What Your Brain Looks Like on NeuroPlus Video Games

Families that train with and play NeuroPlus games have seen some amazing results. Whether you’re familiar with biofeedback and neurofeedback or they’re totally new concepts to you, we wanted to break down the scientific foundation of our games and how players and families can see improvements in focus, body control, and impulsivity by using the product. We’ll start by explaining how we measure focus by looking at the building blocks of your brain and the way scientists track if someone’s paying attention.

Neurons, the cells that help you think and feel, communicate by shooting electrical signals to each other in a big network throughout our bodies. When groups of neurons fire together, they leave traces that can be detected as brainwaves through an EEG (electroencephalogram) device. These brainwave signals can be separated into general clusters that doctors and researchers recognize. Right now, there’s not a scientific consensus about why or how these signals work this way. The different types of brainwaves are named after Greek letters, and the ones we use for NeuroPlus games are the beta and theta waves.

Scientists have identified a relationship between beta and theta brainwaves that indicate when someone is paying attention. Higher beta and lower theta is generally associated with more attention. There’s even an assessment called NEBA that doctors sometimes use when diagnosing someone with ADHD. Similar to that assessment, our system looks at a player’s beta and theta waves every 1 second or so, and determines the relationship between these two patterns. When the ratio is high (beta is high, theta is low), the player is rewarded, while a low ratio – indicating less focus – is punished. In the game that might translate to a player going faster when he’s paying attention or slower when he needs to focus more. When he first starts playing the game it might be hard to know exactly what it feels like to pay attention, but it’s something that comes with a little bit of practice.

Body control
It’s often hard to focus when you can’t sit still, and that’s why body control is the second pillar in the NeuroPlus system. The EEG headset that tracks brainwaves when you play NeuroPlus games also has an accelerometer that can tell if a player is moving around too much. When the game detects this kind of movement, the player is penalized in the game environment. They may, for example, lose control of their vehicle or lose points. This kind of feedback within the game leads to recognizable benefits in everyday life. With many people, constant movement and fidgeting are hard habits to break. Practicing with NeuroPlus helps individuals become more aware of their bodies and improves self-control.

Impulse control
The final pillar of our games is getting a player to react to the right stimuli on the screen and to ignore what’s not important through what we call go/no-go tasks. Researchers use this same type of technology in cognitive training therapy, challenging players to decide quickly when to react to something and when to ignore it. In NeuroPlus games, there is a lot happening by design. Go/no-go training is combined with the other pillars to make it more challenging and therefore more effective for the players. Stimuli appear rapidly on the screen and the player has to react as fast as possible, deciding whether to tap it or ignore it based on the game’s instructions. The player will not do well if they’re hyper focused on only one aspect of the game, or if they’re just passively paying attention. The player has to tap the stimulus correctly in order to earn points or avoid costly penalties.

Practice makes perfect
As with anything practice makes perfect. Since the foundation of NeuroPlus games are made from all three pillars—focus, body control, and impulse control—players see improvements not only within the game, but also in other aspects of their lives over time. We’ve seen these results within independent, blinded research and heard about them from individuals that can perform better in meetings or families that say a child is able to focus better on homework and get better grades.

If you’d like to try out NeuroPlus, you can sign up here, or schedule a time to talk to someone from our team about your questions.

To stay current on NeuroPlus news, follow us on Facebook, Instagram, and Twitter!

Photo courtesy of Jesse Orrico.

Fidget spinners: Helpful or harmful for focus?

Fidget spinners have taken hold recently with everyone from children to adults across the nation as the newest craze to help with focus. These mesmerizing spinning pieces roll around bearings, but can we say they’re helping?

Children love playing with them and some have said that it allows them to focus better. Teachers aren’t so convinced with their ability to help students stay on task, and many schools have started banning them. This hasn’t kept sellers from claiming that fidget spinners are everyday tools, especially for those with ADHD and attention issues. Although it seems little research has been done on the use of fidget devices, we wanted to take a dive to see if we could learn anything from what we do know about fidgeting and executive cognitive functioning.

