ADHD — It’s all in the hands

Posted by Peter on April 5th, 2011 | Comments off

Can certain hand movements reveal ADHD?

Two studies, both funded by the U.S. National Institutes of Health and published in the Feb. 15 issue of the journal Neurology, reveal that ADHD children have a greater amount of unintentional hand movement than children not labeled ADHD.

Researchers from Cincinnati Children’s Hospital Medical Center and the Kennedy Krieger Institute in Baltimore performed joint research using sequential finger-tapping experiments on children with ADHD. The researchers found that ADHD children exhibited more than twice the amount of unintentional movements than typical children on one of the two tests used.

Additionally, the researchers measured cortical inhibition with magnetic pulses (transcranial magnetic stimulation or TMS) and compared the results to children without ADHD.

Let’s do a little brain anatomy here to make things clearer. The cortex is a layer or sheet of neural tissue that is outermost to the cerebrum. The cortex is responsible for attention, memory, consciousness, thinking, perceptual awareness, and language. The motor cortex is a term that describes regions of the cerebral cortex. The motor cortex plays a key role in the planning, control, and execution of voluntary motor functions (like hand movement).

Cortical inhibition is a term used to describe the cortex’s ability to control these functions. By using magnetic pulses directed across the cortex, the researchers discovered that children with ADHD were less able to inhibit their hand movements than children without ADHD. ADHD children presented unintentional hand movements about 40 percent more of the time than children without ADHD.

“We now have a real, quantifiable measure of a problem with controlling behavior in these children,” said Dr. Stewart Mostofsky, primary author of the study performed at the Kennedy Krieger Institute.

“From a clinical standpoint, the critical issue is … they do have differences with these aspects of normal motor control,” Mostofsky said. “We have to recognize that and account for that in considering how to work with children with ADHD.”

Notably, ADHD children that presented the greatest inability to inhibit their hand movement usually received more severe parental reports of hyperactivity and impulsivity.

The question obviously missing is, “What is the significance of these two studies?” They do not provide any direct applications for either diagnosis or treatment of ADHD. Could any parent with an ADHD child tell the researchers that their ADHD child could not control himself like other children his age? The answer is likely a resounding, YES!

The studies do identify patterns of inhibition control. This has been documented in previous studies and is a known factor in ADHD. Could the researchers develop a diagnostic tool based on inhibition control? Yes. As a matter of fact, this type of measurement is commonly obtained in a Computerized Performance Test or “CPT.”

The CPT typically flashes a letter, number, or symbol on a computer screen. The student is tasked to press the space bar or mouse when a preselected number, letter, or symbol appears on the screen. The computer will measure how many times the student clicks correctly, incorrectly, unnecessarily, or impulsively. A wide variety of data are obtained from a CPT. Yet they can only be part of a comprehensive evaluation for evidence of ADHD as so many variables are involved that may mimic ADHD.

So, while studies like the finger tapping study are interesting, they do not provide significant insight into the field nor do they provide basis for a single method of diagnosis. One may wonder why we fund such studies given what is already known in the field.

PDF

Texting and ADHD

Posted by Peter on December 3rd, 2010 | Comments off

How much has information and communication technology (ICT) affected our lives? Researchers say that the average teenager sends a total of over 3,400 electronic [text] messages every month or surfs the Internet at bedtime. Could texting and bedtime web time influence the severity of your child’s ADHD symptoms?

In a study by the JFK Medical Center in Edison, New Jersey, and presented at the 76th annual meeting of the American College of Chest Physicians (ACCP), lead author Dr Peter G. Polos and his team found that more than half of these bedtime kiddy texters or web surfers are not only prone to have problems falling asleep, but experience mood, behavior and cognitive problems during the day.

"It is significant that these children are engaging in stimulating activity when they should be in an environment to promote sleep," says Polos.

Polos’ team analyzed questionnaire responses from 40 children and young adults aged between 8 and 22. This is a small group and the results must be considered preliminary. However, the researchers found that those who used electronic technology at bedtime (texting, game playing, email, surfing, etc.) also experienced sleep-related problems such as excessive movements, leg pain and insomnia, and also had a "high rate of daytime problems, which can include attention deficit hyperactivity disorder [ADHD], anxiety, depression, and learning difficulties," said Polos.

