate nucleus and norepinephrine are involved in both ADHD and in sleep, which is one reason people may struggle to sleep some nights. Most children with ADHD tend to have difficulty settling down at night and getting into bed because of their hyperactivity and impulsivity, which can spike in the evening hours. But once in bed and calmed down, children with ADHD can usually fall asleep in a time frame that is considered “within normal limits.” Many children with ADHD tend to wake quickly and experience an accelerated start to their day.

 

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Donna Mac has worked professionally with ADHD for 15 years as a teacher, a YMCA director and currently as a licensed clinical professional counselor in a therapeutic day school. She is also the mother of twins diagnosed with ADHD at age 3. She has published a book titled Toddlers & ADHD, available on Amazon.com, BarnesandNoble.com, Balboapress.com and at her website: toddlersandadhd.com.

 

Using neurofeedback to treat ADHD

By Heather Rudow February 21, 2013

LoriLong

Lori A. Russell-Chapin

Attendees of next month’s 2013 American Counseling Association Conference & Expo in Cincinnati will be treated to a new series of conference sessions aimed at shedding light on research by ACA members on topics that uniquely benefit clients. 

Called the Client-Focused Research Series, these 30-minute presentations aim to increase awareness of research that focuses on improving the services that professional counselors provide to clients.

In the weeks leading up to the conference, Counseling Today is speaking with some of the presenters about their research and why they believe it is important to the enhancement of the profession. Next up is Lori A. Russell-Chapin, professor of counselor education and associate dean of the College of Education and Health Sciences at Bradley University. Russell-Chapin, who is also co-director of the Center for Collaborative Brain Research and a member of the Association for Creativity in Counseling and the Association for Counselor Education and Supervision, will be presenting with Theodore J. Chapin on “A Pilot Study of Neurofeedback, fMRI and the Default Mode Network: Implications for the Treatment of ADHD.”

What would you like attendees to take away from your session?

Counselors need to better understand that there is another noninvasive method for the treatment of psychological and behavioral symptoms. Neurofeedback (NFB) is that other option, in addition to counseling and medication. Neurofeedback, a type of neuromodulation, helps to regulate the brain and helps it to perform in a more efficient and effective manner. NFB works with computerized software, an electroencephalograph (EEG) instrument and the principles of operant and classical conditioning to help normalize and strengthen dysregulated brainwaves.

Counselors also need to better understand the importance and role that neuroscience must play in our everyday counseling lives. What we now know about the brain enhances and changes how we conduct counseling. I have been telling our graduate students for years that understanding the brain will change how we do counseling. That knowledge has arrived, and we counselors must understand and utilize those fascinating results. It only makes us more competent in our trade.

How did you first get involved with studying attention-deficit/hyperactivity disorder (ADHD)?

Whenever I would go into the school system to help our student counselors, there always seemed to be so many young children who had symptoms of ADHD. In our private practice it is also a prevalent concern. ADHD is the most common childhood psychiatric disorder, with a cumulative incidence reaching 7.5 percent by age 19 (Barbaresi, Katusic, Colligan, Weaver, Pankratz & Mrazek, 2004). 

Why did you decide to perform this study?

According to Konrad and Eickhoff (2010), there has been a shift of focus from regional brain pathology in children with ADHD to dysfunction in distributed network organization. Because of that belief, I took the opportunity to write a proposal for monies through our Center for Collaborative Brain Research. Our team of researchers did pre- and post-tests with fMRIs to test the ADHD hypothesis of the dysfunctional distributed network. Neuroimaging provides researchers much more advanced methods of understanding the brain and its functions and structures.

What surprised you most as you compiled your results?

Our research team certainly wanted to validate and replicate the efficacy of NFB in the treatment of ADHD, which we were able to state. However, in our pilot study, finding that the Default Mode Network (DMN) was consolidated and, even more importantly, normalized to some extent after 40 sessions of NFB was exciting and remarkable. Many researchers believe that the DMN is essential to our everyday functioning especially in the world of subjective, internal functioning of the environment around us. Often children with ADHD have great difficulty activating the DMN during a resting state or quiet time. The post-fMRIs showed that activation during the resting state after 40 NFB sessions.

Why do you feel this kind of ADHD research is important?

Further advancing knowledge is always an important reason to conduct research. Taking that knowledge and being able to offer those results to children and parents as another type of treatment for ADHD that is intrinsic, noninvasive and long-lasting is a “breath of fresh air” compared to the many side effects of stimulant medications.

Who do you feel is the best audience for this session?

Our workshop would be appropriate for any counselor who wants to know more about additional treatments for children with ADHD. It is just fascinating to see the brain results that the advancements in neuroscience offer. 

Is there anything else you would like to add?

I have been providing individual counseling for several decades. I know counseling works and helps people change their lives. My neurotherapy and neurofeedback training has changed how I conduct counseling and my view of the counseling world. It has strengthened my skills and helped me have better outcomes for my clients.