Mark Rapport, a University of Central Florida clinical psychologist and ADHD researcher, told a Vox reporter he assumed, “[u]sing a spinner-like gadget is more likely to serve as a distraction than a benefit for individuals with ADHD,” as it takes away attention from tasks. His research, instead, shows that more full body movement—like cycling or running—engages the areas in the brain that aid focusing.

Meanwhile, Dr. Pilar Trelles, MD, a psychiatrist at the Icahn School of Medicine at Mount Sinai in New York City, suggested to Health.com that “when someone is hypersensitive to the environment they might bite their nails, pull out their cuticles, or pinch their skin.” While these fidget spinners are a healthier alternative to expel energy, she notes that they are not a therapy and should not replace other recommendations.

Check out this family’s reaction to fidget spinners.

Especially when we consider the spectrum of differences experienced by people with ADHD, autism, and anxiety, we can assume that fidget spinners are likely to have different effects on different individuals. In fact, a pilot study with middle school students suggests that limited intervention of a stress ball might in fact help decrease distractions and increase grades during lessons for those with ADHD while not offering much help, and potentially increasing distractions, for typical students.

It appears that while these popular fidget spinners might be a solution for some people to explore, they might only be a fun (or distracting) toy for others. The best option may be to test out various accommodations and coping mechanism and see what works for your particular situation. Ultimately, if a solution shows promise in the areas we want to improve—such as focus, calmness, and impulse control—there’s no harm in trying it out.

What do you think about fidget spinners? Are they helpful or a nuisance? Let us know in the comments or reach out to us on Facebook or Twitter!

Visiting the World Congress on ADHD

Last week, the sixth meeting of the World Congress on ADHD descended on Vancouver, Canada. The World Congress on ADHD is a biannual conference that is sponsored by the World Federation of ADHD, attended by clinicians, scientists, and other healthcare professionals. Our CEO Jake Stauch traveled north to hear more about the latest in ADHD research and I asked him a few questions about his experience.

Why do you think it was important to be at the World Congress on ADHD for NeuroPlus?
Although NeuroPlus is not a treatment, a lot of our users struggle with ADHD. Much of our team has a background as researchers and we are passionate about science and evidence-based innovations. Assessing and addressing attention issues are a core part of our product. So when there’s a conference about the latest research in ADHD and attention issues, we want to be present both to talk about the research and be a part of the conversations on the best way to move forward.

So, when thinking about that, what is some interesting research you heard about?
New research is starting to shed light on the long term effects of medication. Recent studies suggest that stimulant medication alone is not the best intervention for ADHD and there’s some evidence showing that while being an effective short term treatment option, there are diminishing effects from medication after the first year with some growth suppression in the long term. The best effectiveness is observed when medication is coupled with counseling with a  doctor every four weeks to adjust dosage. These findings have come out of Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study, the largest study on medication used to treat ADHD that follows the efficacy of various ADHD interventions  over long time periods.

How about in the areas of other kinds of treatment?
Neurofeedback, one of the core components of NeuroPlus, is accumulating evidence supporting its efficacy in addressing attention issues.  On the other hand, what’s interesting is the conflicting evidence on simple cognitive training—these brain games that we’re used to seeing in the market. Some studies are showing how they have a positive influence, especially in skills closely related to playing the game, but others are showing that these results may not extend to real-world situations. Researchers are very interested in these alternative interventions and it will be interesting to keep a close watch on the research in this field.

