Paying Attention to the Problem of Attention

Without a doubt, there has been an increase in the prevalence of concerns related to attention management in pediatric patients. Distinguishing ADD/ADHD from attention problems that are related to learning issues, anxiety, depression, or conflict with peers or family is not easy, and often requires more than one set of eyes and ears to make an accurate diagnosis. Obtaining a comprehensive neuropsychological evaluation is often a critical step to arrive at a clear diagnosis and generate an appropriate treatment plan.

A Synopsis of ADD/ADHD Facts

• There has been a 20-fold increase in the prescription of stimulant medication in the past 30 years
• Stimulant medication clearly produces short-term benefits in the ability to focus attention
• A diagnosis of ADD/ADHD needs to be based upon multiple sources of information about other causes of attention management difficulties
• There is strong evidence that use of stimulant medications alone is limited in its ability to effectively address co-morbid problems with anxiety, depression or the effects of intra-familial conflict or distress

A Clear Diagnosis Supports Positive Outcomes

Disruption of attention is one of the most common features of numerous cognitive and psychological conditions. While detection of inattention is important, it does not provide a complete picture to provide an accurate diagnosis of the underlying cause of the inattention.

At the Institute for Brain-Behavior Integration (IBBI), our comprehensive neuropsychological evaluation process generates a detailed picture of:

• Attention management skills
• Learning and information processing abilities
• Behavioral and emotional self-regulation skills
• Family history and current family functioning factors
• Relevant medical concerns, including dietary factors

The information derived from the evaluation is designed to diagnose the specific factors that activate, maintain and/or exacerbate each child’s or teen’s attention difficulties. These can include primary learning or psychological challenges, as well as ADD/ADHD. We will provide the referring physician with thorough evaluation results within 1-2 weeks after the evaluation is conducted.

Collaborative Responses to Multiple Challenges

The problems that go along with attention difficulties include academic performance concerns, family and peer relationship strife, sleep disturbances, and mental health concerns related to anxiety and depression. The co-morbidity of attention problems and learning disabilities is also quite high. Therefore, the biggest challenge lies in how to respond to the concerns regarding attention and behavior when the concerns are brought up with the child’s or teen’s health care provider.

A Multi-disciplinary Health Care Team Can Help—

At Partners in Healing of Minneapolis and the Institute for Brain-Behavior Integration, our integrated health care team consists of professionals trained in:

• Neuropsychology
• Health Psychology
• Clinical Psychology
• Child and Family Therapy
• Nutritional Medicine

Our experienced team of professionals actively collaborates with the pediatric team and the family to discuss the diagnosis, and then develop and implement the treatment plan that works best for each child or teen. Beginning with the diagnosis of causes of inattention through treatment of the child’s or teen’s needs, our collaboration with the pediatric medical team allows us to serve as true Partners in Healing. We look forward to working with you.

First came the stories about cognitive problems (e.g., early onset dementia) experienced by retired professional football players. Then came increased concerns about active professional athletes who suffered on-field concussions and the guess-work as to when they could return to the playing field. Next came stories about athletes under age 18 who suffered concussions, and the legitimate questions as to whether their younger brains made them more vulnerable to the effects of repeated blows to the head sustained in the course of their chosen sports. Other questions about managing concussions in young athletes abound. For example:

• Should kids be required to leave the game after their “bell is rung” or they “see stars?”
• What is the timetable for a safe return to play?
• On what basis is the decision to return to play made?

These and other questions have been raised about how to balance the benefits of participation in school sports with the need to manage the near-term and potential long-term consequences of concussion in athletes younger than 18 years of age.

Current statistics indicate that more than 140,000 youth suffer concussions each year, with approximately one third of them suffered in the course of playing organized sports. Most of the injuries occur as a result of participation in football and ice hockey, but according to a recent article in Scientific American (February 2012), soccer, wrestling and other sports, contribute their fair share to the total.

Identifying the Signs of Concussion

Concussion involves when a blunt force to the head produces altered concentration, memory, judgment, balance or coordination problems, however transient. Loss of consciousness is not a required symptom. The alteration of normal mental status, which often lasts only a short period of time, nevertheless indicates a minor traumatic brain injury has been sustained.

A neuropsychological evaluation assesses key functions that are sensitive markers of readiness to resume play:

• Attention, concentration, and vigilance
• Reaction time, divided attention, and mental flexibility
• Learning and memory abilities (verbal and non-verbal)
• Problem-solving, planning and reasoning skills

A neuropsychological evaluation of the athlete at the Institute for Brain-Behavior Integration (IBBI) carefully examines these cognitive abilities and determines whether current levels of functioning are consistent with estimates of how they have functioned in the past. IBBI uses this data to help guide subsequent treatment plans and assist in making decisions related to safe levels of activity that the athlete can be engaged in during the various phases of recovery.

