Here in the UK, Dr Robin Pauc is making a splash with his new book and his claim for cures for ADHD, dyslexia and most other developmental problems. His book, Is That my Child?, has received coverage in the Daily Mail and on GMTV. Dr Pauc belives that all the ‘conditions’ can be dramatically improved if the child is put on a junk-free healthy diet high in Omega 3 and 6 fatty acids and follows a pattern of tailor-made exercises to stimulate the brain.
This is hardly a breakthrough. Fish oils with Omega 3 & 6 have been recommended for sometime, cutting out junk food will make anyone feel and perform better, and right type of exercise will stimulate the cerebellum.
At one level Dr Pauc is promoting the right approach to developmental problems. I’ve not read the book but I doubt there is anything in it I would disagree with. The problem is that he is making claims he cannot justify. Where are the peer-reviewed results of his double blind trials of his treatment? They simply don’t exist.
More worrying is that Dr Pauc is not a medical doctor or neurologist. He is a chiropractor. Ben Goldacre on Bad Science has a good piece on Dr Pauc qualifications in When in doubt, call yourself a doctor.
I’ve been playing with a Reflex Ball from Power Systems and its a great way to improve your hand-eye coordination. The ball is slight smaller than a tenis ball bit it is not spherical, instead its has uneven surface. This causes it bounce unpredictably making it a lot harder to catch. Quick hands and eyes are required to keep control so this is a tool for people who can already catch but want to improve. For people who can’t catch, a problem common in dyslexics and people with ADHD, check out the PlusBall.
Reflex Ball User Guide
The purpose of my recent visit to the Sound Learning Centre was to be assessed for Neuro-Developmental Delay (NDD). The assessment and treatment programme for NDD was developed by the Institute for Neuro-Physiological Psychology (INPP) and focus on the role of primitive reflexes such as the Moro Reflex. As the name Primitive Reflexes suggests these are involuntary movement of the body that are present in everyone when born but over the first 18 months the baby learns to repress the reflexes as it begins to crawl and walk.
In many children and adults with dyslexia, ADHD and other learning problems, these reflexes are retained. This limits their ability to move freely and this can have impact on their education. For example the Palmer or Grasp Reflex is the instinctive grasp action a baby makes when something is placed in to its hand. If this reflex is not fully suppressed then it can interfere with their ability to hold a pen properly.
The assessment process for NDD is comprehensive and takes about two hours. Pauline Allen, who runs the Sound Learning Centre, was excellent as always. Her friendly and efficient manner made the tests interesting and enjoyable. After performing the tests Pauline took a couple of hours to write up here findings before sitting down with me and explaining what she had found. Note the % refers to how much is retained: 0% no dysfunction, 1% to 24% mild dysfunction, 24% to 49% significant dysfunction, 50% plus major dysfunction.
Moro Reflex: 12%
Asymmetrical Tonic Neck Reflex: 1%
Symmetrical Tonic Neck Reflex: 38%
Spinal Galant Reflex: 0%
Tonic Labyrinthine Reflex: 38%
Babinksi Reflex: 75%
Rooting Reflex: 25%
Suck Reflex: 25%
Infant Plantar Reflex: 75%
Palmar Reflex: 75%
Landau Reflex: 25%
Transformed Tonic Neck Reflex: 0%
Oculo-Head-Righting Reflex: 45%
Labyrinthine-Head-Righting Reflex: 90%
Amphibian Reflex: 6%
Segmental Rolling Reflex: 94%
Abdominal Reflex: 100%
As can be seen the tests revealed a mixture of good and bad. Most of the areas I have difficulties relate to balance. This is interesting as my balance is significantly better than it used to be (see Dore / DDAT Posturegraph) but I still appear to have some issues with it. Other tests showed I also had minor issues with visual processing and cross-lateral movement.
Pauline’s next step was to work out a treatment programme to combat these problems. As balance plays a significant part of my problems, the first exercise concentrates on training the vestibular. Many of the exercise INPP recommend recreate movements a child will experience in-utero and during the first two years of life and my first one is no exception. It involves sitting cross armed and legged, rocking slowly and gently, in a manner that can only be described as fetal. The aim of this is to improve my vestibular’s ability to detect small movements and to be comfortable whilst slightly off-balance. Other exercises involve cross-lateral movements, e.g. right hand to left knee and eye-tracking exercises.
These are just the start of a long process in retraining my body and how it moves. Reassessment and more exercises will follow.
The bible for testing and understanding the role of the Primitive Reflexes is Reflexes, Learning and Behavior: A Window into the Child’s Mind by Sally Goddard.
Also on Myomancy: INPP One Day Training Course, Review: The Well Balanced Child by Sally Goddard, Autism Detection At Six Months Old?
Sensory Integration is often used with autistic children or childern with severe learning problems but its is not a specific technique. Its an approach that tries to normalise a child’s reactions to sensory input. The School Psychology blog has identified a publication by the National Association of School Psychologists on Sensory Integration in 2002. They weren’t impressed.
