Are drugs the best treatment for attention problems?

So many parents are being told that their children have concentration problems, can’t focus or show limited attention span.  Along with these descriptors, they hear that their child daydreams, fails to complete tasks, loses things, fidgets excessively and so on.

 

Seeking medical help usually results in a prescription for a stimulant drug, such as Ritalin, Concerta and Strattera.  We do know that behaviour can be changed using certain drugs.  On Ritalin, for example, children are better able to pay attention, stay on task and sit still but the results are temporary; only with repeated dosages and sustained-release tablets will the benefits last all day.  Increasing the dosage over time brings risk of potential side effects even if these don’t show immediately and prolonged use should be discouraged because of uncertainty about long-term effects.   In addition, the drugs don’t address the basic problem.  They may make children easier to manage but don’t make them smarter or happier.  Children don’t learn any better when on medication – in fact, their work may show a lack of thought and originality.  They help the children get through the day in a mechanistic way but don’t make them better prepared for tomorrow.  Unfortunately, the drugs are often used alone, with no on-going programme to help the child in other ways.  In short, they may be the quickest and easiest ‘solution’ for children with attention problems but they aren’t the best.

Are drugs the best treatment for attention problems?

So many parents are being told that their children have concentration problems, can’t focus or show limited attention span.  Along with these descriptors, they hear that their child daydreams, fails to complete tasks, loses things, fidgets excessively and so on.

 

Seeking medical help usually results in a prescription for a stimulant drug, such as Ritalin, Concerta and Strattera.  We do know that behaviour can be changed using certain drugs.  On Ritalin, for example, children are better able to pay attention, stay on task and sit still but the results are temporary; only with repeated dosages and sustained-release tablets will the benefits last all day.  Increasing the dosage over time brings risk of potential side effects even if these don’t show immediately and prolonged use should be discouraged because of uncertainty about long-term effects.   In addition, the drugs don’t address the basic problem.  They may make children easier to manage but don’t make them smarter or happier.  Children don’t learn any better when on medication – in fact, their work may show a lack of thought and originality.  They help the children get through the day in a mechanistic way but don’t make them better prepared for tomorrow.  Unfortunately, the drugs are often used alone, with no on-going programme to help the child in other ways.  In short, they may be the quickest and easiest ‘solution’ for children with attention problems but they aren’t the best.

 

The reason is that drugs don’t affect the underlying problems.  Behavioural problems and inattentiveness are symptoms of other problems and the answer isn’t to be found in medication.   Let’s have a look at some case studies:

 

Little Anna was the smallest child in class and came across as being quiet, withdrawn and easily distracted.  She stares at other children and plays nervously with her crayons and books.  When evaluated for neurodevelopmental delays, she showed that her stress levels were very high.  She had some early developing irregularities that interfered with her brain’s ability to cope with the sights and sounds in the world.   She was simply overwhelmed by what she perceived as ‘threats’ from her environment.  Once these were addressed, her stress levels dropped and she became more responsive.

 

John never sits still.  His constant activity often makes him a nuisance in class and at home.  Under investigation, ILT found that due to hitches during his birth and early development, he had mixed dominance, and had failed to develop left-right preference because he hadn’t integrated the two sides of his body.  He also hadn’t developed the foundational systems needed for efficient motor functioning and stable posture.  As these were addressed, he became better able to keep his body still and use it in developmentally healthy movement activities that he could not master before.  This led to his behaviour becoming less annoying, increased ability to make friends and improvements in classroom learning.

 

Kevin is a daydreamer. He often stares out a window or at the television screen.  He is slow to complete his work.  He is clumsy and often drops things.  He has allergies and is often ill with sinusitis and colds. An ILT evaluation showed that his body didn’t work automatically.  He was using his mind to run his body so the brain’s higher levels, supposed to be used in learning and daily coping, were not available for cognitive functioning.  It would have been so easy for Kevin to slip through the cracks without achieving his potential.  A programme to help underdeveloped brain areas brought about noticeable improvements in his schoolwork and physical coordination.

