What is the underlying cause of attention disorders? The National Institute of Mental Health states that “scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.”
At this point in scientific research there is no definitive answer to this question. Indeed, many parents try a variety of solutions to improve their child’s attention capabilities from the control of diet, to increase in exercise, to neurobiofeedback therapy, to the intake of natural supplements, or to the use of stimulant medication. I have seen positive results from my clients using one or the majority of these intervention methods. As well, I have seen limited results, depending on the client. There is no question that each brain and the environment it lives in is so diverse that it is difficult to imagine a study that can generate one definitive result that proves why a child struggles to attend to information. Parents often attempt to try solutions based on the information they receive and observe their child’s response to that treatment.
The American Academy of Pediatrics published the Clinical Practice Guideline: Treatment of School-Aged Child With Attention-Deficit/Hyperactivity Disorder . They noted that 4% to 12% of school-age children show ADHD behaviours. The guideline stipulated the need for pediatricians to work with other service providers to consider the best treatment plan, management of behaviours and monitoring of outcomes:Primary care clinicians cannot work alone in the treatment of school-aged children with ADHD. Ongoing communication with parents, teachers, and other school-based professionals is necessary to monitor the progress and effectiveness of specific interventions. Parents are key partners in the management plan as sources of information and as the child’s primary caregiver. Integration of services with psychologists, child psychiatrists, neurologists, educational specialists, developmental-behavioral pediatricians, and other mental health professionals may be appropriate for children with ADHD who have coexisting conditions and may continue to have problems in functioning despite treatment. Attention to the child’s social development in community settings other than school requires clinical knowledge of a variety of activities and services in the community.
Researchers also realize that medication is not always the answer for their clients. Dr. David Rabiner noted in a research review study that, “Although medication treatment is effective for many children with ADHD, there remains an important need to explore and develop interventions that can complement or even substitute for medication.” He goes on to state that not all individuals benefit from medication. Some individuals experience adverse affects to medication. Medication benefits do not continue once it is discontinued. Dr. Rabiner notes that, “Because of these limitations, some researchers have pursued cognitive training as an alternative method of treatment. The basic idea behind cognitive training is that important cognitive skills such as attention and working memory can – like any other skill – be strengthened and enhanced with intensive and
focused practice. Furthermore, when an individual builds these skills the benefits may endure beyond the time when the actual training is provided.”
The Arrowsmith Program provides one such cognitive intervention service. Over the last 30 years the Arrowsmith Program has successfully improved the executive control abilities of children diagnosed with ADHD. The Arrowsmith Program, founded on neuroscientific research, involves intensive and graduated mental exercises that are designed to strengthen the source of the attention disorders – underlying weak cognitive capacities. Over 30 years of experience the Arrowsmith Program has demonstrated that these affected brain areas can be improved through mental exercises, resulting in increased mental capacities and strengthened learning abilities. Weaker areas of the brain are treated like weak muscles and are intensely stimulated through mental exercises in order to produce strengthened learning capacities. Research at Arrowsmith School has also shown that when the deficient area is improved, the individual’s ability to plan, organize and actively engage in academic work requires less effort.
A significant number of children previously on stimulant medication for ADHD can successfully end this treatment through the Arrowsmith Program. That is, the Arrowsmith Program has found that a portion of children with ADHD actually have multiple cognitive dysfunctions that impact their ability to sustain active engagement in a classroom setting. The ADHD diagnosis is not a primary disorder, but rather secondary to the multiple cognitive weaknesses impacting processing, memorizing or conceptualizing information. David was one such student.
David was given a full psycho-educational assessment for a possible learning disability. He was struggling at school. His mother would have to get him to sit down to do his homework. When she went over his assignment it appeared to her that her son was not listening in class. This was frustrating and resulted in conflicts at home. Yelling, arguing, debating were common social interactions between her and David on a daily basis. She really felt that David was to blame.—if only he could pay attention and work harder. The psycho-educational assessment identified specific learning disabilities. The primary problem appeared to be written expression. The ADHD checklists highlighted ADHD- Inattentive Type as another area of concern. He showed at least six of the nine behaviours often associated with the Inattentive subtype. This included not listening to instructions, difficulty following through on homework or school related activities, forgetting assignments, inability to sustain attention and being easily distracted in class.
David’s mother heard about the Arrowsmith Program through a friend. Through discussion with Arrowsmith staff, it was determined that David had at least 7 specific learning dysfunctions that would impact classroom management. David was then assessed to determine the severity level of his learning dysfunctions and to determine his Arrowsmith cognitive remediation program. Several of the cognitive weaknesses would certainly impact attention control, including weak memory for information and instructions, weak visual-motor integration for printing and copying and a weakness with determining the main idea, also known as saliency determination. After three years of intensive cognitive remediation (brain exercises) David was able to move these learning
dysfunctions from a severe level of disability to average ability. He was then capable of listening to instructions, sustaining active engagement on school-related tasks, following through on homework and assignments and was not easily distracted in class. These neurological improvements took hours and hours of cognitive training. Brain change requires active engagement and repetitive brain exercises that require increasing complexity. By improving neurological weaknesses through cognitive intervention training he no longer demonstrated ADHD-like behaviours.
In summary, it is important for those diagnosing and managing children with ADHD to consider cognitive intervention training. The Arrowsmith Program is one such method available in Vancouver, B.C. Results from a 2007 study on the Arrowsmith Program highlighted positive gains in ADHD-like behaviours. The study was completed with the cooperation of the Toronto Catholic School Board, which has used the Arrowsmith Program for the last 12 years (since 1997). The study showed that the students that had completed the Arrowsmith Program and were now fully immersed in regular education classes show significant improvements in following instructions, organization skills and willingness to complete homework. All of the teachers identified a noticeable to extremely noticeable change in the Arrowsmith students’ ability to follow and understand instructions (for those students for whom this was a concern). In regards to willingness to attempt and complete homework, 80% of teachers recognized a noticeable to extremely noticeable change. Only 7 % of teachers noticed no change (for 13% of students this was not a concern). Finally, in regards to organizational skills, 85% of teachers recognized a noticeable to extremely noticeable change. Only 4 % of teachers noticed no change (for 11% of students this was not a concern). Medication for ADHD can certainly provided immediate results, but long-lasting changes in brain functioning can occur through cognitive training methods.