News and Notes
Dr. Bauman recently completed his fourth ADHD diagnosis and treatment class at Mass General/Harvard Medical School. He is eager to use the latest strategies. Education never gets old!
It is becoming an open secret that Dr. Bauman treats ADULTS with ADHD/ADD. That has happened organically due to his long history of expertise in helping younger patients and emerging adults to thrive with ADHD/ADD. He can evaluate for ADHD/ADD and document the diagnosis for primary care physicians.
New thinking on kids with ADHD Healthy lifestyle could be effective intervention!
In this regard, Dr. Bauman recently completed a second multi day class at Harvard Medical School, in the company of medical professionals from around the world. This live course was entitled Lifestyle Medicine: Tools for Promoting Healthy Change. He is now a member of the American College of Lifestyle Medicine and the American College of Sports Medicine. Most recently he completed a class led by Dr. John Ratey-Harvard Psychiatrist and author of SPARK-The New Science of Exercise and the Brain. Dr. Ratey is a thought leader in the treatment of ADHD, Anxiety, Social disorders and the positive impact of exercise.
Dr. Bauman recently returned from a Minnesota Medical Association conference featuring Dr. Russell Barkley, ADHD leading researcher, author, teacher.
He also recently completed two additional post graduate class at Harvard Medical School. The first focused on motivational coaching. He also learned useful information on dopamine supporting nutrition. Research has often focused on a lower level of dopamine in the ADHD population. The second class reminds us how important it is for each child/teen to have a charismatic adult in their life. This person is one from whom the child/teen can draw strength. Dr. Bauman enjoys serving as charismatic adult in the lives of countless children, teens, and emerging adults.
Additional coursework and tools brought to south Florida from Boston and Cambridge- Middle School through College MENTAL HEALTH and EDUCATION, and Meditation and Visualization for Well-Being and Peak Performance. That last course was designed to assist primary care physicians and surgeons in their OWN Peak Performance. Dr. Bauman often finds himself assisting physicians in their OWN effective living. This has been a natural outgrowth of decades spent assisting the families of area physicians.
Neurofeedback and other controversial treatments.
Just like Neurofeedback, too many colleagues are selling other unproven tools. http://www.nbcnews.com/health/mental-health/new-psychiatric-dna-testing-unproven-ground-n437781?cid=sm_fb
Some of the latest information on Neurofeedback and CogMed
A meta-analysis (study of many other studies) of efficacy of cognitive retraining(such as CogMed) (Cortez et al.(2015) supported some benefit for working memory. However, impact on ADHD symptoms and academic performance was NOT demonstrated. More research is needed before recommending as ADHD intervention.
Neurofeedback is a self-regulation technique in which an individual is taught to alter his or her brain’s electrical activity in an attempt to stay focused and attentive. The American Academy of Pediatrics (AAP) does not recommend neurofeedback in its clinical guidelines for diagnosis and management of ADHD.
CogMed is marketed as a computer-based solution for attention problems caused by poor working memory. Barkley’s 2015 ADHD text advises that FIT programs such as CogMed have not demonstrated sufficient effectiveness for improving the core symptoms of ADHD. “we do not recommend the adoption of these treatment approaches for routine clinical practice.”
Dr. Bauman will continue to hone and implement effective cognitive and behavioral strategies and a motivational COACH approach to help children/teens/ and families manage ADHD and associated challenges.
Dr. Sam Goldstein has given permission for Dr. Bauman to post the following article.
Controversial Treatments for Children with Attention-Deficit/Hyperactivity Disorder
Sam Goldstein, Ph.D.
In the past decade there has been a tremendous upsurge of scientific and public interest in Attention-deficit Hyperactivity Disorder (ADHD). The interest is reflected not only in the number of scientific articles but in the explosion of books for parents and teachers. Great strides have been made in understanding and managing this common childhood disorder. Children with ADHD who would have gone unrecognized and untreated only a few short years ago are now being helped, often with dramatic, positive results.
It is critical for parents to seek the best in evaluation, as well as the best in treatment. Evaluations that consist of a single checklist or ten minute discussions, will likely run the risk of mis-diagnosis of the disorder or in fact a misunderstanding of co-occurring problems that often present for children with ADHD. Symptoms of inattention, restlessness, impulsivity, social and academic difficulties, can reflect a variety of childhood disorders. It is essential to obtain a thorough understanding of problems before attempting to intervene, especially since many children with ADHD also experience co-existing learning and behavior problems. A good treatment plan follows logically from a thorough evaluation.
There continues to be many questions in need of answers concerning the developmental course, outcome and treatment of ADHD. Although there are a number of effective treatments, they may not be equally effective with all children experiencing ADHD. In their efforts to seek effective help for their children, parents may become desperate. In their desperation and confused by misinformation in the marketplace, parents may turn to treatments which claim to be useful but have not been demonstrated to be truly effective in accordance with standards held by the scientific community. We refer to such treatments as controversial. That is, they are marketed beyond their proven worth.
Unfortunately, most parents, no matter how intelligent or well-educated, do not have the training nor expertise necessary to identify and evaluate relevant scientific findings concerning the effectiveness of various treatment which have not as yet met scientific standards for effectiveness. Some of these treatments merit continued research, others do not. We do not recommend these as proven treatments. We know that parents need to be informed about them because they may be offered as proven and accepted approaches to the treatment of ADHD which they are not.
How Are New Treatments Evaluated?