Managing the After-Effects of Concussion

It is said that, “time heals all wounds.” How much time is really needed to heal the wound of concussion? In the case of pediatric concussion, several issues combine to determine the length and extent of an individual’s recovery. 1) What was the baseline functioning prior to the concussion? 2) Was this the first concussion and what was the interval of time between the current and prior concussion if there was more than one? 3) Have changes in the functions or behaviors seen in Post-Concussion Syndrome been observed? Answering these and other questions as part of the IBBI evaluation helps determine the optimal plan for each affected athlete (or for a child or adolescent who has sustained a concussion for any reason).

Clinical Collaboration is the Key to Treatment Success

Managing the after-effects of concussion is challenging because in addition to cognitive concerns, problems with sleep, emotional disturbance, somatic complaints and also changes in family and peer relationships prove to be very challenging. At IBBI we actively work with the referring team of health professionals to formulate the optimal plan of care for each patient. Our professional staff is available to address the psychological, interpersonal and behavioral issues that can arise with the patient and his/her family.

Prompt & Actionable Evaluation Findings

At IBBI, we work to schedule and evaluate patients as soon as possible after their injury. Following the evaluation process, we provide prompt results to the referring physician, which contain comprehensive and actionable recommendations that guide the student, his/her family and treating physicians in how best to manage the neuropsychological and psychological aspects of the post-concussion recovery process. Also, we remain available to consult with the physicians throughout the evaluation and treatment process.

• Change is inevitable, but overcoming depression requires learning how to notice it and how to utilize the opportunities for positive change when they arise
• Symptoms often represent people’s best attempted solutions based on the absence of acceptable and available alternatives, but symptoms can resolve when better alternatives are discovered
• Clients almost always possess the internal and personal resources for positive change but need help developing them in carefully built up and gradual steps
• People’s most important resources often exist outside of our their immediate awareness: effective therapy involves helping people gain access to the resources they don’t know they already have
• People learn best when they encounter new experiences that naturally challenge them to expand their range of skills and put new problem-solving tools in their personal life skills “toolkits”
• The primary job of an effective therapist is to know how to access and utilize the naturally occurring  personal resources within each client and guide him or her on the path toward positive change

Applying our Therapeutic Approach with our Clients:

Sam’s* decision to seek therapy, he said, was primarily because of his physical pain caused by the car accident in which he was involved several years earlier.  He saw the pain as the basis for a slew of problems he now faced.  He was not able to participate in his life the way he did before the accident.  His marriage relationship was strained and he was more irritable and less patient with his children.  The intimacy that he and his wife used to enjoy was just a distant memory.  He had no energy or interest for those activities in which he used to find pleasure.  He had been demoted at work, which put additional financial pressures on him and on the family.  His weight had increased by more than 35 lbs, negatively impacting his self-image and lowering his already  injured self-esteem.  Sleep was erratic and non-refreshing.  Most worrisome to him was the expectation that his future held little chance of offering anything   except “more of the same.”   

Partners in Healing’s Whole-Person Approach to the Treatment of Depression

Treating Sam involved four therapeutic components that highlight the individually tailored approach that Partners in Healing (PIH) uses in the treatment of depression.  Of course, we recognize that other approaches to treatment can and do play an important role in the overall plan of care of patients.  That is why PIH clinicians strive to partner with health care professionals from other disciplines (e.g., physician colleagues) whenever possible.  We seek to provide effective, collaborative and integrative treatment experiences for our clients. 

• Psychotherapies: Treating depression typically requires identifying and learning to change the negatively biased thinking and emotional “habits” of  depression that serve to maintain a person’s limited self-view and reduces their chances of making  positive change.  By helping Sam to change the thought patterns supporting his negative self-fulfilling prophecy, he was able to open the door to positive change in his life. It also opened the door to pain management.
• Natural medicine therapies: Many people believe that treating depression requires altering brain chemistry.  This is one reason people seek prescribed medication in depression treatment.  We agree that at some level, every mood, thought and action involves a chemical aspect.  It is widely recognized that over-reliance on prescribed medication is not the most effective method of treating depression.  Moreover, there are many ways to impact the body’s chemistry without over-relying on prescription medications.  Sam met with our Naturopathic physicians and learned about natural therapies that supported healthier digestive and metabolic functioning of the body.  This nutritional and natural medicine support gave his body the nutrients it needed to support healthy brain functioning. With a brain that was metabolically healthier, he was able to put into practice some of the suggestions and skills he learned in his psychotherapy work.
• Self-regulation therapies: The ability to regulate one’s thoughts, emotions and behaviors is essential to healthy mental and emotional functioning.  Without self-regulation skills, we are at the mercy of our environment, reacting to whatever happens in our lives rather than actively shaping our life paths.  Learning to utilize self-regulation skills (e.g., hypnosis, biofeedback and meditation) was an important part of Sam’s overall depression treatment plan.  It also helped impact the psychological and physiological aspects of his pain disorder.
• Behavioral activation: We live in the world and not in our heads.  Therefore, an essential part of the Partners in Healing approach to depression treatment involves learning to weave the skills learned in therapy into the fabric of one’s life.  That was a critical part of Sam’s treatment process.  All three components of his therapy (i.e., psycho-therapy, self-regulation training and natural medicines) led to changes in how he conducted his life. The fourth element, the behavioral application of his skills, finally helped Sam to make a positive impact on his sleep cycle, his response to pain sensations, and his capacity to interact with his spouse and children in more satisfying ways. 

