THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Tuesday, August 13, 1996 TAG: 9608130042
SECTION: DAILY BREAK PAGE: E1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
LENGTH: 250 lines
BLIP. BLIP. BLIP. Nine-year-old Brian Baker grinned as he watched Pac-Man's hungry mouth gobble up yellow dots on the computer screen. Blip. Blip. Blip. Pac-Man sped up, eating more dots.
Brian beamed in triumph as he won the game. And look, Ma - no hands!
Using energy from his brain, transmitted to the screen via two metal clips fastened to each ear and a wire leading to the computer, Brian controlled the direction and speed of the yellow Pac-Man. In doing so, say his mother and Virginia Beach therapist Kathy Forti, he was controlling his illness, attention deficit hyperactivity disorder, or ADHD.
The treatment - called EEG (electroencephalogram) biofeedback - uses visual images and sound to teach Brian to alter the way his brain works.
While most children with attention deficit disorders are treated with drugs, increasing numbers of parents are trying alternative therapies in an effort to control their children's hyperactivity, impulsiveness and inability to pay attention.
The attention disorders, which may not include hyperactivity, are estimated to afflict about 3.5 million American children, approximately 5 percent of all school-age kids. Based on school enrollment in South Hampton Roads, that would be about 10,000 area children.
However, parents shouldn't let their desperation cloud their common sense, medical experts warn. Alternative therapies can be expensive and risky for children, they say. So in seeking less traditional treatments, parents shouldn't automatically disregard the tried-and-true.
Medical experts agree on little about attention disorders, including the number of children who really have them. Some say there is an epidemic. Others charge that attention disorders are diagnosed too often, sometimes in children who have less serious problems.
The preferred treatment for attention disorders is daily doses of drug stimulants, the most common of which is Ritalin. In the past five years, the production of Ritalin has increased 600 percent, according to the Drug Enforcement Agency.
In people with attention disorders, stimulants have a calming effect and heighten concentration. They are effective in about 75 percent of cases, according to numerous long-term scientific studies.
But the drugs don't always work. In some children, they cause side effects such as loss of appetite, dizziness, insomnia and growth suppression. Recent reports that Ritalin may cause cancer in laboratory rats scared some parents. And some parents don't want kids taking medication they may have to stay on for the rest of their lives.
Therefore, many parents are seeking out alternative treatments, including special diets, mega-vitamin therapies and accupressure.
Some treatments, like EEG biofeedback, are receiving serious scientific attention. Others, like those in advertisements that exhort parents to call 1-800 numbers for ``non-drug breakthrough approaches,'' smack of medical scams.
``It's big money,'' says Mark Stein, a psychologist who directs the ADHD clinic at the University of Chicago. ``And, unfortunately, (proponents of cures) are preying on people who are really trying to do the best for their children.''
Some non-traditional treatments seem to work, but unlike drug therapy, none has been scientifically proven in large-scale, controlled studies to be effective in controlling attention disorders, Stein said.
Brian's mother, Karen Baker of Chesapeake, started seeking an alternative when medication failed to improve her son's behavior.
Brian's disorder was diagnosed when he was in first grade. He couldn't sit still, struggled to pay attention and was extremely impulsive. He once scaled a 6-foot fence and ran out into traffic to tell his mother something after she'd dropped him off at school.
He started taking daily medication in the first grade, but after three years, Butler became frustrated with his continuing problems. Then a friend told her about Forti and EEG biofeedback.
Forti, a licensed professional counselor who received her master's degree in clinical counseling, began offering the therapy two years ago, after she learned of its success with attention disorders.
Traditional biofeedback, which has proven effective in treating chronic pain, uses temperature sensors to teach subjects how to relax and reduce the pain.
The theory behind EEG biofeedback is that brain waves in children with attention disorders differ from other children and that biofeedback brings their brain waves back into a normal range.
