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.

Did you know that children’s and adolescent’s behaviors can talk? 

• “I hate school!”

• “I forgot my homework—again.”

• “My stomach hurts; do I have to go to school?”

At the Institute for Brain Behavior Integration (IBBI) we believe that children and adolescents often use their behaviors to tell us that something is not quite right. Our brains are made up of a series of interacting modules:

• auditory and visual processing
• attention and memory
• complex problem solving
• reading and language
• motor skills

Learning requires these modules to work in concert in order to produce a written, oral, or behavioral response.  A breakdown in one of these areas can interfere with your child’s ability to learn and achieve academic success.  And, since children and many adolescents are not aware of how their brains work, they use their behaviors to communicate with their parents. Most often, defiance and noncompliance regarding homework can be ‘tip-off’s’ that they have an undiagnosed learning disability that can give rise to depression if not recognized.

How Can You Tell if Your Child or Adolescent May have a Learning Disability

Here are some simple clues:

• Poor Handwriting
• Tends to be clumsy
• Meltdowns while doing homework
• Reads in a slow and choppy manner
• Difficulty sounding out and spelling words
• Delays in fine and gross motor skills
• Family history of learning disabilities
• Speaks and/or writes in short, choppy sentences
• Homework is returned with many comments from the teacher

Substance Abuse, Depression & Learning

It is well documented that learning disabilities and substance abuse go hand-in-hand. Adolescents with an undiagnosed learning disability tend to personalize their academic underachievement rather than attribute it to how their brain processes information. They may develop depression-generating thoughts such as:

What’s wrong with ME? How could I be so stupid? I am such a loser.

When thoughts such as these go unchecked, they begin to take on a life of their own and can negatively shape a child’s self-perception. By adolescence, negative thoughts and habits may have become ingrained, affecting friend choices as well as their relationship with their parents. Adolescents with undiagnosed learning disabilities not only have higher rates of depression, their rate of substance abuse is also much higher than that of their peers.

How a Neuropsychological Evaluation Can Help

An evaluation at the Institute for Brain-Behavior Integration can be an important step in putting your child or adolescent back on a path to success.  IBBI evaluations focus on the pathways between brain functioning and daily behavioral functioning. We work to identify resources that help clients improve day-to-day functioning by improving the integrative functions of the brain through various therapy tools we utilize. This can result in positive changes to school performance, relationship health in families and with peers, and benefit social relating skills. 

By Nancy Foster, PhD