Any other observations you noticed from the presentations and conversations at the conference?
As an industry, researchers, clinicians and professionals continue to pursue an understanding of the differences among those with ADHD. There seems to be a growing consensus that what we call ADHD may be heterogeneous in origin, meaning that two different individuals with ADHD may have different deficits with different underlying causes. Because of that, the ideal treatment may be highly specific for each individual. By focusing on the label of “ADHD,” are we missing an opportunity to instead address the cognitive and behavioral deficits shared by people with a range of attention disorders? In other words, if you struggle with attention, whether or not you have ADHD, maybe a future intervention will provide relief from your most pressing challenges. We’ll have to wait and see what the research says!

Thanks for the insight from your travels, Jake! What do you think about the way we talk about ADHD? Do you think there’s a different way of talking about treatment?

Let us know in the comments or reach out to us on Facebook or Twitter!

What is NeuroPlus? An overview

Are you curious about NeuroPlus, but would like to know more?

You’ve come to the right place.

NeuroPlus is a game-based attention training program clinically proven to help individuals, especially those with attention difficulties, exercise their brain in order to develop and improve their focus and self-control.

One of our neurofeedback training games, Conduit
One of our neurofeedback training games, Conduit

How does it work?

NeuroPlus incorporates neurofeedback, motion-based biofeedback, and cognitive attention training to help improve focus, calmness, and self-control.
These methods are embedded in a mobile training games (iOS and Android compatible) that are controlled by a brain-sensing EEG headband.

With NeuroPlus, the same neurofeedback strategies typically seen in clinical settings are now available for home use, and at a fraction of the price. NeuroPlus users wear a dry, wireless, easy-to-use EEG headband that measures their brain waves, and play a training game that challenges them to amplify patterns of brain activity associated with focus. The better they’re able to show the right kind of brain activity, the better they perform in the game. Depending on the game, users’ focus will control the speed of a flying dragon, the size of an energy shield, or the brightness of lights in a dark tunnel. What could be more fun than playing a video game with your brain?

Motion biofeedback

Accelerometers and sensors in the headband also monitor the user’s movements and muscle tension, so that the game can give them feedback on their level of calmness. While playing the training game, users must maintain complete control of their bodies and remain absolutely still and relaxed in order to avoid penalties. If they move too much or are too tense, their dragon might falter, or their hover-bike might crash into a wall! Practicing this kind of relaxation can help users maintain calmness and self-control in everyday scenarios.

Cognitive attention training
To further practice and develop self-control, NeuroPlus users are challenged with “go/no-go tasks” requiring them to quickly and accurately respond to stimuli and ignore distractions. Different colored dragons might attack them, for example, and they’ll be instructed to only respond to a given color, ignoring others. Or, they’ll have to scan a cave for treasure and only respond to certain signals. In this way, users practice the act of self-control while also developing working memory and reaction-time skills.

Axon, another NeuroPlus training game
Axon, another NeuroPlus training game

Does it work?
Yes. A registered, randomized, controlled, blinded clinical study showed NeuroPlus to dramatically improve attention while reducing hyperactivity, impulsivity, and learning problems in children. This was after only 10 weeks of training, 3 times per week. Those results will be published in full in the coming months.
In addition to this study, there is overwhelming evidence supporting neurofeedback as an effective tool for improving attention skills in individuals. In fact, the American Academy of Pediatrics classifies neurofeedback as a Level 1 – Best Support Treatment for ADHD, the same rating given to medications and cognitive behavioral therapy.Dozens of clinical studies have shown the protocols used in NeuroPlus to be effective for improving attention and reducing hyperactivity/impulsivity. Here are two recent from the scientific literature, with more research available on our website.

Duric et al. (2012): Neurofeedback for the treatment of children and adolescents with ADHD: a randomized and controlled clinical trial using parental reports. Neurofeedback improves attention and reduces hyperactivity as well as methylphenidate (Ritalin®). http://www.biomedcentral.com/1471-244X/12/107

Steiner et al. (2014): Neurofeedback and Cognitive Attention Training for Children with Attention-Deficit Hyperactivity Disorder in Schools. Neurofeedback produces sustained improvements in attention after only 3 months of training. http://pediatrics.aappublications.org/content/early/2014/02/11/peds.2013-2059.abstract

How do I sign up?

