Attention Disorders and Arrowsmith Program

What is the underlying cause of attention disorders? The National Institute of Mental Health states that “scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.”

At this point in scientific research there is no definitive answer to this question. Indeed, many parents try a variety of solutions to improve their child’s attention capabilities from the control of diet, to increase in exercise, to neurobiofeedback therapy, to the intake of natural supplements, or to the use of stimulant medication. I have seen positive results from my clients using one or the majority of these intervention methods. As well, I have seen limited results, depending on the client. There is no question that each brain and the environment it lives in is so diverse that it is difficult to imagine a study that can generate one definitive result that proves why a child struggles to attend to information. Parents often attempt to try solutions based on the information they receive and observe their child’s response to that treatment.

The American Academy of Pediatrics published the Clinical Practice Guideline: Treatment of School-Aged Child With Attention-Deficit/Hyperactivity Disorder . They noted that 4% to 12% of school-age children show ADHD behaviours. The guideline stipulated the need for pediatricians to work with other service providers to consider the best treatment plan, management of behaviours and monitoring of outcomes:Primary care clinicians cannot work alone in the treatment of school-aged children with ADHD. Ongoing communication with parents, teachers, and other school-based professionals is necessary to monitor the progress and effectiveness of specific interventions. Parents are key partners in the management plan as sources of information and as the child’s primary caregiver. Integration of services with psychologists, child psychiatrists, neurologists, educational specialists, developmental-behavioral pediatricians, and other mental health professionals may be appropriate for children with ADHD who have coexisting conditions and may continue to have problems in functioning despite treatment. Attention to the child’s social development in community settings other than school requires clinical knowledge of a variety of activities and services in the community.

Researchers also realize that medication is not always the answer for their clients. Dr. David Rabiner noted in a research review study that, “Although medication treatment is effective for many children with ADHD, there remains an important need to explore and develop interventions that can complement or even substitute for medication.” He goes on to state that not all individuals benefit from medication. Some individuals experience adverse affects to medication. Medication benefits do not continue once it is discontinued. Dr. Rabiner notes that, “Because of these limitations, some researchers have pursued cognitive training as an alternative method of treatment. The basic idea behind cognitive training is that important cognitive skills such as attention and working memory can – like any other skill – be strengthened and enhanced with intensive and focused practice. Furthermore, when an individual builds these skills the benefits may endure beyond the time when the actual training is provided.”

The Arrowsmith Program provides one such cognitive intervention service. Over the last 30 years the Arrowsmith Program has successfully improved the executive control abilities of children diagnosed with ADHD. The Arrowsmith Program, founded on neuroscientific research, involves intensive and graduated mental exercises that are designed to strengthen the source of the attention disorders – underlying weak cognitive capacities. Over 30 years of experience the Arrowsmith Program has demonstrated that these affected brain areas can be improved through mental exercises, resulting in increased mental capacities and strengthened learning abilities. Weaker areas of the brain are treated like weak muscles and are intensely stimulated through mental exercises in order to produce strengthened learning capacities. Research at Arrowsmith School has also shown that when the deficient area is improved, the individual’s ability to plan, organize and actively engage in academic work requires less effort.

A significant number of children previously on stimulant medication for ADHD can successfully end this treatment through the Arrowsmith Program. That is, the Arrowsmith Program has found that a portion of children with ADHD actually have multiple cognitive dysfunctions that impact their ability to sustain active engagement in a classroom setting. The ADHD diagnosis is not a primary disorder, but rather secondary to the multiple cognitive weaknesses impacting processing, memorizing or conceptualizing information. David was one such student.

David was given a full psycho-educational assessment for a possible learning disability. He was struggling at school. His mother would have to get him to sit down to do his homework. When she went over his assignment it appeared to her that her son was not listening in class. This was frustrating and resulted in conflicts at home. Yelling, arguing, debating were common social interactions between her and David on a daily basis. She really felt that David was to blame.—if only he could pay attention and work harder. The psycho-educational assessment identified specific learning disabilities. The primary problem appeared to be written expression. The ADHD checklists highlighted ADHD-Inattentive Type as another area of concern. He showed at least six of the nine behaviours often associated with the Inattentive subtype. This included not listening to instructions, difficulty following through on homework or school related activities, forgetting assignments, inability to sustain attention and being easily distracted in class.

David’s mother heard about the Arrowsmith Program through a friend. Through discussion with Arrowsmith staff, it was determined that David had at least 7 specific learning dysfunctions that would impact classroom management. David was then assessed to determine the severity level of his learning dysfunctions and to determine his Arrowsmith cognitive remediation program. Several of the cognitive weaknesses would certainly impact attention control, including weak memory for information and instructions, weak visual-motor integration for printing and copying and a weakness with determining the main idea, also known as saliency determination. After three years of intensive cognitive remediation (brain exercises) David was able to move these learning dysfunctions from a severe level of disability to average ability. He was then capable of listening to instructions, sustaining active engagement on school-related tasks, following through on homework and assignments and was not easily distracted in class. These neurological improvements took hours and hours of cognitive training. Brain change requires active engagement and repetitive brain exercises that require increasing complexity. By improving neurological weaknesses through cognitive intervention training he no longer demonstrated ADHD-like behaviours.