In EEG biofeedback, patients are taught to concentrate, which modifies the electrical current in their brain. The brain's electrical current is transmitted to a computer, which uses that current to manipulate images on the screen. When a patient gets the signal right, he earns ``rewards,'' like winning a video game.
The therapy costs about $50 a session, in addition to a $200 initial evaluation. It usually takes at least 20 sessions to achieve long-term results, Forti said.
After 26 sessions, two a week, Brian stopped taking Ritalin. He stopped attending a special learning class in school, brought home the best report card he'd ever had and began making friends. He even spent a night out - something never before possible because of the night terrors that plagued him.
Brian sums up his transformation by saying that before biofeedback, ``life was pretty much down.'' Now, ``life is very good.''
Dr. Thomas R. Montgomery, director of developmental disabilities at Children's Hospital of The King's Daughters, says that children like Brian can be helped with biofeedback, but not for the reasons claimed by its practitioners.
The basic premise is off, he said, because it hasn't been proven that children with attention disorders have abnormal brain waves. It it had, doctors would have a clear test for the disorder.
The improvement comes, Montgomery suggests, not from any change in brain waves but because kids learn how to concentrate better. Traditional biofeedback might work just as well, he suggested.
Other medical professionals suggest that the one-on-one attention from the therapist, coupled with the intensity of the sessions, produce a placebo effect. That means results mainly reflect the subject's expectations that the treatment will work, rather than the therapy itself.
More data on the effectiveness of EEG biofeedback should be available in about year, when a large, controlled study on the technique's effect on children with attention disorders is completed.
Brian's treatment didn't stop with biofeedback. When he didn't show any significant improvement after several sessions, Forti sent a lock of his hair to a Texas laboratory for a mineral analysis. The results showed the boy was lacking in magnesium, which affects neurochemical transmissions, like those in the brain. Now he takes two multi-vitamin supplements daily.
Diet and vitamin therapy have long been used to treat hyperactivity. However, dozens of scientific studies have shown that diet has no effect on attention disorders and that even sugar - long suspected as a culprit in making children extra-bouncy - does not cause or increase hyperactivity.
Virginia Beach pediatrician Linda Rodriguez thinks that the children in her practice who benefit from the special diets she prescribes don't actually have attention disorders - just some of the symptoms. Those symptoms, like hyperactivity and inattention, she says, probably are caused by food allergies and yeast infections.
The diet she recommends eliminates dairy foods and is high in fruits, vegetables and grains. If it works, she sees a change within 10 days, she said. If, after a month, there is no improvement, she recommends medication.
If the drug therapy works, she says, then the child truly has an attention disorder.
Virginia Beach psychologist Jeffrey Katz, who specializes in the treatment of kids with attention disorders, recommends that parents try the drug treatment first as a means of gauging the results of any alternative therapies.
``If you don't know the gold standard, how can you compare it to anything else?'' he said.
Montgomery and Katz recommend a multidimensional approach to treating attention disorders:
Drugs for any biochemical deficiencies.
Behavior modification to influence actions.
Educational intervention to improve school performance.
Talk therapy to address self-esteem problems and to help parents and kids cope with the disease.
The combination approach works well for Dawn Sherrill's 13-year-old son, who was diagnosed with attention deficit hyperactivity disorder when he was 5.
Sherrill tried the Feingold diet for a year, because she didn't believe in manipulating her child's behavior with medication. But when her son's behavior continued to worsen, she tried drug therapy.
Today, her son does very well on a low dose of Dexadrine.
But she understands parents' need to try different approaches.
``These are our children,'' she said. ``If your child was less than perfect to the point where he was having a difficult time functioning, wouldn't you do anything you possibly could?'' MEMO: ALTERNATIVES
Some of the more common alternative treatments for attention deficit
disorders:
Vitamin therapy. Uses very high doses of vitamins to treat what is
thought to be a vitamin deficiency. In 1976, the American Academy of
Pediatrics Committee on Nutrition stated that megavitamin therapy for
children with learning disabilities and other psychiatric conditions is
not justified, based on documented clinical results.