Please visit http://www.neuro.plus to sign up and learn more. If you have additional questions, you can email us at info@neuro.plus, or give us a call at (866) 730-6619.

Happy training!

When it comes to ADHD, age is more than just a number


You could be increasing your child’s chances of receiving an ADHD diagnosis by pushing them ahead in school.

A recent report by NPR claims that the youngest children in the classroom are at a higher risk of acquiring an ADHD diagnosis. The article cites multiple studies  done abroad which indicate that children who are young for their grade in school are diagnosed with ADHD more often than their older peers. In sum, these studies highlight the importance of considering a child’s age within their grade when diagnosing a child with ADHD or prescribing them medication.

While age within a grade seems to be a predictor of diagnosis, it may not be a compelling predictor of disorder. One factor that complicates matters is that teacher-report serves as a focal diagnosis tool. Teachers, however, can be biased against the youngest kids in the classroom because they constantly compare them to older, more mature students. A study  recently conducted in the U.S. indicates that where a child’s birthdate falls in relation to their school’s kindergarten cut-off date significantly influences their likelihood of diagnosis due to teacher-report, which could be misconstrued: “A child’s birth date relative to the eligibility cutoff also strongly influences teachers’ assessments of whether the child exhibits ADHD symptoms but is only weakly associated with similarly measured parental assessments, suggesting that many diagnoses may be driven by teachers’ perceptions of poor behavior among the youngest children in a classroom.” Comparison is intrinsic to a classroom setting, but may play to the detriment of those who are behind in their social development.

Not only does social maturation influence teachers’ perception and subsequent diagnosis rates of younger children, but also biological maturation. That is, a child’s maturity is connected to both their bodies and their minds. Evidence  shows that children diagnosed with ADHD early in their school careers often show a significant symptom reduction as they age, indicating that misdiagnosis often occurs and is correlated with biological immaturity: “This study gives support to the theory that there is a group of children with ADHD-symptoms who have a biological maturational-lag who will show a decrease in their ADHD-symptoms as they show a maturation catch-up with increasing age.” In essence, children exhibiting immature behavior do not necessarily have ADHD, yet there is a strong bias towards diagnosing them.

While these misdiagnoses are understandable and probably somewhat inevitable, they could be dangerous. First and foremost, it may not be advisable to put a child on stimulants if they’re simply young for their class, for fear of purposeless side effects. Moreover, their symptoms may remedy themselves as the child matures. Secondary dangers include social effects. Children diagnosed without cause could experience a type of Golem Effect,  a self-fulfilling prophecy whereby a child transforms into the label they are diagnosed with… This phenomenon has parallels to Malcolm Gladwell’s “relative-age effect,  by which an initial advantage attributable to age gets turned into a more profound advantage over time.” Gladwell discusses this in the context of professional Canadian hockey players, who are far more likely to be born in January, February and March than in other months, due to the junior hockey league’s cut-off of January 1st. Because the oldest kids are more physically mature and seem better, they get extra attention, better coaching, and more practice, factors that compound over time and eventually lead them to become professionals. The same idea could hold true for ADHD diagnosis, but unfortunately, in the opposite direction. Children who are younger seem symptomatic and are labelled as such, limiting their ability in the eyes of teachers, who in turn put less effort into cultivating their abilities.

Gladwell proposes an interesting solution. He suggests that elementary and middle schools put students with January through April birthdays in one class, the May through August birthdays in another, and those with September through December in a third, in order “to level the playing field for those who—through no fault of their own—have been dealt a big disadvantage.” Promising as it sounds, we’re unlikely to see these kinds of systematic changes anytime soon.

More attainable for you, however, is the possibility of training attention skills to compensate for relative immaturity in the classroom. Products like Neuro+  can help improve attention skills in children who are developmentally behind their peers. In this way, children can accelerate the maturation of their attention abilities in a safe and controlled environment, void of negative side-effects.

