Science

The Science behind diagnosing and treating ADHD, Dyslexia and Autism

Science

Being a proud Nottingham lad, I have to link to this excellent project at my local university: Test-Tube. Its name is a play on YouTube and, well, test tube, which is highly fitting for a project involving science videos on the internet.

Brady Haran is a video journalist who has been appointed filmmaker-in-residence at one of Nottingham’s science parks. He’s producing a feature-length documentary following a year in the life of local scientists and Test-Tube is his production blog where he posts various clips and work-in-progress. Such as this one below where Brady tries out an fMRI scanner.

Science, Television

The campaign group Sense about Science have started to attack the spread of Brain Gym through the UKs primary schools.

Sense About Science has been receiving calls from parents and teachers who are concerned about the use of ‘Brain Gym’ – a programme of teacher-led physical exercises claimed to improve cognitive abilities – in primary schools.

These exercises are being taught with pseudoscientific explanations that undermine science teaching and mislead children about how their bodies work.

Whilst I’m favour of movement based programmes and want to see teachers being more aware of how movement and learning go hand-in-hand, some of the claims made by Brain Gym are bizarre. More importantly they are not back by proper peer-reviewed science.

The BBC’s Newsnight program did a segment on the Sense about Science’s campaign and Brain Gym. It wasn’t very flattering.

Part 2

ADD / ADHD, Dore Achievement Centres, Dyslexia, Science

Mind Hacks points to a good article on the current state of research into the effectiveness of biofeedback on ADHD. Its conclusion that biofeedback is a promising but unproven treatment is fair one.

What is interesting about the article is that it talks about what makes a good research study and delves into the problems of having a control group. In medication trials the control group takes a placebo pill, an inert sugar pill, whilst the study group takes the real medication. Both pills look the same and none of the medical staff handing out the pills know who is getting what. This minimises the confounding variables in the experiment.

In biofeedback studies, the problem is what to do you do with the control group. The treatment typically consists of 30 minutes a day using a computer and a biofeedback device. The control group needs to have a dummy treatment that is identical so that no one knows who is getting the real treatment but yet is guaranteed to have no effect. By its nature, biofeedback is an interactive process so the control group must have some sort of interactive experience. A device that just randomly responses to the the biofeedback would be quickly spotted.

This problem, when applied to a treatment such as the Dore program, becomes even more significant. Dore is series of exercises forming a 12 month program of twenty minutes a day. What activity could be used as a placebo that isn’t immediately recognised as the placebo? The only possibility would be to give one group the proper Dore exercises whilst the control group gets a random selection of exercises. But, the random exercises are too much like the real thing and there is a chance they help develop the cerebellum. Though they certainly would not be as effective it would introduce an unknown variable into an experimental set-up designed to remove unknowns.

A secondary problem is that children are assessed every six weeks under Dore using sensitive balance and eye-tracking devices. The child gets regular empirical evidence that the treatment is having an effect long before any improvements are seen in academic work. Obviously the users of the placebo should not see any improvement and this could have a significant effect on the child’s general confidence.

There is a way to conduct trials in these situation. You have two treatment groups, A and B plus a control, Group C. Group A gets the treatment whilst Group B gets a different activity, for example one-to-one help for 20 minutes a day. Group C gets no treatment. After Group A has received the treatment, the groups switch so Group B get the treatment and Group A gets the other activity. Once Group B has completed the treatment the experiment ends.

Both Groups A and B should of made more academic progress than the control Group C because of the one-to-one help they received and confounding variables such as the Placebo and Hawthorne effects. If the treatment worked better than the one-to-one help, then Group A would be expected to show academic improvements during the first period greater than Group B. This progress would slow down in the second period after the two groups switched roles and Group B would catch-up. If the treatment did not work, Group B would be ahead after the first period thanks to the one-to-one help and Group A would catch-up in during the second period.