According to Medical News Today (www.medicalnewstoday.com), the analysis of the questionnaire data showed that:

* 77.5 per cent of the participants had persistent problems falling asleep.

* On average, participants were woken once per night by an ICT device.

* On average, a participant sent 33.5 emails or texts per night when they were supposed to be asleep; and the average number of people texted each night was 3.7.

* The average number of messages sent via ICT per person per month at sleep time was 3,404 and occurred over periods ranging from 10 minutes to 4 hours after bedtime.

* Among the adolescent participants, the older they were, the later they went to bed, and the more time they spent with their ICT devices at bedtime.

* Boys were more likely to use ICT to surf the net and play online games, while girls were more likely to text and make cell phone calls.

* High rates of cognitive and mood problems during the day were linked with sleep time related use of ICT, including ADHD, anxiety, depression, and learning difficulties.

* There were also higher rates of nighttime problems such as excessive movements, leg pain and insomnia.

Polos and colleagues concluded that use of ICT at bedtime may have "an adverse impact on sleep hygiene and daytime function which may be significant", and that questions about this should be included in routine evaluations of patients reporting problems sleeping.

"These data suggest that further studies are needed to evaluate the short and long term consequences of STRICT on sleep," they wrote.

Polos explained that "sleep is largely habitual in nature", and if "children begin this type of behavior, they may set themselves up for the need for external stimulation before sleep later in life".

This could lead to problems like difficulty falling asleep, not having enough sleep, and feeling sleepy during the day, he said adding that:

"More research is needed to determine all of the short- and long-term consequences."

Many parents know that healthy sleep habits are especially important to ensure progress at school and healthy development, and are concerned about how best to handle the growing problem of ICT devices in the bedroom.

Polos said that using cell phones or computers, to talk, text, surf the net, or play games, is "more addictive, seductive, and interactive than passively watching television," because of the graphics, rapid responses and interactivity.

"The sooner parents establish appropriate times for children to use this technology, the better," he urged, adding that perhaps they should also "move key items, such as computers, from a child’s bedroom into a common area".

Dr David Gutterman, President of the American College of Chest Physicians said concern about insomnia and other sleep disorders in children is growing and that "research shows that the problem is increasing, so it is more important than ever for physicians to ask questions about technology use when evaluating children for sleep issues".

PDF

Training the ADHD Brain

Posted by Peter on September 27th, 2010 | Comments off

For years, we at Play Attention, have trained thousands and thousands of people to better pay attention, learn the cognitive skills they need to succeed, and change their behavior. Our results have spoken clearly for us since 1994. Now science is catching up.

Two recent distinct studies validate the brain’s ability to change. While a vast plethora of research confirms these studies’ findings, they are noteworthy. The first study demonstrates the efficacy of skill training, and the second demonstrates how teaching skills rewires the living brain.

The first study, published in the August 25 Journal of the American Medical Association, was performed by researchers from Massachusetts General Hospital (MGH). They utilized cognitive behavioral therapy as a direct intervention for ADHD adults. Cognitive therapy teaches skills for managing life challenges.

The researchers at MGH found that while medications were the first line of treatment, many patients still persist with underlying symptoms. While previous studies on cognitive behavioral therapy for ADHD were small and short term, the researchers at MGH claim their study to be the first to conduct full-scale randomized, controlled trial of the efficiency of an individually-delivered, non-medication treatment of ADHD among adults.

“Medications are very effective in ‘turning down the volume’ on ADHD symptoms, but they do not teach people skills,” commented Steven Safren, PhD, ABPP, director of Behavioral Medicine in the MGH Department of Psychiatry, who led the study. “This study shows that a skills-based approach can help patients learn how to cope with their attention problems and better manage this significant and impairing disorder.”