Regardless of the course you take, if you have a child who is young for their grade and struggling in school, know that attention takes practice and time.





Methylphenidate: Effective or Defective?

New research concerning the efficacy of methylphenidate, brand-name Ritalin, revealed disturbing results. Study authors, led by Ole Jakob Storebø, performed a meta-analysis of 185 randomized-controlled trials which included 12,245 participants to determine the effects of methylphenidate in children and adolescents with ADHD.

The main findings reveal that most of the scientific information doctors use to prescribe methylphenidate is very low-quality evidence. What does “low-quality evidence” mean? Essentially, the research reveals that measures such as teacher reported symptoms, general behavior, quality of life, serious and non-serious adverse events, are all at high risk for reporting bias, imprecision, indirectness, heterogeneity, and publication bias. Although methylphenidate may improve concentration, hyperactivity and impulsivity, it is unclear what the magnitude of these benefits are, especially in comparison to the side-effects like sleeping problems and decreased appetite. In sum, it is uncertain whether taking methylphenidate over a long period of time is effective in treating ADHD: “At the moment, the quality of the available evidence means that we cannot say for sure whether taking methylphenidate will improve the lives of children and adolescents with ADHD,” the authors conclude.

What does this mean for somebody with ADHD? If he or she is already on medthylphenidate without adverse effects, it is not advisable to stop use based on these results. Discontinuing treatment may have further adverse effects. You should consult your doctor if you have any questions about this new research.

What about doctors? The researchers urge clinicians to take extreme caution in prescribing methylphenidate, and consider the full scope of the situation before committing to its use.

What next? The authors encourage further research with depersonalized individual data and reliable reporting of all treatment outcomes. More research should also be conducted concerning non-pharmacological strategies for helping individuals living with ADHD.

It is likely that given these results, more analysis concerning the efficacy of ADHD-related drugs will occur. Keep on the look out for reports and new data. This is not the end of the story, more is to come!

ADHD Beyond Borders

This past semester I have been studying abroad in Copenhagen, Denmark. Living here has been a social experiment, immersing myself in a welfare state with progressive values. I have explored all over Europe as well, visiting thirteen countries and many more cities in my short time here. As the semester nears its end, it has come to my attention that ADHD, and many other neurological disorders, are viewed quite differently internationally than they are in the United States. A recent article by the New York Times details varying accounts of parents around the world who have experienced stigmatization and other difficulties surrounding their children’s ADHD diagnosis.

In Argentina, Olga Elizabet Abregu, mother of Santino, 8, testifies: “Here where we live no one knows about A.D.H.D., and the few people who’ve heard of it say they don’t believe in it, that it’s only rude kids without limits.”

In Georgia, stimulants are banned, so unless parents can smuggle the medications like Adderall and Ritalin from nearby Ukraine, children are left with neurologists’ prescriptions for sedatives and other drugs, typically used to treat dementia and psychosis: “They make the children dumb — I really feel sorry for them,” Nino Jakhua, mother of Nikoloz, 6, said.

In Istanbul, Sinan’s parents could not cope with the maltreatment of their son and his ADHD any longer. They moved him to a private school in Utah, paying $10,000 a year for fair treatment.

“In Germany,” one mother, Ms. Oedell, says, “it’s really not accepted to be different. Either people say ADHD. doesn’t exist, or they make it seem like some terrible moral problem.”

In Japan, the only stimulant permitted is methylphenidate, but all stimulants are treated as narcotics.

