For many adults and children with attention deficit disorder (ADHD), the biggest daily challenge is paying attention – at work, in class, in the middle of conversations... Even the non-ADDers among us could benefit from some attention training from time to time. And now new evidence suggests that alternative ADHD treatments. like meditation and working-memory training can improve attention and focus across the board.
One study found that, after just five days of computer-based training, the brains of six-year-olds begin to act like those of adults on one crucial measure of attention. Another study suggested that boosting short-term memory seems to improve children's ability to stay on task.
We do not yet know how long these gains may last, or the best methods for developing attention. But the demand is clear: Dozens of schools nationwide are already incorporating some kind of attention training into their curricula. And as this new arena of research helps overturn long-standing assumptions about attention and memory, it offers intriguing possibilities. Find out about the specific brain training practices here:
What it is: Neurofeedback is an alternative ADHD treatment that uses brain exercises to reduce impulsivity and increase attentiveness.
How it works: Neurofeedback is based on a simple principle: training the brain to emit brain-wave patterns associated with focus (as opposed to those waves associated with day dreaming. The result: Some ADHD symptoms — impulsivity, distractibility, and acting out — are less detectable.
Treatment: First, a practitioner takes a detailed history of the patient and then maps the patient's brain by having him wear an electrode-lined cap while performing a complex cognitive task, such as reading aloud. The brain activity is fed to a computer, which then maps the areas of the brain where there is too much or too little brain-wave activity — the sources, theoretically, of the patient's ADHD symptoms.
The patient then trains those areas of the brain that are under-aroused by controlling a computer or video game by producing short bursts of sustained brain-wave activity in the target areas. The games only run when the patient exercises that portion of the brain that is deficient in focus.
Cost: While sessions are brief (approximately 30 minutes) and painless, they are expensive. The average course of treatment can range from $2,000 to $5,000.
Working Memory Training
What it is: Training that aims to build up those areas of the brain that hold onto information long enough to accomplish a specific goal. For example, you hold a phone number in your mind as you dial it, or you hold the task at hand in your mind—organizing your room, say—as you work on it.
How it works: When you improve working memory, you improve fluid IQ—the ability to solve problems or adapt to situations as they occur.
Treatment: The patient logs on to the working-memory program, such as the software developed by Cogmed, which is downloaded on his home computer. He completes eight exercises that vary from shooting down floating asteroids to recalling numbers in the reverse order in which they are given. The program stays a step ahead of the patient's ability, making exercises increasingly harder. A trainer calls once a week to talk with the parents, troubleshoot, and encourage the patient.
Cost: The training runs five weeks, five days a week, an hour a day. It ranges in price from $1,500 to $2,000, and it is not covered by most medical insurance plans.
Considerations and Benefits of Working Memory Training
Things to keep in mind:
-- The training is rigorous, so few children under seven can stick with it. Children recently diagnosed with ADHD should have their medication adjusted before beginning training.
-- The program does not claim to replace medication. While many kids get good results on meds, drugs don't usually manage all ADHD symptoms. Improving working memory can address those problems.
-- About 75 to 80 percent of kids show improvement in inattention and hyperactivity. Kids also become more alert to their surroundings. They are also more aware of social cues. Learn about the age-by-age working-memory 'milestones' here.
-- Parents often report that their kids become more "mature." They take charge of their hygiene and do chores without being nagged. They remember to bring books and materials to and from school.
-- Studies have found that at six-month and one-year follow-ups, about 80 percent of subjects maintained their working-memory gains or improved on them.
What it is: Mindful awareness, or mindfulness involves paying close attention to your thoughts, feelings, and bodily sensations; in other words, developing a greater awareness of what’s going on with you from moment to moment. It can be used as a tool to foster wellness, especially psychological well-being. Similar techniques have been used to lower blood pressure and to manage chronic pain, anxiety, and depression.
How it works: Meditation improves your ability to control your attention. In other words, it teaches you to pay attention to paying attention. Mindful awareness can also make people more aware of their emotional state, so people with ADHD won't react impulsively as often.
Treatment: The basic practice is very simple: sit in a comfortable place and spend five minutes focusing on the sensation of breathing in and breathing out—pay attention to how it feels when your stomach rises and falls. If your mind wanders to something else—your job or some noise you just heard, label these thoughts as "thinking," and refocus your attention on your breath.
This practice should be done daily, and every couple of weeks patients should increase the length of time spent on the exercise—up to 20 or more if they feel they can.
Apply the same thinking throughout each day, focusing on your breath for a few minutes as you walk from place to place, or when you're stopped at a red light or sitting at the computer. The meditation sessions are important practice, but the key is to use mindfulness throughout your daily life, always being aware of where your attention is focused while you are engaged in routine activities. For example, you might notice while you drive that your attention wanders to an errand you must run later that day. Lots of people practice mindfulness while eating. Once you get used to checking in with yourself and your body, you can apply the technique anytime you start to feel overwhelmed.
Training centers can also help explain these basic concepts, and keep you on track.
Cost: $0 if you do it on your own, but training programs and books are available for purchase.
Benefits and Considerations of Meditation
Things to keep in mind:
-- It's the nature of the mind to be distracted. Mindful awareness isn’t about staying with the breath, but about returning to the breath. That's what enhances your ability to focus. And this emphasis on re-shifting your attention, of outwitting the mind's natural tendency to wander, is what makes experts think this technique could be especially helpful to ADHD children and adults.
-- With a long history but little scientific data on its effects, more research is still needed to confirm these early findings.
-- Some studies show promising results with significant improvements in both inattention and hyperactivity for ADD and ADHD adults.
-- In cognitive tests, the participants got better at staying focused, even when different things were competing for their attention. Many of them also felt less anxious and depressed by the end of study.
Attention Training in School and Beyond
If focus skills can be groomed, as research has begun to hint, the important next question is whether, and how, attention should be integrated into education. Will attention become a 21st-century 'discipline', a skill taught by parents, educators, even employers? Already some educators are showing interest in attention training, mostly through the practice of meditation.
But with the field of attention training still in its infancy, scientists don't know whether any current teaching brings long-lasting gains—or, for that matter, which practices work best. Nonetheless, with global use of ADHD medications tripling since the early 1990s, and evidence mounting that attention can be strengthened, researchers are permitting themselves cautious excitement at the prospect that attention training could work.
Portions of this article were adapted from an article that originally appeared in The Boston Globe.
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