“Sessions were designed specifically to meet the needs of ADHD patients and included things like starting and maintaining calendar and task list systems, breaking large tasks into manageable steps, and shaping tasks to be as long as your attention span will permit,” commented Safren, an associate professor of Psychology in the Harvard Medical School Department of Psychiatry. “The treatment is half like taking a course and half like being in traditional psychotherapy.”

Like Play Attention has been doing since 1994, the researchers provided training sessions mainly that included skills training in filtering of distractions, organization, problem solving, and planning.

Safren’s group receiving cognitive and behavioral training demonstrated advanced control of their symptoms over their control group. This benefit had persisted when measured three and nine months after the training.

The second study, published in The Journal of Neuroscience (August 25, 2010, 30 34 11493-11500 doi 10.1523 JNEUROSCI.1550-10.2010), examined the brains of rats when they learned to control their impulses. The researchers documented synaptic changes in the medial prefrontal cortex. They concluded that the rat’s brains rewired themselves to produce the impulse controls necessary to be successful in the tasks the scientists had established for them.

Other past studies have confirmed that the brain will rewire to make changes for skills, impulse control, organization, etc. We’re glad that science is catching up to an learning process that we’ve done at Play Attention for sixteen years now. That’s beyond cutting edge; it’s leading the way for others.

PDF

Misdiagnosing ADHD

Posted by Peter on September 13th, 2010 | Comments off

According to a study released by the University of Michigan, nearly 1 million children in the United States are potentially misdiagnosed with ADHD.

The research was conducted, not by a medical group, but by economist Todd Elder in the Journal of Health Economics (Elder et al. The importance of relative standards in ADHD diagnoses: Evidence based on exact birth dates. Journal of Health Economics, 2010; DOI: 10.1016/j.jhealeco.2010.06.003).

Elder found that the youngest or often the most immature children are misdiagnosed with the ADHD label simply because of their age and exhibited maturity. Elder also found that these children are significantly more likely than their older classmates to be prescribed medications like Ritalin to control their behavior. Using a sample of 12,000 children, Elder examined the difference in ADHD diagnosis and medication rates between the youngest and oldest children in a grade. He found that the youngest kindergartners were 60 percent more likely to be diagnosed with ADHD than the oldest kindergarten children. Elder followed that group of children and found that they were more than twice as likely to be prescribed stimulant medication by the time they reached the fifth and eighth grades.

Currently, about 4.5 million children are diagnosed with ADHD. Elder concludes that about 20 percent or about 900,000 children have likely been misdiagnosed.

In a press release from the University of Michigan, Elder said that such inappropriate treatment is particularly worrisome because of the unknown impacts of long-term stimulant use on children’s health. Elder is also concerned that misdiagnosis wastes an estimated $320 million-$500 million a year on unnecessary medication. He estimates that between $80 million-$90 million of it is paid by Medicaid.

"If a child is behaving poorly, if he’s inattentive, if he can’t sit still, it may simply be because he’s 5 and the other kids are 6," said Elder. "There’s a big difference between a 5-year-old and a 6-year-old, and teachers and medical practitioners need to take that into account when evaluating whether children have ADHD."

ADHD has no pathology, no biological marker in the brain that clearly demonstrates its existence. Thus, its diagnosis is always subjective. While teachers are not permitted to make this diagnosis, their perceptions and opinions serve as the initial step to a diagnosis made by a doctor.

"Many ADHD diagnoses may be driven by teachers’ perceptions of poor behavior among the youngest children in a kindergarten classroom," he said. "But these ‘symptoms’ may merely reflect emotional or intellectual immaturity among the youngest students."

According to Science Daily, Elder’s paper will be published in the Journal of Health Economics in conjunction with a related paper by researchers at North Carolina State University, Notre Dame and the University of Minnesota that arrives at similar conclusions as the result of a separate study.

PDF

Is ADHD all in your head?

Posted by Peter on July 19th, 2010 | Comments off

A study published in the June 14 edition of the Journal of Developmental and Behavioral Pediatrics has sparked controversy regarding ADHD medication and the brain’s power to regulate itself.