There are some obviously difficulties in using this experimental design with Dore. Firstly it is a year long treatment. That means the whole experiment will last two years. To allow for people to move schools or drop out without having a major impact on the statistics, each group needs to be quiet large. Given that for the two treatment groups, there is a lot of investment of time in doing the exercises or taking children to the one-to-one sessions, the drop-out rate is likely to very high. Each group would probably need to start with about 50 people.

The cost of all this is significant. One-to-one teaching everyday for 50 people for year, twice, won’t be cheap. Nor will provision of the Dore treatment. Overheads in managing the experiment, tracking the academic performance of the children all add up. A gold standard experiment like this costs tens of thousands of pounds. Of course if Wynford Dore pays for the experiment then it won’t be an independent study but no one else will fund the experiment. The only dyslexia research body with that sort of funding is the department at York University. It is run by Professor Snowling who is rabidly opposed to Dore so its unlikely that any funding will come from there.

Another problem with an experiment on Dore is an ethical one. Asking a child to take part in a drug trial for four weeks is OK because if the treatment has no benefit then the child isn’t effected in anyway. For a Dore trial, the child has to spend twenty minutes a day for a year. If the treatment doesn’t work then the child has lost a huge amount of time and effort that could of been spent on more established therapies and the child would of fallen even further behind academically. This is major problem as the basis of any ethical experiment is that in no way, regardless of the experiment’s outcome, should the subjects experience any detrimental effects.

There are good reasons to criticise Dore’s scientific research and similar research by other alternative treatment but it has to be seen in context. The practicalities of an effective study that proves in one go the treatment works are both difficult and expensive. Dore and others are stuck in a catch-22 situation where if they pay for research there will be immediate accusation of bias but if they don’t pay for it, no one else will. Finally the ethical issues make the whole feasibility of an experiment doubtful.

Source: How Strong is the Research Support for Neurofeedback in Attention Deficits?

Dore Achievement Centres, Dyslexia, Dyslexia Treatment, Science

Myself and a reader going under the name of Tom, are having a discussion on the Dore Treatment. Tom is very much against Dore and has described it as a “con”. He has also accused me of promoting Dore for money and that I am lying about my treatment and subsequent improvement. You can read all this on iPhone Plays Guitar or via the Myomancy Forum.

One of the interesting points that has arisen out of this discussion is the idea that any improvement in my dyslexia has been caused by the placebo effect.

The placebo effect is defined as “…occur[ing] when a patient’s symptoms are altered in some way (i.e., alleviated or exacerbated) by an otherwise inert treatment, due to the individual expecting or believing that it will work. “. The two important elements are that the patient receives a totally inert treatment and that the patient’s symptoms really change.

The placebo effect is normally found in relation to physical medical problems ranging from common colds to cancer. Alternative medical treatments such as homeopathy and faith healing rely on the placebo effect for most of their benefits. It is also common practice in drug trials to give half the patients the real drug to be tested and the other half a sugar pill placebo. It is then possible to compare the results from the real drug to the placebo and work out how much more effective the real drug is. These drug trails regularly show 20%-30% of people on the placebo show an improvement of symptoms. In some cases, such as drugs designed to control pain, up to 75% of people on the placebo reported less pain. The placebo effect is very real and may be far more important to how effective drugs are than the big pharmaceutical companies would like you to know.

It is important to note that there is no evidence that the placebo effect actually cures anything. They can make you feel better by reducing pain or other symptoms and this can have a knock-on effect. A patient with less pain may be more positive and more active and this can help the bodies natural healing process. Another vital aspect of the placebo effect is that it wears off. A placebo only works because the patient believes it is going to work. After they have been taking a placebo for sometime the patient will begin to question why their illness hasn’t been cured. Once this loss of faith occurs the placebo loses its symptom reducing effects.

