Dr. Barbara C. Fisher United Psychological Services Clinic Director Van Dyke Rd. Shelby Twp., MI Brainevaluation.com

Treatment for ADD and Co-related Disorders

1. D iagnosis is key 2. T hings you can do on a daily basis 3. S pecialized Programs 4. T raining the brain in specific deficit areas: neuronal conditioning –I–I–I–IM –B–B–B–Brain Training

Diagnosing ADD/ADHD and Co-related Disorders  Neuropsychological testing for differential diagnosis: Is it ADD? Or ADD Plus an Additional Disorder? Or not ADD at all?  Neuropsychological evaluation for: Memory, Visuospatial, Frontal processes  Psychological evaluation  Speech and Language assessment  Rule out sleep disorders  Do not depend upon self-report symptoms

Things you can do on a daily basis Plan family vacations and outings Take a day with your spouse or significant other Play music in the house Provide reminders for appointments If you are more tired, drained during the day, a channel clicker: rule out sleep disorders Physical problems are the wake up call for life changes Coherence in life= Key to graceful aging

Things you can do on a daily basis Anxious: Exercise Feeling overwhelmed: Watch the stress Too much to do and no time to do it: Manage time, estimate each task Distractibility increased: Stress, food Set daily goals you want to accomplish Assign homework time to your children Good sleep hygiene

Things you can do on a daily basis Music for distractibility Term papers in component parts Museum trips to teach concepts Movie night for English & History Look up meaning and re-write vocabulary words Re-write math facts Re-write chapter portions

Specialized Programs  Summer Camps  Social Skills Groups  Home Tutorial Program  Study Strategies  Math Concepts  Speech and Language Help  Home Cognitive Training  Interactive Metronome

Interactive Metronome: Reading Intervention Basic treatment for ADD/ADHD  Training the spatial areas;  Significant improvement on: –Decoding –Reading and desire to read –Handwriting  Improved performance on ADD/ADHD assessment:  Information Processing  Distractibility  Timed Assessment

IM: Changes for children, adolescents, adults and the aged Sustained attention, decreased distractibility Improved ability to decode language, writing skills Increased calm, less anger Used for anxiety, depression, trauma: Motivation & self- esteem increased, sense of well being, decreased anxiety & depression (self-report measures) Time management More coordinated, less clumsy

Reading Benefits of IM: 13 yr. old girl Word Attack: Using structural analytic skills to read pseudo words. Word Identification: Identifying real words. Following training she started to read on her own for the first time. Performance increased from grade level of:  3.0 to 16.9 for Word attack  4.4 grade to 7.1 for Word ID

Benefit of IM: ADD testing for Distractibility Medication vs. No-Medication She improved on the Stroop Color Word Test from a Pre-IM raw score of 27, while on medication, to a post IM raw score of 35, late at night, on no medication. When compared to normative data, her pre-IM T-score was 48, while her post-IM T-score was 56, on no medication. The fall of the school year following IM resulted in all A’s for the first time on her first report card marking.

Benefit of IM: ADD Test of Whole Brain Functioning: No Medication He had a Written Pre-IM raw score of 41 (1.28 SD above the mean) and Written Post- IM raw score of 51 (2.47 SD above the mean). He had a Pre-IM raw score of 51 (1.17 SD above the mean) for the Oral condition and Post-IM raw score of 64 (2.71 SD above the mean). He has never been on medication despite his diagnosis of ADHD Inattentive Type.

Memory Benefits of IM: Visual Retrieval She had a scaled score of 8 on Design Memory subtest from the WRAML prior to IM and post score of 17 on a measure that is typically difficult for ADD diagnosed children. Initially there was a concern with regard to additional neuropsychological issues. Testing completed late at night.

Pre & Post-Testing IM over time: 18 & 22 years ADD Test Measures of distractibility, whole brain functioning, ADD Test Measures of distractibility, whole brain functioning, logical reasoning, male college student Stroop: Improved from pre score of 59 (almost above average) to 68 (almost superior) SDMT: Written score improved from 59 to 72 correct responses SD above mean and Oral from 93 to above mean Trail A: Improved in time from 31 to 14 seconds, 1.40 SD below mean

Pre & Post-Testing IM over time: 18 & 22 years, ADD Testing: Information Processing Pre-IM vs. Post-IM PASAT score: 3 errors vs. 0 errors for the first trial, 15 errors vs. 5 errors for 2 nd trial, 15 vs. 0 errors for the 3 rd Trial, 22 vs. 13 errors for the 4 th trial

Pre & Post-Testing IM over time: 18 & 22 years, ADD test: Phonetic Decoding Scores improved following IM training on National Adult Reading Test-Revised, a measure of reading recognition, from 24 errors to 12 errors, standard score of 118 (above average) to pre-IM standard score of 109, (average).

Brain Training for Frontal and Memory Processes Pre and post testing: Improvement in memory due to learning strategies to recall information as well as memory improvement Improved ability to selectively attend, decreased rigidity and perseveration Increased processing efficiency

Brain Training Program: Memory Testing: Visual and Verbal Recognition tasks Scoring on Doors and People test: two subtests: Doors and Names Pre/Post Scores: low (SS of 8) to above average (SS of 13) for Doors Pre/Post Scores: Below (SS of 6) to above average (SS of 14) for Names Performance did not improve and in fact declined on measure of verbal retrieval 22 year old diagnosed with sleep apnea and history of neurological impairment

Brain Training Program: Listening Comprehension Performance on the Listening comprehension of the OWLS: Resulted in improved raw score age equivalent of 11-6 to 15-3 for pre and post testing. Improved listening skills reported in home environment 22 year old diagnosed with sleep apnea and history of neurological impairment

ADD takes on a life of its own ADD is the reason for not attaining success in life either on the job or at school ADD is the reason for not studying ADD is the reason for poor grades ADD is the reason for not passing a test ADD is the reason for not reading ADD is the reason homework takes so long ADD is why school is not fun and rewarding Just how bad is the ADD?

The task is to control ADD so it does not control you To understand the symptoms What it is and what it is not The more information, the more control Less information makes ADD more powerful than it needs to be Same pattern of symptoms- the degree is individualized

A new day….. New Horizons New Treatments New Solutions For the first time we can offer treatment for ADD and co- related disorders, whereby medication is not necessary 100 percent of the time or not necessary at all. For the first time we offer cognitive and brain training for the memory and frontal processes For the first time the future looks good!