The study was funded by the National Institutes of Health and conducted by Dr. Adrian Sandler, a developmental-behavioral pediatrician and medical director of the Olson Huff Center for Child Development at Mission Children’s Hospital in Asheville, North Carolina. The research was performed over the course of eight years using 99 patients from Western North Carolina.

Sandler found that children with ADHD can do just as well on half their medication when the medication is combined with a placebo. They performed as well even when parents and children had full knowledge they were taking a placebo.

[Placebo -- A substance containing no medication and prescribed or given to reinforce a patient's expectation to get well. The placebo in this research was akin to a harmless inert pill].

Previous studies have shown that common stimulant medication causes side-effects like tics, weight loss, stunted growth, and even heart complications in some instances. This often causes trepidation in parents afraid of the possible side-effects on their children.

Sandler compared fully medicated children, children on reduced medication, and children on reduced medication with a known placebo. The results were quite intriguing. Both the fully medicated and reduced medication groups had increased side-effects while the reduced medication with placebo demonstrated decreased side-effects. Furthermore, the reduced medication group reported decreased control of their ADHD symptoms. However, the control of ADHD symptoms was no different in the reduced medication with placebo group than in the full dose group, i.e. the reduced medication with placebo performed as well as the fully medicated group with less side-effects as well.

“I’ve been getting a lot of calls and e-mails,” said Sandler,, who conducted the research with James Bodfish, a professor in the departments of psychiatry and pediatrics at UNC Chapel Hill School of Medicine, and study coordinator Corrine Glesne.

“Medications work,” Bodfish said in a statement. “The question is whether we always need to use them at the highest dose. Many parents are concerned about placing their child on medication. Some choose not to treat their child because of concerns about side effects.”

While the research doesn’t address it, the obvious question is, Why? Parents and children in this study knew they were taking a placebo. Why then did they perform as well as their peers without the side-effects — at essentially half the dose as their peers? While the placebo effect has been studied widely, the exact mechanisms are unknown. We do know that the mechanism is governed by the brain. This clearly tells us that having ADHD or not, our brain is still a powerful weapon in our arsenal.

We also cannot exclude the influence of the parents during this research. Did they expect their child to do better? The authors suggest that this was so. This dynamic cannot be overlooked in your family either.

The bottom line is that we likely have far more control over our behaviors and cognitive processes than we are given credit for. Modern medicine, as this research suggests, is just beginning to understand the brain’s role in shaping our lives. We’ve known this for years at Play Attention. Cognitive training. Memory training. Motor skills. Attention training. Behavioral shaping. It’s time to take control over our lives. We’ve all got the power to do it. It lies right behind our eyes.

PDF

New research on attention and video games

Posted by Peter on July 6th, 2010 | Comments off

Research published in the July issue of Pediatrics reveals that too much time spent watching television and playing video games can cause attention problems.

A graduate student at Iowa State University, Edward Swing, found that excessive screen time, whether in front of a computer or TV, could double the risk of attention problems in children and young adults.

Swing’s research confirms previous findings from Dr. Dimitri Christakis, the George Adkins Professor of Pediatrics at the University of Washington in Seattle. Christakis’ research found that faster-paced shows increased the risk of attention problems. "You prime the mind to accept that pace. Real life doesn’t happen fast enough to keep your attention,” says Christakis.

The American Academy of Pediatrics (AAP) has long recommended that children over the age of 2 view less than two hours of TV or computer per day. Prior to that age, they suggest no TV viewing or computer.

Swing compared data of 1300 children in grades three, four, and five who watched TV or played video games less than two hours a day to children who watched more. He found that more video time could nearly double the risk of attention problems in children and young adults

"The children were reporting their TV and video game use and the parents were also reporting TV and video game use," Swing said. "The teachers were reporting attention problems," he said of the middle school students.

While both Swing’s and Christakis’ studies do merit attention, they are quite limited. For example, Swing used teacher rating reports to assess whether children had problems paying attention, if they interrupted classmate’s work, if they had trouble staying on task, or showed problems in other areas related to inattention. Teacher reports typically vary over time and from teacher to teacher. They are also highly subjective. To account for this, Swing had more than one teacher rate the children and that the ratings tended to be in agreement.