Mineral therapy. At least 13 minerals have been identified as
necessary for good health. Proponents of this therapy claim that mineral
deficiencies can result in learning and behavior problems. But most are
necessary only in tiny amounts, and taking too much can be dangerous.
Cognitive therapy. Emphasizes teaching ADHD children better
problem-solving strategies. May be used in conjunction with other
treatments, like medication. The scientific studies are ambiguous,
although early studies did show some improvement.
Sensory integration therapy. This theory holds that children with ADD
have difficulty organizing information from their various senses.
Special experiences, such as brushing and rubbing of the skin, are used
to help the child organize his brain. Research has not shown that ADD
children have problems with sensory integration, and no studies have
shown its effectiveness as a therapy.
Optometric vision training. This theory holds that vision problems
are the underlying causes of learning disabilities, and that even if a
child has perfect eyesight, he might still have difficulty interpreting
and understanding what he sees. The American Academy of Pediatrics and
the American Association for Pediatric Ophthalmology and Strabismus have
concluded that the approach is not effective.
Chiropractic Therapy. This approach holds that learning disabilities
are caused by the misalignment of two specific bones in the skull, and
uses chiropractic realignment to adjust them. The theory underlying this
is suspect because standard medical textbooks state that the cranial
bones don't move.
Source: ``Attention Deficit Disorder and Learning Disabilities:
Realities, Myths and Controversial Treatments,'' by psychologists
Barbara D. Ingersoll and Sam Goldstein. (Doubleday, 1993).
A RAY OF HOPE IN STUDY
Could a tiny gold bead the size of a pin head help reduce attention
deficit hyperactivity symptoms?
Maybe.
That's the conclusion of a group of researchers at the Medical
College of Virginia in Richmond. The scientists, headed by pediatrician
and child psychiatrist Neil Sonenklar, just finished a small study
looking at the effects of accupressure on attention deficity
hyperactivity disorders.
In a double-blind study of six children with ADHD, researchers found
that when they taped the bead to a particular pressure point on the
child's ear, and had parents massage that point several times a day,
half the children improved. Two children's symptoms remained the same,
and one child's worsened, said Dr. Cindy Ellis, a behavioral
pediatrician who is working on the project.
The study is too small to have any significant application, Ellis
said, but its results warrant additional research.
She and her associates will be looking for funding to expand the
study.
NO DEFINITIVE TEST FOR ADD IS AVAILABLE
THERE IS NO single definitive test to diagnose attention deficit
hyperactivity disorders.
Some children are tagged with the diagnosis after completing a
29-item check-off test in a pediatrician's or school counselor's office.
Others undergo rigorous evaluation by psychologists and educational
counselors - all of whom may use their own smorgasbord of tests.
Many conditions, such as an over-active thyroid gland, can cause
symptoms found with attention disorders, such ashyperactivity,
impulsiveness, difficulty in concentrating or sitting still, said Dr.
Thomas R. Montgomery, director of developmental disabilities at
Children's Hospital of The King's Daughters.
Because of the media focus on the disease, many parents assume that
their children have attention disorders without considering other
possible causes, said Virginia Beach psychologist Jeffrey S. Katz.
``We don't want parents to ask if their kid has ADD,'' said Katz, who
specializes in treating children with attention disorders. ``But to
describe the problem and then look for the solution.''
Research shows, he said, that children with attention disorders have
a 30 percent chance of having another neurological disorder, like
depression or a learning disability.
He puts kids through a comprehensive evaluation before making a
diagnosis. His evaluation includes a detailed family history, because
attention disorders are thought to have a genetic basis; several
psychological and personality tests; and a thorough evaluation of school
records and report cards.
But a diagnosis is just the beginning, he said, adding, ``It gives
you a way of looking at the problems and a way to approach it.''
- Debra Gordon ILLUSTRATION: Color drawing
By SAM HUNDLEY, The Virginian-Pilot by CNB