To apply this to dyslexia we have to identify the ‘disease’ and the ‘symptoms’. If the Dore Treatment is a placebo, the symptoms should reduces in intensity for a while but then return because the underlying problem or ‘disease’ still remains. Most dyslexia experts believe that dyslexia, the ‘disease’, is caused by a fundamental difference in the brain that cannot be changed. The ‘symptoms’ of this disease are reading problems, poor spelling, poor handwriting and poor short-term memory. Because the ‘disease’ is an unchangeable flaw, these symptoms can only be ameliorated. If a placebo works on dyslexia then we would expect one or more of those symptoms to show improvement and then return to its previous levels once the effect is lost.

A patient receiving a dyslexia treatment placebo might well do better in a spelling test than before because they believe they are being cured. This success would boast their confidence, helping them to learn new words and to make further progress in the next test. But if dyslexia is a lifelong condition that can only be ameliorated then this cycle of progress can only continue until the limits on the patient’s ability, placed on them by the underlying ‘disease’, are reached. Once this limit is reached the patient would lose faith in the placebo, the placebo effect would stop working, levels of confidence would drop and most of the improvements seen would disappear.

This does not appear to be the case. My own, other people’s anecdotal evidence, and research by Dore shows that the improvements gained whilst on the treatment remain and further improvements are seen after the treatment has stopped. Though the treatment has certainly not worked for some, no one has reported seeing significant improvements and then losing them once treatment stops.

This persistence of improvement is the clear sign that the Dore treatment is not working through a placebo effect but is making a permanent change in the brain.

None of this proves the underlying hypothesis of the Dore treatment that dyslexia is caused by an under-developed cerebellum or that the Dore treatment does anything but boast the patient’s confidence. But because the effects of the treatment are permanent it cannot be described as a placebo effect.

Books, Science

Baby Einstein and Brainy Baby videos may reduce infants vocabulary according to new research

Over the last few years there has been an explosion of educational videos for very young infants (3 months+) such as Baby Einstein and Brainy Baby. However there has been little or no evidence of their effectiveness or any benefit for the millions of dollars parents are spending on these videos and toys.

In the first study on whether Baby Einstein videos work, Dr Frederick Zimmerman, examined the vocabularies of infants that watched baby training videos and compared them to infants that did not watch the videos. For every hour per day spent watching baby DVDs and videos, infants understood an average of six to eight fewer words than infants who did not watch them. Six to eight words doesn’t sound like very much but in children under 16 months of age that is a large percentage of their vocabulary.

This research is part of a much large project that is examining the effects of TV on young children’s involving over 1,000 families in the Minnesota and Washington areas. The researchers where surprised at the results showing Baby Einstein reduces vocabulary.

“The results surprised us, but they make sense. There are only a fixed number of hours that young babies are awake and alert. If the ‘alert time’ is spent in front of DVDs and TV instead of with people speaking in ‘parentese’ – that melodic speech we use with little ones – the babies are not getting the same linguistic experience,” said Meltzoff, who is the chair in psychology at the University of Washington.

In contrast to the Baby Einstein videos, babies whose parents read them books or told then stories had slightly better langauge skills. Whereas parents talking or reading to their children involves a range of language skills, the researchers believe the baby DVDs and videos tend to have little dialogue, short scenes, disconnected pictures and shows linguistically indescribable images such as a lava lamp.

Is it time to throw away all those Baby Einstein videos and toys? Well maybe. The research needs to be taken with a pinch of salt. Firstly the actual study has not been published and all that is available is a press release from the university. Close examinations of the actual results or the methods used in the study may cast doubts over the research. Secondly, the makers of these products would say the videos are tools to stimulate interaction between parent and child. It must be suspected that many parents simply place their infant in front of the TV and expect the video to entertain and educate the baby all by itself.

Once the study has been scrutinized and further work done on the subject, then we may be able to say for sure if Baby Einstein videos make a positive or negative effect on a child’s development. As the researchers themselves put it:

“We don’t know for sure that baby DVDs and videos are harmful, but the best policy is safety first. Parents should limit their exposure as much as possible,” said Zimmerman. “Over the course of childhood, children spend more time watching TV than they do in school. So parents need to spend as much time monitoring TV and other media viewing as they do in monitoring their children’s school activities.”