The greatest flaw in this research is that Swing did not account for content, i.e. what were the students watching or playing? Were the students watching educational TV or playing educational games? Were they playing race car games? Shooting games? Were they playing problem solving games? Were the games fast paced? Slow? Did they require reasoning skills? We’ll never know and that’s problematic because it leaves so many questions unanswered. As we are what we eat, we are what we stimulate ourselves with.

"These media aren’t going away," Christakis said. "We do have to find ways to manage them appropriately." On this I can agree. Limiting time to the AAP recommendations is prudent parenting.

PDF

The ADHD link to social dynamics

Posted by Peter on June 21st, 2010 | Comments off

If I told you that women who received only basic education were 130 % more likely to have a child on ADHD medication than women with university degrees, you’d see a link, wouldn’t you?

Well, that’s what a study published this month in Acta Paediatrica found. That implies that nearly half of the serious cases of ADHD in children are closely tied to social factors. The study reveals that factors like single parenting and poor maternal education were directly tied to ADHD medication use.

While we know that a genetic propensity likely exists, the human brain develops based on a complex interplay between nature and nurture; between genetic endowment (nature) and environment/social factors (nurture). Epigenetic theory tries to explain this relationship.

Curiously, few large-scale studies have tried to determine the impact of social and family influences on ADHD. Researchers at the Karolinska Institute in Stockholm, Sweden assessed data on 1.16 million school children and examined the health histories of nearly 8,000 Swedish-born kids, aged six to 19, who had taken ADHD medication.

"We tracked their record through other registers … to determine a number of other factors," said lead author Anders Hjern.

Here’s what the researchers found:

Living in a single parent family increased the chances of being on ADHD medication by more than 50 percent.
A family on welfare upped the odds of medication use by 135%.
Boys were three times more likely to be on medication than girls.
Social dynamics affected both sexes equally.

"Almost half of the cases could be explained by the socioeconomic factors included in our analysis, clearly demonstrating that these are potent predictors of ADHD-medication in Swedish school children," Hjern said.

It’s clear that this study found a link between socioeconomic factors and ADHD medication use/diagnosis. Other US studies have found that minority children and children of low socioeconomic status were more likely to receive ADHD medication.

Factors like low income and diminished quality time are more common in single-parent families. These typically lead to stressors like family conflict and a lack of social support, Hjern said.

While more research must be done, one has to ask, is medication the answer to social stressors like lack of time and money? Sounds too silly to ask, but it seems that our answer, ridiculously, is a resounding, YES!

We are the masters of our lives. We can make significant personal changes, but we must have the tools to do so. That’s why I began Play Attention (www.playattention.com) years ago.

PDF

Immediate rewards and the ADHD brain

Posted by Peter on April 23rd, 2010 | Comments off

A Nottingham University research team in the United Kingdom found that the brains of children with ADHD appear to respond to immediate rewards in the same way as they do to medication. Their research was published in the journal Biological Psychiatry.

“Our study suggests that both types of intervention [medicine and immediate reward/reinforcement] may have much in common in terms of their effect on the brain,” said Professor Chris Hollis, the lead investigator of the study.

The research team used an EEG (electroencephalograph) to measure the brain activity of children as they played a computer game that provided extra points for less impulsive behavior.

The researchers devised a computer space game which rewarded the ADHD children when they caught aliens of specific colors while avoiding aliens of designated colors. The game design actually tested the children’s ability to resist the impulse to grab the wrong colored aliens.

To test whether immediate reward/reinforcement made a difference, one iteration of the game rewarded the children fivefold for catching the right alien and penalized them fivefold for catching the wrong one. All of this was done while activity in different parts of their brains was monitored with an EEG.

Hollis found that the immediate rewards helped the children perform better at the game. This was verified by the EEG which revealed that both medication and immediate reward/reinforcement were "normalizing" brain activity in the same regions.

Many parents of ADHD children are aware that giving a reward to an ADHD child a week after their good behavior is insignificant to that child. ADHD children respond better to immediate reward, not delayed reward.

