Memory Training Helps Treat ADHD
As Attention-Deficit/Hyperactivity Disorder (ADHD) diagnoses among children continues to rise, one Traverse City psychiatrist might have some good news to share with parents and educators: A diagnosis could be wrong.
Many children exhibit one or more of the three classic symptoms: Distractibility, impulsivity and hyperactivity. But Dr. Sander Weckstein of Northern Michigan Psychiatric Services explained, "lots of little people have all three, but having ADHD is a matter of degree – a question of how maladaptive these behaviors have become."
Estimates of the number of ADHD sufferers vary from 6 to 10 percent of the child and adolescent population. Weckstein, an M.D. and a child, adolescent and adult psychiatrist, contends that only a thorough, professional diagnosis can accurately determine ADHD.
Like many ailments, ADHD is a spectrum disorder, so even when diagnosed, treatment is decided on a case-by-case basis. Some children are profoundly affected, while others have only a mild form. Roughly half the children diagnosed with ADHD ultimately grow out of it. Others suffer their entire lives, often undiagnosed and untreated, which Weckstein says is a tragedy.
"Society pays a lot of lip service to kids, but so many more could be helped. Treating kids with ADHD could make a huge difference. It could reduce the number of ADHD sufferers who end up as dropouts, incarcerated or who just never realize their potential."
It is especially troubling, he said, because treatment options exist to manage and reduce symptoms and help young ADHD patients.
Weckstein says pharmaceutical options can – when used cautiously – have a positive effect, but he acknowledges that "every med has its side effects."
INTRODUCING COGMED
This is one reason Weckstein has begun training parents and kids in COGMED Working Memory Training, a computer-based, at-home program developed in Sweden in 2001. COGMED is a proprietary system now owned and distributed internationally by Pearson Education, Inc.
The goal of COGMED treatment is to expand working memory capacity, which is the ability to remember and manipulate increasing amounts of information, usually numbers, letters or simple instructions.
The underlying concept of working memory training is neuroplasticity, the brain’s ability to reorganize itself and improve its performance in response to particular exercises.
The company – and numerous independent studies – suggests this flexibility has implications for improving brain function.
Neuroplasticity is also the basis for other ADHD treatments being used locally.
"We know now, through science, that our brains can be taught to adjust, change, adapt," said Joseph Sanok, licensed counselor and owner of Mental Wellness Counseling in Traverse City.
Sanok uses a relatively new system called MUSE that relies on brainwave feedback from a medical-grade EEG machine. The feedback helps patients train themselves to improve concentration and avoid distractions. Patients wear a headband with built in sensors that let them know when they have reached calmer mental states. This technology is being tested by Harvard University and the Mayo Clinic.
Over the past few years, Weckstein has based many of his patient treatment plans on neuroplasticity, using COGMED with more than 400 patients, often in conjunction with prescribed medications. He and his colleagues train parents, and then function as coaches to families using the program.
WITNESSING RESULTS
The results are promising in Weckstein’s practice and also in many research settings. Without guaranteeing individual results, Pearson Education touts "improvement" in 80 percent of patients treated.
Weckstein breaks this statistic down further. He says that, with support from coaches and parents, about one-quarter of the patients at his practice have a "really positive, even life-changing" response, about half show moderate progress and the remaining one-quarter show mild improvement.
Parents are a big part of program success.
Their roles in the daily sessions are to keep kids on track and provide a structured atmosphere with rewards. Parents are taught to accept, not criticize, their child’s current memory capacity, and begin building from there. The daily goal is incremental memory improvement.
Results are tallied automatically, so there’s little guesswork. If scores fall below a certain point, the difficulty level is automatically reduced. Gradually, kids learn they can learn.
COGMED has spawned a recent spate of memory-training programs marketed for adults, but Weckstein is not impressed.
"The difference is that COGMED is based on peer-reviewed studies, but knockoffs are based more on testimonials than research."
Yet, Weckstein admits COGMED isn’t a magic cure. Like all treatment options, it relies first on a professional diagnosis, including an understanding of where the child falls on the ADHD spectrum. It’s also a lot of work, requiring a weekly review by a coach like Weckstein, and it works only when parents commit to working side by side with their child.
COGMED complements other behavioral changes parents can make, such as creating a calm, orderly home atmosphere with predictable boundaries, utilizing a system of rewards and consequences and instilling a sense of progress and confidence in their child.
"It’s a matter of avoiding a negative loop," Weckstein said. "Instead of yelling, spanking, always taking things away, you now catch your kids at being good."
"That might be hard at first," he admitted, "but when you understand your kid is actually hardwired a bit differently than other kids, you can develop the patience to catch him or her doing well at least 10 times a day."
Improvements in diet, regular aerobic exercise and, in many cases, omega 3 fatty acid supplements in the right dosage can also help, he said.
Sanok agrees that a calm home environment and consistent consequences for behavior – along with proper diet, exercise and sleep – can produce significant positive changes in ADHD patients.
"I think parents who make these simple changes can eliminate half of the behaviors associated with ADHD," he said.
Weckstein says the concept of neuroplasticity and the COGMED program can also benefit non-ADHD patients. Working alongside a new local group, Life Beyond Borders, members of Northern Michigan Psychiatric Services now employ working memory training with other therapies to help brain injury patients.
There are reasons that ADHD diagnoses, medication, and even less invasive treatment programs such as COGMED and behavior modification training for parents aren’t utilized by all affected patients. For one thing, there are myths that keep people from seeking help for their child.
"Some people say ADHD is over-diagnosed and over-treated," Weckstein said. "Just the opposite is true."
"And I’ve heard it said that all of these meds will make you kill yourself or kill others, when the truth is that, under careful, conservative supervision, the right meds really help patients across the ADHD spectrum. I’ve even heard the argument that ADHD is just an American diagnosis," he said, "but it’s a real problem in many countries."
Still, at least one very real problem exists for families in need of professional help: insurance.
"At this point, most insurance companies will not pay for working memory training," Weckstein said. "Insurance companies are way behind the curve on this."
"I wish I could treat every kid in northern Michigan who suffers from ADHD, but that isn’t possible," he added. "It would help improve the quality of their lives."