 

Little Sam was asked to leave his nursery school because his ‘violent’ behaviour and tantrums became too much to manage.   A full neurodevelopmental evaluation by ILT showed no irregularities in development or sensory-motor system functioning.  What was suspected was a sensitivity to food colourants and preservatives.  On a trial basis following this suspicion, Sam’s family excluded any foods containing these additives and Sam almost immediately became calmer, eventually returning to his school as a happy, friendly little boy.

 

So drugs aren’t the answer to behavioural problems or inattentiveness.  Instead, these children need a comprehensive evaluation followed by an individualized programme that corrects identified areas of irregular functioning.

 

Interestingly, an ILT associate ran a programme with a group of over 50 children, all diagnosed with ADHD[1].  They were given daily certain sensory-motor stimulation and other movement activities designed to recreate the movement patterns that function to develop the brain in the early years.  About half these children were on Ritalin when they started the programme.  All were taken off Ritalin from three to six months later with no need to be put back on Ritalin or other behaviour-modifying medication.  For all children, the results showed the elimination of behaviour problems, better school results and dramatically improved coordination.  Social skills improved significantly as well but most importantly, the children were clearly happier.

 

Correcting behavioural and learning problems isn’t easy.  Effective intervention needs a holistic approach that reaches to the problems in the background and provides a supportive, encouraging environment.  For this reason, ILT is practiced in the family – no weekly visits to a therapist but ‘quality time’ spent in movements in which one or both parents can be involved.  The rewards are immeasurable. There is nothing better than watching a child who begins to feel good from the inside out!

 

[1][1][1] Shirley Randolph, Tree of Learning Centre, Boise, Idaho

Left brained, right brained learners?

 In recent years, I’ve had parents phoning me with the news that they have a child who has had an assessment to find out their learning style.  They usually go on to say that results showed their child to be a ‘right-brained’ learner and that they need help in convincing schools to change the curriculum. Seems that right-brained learners struggle to cope with a largely left-brained approach to schooling.  What’s going on?  Is there really a battle going on in children’s heads as the two brain hemispheres fight for supremacy?  Are children really operating with only half a brain?  Can their learning, future career and general future well-being in their careers be predicted on the basis of body and brain dominance?

 

It’s a moot question but despite hearing all about these evaluations and the significance of results, only two facts remain clear.  Children, as with all humans, are whole-brained learners and the brain hemispheres prefer cooperating rather than conflicting with each other.

 

The terms ‘right brain’ and ‘left brain’ are used to oversimplify what is actually a highly complex research field.  Referring to the two hemispheres as separate brains with specialized areas of functioning is more a metaphor than a fact.  We would serve children better by improving our understanding of how we can sensibly apply brain research to help children use both hemispheres as an efficient and flexible system for learning and performing.  To put this more simply: if a particular hemisphere is not supporting the child adequately and relies on the opposite half to do most of the learning work, the question to be asked is why?  What is going on in the ‘weaker’ half and how can we encourage it to step up to the mark and do what it is supposed to do?

Children not paying attention? Get them moving!

There is a reason why some children are so restless in class.  They are showing a need to move.   While this need may be rooted in some irregularities in the functioning of their nervous systems, it may also be a sign that they need to move in order to focus better on their teacher and schoolwork.  What is this connection between moving and attention?

 

There isn’t any single part of the brain that controls our attention. Instead, attention happens as a result of a web of neural connections that transports signals throughout the brain to wake it up and cue our attention.  This network includes areas such as the reward centre, the limbic (emotional) system, the cerebral cortex (the highest level of the brain where learning and thought takes place) and the cerebellum (the ‘small brain’ responsible for our coordinated movements, amongst other things).  It turns out that there is a lot of overlap between consciousness (i.e. being awake), attention and movement.

 

The neural pathways that enable us to pay attention are regulated by two neurotransmitters: norephinephrine and dopamine.  These are the chemicals targeted by ADHD medications, which stimulate the release of more chemicals being released into the brain synapses.   According to Dr John Ratey[1] the problem for people with attentional challenges (‘ADHD’) is that their attention system is patchy, discontinuous, fragmented and uncoordinated.  The reason might be that the neurotransmitters responsible for efficient transport of impulses through the attention circuits are dysfunctional.  Another reason is that there can be irregular functioning in any one of the brain areas that form part of the attention circuits.  The trouble with the medications is that they are mind-altering drugs with as yet unknown long-term effects and some serious side-effects.  Don’t we have an alternative?