"Although medication and behavior therapy appear to be two very different approaches of treating ADHD, our study suggests that both types of intervention may have much in common in terms of their effect on the brain. Both help normalize similar components of brain function and improve performance," said Hollis.

"We know that children with ADHD respond disproportionately less well to delayed rewards – this could mean that in the ‘real world’ of the classroom or home, the neural effects of behavioral approaches using reinforcement and rewards may be less effective."

It’s obvious that providing immediate rewards/reinforcement 24 hours a day and 7 days a week would be impractical and impossible. But what does this research tell us? It tells us that if we are to train an ADHD student, feedback, reward, and reinforcement need to be immediate if we are to get their brain to rewire.

We at Play Attention have known this for many years. This is why we integrated immediate feedback/reinforcement for attention training, cognitive training, memory training, and behavioral shaping by using feedback technology. We patented this method years ago because of its inherent strength. While we knew this was the best way to achieve success, we feel research like this rather reinforces our approach. It’s about time the world caught up!

PDF

Should I play or should I grow?

Posted by Peter on March 1st, 2010 | Comments off

PART TWO OF THREE

Entertainment vs. learning
Entertainment is usually a passive act that includes an activity which provides a distraction to everyday events or provides amusement. A good example of entertainment is watching a movie or concert. However, one may also actively participate in recreational entertainment such as playing video games or sports. One does not participate in an entertaining activity to be educated. That is far from the goal of entertainment. In fact, we participate in entertainment to be relieved of having to work, having to learn, or having to be actively engaged for those purposes. We seek entertainment for fun and pleasure.

Entertainment is a vast industry. The modern American video game industry made about $18.85 billion on video-game hardware, software, and accessories in 2007. That’s nearly twice what movie theaters made and triple what the video game industry made in 2000. Most authorities on video games estimate that 70 to 80 percent of boys and approximately 20 percent of girls play video games daily.

Learning is on the other end of the spectrum from entertainment. In order to learn, we need attention, challenge, and deliberate practice. We need to be actively engaged. To apply the mind with the intent of long-term retention, assimilation, and application of new information. This implies both effort and commitment. While we may employ some of these elements, the purpose is far different in a learning environment. The purpose of learning in Star Trek: Bridge Commander is to keep the ship from exploding by using the controls correctly. Learning is there to benefit your game play. While this takes some reasoning and trial and error, is this useful in the classroom or at the office? Not likely. It’s not likely transferrable or to generalize either unless your child’s job is commanding Star Fleet.

If I may paraphrase the late martial artist and film legend Bruce Lee, you cannot learn to swim by kicking your legs and stroking with your arms on land. You have to jump in the water. You cannot learn to run a marathon by jogging around the track.

In other words, if we want to learn something, it has to be taught with a purpose or aim, and we have to practice it deliberately to improve. If we closely examine what video games our spouse, child, or clients are playing, then we might just be alarmed at the violence, the lack of humanity, and gratuitous sex involved.

The most popular video games are those that are visually intense and graphically frenetic. It’s important to mention here that paying attention to visually stimulating and frenetic activity is another hallmark of an ADHD individual. Offer a 3-ring circus and their brain is quite capable of attending to it. Ask them to clean their room, a much less stimulating activity, and it’s very difficult. This predisposition towards highly stimulating activities seems to involve the brain’s reward and gratification systems as well as its processing and other regulatory systems.

Thus, a high stimulation Xbox or Play Station game is quite satisfying; ADHD individuals can hyperfocus on these games for hours on end. What does that teach? Research tells us that people who play these games do learn visual recognition skills, i.e. they can rapidly determine the number of opposing characters on screen far faster than the average human being. So, if the only thing they’re going to be is a fighter pilot, then these games might be suitable.

Other research tells us that if one chronically plays these games (chronically would be classified as one hour or more per day), one is more likely to report lower grades at school, diminished attention at school, and a greater probability of being addicted to these games or the Internet itself. Good Japanese research also noted that entertaining, highly stimulating video games that involve little else than pointing and shooting can lower both the metabolic rate and EEG in the frontal lobes of the brain. The frontal lobes, among other capacities, govern attention, aggression, and impulsivity. This is important to know especially if you have an ADHD person in your household using these games.