In summary, it is important for those diagnosing and managing children with ADHD to consider cognitive intervention training. The Arrowsmith Program is one such method available in Vancouver, B.C. Results from a 2007 study on the Arrowsmith Program highlighted positive gains in ADHD-like behaviours. The study was completed with the cooperation of the Toronto Catholic School Board, which has used the Arrowsmith Program for the last 12 years (since 1997). The study showed that the students that had completed the Arrowsmith Program and were now fully immersed in regular education classes show significant improvements in following instructions, organization skills and willingness to complete homework. All of the teachers identified a noticeable to extremely noticeable change in the Arrowsmith students’ ability to follow and understand instructions (for those students for whom this was a concern). In regards to willingness to attempt and complete homework, 80% of teachers recognized a noticeable to extremely noticeable change. Only 7 % of teachers noticed no change (for 13% of students this was not a concern). Finally, in regards to organizational skills, 85% of teachers recognized a noticeable to extremely noticeable change. Only 4 % of teachers noticed no change (for 11% of students this was not a concern). Medication for ADHD can certainly provided immediate results, but long-lasting changes in brain functioning can occur through cognitive training methods.

http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/complete-index.shtml
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/4/1033
http://www.sharpbrains.com/blog/2008/06/12/promising-cognitive-training-studies-for-adhd/
http://www.arrowsmithschool.org/research.htm

Assessment of Children with Learning Disabilities

Parents are usually the ones to first identify that a problem at school is apparent.  This is due to the child’s dropping self-esteem that shows up at home, or the child refusing to go to school and not letting the parent know why.  Yes, teachers can also be the first to identify a problem, but parents are often the ones who see the emotional shifts showing up at home in their child.

The parent then approaches the teacher and asks them for advice.  Teachers can respond in a variety of ways including agreeing with the parent, or saying the problem is not significant and could be just a developmental issue.  The use of the word developmental often relates to the teachers opinion that time will take care of the issue and the child will slowly develop the abilities necessary to be successful at school. One just has to be patient, and things will get better.  Other teachers might agree with the parent, and begin the process to see if the child can be assessed for possible learning problems.  Depending if you live in Canada or the United States, and depending what province or state you live in, a sequence of events take place to monitor the child’s progress and to determine if assessment is necessary.

At some point, some of these children are assessed either by the school system or privately.  Most often the child is in Grades 3, 4 or 5 by now, and struggling with the work load at school, and likely underachieving in basic skills.  A date is set for the assessment.  A psychologist or educational assessor will conduct a series of tests to identify possibly learning difficulties.  In terms of the assessments used, this often includes a measure of intelligence, cognitive ability and achievement.  The intelligence measure is used as the definition of Learning Disabilities North American wide includes the fact that a child needs to have at least average IQ to be classified or diagnosed with a Learning Disability.  As well, discrepancies, or differences within measures, are used with IQ tests and measures of achievement (reading, writing, spelling and math).  That is, if the child has average IQ then they need achievement scores well below what is considered average intelligence in order to also be classified as having a learning disability.  The psychologist or educational assessor will then determine achievement levels by administering tests of reading, writing and math.

If the child has a learning disability the assessor will report that in the full report (i.e., psycho-educational assessment).  At a meeting the psychologist or assessor will tell the parents and teaching/administration staff whether the child meets the local district or states definition of a learning disability. If the child does have a learning disability than services are discussed with the parent.  This may include some kind of pull-out special education service such as small group reading instruction, study-skills support, learning resource help and accommodations such as extra time on tests, scribe to help with writing, or use of technology – like a laptop to be used in class.  The focus on this meeting is how to help the child bypass the weaknesses that result in the learning problems.

This method of assessment is flawed.  First, the assessment is often brief.  Psychologist or educational assessors are not given enough time to really assess the child’s learning profile.  They often are permitted two or three hours of testing – just enough time to do an IQ test and achievement measures to determine if a diagnosis is possible.  Thus, many areas of brain functioning are not assessed.  This provides an inaccurate assessment of the child’s ability to learn, and can miss key neurological weaknesses that will impact the child’s ability to succeed in the regular classroom – such as Oral Language functioning or Social Perception skills.  This is not the fault of the psychologist or assessor, but rather the limits put on these individuals to spend time with the child.  The second reason that this method of assessment is flawed is that it does not lead to appropriate remediation of the learning disability.  The focus of the assessment is to diagnose the problem in order to get the funding necessary to provide the staffing necessary to support the bypass techniques used in the school.  The assessment is not designed to pinpoint the neurological weaknesses and then to create a program to directly remediate them.  Learning disabilities result from neurological weaknesses in the brain, in fact this is part of the definition of Learning Disabilities used thoroughout North America.  If we can identify these neurological weaknesses do we have to tools to improve these brain functions?  Yes, there are now cognitive remediation programs that can do this directly.  The third reason that the current method of assessment is flawed is based on the reality of IQ testing.  Again, to diagnose a learning disability a child needs average IQ.  What is interesting about IQ is that it is alterable – it can change depending on the child’s environment.  That is, the brain is plastic and can improve capacities such as language processing, visual-perceptual thinking, working memory and visual processing speed.  These are measures tested on most IQ batteries.  If a child is tested and comes out having a Low-Average IQ (not Average) does that mean the child should not be diagnosed with a Learning Disability, and thus not receive special education services?  What if we can provide cognitive remediation to improve brain functioning and thus raise that child’s IQ?  Should we not rethink the use of IQ testing and assessment all together, and rather figure out how to determine what child can best respond to cognitive remediation training.

Assessment practice should be directly linked to remediation, and not be designed for labelling and funding, which it often is today in schools across North America.  As well, we need to realize that assessment should be focused on cognitive functioning and how to improve these weaknesses in children that underly the reason for the existence of learning disabilities in the first place.  If we focus on the assessment of reading, writing and math we are in reality missing the underlying reason that learning disabilities exists in the first place.