How do you teach children to pay attention?

If we really couldn’t pay attention, we wouldn’t be able to learn anything.  Attention and self-regulation are the foundations of all learning.  They are also seemingly an increasing problem in today’s society, with difficulties in attention being the reason for numbers of children referred as having a psychiatric disorder such as ADHD.

 

The question of ADHD is controversial.  Definitions and testing procedures are vague and vary among different communities and professionals.  You’ll probably have heard that French children are seldom diagnosed with an attentional disorder, while other countries, including South Africa seem to be experiencing a virtual epidemic with large numbers of children receiving psychotropic medications such as Ritalin, Concerta or Strattera.  These drugs clearly help some children control their behaviour and attend better in the short term.   They also can cause distressing side effects and effects on the brain of long-term use remains uncertain.  So they can’t be considered a ‘cure’ for the behaviours causing problems at school and at home.  What can we do?

 

Some children with poor concentration and related issues show improvement at adolescence; others don’t.   We are recently reading more about adults being diagnosed with ADHD and struggling to cope with the challenges of inattentiveness, disorganization and so on.  There seems to be evidence that attention difficulties are hereditary and that the brain’s chemical balance can be changed by environmental factors like stress.  On the other hand, many studies show that learning to keep one’s brain quiet, as in practicing Mindfulness or meditation, helps attention.  So even though a child may have inherited the genes for attention problems, the way these affect him will be influenced by the home and the school

 

Attention changes with age.  A normal lack of inhibition in a four-year-old is considered a problem in a ten-year-old.  A vigorous, highly active young boy seems out of place in a desk in a crowded classroom.  There is no doubt that changes in school routines are adding to the high numbers of so-called inattentive and hyperactive youngsters because it is not normal for children to be condemned to desks and routine pen-and-paper tasks all day.  Playtime is getting less too, which is bad news for children with a strong need to work off physical activity.

 

Society’s obsession with screens and technology is very likely exacerbating the problem too.  Rapidly shifting TV programmes and fast-paced video games are training brains in a different way to yesterday’s education. What modern child can bear to read the books so beloved of yesterday, with great detail, characterisation and carefully hewed storylines?

 

What we can do is to intervene at an early age, to build positive habits of attention-giving in young brains well before school-going age.  Here are some ideas:[1]

 

  1. Homes with a positive emotional climate help promote the development of an attentive brain.  Overly permissive or overly bossy parents tend to have problematic children.  The best type of parenting seems to be ‘authoritative’, and produces children who are able to manage their own behaviour (self-regulation), stay out of trouble at school and develop good attention and motivation.  Such parents are firm, loving, reasonably patient, empathetic, willing to listen, negotiate rules and available to give emotional support.  Emotion, motivation and attention are intricately linked.
  2. Establish reasonable expectations for behaviour, set clear rules and discuss or negotiate them with your child.  Also talk over what the consequences will be for breaking rules.  Note the emphasis on ‘reasonable’.  No child of five or six should be spending an hour or more on schoolwork every evening. Understand the real limitations that immaturity places on the ability to stay with one task, especially one the child didn’t choose.  On the other hand, some parents never learn to say ‘no’. A parental control system should be reasonable and kind.
  3. Try really hard to establish a well-regulated household environment. Uncontrolled households, where routines are never made clear, blast young brains with too many stimuli and too little structure.  They cause stress on the growing brain which in turn will negatively affect the development of internal control systems, needed for eventual self-regulation.  Watch your child to learn to gauge their tolerance for amounts of stimulation – auditory, visual and tactile.  Children show distress through unusual behaviours, overexcitedness, wildness or withdrawal, all of which may be signals of a need for protection from sensory bombardment.  Don’t expect children to know their limits for excitement.  As with TV or computer screen watching, children find it very hard to turn away from excitement even when they have reached their tolerance limits.
  4. Teach your child to use words to plan and control behaviour.   Talking to ourselves, or using ‘inner language’ can help us work through problems or plans.  Parents can help a toddler, for example, by describing what she is doing and encouraging her to use words.  (“You are hammering the pegs into the board. Let’s say ‘hit’ every time you hammer one”).  Household activities such as cooking present many opportunities. (“Let’s go over the steps before we start.”  “What ingredients do we need?” “Did I do it right?” “What’s the next step?”)  With forgetful youngsters, help establish inner language as a habit.  Every day say: “What will you need for school today?”  “Now ask yourself, ‘Do I have my book? My swimming costume?”   Repeat this regularly, until it becomes part of the child’s routine.
  5. If you think your child has a problem with attention that is inconsistent with age and has persisted for six months or more, you may decide to consult with a professional.  Try to resist a diagnosis of a psychiatric disorder or drug treatment.  Instead, perhaps start with a neurodevelopmental evaluation to clarify whether or not the cause of the problem could be rooted in early development, traumas, environmental offenders or nutrition.  ILT is one such approach that proves valuable both in recognising the cause and addressing the symptoms.