“There is no study that uses a quality research design (e.g., random assignment of subjects, matched control groups, consideration of the effects of maturation, evaluators blind to treatment condition) that finds SI therapy to be effective in reducing any problem behaviors or increasing any desired behaviors. There is plenty of evidence from which a verdict can be drawn. And the verdict is that, despite the intuitive appeal and glowing testimonials, SI therapy is not an effective treatment ….
Despite this harsh criticism, SI theorists and practitioners may be close to something important. I strongly encourage continued research in this area. However, the general public should not be Guinea pigs. Nor should resources be taken from effective treatments to go towards an unproved treatment. I hope that when new and improved SI models are proven safe and effective, they will dramatically improve the lives of children and their families. When there is evidence of SI as a safe and effective treatment, I promise to publicize such positive findings as vigorously as I have pointed out its current shortcomings.“.
A School Psychologist Investigates Sensory Integration Therapies: Promise, Possibility, and the Art of Placebo
Previously on Myomancy: The Senses of Autism, Sense Round-Up, Integrated Senses, Sensory Integration and ADHD, Sensory Integration, Sensory Integration Research
There is now quite a lot of evidence that premature or low birth weight children have a greater risk of learning and physical disabilities and this is further supported by a new Finish study. Looking at children born between 1996 and 1997 with Extremely Low Birth Weight (ELBA), e.g. birth weight below 1000g or 2.2lbs, the study assessed the children at the age of five.
CONCLUSIONS: Only one fourth of the ELBW infants were classified as normally developed at age 5. The high rate of cognitive dysfunction suggests an increased risk for learning difficulties that needs to be evaluated at a later age. Extended follow-up should be the rule in outcome studies of ELBW infant cohorts to elucidate the impact of immaturity on school achievement and social behavior later in life
Neurodevelopmental outcome at 5 years of age of a national cohort of extremely low birth weight infants who were born in 1996-1997
Previously on Myomancy:
Premature Babies Have High Chance of Learning Disabilites
World of Psychology
Cerebellum More Than Just a Motor
A short but informative article on Dr Martha Denckla, a neurologist who has spent her working life studying the connection between learning difficulties, motor skills and the brain’s construction.
"With a practiced eye, Denckla studied ADHD children and saw tell-tale motor differences typical of basic brain immaturity. "Go to a nursery school, say ‘walk on your heels,’ and 100 percent of the children also ‘walk’ their hands. At that age, the motor cortex doesn’t control the feet elegantly enough, and stimulation overflows to the hands. Tongues stick out when little ones tie their shoes." But what’s normal in nursery school signals problems in teenagers. By Jason’s age, Denckla says, ‘motor control should be perfect-no mirroring, no overflow.’"
No Self Control? ADHD mirrors an immature brain.
Dr Denckla was also the research behind the study covered in Twenty Eight Years On and the Evidence is Still Being Ignored
Why is it that despite numerous studies that show a connection between poor coordination and learning difficulties that people like Professors Elliot and Snowling still insist that learning difficulties are relate solely to academic performance? In a study done in 1977, 89% of hyperactive boys had immature coordination. Almost thirty years ago people were making the connection between the brain and the body and yet in the UK the government focuses more and more literacy and numeracy rather than the neurological skills than underpin our ability to learn.
Anomalies of motor development in hyperactive boys: “Forty-eight boys who scored high on rating scales for the hyperactive syndrome but who went without traditional neurological signs of learning disabilities were compared with 50 control boys on coordination tests. Discriminant function scores for speed, rhythm, and overflow correctly classified 89% of the boys as those with hyperactive versus normal behavioral histories. Thus, neurological examination of hyperactive boys does reveal developmentally immature coordination“.
What is it like being a parent of a child with ADHD or similar learning difficulties? If you are reading this then you probably already know but this interesting paper What Do Parents of Children with Learning Disabilities, ADHD, and Related Disorders Deal With? looka at the issue from an academic angle. It covers the problems in identifying learning difficulties, the emotional cost for parents in facing the fact their child has problems, the ongoing day-to-day stresses and presents possible strategies for parenting.
It is often confusing to parent children with learning disabilities, ADHD, and related disorders. One of the biggest confusions and challenges parents face is the large hiatus between what the children can do and what they cannot do. Often they are very smart, know a great deal, and reason well, yet cannot read or write. School teachers and family may be telling them to try harder, and they are usually trying their hearts out. They tend to work 10 times harder than everyone else does, but still they may be called lazy.
Another aspect of the confusion for parents lies in how hard it can be to distinguish between a child who can’t do something and a child who won’t do something. For parents, it can be vexing not to be able to control a 5 or 6-year-old or to know whether to push an adolescent or reduce expectations. In this confusion, parents tend to ask, What is wrong with me? rather than What challenges is my child having to face?[emphasis added] Shifting this focus can be therapeutic for parents and children
See also: Parenting and ADHD
Bramhall is a small suburb of Stockport in the north-west of the UK and is home to the Bramhall Neuro-Developmental Therapy Practice. The practice is run by Lyn Wells who uses a variety of techniques to help children and adults with learning difficulties. I travelled up to Bramhall to see first-hand a treatment that intrigued me.