Source: Baby DVDs, videos may hinder, not help, infants’ language development

Science, Web/Tech

Which web sites are the most significant for human progress? Off the top of my head I can think of three that make a real difference not just to me but all of humanity. Wikipedia is one, Google Scholar is another but my third choice may not be so familiar, MIT Open Courseware.

MIT is one of the major US university and a centre for world class teaching and research. A few years ago it started releasing its course notes and lectures free over the internet. Allowing anyone to access top-notch education materials that were previously only available to a tiny handful of people.

The range of courses is amazing, covering astronautics to women’s studies. For the Myomancy reader, there are courses on the Neural Basis of Movement, the Neural Basis of Learning and Memory or Language and Mind. These courses are not cut down, bite-sized chunks but educational material designed for top-class university students. Consequently they are hard work. However if you really want to improve your understanding of a subject, there is no better resource.

Dyslexia, Dyslexia Treatment, Science

Myomancy reader Monica, sent me details of a very interesting fMRI study on dyslexia. The researches compared a group of adult dyslexics with a control group of normal readers in the learning of a simple sequencing task. The subjects had to press one of four buttons that corresponded to a visual stimuli that appeared in a predictable pattern and they did this whilst sitting in an fMRI machine having their brains scanned. Previous studies had found that dyslexics are worse at learning this simple sequence and the researchers were interested in the differences in brain activity between the two groups.

The study found that there was a notable difference in brain activity between dyslexics and non-dyslexics. Significantly the cerebellum was more active in the dyslexics than it was in the non-dyslexics. As treatment programs such the Dore Achievement Centres focus on training the cerebellum it would seem more likely that the fast learning, non-dyslexics would show more activity in this area. The key to this counter-intuitive result is the role the cerebellum plays in learning.

Research suggests that the cerebellum plays a key role in learning by comparing what the brain expects to happen with what actually happens. As the subjects learn the sequence, the difference between expected and actual results diminishes and the work load on the cerebellum reduces. In the better developed, non-dyslexic brains, the cerebellum is more efficient at this process so sequence learning and the corresponding drop off in cerebellum activity occurs sooner.

The study concludes

Reading is a complex cognitive activity that involves functions
arising from different networks of brain structures. To achieve
reading fluency, the skill must be automatized. The cerebellum
appears to have all the potentialities to facilitate the numerous and
coordinated operations involved in proficient reading.

Study: Implicit learning deficit in children with developmental dyslexia
Previously on Myomancy: Reading and the Cerebellum, The Cerebellum as the Cause of Dyslexia, Cerebellum More Than Just a Motor

Balance & Coordination, Music, Science

What role does left or right handedness play in dyslexia? Some approaches such as
The Dominance Factor by Carla Hannaford argue that learning problems occur when children have mis-matched dominance. For example, right handed but left eyed. The data on this is very confused and no one really knows even the basics such as why are most people right handed but some are left handed?

The two hemispheres of the brain communicate using the Corpus Callosums. A thick bundle of nerves that links the two halves of the brain. Research has shown that its thickness can vary a great deal from person to person suggesting that some people are better equipped for cross-hemispheric communication. What difference does this make and what factors influence the size of the corpus callosum? BPS Research Digest has an interesting article looking at new research in this area.

…the callosum varied little between the sexes or between the left and right-handers (less than 3 per cent difference in each case), but varied significantly according hemisphericity, with right-brain dominant participants having a 10 per cent thicker callosum on average.

Thickness of the callosum was also independently related to something called ‘dichotic deafness’, a common characteristic of people with a left-hemisphere dominant brain . This is the inability of some people to hear two sounds presented simultaneously, when one sound is played to one ear and the other sound to the other ear.

The brain’s great connector