Studying abroad here in Copenhagen, however, I’ve experienced a different perception of ADHD. Maybe it’s the Scandinavian progressivity or the socialist welfare state, but Danish ADHD is not stigmatized like it is in the rest of Europe. It is however, over-diagnosed and over-medicated, according to my professor in “The Social Brain,” named Lone: “It’s so normal now. I’ve noticed in my practice as a neuropsychologist that parents come up to me and ask for advice all the time. It’s like asking about the weather.” However one of the problems she sees is Denmark’s over-acceptance of the disorder. Education is free and schools are now adopting an “inclusion” policy, whereby all kids, even those with special needs, are to be given appropriate accommodations. “Because ADHD is so common, kids with ADHD are no longer considered special because it’s too prevalent to accommodate so many children…we lose specificity and ADHD is no longer considered a real problem.” In contrast with other European countries, Denmark’s lack of stigmatization of ADHD has almost lead to trivialization.

All over the world, discrimination and misperception of ADHD threaten the well-being of patients and their families. Despite the international attitude towards ADHD, the number of diagnoses has soared in recent years. A recent meta-analysis revealed that the amount of children with ADHD worldwide hovers rather consistently around 5.29%. The authors concluded, “Our findings suggest that geographic location plays a limited role in the reasons for the large variability of ADHD prevalence estimates worldwide.” The recent rise in ADHD diagnoses worldwide is staggering. While in 2007, the international community accounted for 17% of the world’s use of Ritalin, by 2012 that number had doubled. Certain countries in particular have experienced dramatic increases. The number of prescriptions for stimulants in the UK rose by more than 50% in the same time period. Germany’s diagnosis rate rose 381% from 1989 to 2001. The international market for ADHD drugs now tallies at more than $11 billion.

Unfortunately, in most countries, higher incidence of ADHD does not mean that the disorder is becoming more accepted. As diagnoses increase, public perception, education policy, medicine and insurance policy all remain stagnant, inhibiting proper care and treatment. Nessa Childers, co-chair of the European parliament’s mental health, well being, and brain disorders interest group, insists, “We all have to go back to our member states and publicize this situation (for ADHD sufferers)”. She went on to say, “ADHD is one of the most neglected and misunderstood psychiatric conditions in Europe.” The call to action is often drowned out by more pressing political matters. Another option may be to appeal to the academic community. More scientific studies and legitimate research may sway some of the international community’s opinions and highlight the importance of acceptance and proper treatment surrounding ADHD. Given the taboo surrounding stimulant medication in many countries, psychosocial treatment is typically endorsed. Alternative treatments and therapies may find faster and more widespread traction internationally than here in America. Maybe the international community would be interested in NEURO+!

October is ADHD Awareness Month!

ADHD Awareness Month aims to educate the public about ADHD, through publicizing reliable research and information. The organization boasts coalitions with five major members: the ADHD Coaches Organization,  Attention Deficit Disorder Association (ADDA), ADDitude Magazine, Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), and The National Resource Center on ADHD (NRC). Together, these coalition members create a phenomenal collection of resources for parents, family-members, friends, professionals and patients with ADHD. The movement’s website also includes a list of relevant and popular blog posts surrounding ADHD, along with resources about symptoms, treatments, and diagnosis.

The movement seeks to not only educate the general population regarding ADHD, but also to target patients themselves in promoting a positive outlook and self-esteem. In featuring 31 stories of patients and their family-members, a central part of the movement’s focus is redefining ADHD as just one part of somebody’s personality that does not encompass who they are. The mission is to advocate against discrimination or daily stereotyping that people with ADHD face and to award legitimacy to the disorder which many still see as a personality flaw. Moreover, ADHD Awareness Month is extremely valuable in disseminating knowledge about ADHD’s less publicized issues, like receiving extra time on examinations in college and for raising funds for research.

This is a national project. U.S. Secretary of Education Arne Duncan issued the following statement earlier this month on Learning Disabilities, Dyslexia, and Attention Deficit Hyperactivity Disorder Awareness Month. He discussed the strides we have made as a country in matriculating more and more kids with ADHD and learning disabilities and emphasized the humanity aspect in understanding how the disorders affect patients and their families: “While we should celebrate these accomplishments, we also must recognize that there is more to do to ensure that students with learning disabilities, dyslexia, and ADHD have every opportunity to fulfill their potential, attain higher education, and obtain good jobs at the same rates as their peers.”  The support for ADHD Awareness Month is rapidly growing. Their Facebook page has over 15,000 likes.