Interactive Metronome is a treatment for ADHD and other learning difficulties that involves developing the child’s or adult’s sense of rhythm. This connection between learning problems and poor rhythm is strong but not obvious.
fMRI studies are used to show what areas of the brain are working the hardest when performing specific task. This technology was used to study the brains of music professions whilst they played various pieces of music and scales on the piano. One of the areas of the brain strongly linked to rhythm is the cerebellum, an area of the brain that has been repeatedly linked with learning difficulties. Several treatment programs such as DDAT and Brain Gym focus on training the cerebellum through physical activity to improve academic performance. This approach seems to work, at least for some people with learning difficulties. Interactive Metronome attacks problems with the cerebellum with a double-whammy. Physical movements such as clapping train up the areas of the cerebellum the control the gross-motor skills whilst simultaneously the rhythmic aspect train the self-control and timing area of the cerebellum. These in turn have an impact on general coordination, mental processing speed and the ability to focus your attention.
The Interactive Metronome system consists of two sensors, one for the hands and one for the feet, headphones and a computer. The computer plays via the headphones a regular beat, sounding rather like a cow-bell. The user claps their hands or taps their feet in time with the beat. The sensors detect this and feed the information into the computer which analyses whether the clapping or foot-tapping was early, late or spot on.
The first step of any treatment is an assessment of your current capabilities. This included fourteen different tests including simple hand clapping, clapping whilst balancing on one leg, and alternating clapping with one hand on the thigh whilst tapping the opposite foot. This last one is a real test of cross-lateral ability. For each test the average number of milli-seconds between when the beat was and when you reacted was reported. Anything within 15 milli-seconds is counted as spot-on.
My results showed an average inaccuracy of 90.1 milliseconds across all the tests. This places me in a below-average category. I’m sure a few years ago I would have been much worse but my DDAT treatment and subsequent practice with Bop-It and various Playstation games such as Eye-Toy Groove have helped.
The treatment process with Interactive Metronome is adapted to the individual but will generally consists of fifteen hours using the equipment split into three sessions a week over a number of weeks. In total a treatment program will consist of approximately 35,000 claps.
A training session is very similar to the assessment process except the user gets feedback through the headphones and visually. When you hit a beat spot-on a sound plays in both ears. If you are early a different sound is played into the left ear only and if it is late, another sound is played into the right ear. These sounds are matched by visual feedback on the computer monitor. The feedback guides the user so that their claps or toe-tapping gets closer to the metronone’s beat. This feedback is introduced slowly and learning to integrate it is important in developing concentration, sensory integration and focusing attention.
Unfortunately there are relatively few practitioners around (the Interactive Metronome web site has a list) so finding one may be pot luck. The practitioners also have to be good because the basic mechanics of the training, e.g. clapping, could be dull. So its important, especially for children with attention difficulties, for the practitioner to engage the child and keep their attention.
Overall Interactive Metronome is a treatment well worth considering. It is not silver bullet to education and behavioral problems but it can help. If you are in the UK then Bramhall NDT can provide a friendly and effective centre for treatment.
Research: Neural Basis of the Comprehension of Musical Harmony, Melody, and Rhythm [ PDF ].
Also on Myomancy: Rhythm and Dyslexia, Cerebellum More Than Just a Motor, The Cerebellum and ADHD
From the archives of Behavioral Brain Research journal I found this study: Do ‘clumsy’ children have visual deficits [ PDF ]. This caught my eye because clumsiness and learning difficulties like dyslexia, ADHD or dyspraxia can be associated. Clumsiness is not quite the same as being uncoordinated which will obviously lead to the occasional accident. It is more about being unaware of the world around you. I tried to find a medical definition of clumsiness but no luck. Clumsiness seems to be one of those things you know when to see it.
The study took 54 children about the age of ten and assessed them using the Movement Assessment Battery for Children, a test that produces reliable “measures of movement competence, manual dexterity, ball skills, static and dynamic balance“. They then took the thirteen worst, highest scoring students and the thirteen children with the best or lowest scores. The group of worst scores had on average a score of 14.5 where as the lowest scorers had an average of 1.3 representing a large gap in their motor abilities. They then put all the children through three separate visual tests that probed how well the brain processes visual information. The result demonstrated that the children with the worst manual dexterity and movement skill also had the worst visual processing skills.
This is significant because it demonstrates how neurological deficits in seeing could have an important role in clumsiness. So if a child is clumsy and has learning difficulties then they both might be caused by the same problem.
See also: Vision and Learning, Left blind-spot ‘gives ADHD clue’ and Visual Problems Equals Learning Problems?