It seems that most ADHD children and adults are prewired to pay attention to overly stimulation things. That seems to be a hallmark of the trait. They frequently become hyperfocused on them for hours at a time. Taking these games away is probably not practical. However, limiting play time is quite sensible.

If one is to learn skills, techniques, or methods that will strengthen the brain, then the video game must be quite different than the Xbox or Play Station most popular list.

Upcoming, part 3, Play Attention vs. off the shelf video games.

PDF

Should I play or should I grow?

Posted by Peter on February 14th, 2010 | Comments off

PART ONE OF THREE

This blog is partially based on material I presented to the International Atomic Energy Agency of the United Nations in Vienna, Austria.

Playing vs. learning
What’s the difference between playing and learning? Sometimes there is no difference. People can learn through play. Educators have known this for years. Grade school teachers often try to teach using games. Games engage, excite, and motivate students. However, there is a significant difference between games that simply entertain and games that facilitate learning.

When learning through games or other modalities, three fundamental catalysts are necessary for the brain to create and grow a neural pathway facilitating long-term retention. These catalysts are attention, challenge, and deliberate practice.

Attention
A student must pay enough attention to incoming stimuli to even begin the learning process. Too little attention causes the student to constantly redirect attention to other stimuli. Picture your ADHD child trying to learn multiplication tables. While the teacher is teaching 2 x 2, he’s paying attention to the bird outside the window. Little chance that multiplication tables will be learned soon. So, attention is crucial, in fact, it’s the core to all learning. For an ADHD person, the ability to direct attention and sustain it without distraction is impaired.

Challenge
If the teacher can get a student to pay enough attention to multiplication tables, the student must then be challenged. Challenge arrives when the brain confronts something it doesn’t quite understand. The brain attempts to place the information into a tenuous relationship with information it already possesses. If the brain already knows the information, it simply retrieves the data from its storage bank. So, if the teacher presents 2 x 1, and the student knows immediately the answer is 2, then there’s no challenge and little is learned. However, if the teacher presents 2 x 7561, then the student is challenged and must use all of his pre-existing knowledge to find a solution. Attention and challenge spark creation and growth of new neural pathways for long-term retention. However, long-term retention is not guaranteed until we practice.

Deliberate practice
Educationalists have known that haphazard studying or practice results in haphazard learning. Deliberate practice is a term coined by Dr. Anders Eriksson, a professor at Florida State University (http://www.psy.fsu.edu/faculty/ericsson.dp.html). He studied how people become experts in their fields and found that the length of time they practiced and their use of deliberate practice greatly influenced their expertise.

Let’s use multiplication tables again to describe deliberate practice. Chances are that you learned your multiplication tables by practicing one group at a time; multiplying by 1, by 2, by 3, etc. In many years of teaching, I never saw a student learn multiplication tables by learning 2 x 3, then 7 x 9, then 6 x7. We learned in a sequence that was deliberately practiced until mastered.

When I was learning to multiply by 6, I had difficulty with 6 x 7, 6 x 8, and 6 x 9. So, my teacher made special flashcards for me with these specific problems written on the cards. I used these cards, blocks, and other devices to practice these difficult sequences. If I didn’t get the right answer, I got immediate feedback that I was incorrect. I used this feedback to make changes to my strategy in attempting to find the correct solution. That’s deliberate practice; sorting out the difficult elements that we have not learned, developing strategies to learn them, getting feedback regarding correctness or incorrectness of these strategies, and practicing them correctly and long enough to attain long-term retention.

Most people do not use deliberate practice. We just practice, i.e. we just repeat the same thing over and over without taking the time or making the effort to work on the elements that are most difficult for us. We often only practice things that are easy or that we’re already good at performing. We avoid the difficult elements that don’t provide immediate reward, and that seems to be the line that clearly distinguishes expert from amateur.

Coming soon, part two: Entertainment vs. Learning

PDF