The road by which a particular treatment is shown to be effective can be long and arduous. The process begins with the formulation of a hypothesis or idea. This hypothesis is usually based upon an existing body of knowledge. The second step is the development of a protocol to evaluate the effectiveness of the proposed treatment. The treatment itself and the way in which it will be implemented must be carefully defined. The researcher must also specify the way in which the effectiveness of the treatment will be evaluated. Care must be taken to be certain that the effects of the treatment are not simply due to placebo. It has been well documented in scientific research that people respond to all sorts of ineffective treatments as long as they believe that the treatment has the power to help them. Placebo effects can be more dramatic than most people realize.
Anti-Motion Sickness Medicine
Advocates of this theory believe that ADHD is caused by problems in the inner ear system. They believe that there is a relationship between ADHD and problems with coordination and balance. This theoretical relationship is thought to reflect a dysfunction in the inner ear system since this system plays a major role in balance and coordination. To treat ADHD, a mixed array of medications, including anti-motion sickness medications and several vitamin like substances are recommended. Using these medications,proponents of this approach have claimed a success rate in excess of 90%. Unfortunately,these results are unpublished and not subject to verification.
This theory is not consistent with what is currently known about ADHD. There is no body of research that supports a link between the inner ear system and attentional processes. Anatomically and physiologically there is no reason to believe that the inner ear system is involved in attention and impulse control in other than marginal ways. In the single controlled study of this theory, researchers evaluated the use of anti-motion sickness medication to treat developmental reading disorders. The results failed to support the theory. This approach to treating ADHD is inconsistent with current knowledge and is not supported by research findings.
Candida albicans is a type of yeast which lives in the human body. Normally yeast growth is kept in check by a strong immune system and by friendly bacteria in the body. When the immune system is weakened or when friendly bacteria killed by antibiotics,candida can over grow. This may lead to the vaginal yeast infection known as candidias is and less commonly in infections of the skin, nails, and mouth.
Those who support this model believe that toxins produced by yeast over growth weaken the immune system. This makes the body susceptible to many illnesses, including ADHD and other psychiatric disorders. The treatment program is designed to discourage the growth of candida in the body. This two-pronged approach includes the use of anti-fungal medication such as nystatin and a low sugar diet. Other aspects of the treatment approach include an elimination diet to rule out food allergies and the use of vitamin and mineral supplements.
Although it is recognized that candida can cause infections of the vagina, mouth, and skin, there is little evidence to support the idea that it also causes the host of other illnesses listed by advocates of this approach. Little evidence is provided to support these theories. Instead, anecdotal data and testimonials are offered as proof that the approach is effective. The theory is not supported by evidence and is not suggested as a helpful treatment for
ADHD. EEG Biofeedback
Proponents of this approach believe that children with ADHD can be trained to increase the type of brain wave activity associated with sustained attention and to decrease the type of activity associated with daydreaming and distraction. They claim the result is improvement in attention and reductions in hyperactivity and impulsivity.
The technique of EEG biofeedback involves measuring levels of electrical activity in various regions of the brain. This information is fed into a computer which transforms it into a signal, such as a light, tone or video game. Using this signal as feedback, the child is taught to increase certain kinds of brain wave activity and decrease other kinds (increase beta, decrease theta). Training involved between forty and eighty treatment sessions according to the proponents of this program. Each session lasts up to forty minutes or more. Since sessions are held two to three times per week, treatment can extend over three to ten months or longer.
Although this treatment has become quite popular and is marketed throughout the country, there continues to be limited, published peer reviewed research to support its use. Although there is an increasing interest in research in this area, the extensive claims initially made by proponents of this treatment (e.g., dramatic improvements in intelligence scores, dramatic reductions in ADHD symptoms) seem almost too good to believe. Many of the initial studies published were seriously flawed by the use of small numbers of children with ambiguous diagnoses. Further more, published studies thus far have not included appropriate control groups to rule out the effects of maturation or placebo.
Biofeedback technology is not new. Although some believe it holds great promise in the treatment of ADHD, at this time it must be considered at the very most an ancillary treatment used to support other treatments. From a research prospective it must be considered unproven. Parents are advised to proceed with caution. It is an expensive approach whose effectiveness, until better studies have been completed, has been not consistently demonstrated.
Other Controversial Treatments
Among other treatments that parents may hear about on the radio, view on television or read about, are the use of applied kinesiology (the manipulation of bones in the body, particularly plates of the skull to improve body and brain functioning), optometricvision training (exercises to improve eye tracking) and auditory training (enhancing the capacity to listen to and process certain frequencies of sounds). All three of these approaches have been marketed as effective for ADHD. However, there is limited if any scientific support that any of these three will exert a significant, positive impact on the functioning of children with ADHD.
In this paper we have reviewed approaches which have been offered as effective for ADHD which have not met scientific standards which would justify their inclusion as mainstream treatments for this childhood disorder. Some of these controversial treatments merit continued research while others likely do not. Although these treatments may be offered in the marketplace as proven and accepted approaches, they are not. Parents are cautioned when considering these treatments that time and money might be better spent on treatments with proven track records. Among the most effective means to date are the judicious use of medication and behavior management. Parent education and appropriate classroom settings, as well as helping children locate areas of success in their lives, are also effective for children with ADHD.
How Can A Parent Be A Wise Consumer?
If you are the parent of a child with ADHD you know how difficult your job can be. You want to obtain the very best treatment for your child. In the spirit of "how can it hurt to try" you might be tempted to throw caution to the wind when you hear about a new treatment that promises to help.
Promises are not enough. You also have the responsibility to invest your family's resources of time, money and energy wisely. This means that as with any large purchase,you must become an informed consumer.
In this paper we have provided general guidelines for evaluating new treatments. Listed below are additional tips to help you recognize treatments that are questionable.