For more information on how Partners in Healing can help you with mood related conditions, please contact us at  763-546-5797.

By David Alter, PhD

*”Sam” represents a composite of several clients written so as to protect the privacy and confidentiality of the individual people the character “Sam” represents.

(Dr. David Alter, PhD, LP) and (Nancy Foster) will present "Harnessing Neuroplasticity: A No Medication Approach to Attention Disorders, Mood Dysregulation, and Learning Disabilities"at "Living, Loving, and Learning with ADHD", the annual conference of the Learning Disability Association of Minnesota on April 16, 2011. Alter and Foster are the principles behind our InstituteI for Brain-Behavior Integration (CBBI) at Partners in Healing. For more information on neuropsychological, academic achievement/learning style, and psychological evaluations for children, teens, and adults, contact us at 763-546-5797 or info@pih-mpls.com.

(Brought to you by Dr. David Alter)

 Spring is coming.  It is a season of renewal, of new  beginnings that restore hope and offer to give us a fresh start.  So, how do we get a fresh start when we so often drag the past around with us?  What are the steps we can take that really make a difference in how the sense of connection we feel to others and to ourselves?  In this inspiring 20-minute talk, Dr. Brene Brown gives us a simple but powerful answer that can not only give us a fresh start this coming spring season, but opens the doors to a life transformed!  Enjoy! 560x349]

New at PIH is theIInstitute for Brain-Behavior Integration (IBBI) is a one-stop resource for comprehensive neuropsychological, academic achievement/learning style, and psychological evaluations for children, adolescents, and adults. The IBBI is a division of Partners in Healing of Minneapolis. David Alter, PhD, LP, ABPP, ABPH and Nancy Foster, PhD bring 40 years of clinical experience in the evaluation, diagnosis and treatment of many conditions affecting mind and body. To schedule an evaluation, contact us at 763-546-5797 or info@pih-mpls.com.
A CLEAR DIAGNOSIS HELPS GUIDE TREATMENT EFFORTS
We specialize in evaluations of problems in daily functioning for children, adolescents, and adults. All clients can:
• Address concerns about ADD/ADHD that rise in childhood through adulthood
• Examine learning difficulties that disrupt academic or work performance
• Evaluate concerns about declines in cognitive abilities and daily function, related to
o Worries about mild cognitive impairment or dementia
o Diseases such as diabetes, heart disease or multiple sclerosis (MS)
o Post-chemotherapy “brain fog”
o Past or current alcohol or other substance abuse
o The presence of significant depression, anxiety spectrum difficulties, and other mental health challenges

Children and Adolescents can:
• Get answers regarding the presence of ADD/ADHD, learning disabilities or other process difficulties, and what you can do to help
• Seek clear recommendations that help families reduce conflict around homework, household responsibilities, and sleep routines
Adolescents and Young Adults can:
• Obtain specific information on academic strengths or vulnerabilities to better prepare for college and career success
• Undergo evaluations to determine eligibility for accommodations for college and graduate entrance examinations (ACT, SAT, GRE, MCAT, LSAT)

Dr. David Alter and Dr. Deborah Simmons are currently taking a master class in hypnosis with internationally known psychologist and marriage and family therapist, Dr. Jeff Zeig.  Dr. Zeig is the Founder and Director of the Milton H. Erickson Foundation in Phoenix, Arizona.  Dr. Zeig conducts hypnosis and psychotherapy workshops internationally and has edited, co-edited, authored, or coauthored more than 20 books that appear in twelve foreign languages. His current area of interest is extracting implicit codes of influence from various arts, including movies, music, painting, poetry and fiction that can be used to empower professional practice, and everyday communica-tion.  Interested in clinical hypnosis?  Call PIH at 763-546-5797. 

