Alternatives to Medication in the Treatment of ADD

Options for treating attention problems

In this op-ed in the New York Times, Richard A. Friedman, Professor of Clinical Psychiatry and Director of the Psychopharmacology Clinic at the Weill Cornell Medical College, discusses the urgent need to address the needs of students with attention problems.  Given the dramatic recent increase in the prevalence of ADHD diagnoses in school-aged children [according to the Centers for Disease Control, the lifetime prevalence in children has increased to 11 percent in 2011 from 7.8 percent in 2003 — a whopping 41 percent increase], Dr. Friedman argues for a need to find more natural (non-medical) ways to help these students. In his op-ed he states, “In school, these curious, experience-seeking kids would most likely do better in small classes that emphasize hands-on-learning, self-paced technology-based assignments, and tasks that build specific skills.”

Whereas many parents and educators consider medication as a first approach to management of disorders of attention, the recent dramatic increase in the incidence and the call for consideration of non-medical interventions for school-aged children is important for parents and teachers to consider when managing learning issues within the classroom. One important type of attention disorder that has been treated successfully without medication is auditory attention disorders associated with some types of learning disabilities. Research conducted by Courtney Stevens and her colleagues at the Brain Development Lab at the University of Oregon has shown that children with specific language learning disorders have problems with auditory attention. Parents and educators rarely use the term “auditory attention”; however, the Stevens et al. research is increasingly supportive of its important role in learning.

We all recognize students who have problems with auditory attention: those who cannot stay focused on listening long enough to complete a task or requirement (such as listening to a class discussion in school). In fact, when educators use the term “listening skills,” they are referring to auditory attention.  It is virtually impossible to imagine a classroom where paying attention to the teacher for sustained periods of time is not critical to academic success.  According to the International Listening Association (www.listen.org), 45 percent of a student’s day is spent listening, and students are expected to acquire 85 percent of their knowledge through listening. Auditory attention skills mature over time, and like many other skills important for learning (memory, thinking skills), students vary in their ability. Children with ADHD have a known diagnosis of significant auditory (and visual) attention problems. However, according to the Stevens et al. research, even across typical learners there is a variation of ability ranging from those with average auditory attention skills to those with excellent auditory attention skills. And like with other cognitive skills, independent controlled research indicates that Fast ForWord training can significantly improve auditory attention and/or reading skills in a variety of students:  typical students and those with specific language impairment.

For those interested in the specifics of the Stevens et al. study, she and her colleagues examined whether six weeks of Fast ForWord Language training would influence neural mechanisms of selective auditory attention previously shown to be deficient in children with specific language impairment (SLI). Twenty 6-8 year old students received Fast ForWord Language training, including 8 students diagnosed with SLI and 12 students with typically developing language skills. An additional 13 students with typically developing language received no specialized training but were tested and retested after a comparable time period as a control group.  Before and after training, students received a standardized language assessment as well as a highly objective electrophysiological neural measure of attention using Event-Related Potentials (ERP).

Compared to the control group, students receiving Fast ForWord Language training showed increases in standardized measures of receptive language as well as an improved effect of attention on neural processing. No significant change was noted in the control group. The enhanced effect of attention on neural processing represented a large effect size (Cohen’s d = 0.8, indicating that the average child in the experimental group is comparable to the child at the 79^th percentile of the comparison group). These findings indicate that the neural mechanisms of selective auditory attention, previously shown to be deficient in children with SLI, can be remediated through training and can accompany improvements on standardized measurements of language development.

Other controlled research, presented by Deutsch et al. at a CHADD conference several years ago, also showed improvement in attention among those students with a diagnosis of ADHD or ADD plus language impairment. In fact, if one considers Dr. Friedman’s finding that children with attention disorders benefit from “self-paced technology-based assignments and tasks that build specific skills,” there are no better designed self-paced e-learning programs than the Fast ForWord and Reading Assistant solutions. The Fast ForWord Reading products and Reading Assistant tasks are self-paced online tasks that require sustained auditory attention.  The tasks in Reading Assistant especially require activities that include listening to modeled reading, reading aloud while receiving corrective feedback through listening, listening to your own reading, and then answering questions about what was read.  Answering “think about it” comprehension questions further exercises both auditory memory and executive function skills.

In conclusion, the effort to find more natural, non-medical ways to help students with attentional disorders is at hand.  Self-paced technology programs like the neuroscience-based Fast ForWord series provide one proven alternative for improving attentional skills in students with language-based learning issues as well as those diagnosed with ADD and ADHD. 

Further Reading:

Stevens, C., Fanning, J., Coch, D., Sanders, L., & H Neville (2008). Neural mechanisms of selective auditory attention are enhanced by computerized training: Electrophysiological evidence from language-impaired and typically developing children. Brain Research, 1205, 55-69.

Students Show Improved Auditory Attention and Early Reading Skills After Fast ForWord Intervention

Related Reading:

Improved Auditory Processing With Targeted Intervention

Why Auditory Processing Disorders (APD) are Hard to Spot