When parents of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) walk into my office for the first time, they often ask what I can offer them and their children that their pediatrician or a psychiatrist can't. As they struggle to get their son or daughter to stay focused, develop organizational and planning skills, and show greater self-control, I often liken their experience to training an excitable puppy to follow rather than lead, to stay on the path rather than stray into the high grass or muddy brook.
Children with ADHD are now understood to have deficits in the part of the brain that is responsible for executive functioning. These deficits manifest themselves in problems with impulse control, distractability, working memory (a system for temporarily storing and managing the information required to carry out complex cognitive tasks,) task completion and organization. These children struggle to control their behavior more than other children and often experience frustration, anxiety and depression as a result of these challenges.
In recent years the primary treatment approach to ADHD has been prescribing amphetamines (Ritalin, Concerta or Adderral) that produce an increase in neurotransmitters such as dopamine and norepinephrine in the brain. This activates the prefrontal cortex, the part of the brain associated with executive functioning that is under activated in children and adults with ADHD. The increase in neurotransmitters often results in greater cognitive and executive control and a decrease in symptoms. In the past 15 years, the prescription rate for this class of medications for children has increased dramatically, by as much as 700 percent according to some reports. Parents and mental health professionals alike are increasingly looking for alternatives to this medical treatment.
Many parents are interested in helping their child build on the strengths he or she already possesses and optimize the workings of his or her brain than altering its biochemistry. This is where various interventions borrowed from complementary and alternative medicine come in. Like the puppy being corrected on the leash, even children (and adults) with ADHD can work to train their brain from wandering less, and can increase their focus and concentration. Meditation in particular is a highly effective way to develop this sort of mental fitness.
In meditation, every time one notices the mind straying from a specified word, sound, mantra or image, one gently pulls it back to the present moment. Initiates describe going off on tangents that sometimes last upwards of five or even ten minutes before becoming aware that they are no longer concentrating on the selected focus of the moment. Over time, practitioners of meditation develop greater presence of mind during their meditation sessions and report that this increased capacity to direct their thoughts continues throughout their day. While most clinicians advocate the use of meditation as an adjunct to psychotherapy and/or medication for adults, therapists are increasingly recommending meditation for children with a host of problems ranging from anxiety to depression to ADHD.
For parents who can't imagine getting their active eight year old to sit down and meditate, computers may provide an alternative pathway for training their child's brain. Dr. Torkel Klingberg of the Karolinska Institute in Sweden is one of the leading researchers on working memory and attention in ADHD. His research group has demonstrated that the systematic use of computer programs designed to promote working memory in children diagnosed with ADHD results in a significant increase in sustained attention and a decrease in disruptive behaviors.
Since the publication of these studies, some ingenious tools are becoming available to families of children with ADHD. RoboMemo by CogMed is a 5 week program that engages children with various visual and numerical tasks that develop their working memory. PlayAttention, designed by Unique Logic and Technology, offers a more high tech program. Using a helmet containing brain activity sensors that feed information about the child's attentive state into a computer, the child performs low stimulation video game-like exercises by relying solely on his capacity to pay attention.
Some computer games offer a somewhat different approach that relies more on biofeedback and less on cognitive training. Journey to Wild Divine is an example of a computer game that, unlike the vast majority of highly stimulating computer and video games which activate the "fight or flight" adrenaline response, promotes calm, focused engagement. To succeed at this game, players must slow their breathing and decrease their muscle tension and heart rate. While biofeedback techniques such as this have been around for some time, they are generally aimed at reducing stress in adults. Recently, having recognized that focused attention is a key component of these activities, clinicians have begun to use such techniques in working with the ADHD population.
Certainly practices like meditation and biofeedback alone won't eliminate all symptoms of ADHD. Parents will want to work with a mental health professional and consult with learning specialists to determine whether psychotherapy, medication, and special modifications in the child's academic program are indicated. They will also want to develop interventions at home for increasing compliance, reducing distractions, managing meltdowns, and using disciplinary techniques tailored to their child%u2019s particular needs. Nonetheless, these alternative practices and interventions can become important additions to a family's strategies for effectively meeting the challenges of ADHD.