However, not everyone is on board with ADHD’s popularity and awareness campaigns. In 2013, the CDC reported that 15% of high school students have been diagnosed with ADHD and the number of kids on medication had increased to 3.5 million from 600,000 in 1990. Dr. Conners, a psychologist and professor at Duke University claims, “The numbers make it look like an epidemic. Well, it’s not. It’s preposterous… This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.” Many blame the wildly successful pharmaceutical campaign by drug companies to publicize the disorder and promote medication to doctors, educators, parents and patients. In ten years, sales of ADHD medication increased from $1.7 billion to $9 billion, according to the data company IMS Health. While raising awareness is necessary and noble, many argue that the awareness campaigns have gone too far in popularizing ADHD. For example, advocacy groups have recruited celebrities like Adam Levine of Maroon 5 for their campaign: “It’s you’re ADHD- Own It.” Some suggest this over-popularization of ADHD can lead to over-diagnosis and over-medication. Another complication is that many of the non-profit organizations involved in raising awareness are sponsored by pharmaceutical companies, raising the possibility of ulterior motives in publicizing ADHD. CHADD, one of ADHD Awareness Month’s coalition members, for example, was reported to have received about $1 million a year, one-third of its annual revenue, from pharmaceutical company grants and advertising. Does this impede the organization’s mission to raise awareness for the sake of education or empowerment? Maybe not, but it is something to keep in mind.

Regardless of the status of ADHD as a diagnosis, we can all agree that attention issues are important and deserve inspection. New research out of Duke University suggests that attention issues may even be the primary predictor of academic achievement. The study finds that children with more attention difficulties early on not only have lower achievement scores in reading and math, but also are 40% less likely to graduate from high school. Attention difficulties often go hand in hand with socio-emotional issues, which cause poor learning-enhancing behaviors like classroom engagement and relationships with teachers and peers, further contributing to decreased long-term academic success. Given the crucial role attention skills have in academic development, it is increasingly urgent that we develop new programs and tools for combatting the causes and effects of ADHD. Let’s pay attention to attention…it’s October!

How young is too young? ADHD in Toddlers

The Center for Disease Control (CDC) just came out with a report estimating that more than 10,000 American toddlers are being medicated for ADHD.

Why is this a problem? First of all, guidelines for diagnosing children under three years old do not exist, so diagnoses themselves are purely speculative and subjective. Furthermore, no significant research surrounding stimulant use in this age bracket exists, so both the safety and the effectiveness of the medication are questionable. The American Academy of Pediatrics does not address the diagnosis of toddlers because hyperactivity and impulsivity,  two primary symptoms of ADHD, are developmentally appropriate at that age.

Despite the growing body of research surrounding stimulant medication in toddlers, the consensus among professionals is that behavioral therapy is always preferable in children who are so young. Some doctors do concede that medication in children under four is acceptable under rare circumstances and as a last resort, but the scientific research is inconsistent at best. A couple studies have found that young children are more sensitive to adverse side effects like delayed growth, insomnia, loss of appetite and anxiety. Yet, another review found that stimulants are safe for carefully diagnosed ADHD preschool children three years and older. In terms of effectiveness, one study found that methylphenidate doses significantly reduced symptoms in preschoolers; however, effect sizes were smaller than they were for school-aged children.

Given this conflicting research, it is clear that without large enough sample sizes and differing results, further research is needed for us to safely say that preschool children should be diagnosed and/or medicated for ADHD.