 

In summary, here are ways of helping the development of good attention:

  • Establish firm limits and predictable routines.  Teach your child the meaning of ‘no’.
  • Insist on a regular bedtime and adequate rest
  • As the child grows, let her have more say in setting and negotiating rules
  • Insist on acceptable levels of noise in your home.  Use ‘indoor’ and ‘outdoor’ voices.
  • Make sure your child has her own quiet space to go to – even if it is table covered with a blanket. Avoid frantic scheduling.  All children need downtime.
  • Keep adult-type stimulation to a minimum (inadequate movies, TV,  alarming adult conversation, etc.)
  • Limit TV viewing.  Be tough about this.
  • Supervise and restrict the amount of time spent on computers.
  • Insist on a good measure of physical activity every day, preferably outdoors
  • Training in sports requiring sequencing and focus, such as the martial arts, swimming, yoga and so on, can be more useful than team sports.
  • Spend time working with your child and showing her how to solve problems systematically.  Play a game, start a project, build models, cook together.  Talk about the steps you take to attack each problem.
  • Let attention span develop naturally by also allowing time for a child to become actively engaged in a task without interruption
  • Get the child’s attention with eye contact, before you give a direction.  Check understanding by asking him what he heard
  • Teach children to shift focus from one activity to another by paving the way in advance (“When you finish building that lego part, I’m going to ask you to wash your hands for dinner.”)
  • Be aware that attention can be affected by allergies or sensitivities to environmental substances
  • Pay attention to nutrition.  The health of a child’s gut affects brain function.
  • Some attention problems show up as a lethargy or ‘spaciness’.   This may be due to physical imbalances or ill-health, needing a medical checkup.

 

 

[1] With thanks to Jane Healy, author of ‘Your child’s growing mind’.

Is my child struggling at school?

Learning difficulties can affect one child in five.    Do you suspect that your child may be one of them?   How, apart from trusting the teacher’s opinion, do you know when your child needs help?   Knowing that no two children are the same makes it very difficult to know whether behaviour or a school report suggests a problem or whether it is just normal stumbling over some temporary obstacle.  If your child is very young, it can be especially hard. Pre-schoolers are going through so many changes – every few months there’s a new development, a new problem, a new aspect of personality appearing. Sometimes your child seems to be doing fine at home but the teacher notes areas of concern. Sometimes a child is good at school but shows problems at home.  How can you tell where the problem lies or whether there is a problem at all?

 

You might sense that your child is not functioning up to his potential. Perhaps he lags behind his classmates academically, or his skills compare unfavourably with siblings.  Other signs that are often seen in children needing help are

 

  • A change in behaviour at home
  • Continued difficulty in performing tasks at school
  • A dive in emotional well-being, and emergence of mood swings, sadness, temper tantrums, withdrawal, acting out or aggression
  • Persistent avoidance of certain kinds of activities

 

Children develop skills at different rates so it’s often hard to see the symptoms of a learning difficulty early on.  These symptoms might not be noticed or taken seriously until behavioural problems develop.  Often these are in reaction to frustrations with learning. 

 

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