(Brought to you by Dr. David Alter)

As the huge baby boomer generation ages, the attention being paid to age-related challenges is growing, too.  I can’t tell you how often I receive requests for evaluations from people in their 60s, 50s and even 40s, worried and sometimes terrified that their memory lapses signal the emergence of that dark shadow we call Alzheimer’s dementia.  Thankfully, the vast majority of the times, those evaluations yield explanations for the problem that are fully reversible, highly treatable, and ultimately totally reassuring to the client!

One of the oldest and most effective treatments for our fears is humor.  Facing our darkest fears with laughter and levity takes the edge off our fears and helps build resilience in the face of life’s ups and downs.  As our gift to you, here is a prescription for facing aging-related worries.  Take this remedy once a day between meals and see whether the urge to call me in the morning passes.  (Of course, should you have any concerns, that persist, give us a call!) 

By Dr. David Alter in MindMatters

Do you believe that simple problems can be solved with simple solutions but that complex problems require complex solutions?  When it comes to the brain, neuroscience suggests that relatively simple solutions are quite capable of producing dramatic change.  The secret lies with the brain’s ability to reorganize itself on a moment-to-moment basis.

The brain is made up of 100 billion neurons that form more than 100 trillion inter-connections to other neurons.  That level of “connectivity” makes the human brain one of the most complex structures in the known universe!  Out of that degree of complexity emerges the brain’s ability to safely smoothly bring a mug of hot aromatic coffee to your lips and to compose an hour-long symphony orchestra’s score that coordinates the movements of 100 musicians playing 25 types of instruments at the same time. 

The brain wires some neurons to other neighboring neurons, and wires others to far-away neurons.  This wired network allows the brain to exercise incredibly fine-tuned regulation of sensation, emotion, thought and action.  Limited inputs have far-reaching effects.  The key is that the brain is also a creature of habit: its firing patterns don’t change unless we deliberately and consistently work to change them.

What effort is required to take advantage of the brain’s ability to reorganize itself on a moment-to-moment basis?  The brain appears to be eager to learn.  It is designed to take in new experience.  New experience is assimilated into the brain’s complex neural circuitry. With repeated practice what was new and challenging becomes routine and effortless.  For example, within three weeks of practicing juggling skills an hour a day, brain imaging studies showed that people with no prior juggling experience had expanded the complexity and activity of the neuron firing patterns in brain areas that regulate fine motor movements needed for juggling.  Just three weeks!

What is the lesson for us?
• Visualize a change you want to make
•Identify the elements of the change in behavioral terms (e.g., what do people do who act in the way you are seeking to develop)
•Focus on consistently practicing one or two elements for three weeks
•Observe the changes that result

Congratulate yourself on using the simple steps to reorganize and transform your brain’s complexity to help you  achieve your goals.

Authored by Dr. David Alter in Dr. Alter's MindMatters

The experience of pain is something with which everyone is familiar.  The experience of chronic pain is something else entirely.  Chronic pain is constructed out of many different components or elements that reinforce each other.  With chronic pain, the whole really is greater than the sum of the parts.  The good news is that the different elements of the overall pain experience can be treated separately.  When this is done, the overall experience of chronic pain can change.  For example, clinical hypnosis, a powerful tool woven into many different pain treatment approaches, can focus on:

• physical aspects of pain (e.g., the location, intensity or other sensory qualities)

• emotional aspects of pain (e.g., the fear that no one can help reduce the pain)

• cognitive aspects of pain (e.g., the belief that limitations in functioning levels make you worthless)

• spiritual aspects of pain (e.g., the conviction that the pain persists because of some past wrong the person committed)

• or the narrative aspects of pain (e.g., the interconnected memories from our past that become the on-going “story” of our lives, that contributes to self-fulfilling patterns of functioning in our lives)

For chronic pain treatment to be effective, each of these different elements has to be examined.  Each of these elements contributes to the overall experience of pain for each person.  Our culture tends to have a hard time considering a problem as caused by many different elements.  That is, perhaps, a major reason that when it comes to pain (a universal experience that creates untold misery for so many) the search for a magical cure is so strong.

Too often, the search for a solution begins and ends with prescription medications, often painkillers of one sort or another.  While moderate and focused use of such medicine can be helpful, it cannot treat all the different elements that make up the experience of chronic pain.  Not surprisingly, when pills are used to treat something for which they are not designed or intended, huge problems with dependence or addiction to pain medications arise.  This only complicates efforts to help people learn to manage the pain. 

If you are suffering from chronic pain, or if painkillers have become the primary tool you use in your efforts to manage pain, consider having a comprehensive holistic evaluation of your pain condition.  Learn what the building blocks are for your pain experience.  Learn how to change some of those building blocks and discover the power you have to change your pain experience.