To complicate things further, the data show that toddlers covered by Medicaid are the most likely to be medicated by stimulants. Why is this the case? First, low-income children are simply more likely to be diagnosed with ADHD. Some experts say the difference may be due to low-income parents struggling to provide a consistent and structured home environment. Others say that teachers in low-income schools lack the resources to provide special services to children in the classroom. Still others point to differing diagnostic procedures used by primary care physicians, who are more likely to make the ADHD diagnosis in Medicaid patients (rather than a psychiatrist or psychologist). Also, Medicaid programs often cannot afford to invest in long term therapy treatments, especially given the lack of children’s psychiatrists in rural areas. Dr. Susanna Visser, the CDC’s top ADHD researcher, explains, “It’s hard to take away medications when therapy isn’t readily available.” Some states like Arizona and Illinois have implemented policies in their Medicaid programs to prevent harmful diagnosis and medication of ADHD in young children by requiring all physicians to seek pre-authorization from a panel of peers two weeks before prescribing stimulants to children under six. Other states like Missouri and Vermont may soon adopt similar policies.

It seems urgent that we take a step back and evaluate the rate of diagnosis and medication in toddlers, given the lack of information. While it is important that we catch and address ADHD symptoms early, it is also important not to misdiagnose or mistreat kids at such a vulnerable age. So, how young is too young? How do we close the socioeconomic gap across different treatments? What are the risks of diagnosing too early versus too late? These are the questions that face us, as medicine begins to outpace the science on this important issue.

Now Available: Neuro+ Attention Training Software

After 4 years of development, we’re happy to announce that Neuro+ is now available to the public.
Axon Neuro+Screen Shot 2015-08-17 at 3.59.49 PMScreen Shot 2015-08-17 at 3.59.29 PMScreen Shot 2015-08-17 at 3.58.53 PM
What is Neuro+?
Neuro+ is a game-based attention training program designed to
help individuals, especially those with ADHD, exercise their brain in order to develop and improve their attention skills.How does it work?Neuro+ incorporates neurofeedback, motion-biofeedback,
and go/no-go cognitive training to help improve focus,
body self-control, and impulse-control. Below is a brief description of each training tool:Neurofeedback: Users wear a dry, wireless, easy-to-use EEG headset and play a training game that challenges them to focus in order to advance through a series of fun and engaging exercises.
Motion-biofeedback: While playing the training game, users must maintain complete control of their bodies and remain absolutely still in order to avoid costly point penalties.
Go/no-go training: To practice impulse control, users are challenged with “go/no-go tasks” requiring them to quickly and accurately respond to stimuli and ignore distractions.
Most users see results after only 6 weeks of training 30 minutes per day, 2-3 times per week.
Is it effective for ADHD?
Neuro+ provides detailed analytics of users performance and improvement over time.
Neuro+ provides detailed analytics of users performance and improvement over time.

There is overwhelming evidence supporting neurofeedback as an effective tool for improving attention skills in individuals suffering from ADHD. In fact, the American Academy of Pediatrics classifies neurofeedback as a Level 1 – Best Support Treatment for ADHD, the same rating given to medications and cognitive behavioral therapy.

Dozens of clinical studies have shown the protocols used in Neuro+ to be effective for improving focus and reducing hyperactivity/impulsivity. Below are some recent findings from the scientific literature, with more research available on our website www.neuropl.us

Duric et al. (2012): Neurofeedback for the treatment of children and adolescents with ADHD: a randomized and controlled clinical trial using parental reports. Neurofeedback improves attention and reduces hyperactivity as well as methylphenidate (Ritalin®). http://www.biomedcentral.com/1471-244X/12/107

Steiner et al. (2014): Neurofeedback and Cognitive Attention Training for Children with Attention-Deficit Hyperactivity Disorder in Schools. Neurofeedback produces sustained improvements in attention after only 3 months of training. http://pediatrics.aappublications.org/content/early/2014/02/11/peds.2013-2059.abstract

How do I sign up?
Please visit http://www.neuropl.us to sign up and learn more. You can see Neuro+ in action in the video below: