An ADHD Case Study
Jake, a twelve year old boy was thought to have a classic history of Dyslexia, and was seen by a specialist following a Psychological Assessment. Although such assessments are valuable and provide lots of detail of childhood development, they do not necessarily provide an understanding of the underlying problems and treatment that might be needed.
Jake: A case studyThe report on Jake included the comments that he did not crawl, was slightly short sighted and was often anxious, struggled to concentrate and had poor personal hygiene and would respond aggressively by biting when frustrated.
Reading and Writing were DifficultReading and writing were major problems putting him way behind his classmates, and Jake found it difficult to explain what he wanted to people. Along with so many other children Jake had suffered from eczema most of his life and was prone to catching colds and infections.
Jake Failed Standard TestsOn examination Jake failed the standard hearing tests, and tilted his head to one side, was totally dyspraxic, had marked weakness of the right little finger and had a positive Babinski sign on the right (a retained primitive reflex).
Crawling is a very important aspect of development as it promotes learning of cross-cord reflexes essential to the development of postural reflexes. Many children bypass this stage and become bottom shufflers instead.
DyspraxicAlthough Jake initially had a label of being Dyslexic it was clear that he was also Dyspraxic, had signs of ADHD and sometimes was obsessional.
Specialist programmesJake was sent home with a set of exercises to perform specifically designed to meet his unique needs. Two weeks later he was again seen, reassessed and treated at the clinic. He was sent home with a computer programme that can be modified to meet the individual needs of the patient. In this particular case Jake had to use the programme daily for two sessions of just six minutes.After two weeks the clumsiness had gone, his confidence was rocketing and his school teachers had reported back to his parents the remarkable changes they had noticed in him. They were unaware at that time that he had any treatment.
Remarkable ChangesADHD per se is characterised by behavioural problems in reacting to an average situation and the diagnosis based on the history of the manifestation of three types of behaviour:
- Inability to perform everyday tasks/distractability
- Impairment to control impulses/impulsivity
ADHD is caused by a problem with the reticular activating system - the attention centre of the brain - itself due to the immaturity of certain areas of the brain. This late development and resulting under functioning may be in the cerebellum, pre-frontal lobes or more diffuse affecting the right or left cerebral hemisphere. In 98% of boys it is the right cerebral hemisphere that is at fault.
Children have Difficulty Gathering and Processing InformationUnder functioning may be caused by two principal factors - the level of stimulation of the brain or the biochemical substrates to the brain. In essence this means that these children have great difficulty gathering and/or processing the information from the environment and then trying to make sense of it.
Fortunately, with greater knowledge and understanding of the mechanisms at work new treatments are now available to tackle the problem without the use of potentially harmful drugs. Computer generated treatments can go right to the heart of the problem.
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Jelly - 11-Oct-11 @ 1:06 PM
AN ADHD CASE STUDY
by Barry Belt
David (not his real name) was a thirteen year old, eighth grade student who had reading and math skills one to two years below grade level. He was failing every subject and seemed destined to repeat the eigth grade. His teachers described him as disruptive and oppositional in class and stated that he had difficulty paying attention during structured and unstructured activities. The school administrators contacted his grandparents and suggested that he was likely suffering from an Attention-Deficit Hyperactivity Disorder (ADHD). They recommended that he be taken to his pediatrician and placed on Ritalin, a Class II prescription drug classified as a stimulant much like speed.
Even at home David was rebellious. His father had abandoned him virtually from birth. His mother, overwhelmed by the task of raising him and his two sisters without spousal help, relapsed into drug and alcohol abuse. She was frequently drunk and around David she was moody and volatile. He ran wild. He refused to obey her curfews, going to bed late at night and failing to rise for school in the morning. Intermittently he wet the bed. He never helped the family with housekeeping or yardwork chores. His mother’s parents, sensing that she needed help with David, and having been advised of his problems at school, intervened.
Even though David attended a good school in an affluent district, his grandparents doubted the wisdom of placing David on drugs. They thought it would only compound his problems. When they sought the advice of the family pediatrician, they asked for an alternative to Ritalin being concerned about David’s potential for developing a substance abuse problem like his mother. They were referred to A Center for Educational and Personal Development (CEPD) where they could find a balanced, non-pharmacologic treatment approach which used as its cornerstone brainwave-based biofeedback, also called Neurofeedback.
Upon initial evaluation Barry Belt, Director of the Center, and a Licensed Psychologist and Certified Neurotherapist, found David so hyperactive that he could only sit still for a minute. When he measured David’s brain functioning, specifically his ability to attend to a task, he found that he had too much slow- wave activity and not enough fast wave activity. In other words, his brain wave activity revealed that his brain was daydreaming instead of paying attention far too much to allow him to learn effectively.
During the interview David described himself as dumb but cool. He hung out with older, rebellious students like himself to compensate for his feelings’of inadequacy. He loved his mother but was struggling to maintain a relationship with her. He hated his father and wanted nothing to do with him. With his grandparents he had a solid and positive relationship and he especially respected his grandfather.
Barry Belt assembled the CEPD treatment team and planned an intervention for David. It was decided that David should be sent to an alternative school for children with learning disabilities. He was enrolled in individual counseling to improve his self-image. The nutritionist cut out his caffeine, reduced his sugar intake, and helped his mother plan and cook well-balanced meals. His mother began counseling with a CEPD Substance Abuse Counselor and Psychologist who helped her stop abusing drugs and alcohol, enhance her mothering skills and strenthen her role in the family. Mr. Belt met with David’s now school teachers to develop an educational plan which would work in tandem with CEPD’s efforts.
Perhaps most importantly, David began to use Neurofeedback which trained him to alter his brain functioning so that he daydreamed less and paid attention more through the use of special software and computer enhanced techniques which allowed him to monitor his progress in a videogame format.
At first, David couldn’t sit still for his Neurofeedback sessions. After the third session he began to enjoy the sessions. By his tenth session his mother remarked that he was more attentive at home and less oppositional. After his fifteenth session he was helping with household chores. After his twentieth session he stopped wetting the bed. By his twenty-fifth session his grades and behavior in school had remarkabley improved. After forty sessions his attention span had increased from less than one minute to approximately forty-five minutes.
Within six-months his reading and math scores had progressed one grade level. He was on the honor roll at his new school and his behavior at school was described as excellent. He began to see himself as a bright young man who had learning problems. He was looking forward to returning to his regular junior high school class at the appropriate grade. He had become a happy, communicative and responsive young man who could express his feelings instead of act them out. His self image no longer required him to be cool, but rather was based on his self-perceived capability to achieve his goals in school and in life.
David continued to make grade-appropriate progress in school but would have occassional setbacks. Intermittently he would return to the center for Neurofeedback sessions and counseling.
The key to David’s progress was CEPD’s multifaceted treatment approach, anchored by Neurotherapy. One can only ask what would have become of David if his chance to straighten out his academic life and his family life had depended solely on a drug.