Is Your Child on the TEAM?


TEAMS: A New ADHD Treatment for Preschoolers

Guestpost from David Rabiner, Ph.D.
Associate Research ProfessorDept. of Psychology & Neuroscience, Duke University
ATTENTION RESEARCH UPDATE – April 2012

=====================================================================================
I have been a huge fan of Dr. David Rabiner’s ATTENTION RESEARCH UPDATE since its inception in 1997. Not only do I count on his comprehensive, plain-English explanations of up-to-date research trends and developments as key resources in my drive to keep my information base current,  I also archive them for future reference.  

For those who aren’t already among the over 40,000 people currently subscribed (sponsored now by CogMed, so no longer a charge to you), at the conclusion of this post I tell you how to get your own monthly copy in your very own email box.

I urge any professional working with individuals on the Attentional Spectrum — whether teachers, counselors, coaches, therapists or physicans — to sign yourself up the second you see those instructions, before it falls through the cracks.  (Parents and ADDers themselves can benefit too!)

Madelyn Griffith-Haynie, CTP, CMC, A.C.T, MCC, SCAC
=====================================================================================

TEAM Training

In this month’s issue of Attention Research Update I review a recently published study that examined a new intervention for preschool children with ADHD called TEAMSTraining Executive, Attention, and Motor Skills.

The premise of this interesting and important study is that through regular parent-child engagement in games designed to exercise important neurocognitive skills, it may be possible to affect enduring reductions in core ADHD symptoms.

Thus, in contrast to current evidence-based interventions like medication treatment and behavior therapy, the goal of TEAMS is to produce more fundamental and enduring change.

I think this is very important work for the field and I believe you will find this to be an interesting study.

Sincerely,
David Rabiner, Ph.D.; Associate Research Professor
Dept. of Psychology & Neuroscience; Duke University; Durham, NC 27708

———————————————————————————————————
mgh note:
 Although this post is longer than usual, I chose to present the entire April issue instead of writing a summary, in answer to the many requests I have received for more information about non-pharmaceutal treatment alternatives.

 TEAMS: A New ADHD Treatment for Preschoolers

Although medication treatment and behavior therapy provide short-term symptomatic relief for children with ADHD, such gains rarely persist after treatment ends. Because these treatments are infrequently sustained over extended periods (most children on medication do not even remain on it for a year), few individuals with ADHD receive effective treatment over the long-term.

This may explain why current treatments provide only limited long-term benefits and why many individuals with ADHD have poor adolescent and young adult outcomes even if they were effectively treated in childhood. Clearly, treatments that can provide enduring benefits are needed.

Cognitive Training Yields Good Results

As knowledge of the underlying neural and neurocognitive contributors to ADHD has grown, and knowledge that brain development is highly responsive to environmental influences has accumulated, a compelling theoretical framework for the development of more enduring ADHD interventions has emerged.

Specifically, it has been hypothesized that particular kinds of experience can ameliorate – or at least diminish – some of the underlying neural factors that contribute to the development and expression of ADHD.

In fact, this possibility has already been demonstrated in several studies.

For example, work in the neurofeedback domain has demonstrated changes in neural activity in individuals with ADHD following treatment. Similarly, significant changes in neural activity have been shown to occur in individuals following working memory training.

Neurofeedback, working memory training, and other forms of computerized cognitive training are distinctly different activities from typical daily experience and are not particularly social in nature.

However, it may also be possible to provide children with environmental stimulation that can enhance neural and cognitive functioning within the context of the parent-child relationship. And, because such activities can be inherently enjoyable, and promote positive relations between parents and children, they may be sustained over time and thus provide children with ongoing experience that can enhance their neural functioning.

In theory, such an intervention could produce enduring treatment gains in children with ADHD, particularly if introduced when children are young and neuroplasticity may be greatest.

This was the premise underlying an extremely interesting and important study recently published online in the Journal of Attention Disorders [Halperin et al., (2012). Training executive attention and motor skills: A proof-of-concept study in preschool children with ADHD. Journal of Attention Disorders, published online March 5, 2012. DOI: 10.1177/1087054711435681.]. To be candid, I found this to be one of the most interesting studies I have read during the past 10 years.

Participants were 29 four- and five-year old ethnically diverse children diagnosed with ADHD and their parents. Children and parents participated in a novel intervention called TEAMS – Training Executive, Attention, and Motor Skills.’ As discussed below, TEAMS was designed to “…apply frequent and enduring positive environmental stimulation to underlying neurodevelopmental processes in children with ADHD.”

Specifically, parents learned to engage in specific game-like activities with their child that placed increasingly challenging demands on a variety of neurocognitive and motor skills. The theory behind TEAMS was that this would promote underlying changes in neural functioning that would lead to enduring improvements in ADHD symptoms.

The authors describe this as a ‘proof of concept’ study. Thus the goals were to learn whether parents would have positive feelings about the treatment experience, whether they would engage regularly with their child in the prescribed activities, and whether there was any preliminary evidence of positive effects. As such, there was no control group and no randomization to condition. Thus, even were favorable results to be found, this was a preliminary study that could not establish the efficacy of the new treatment.

TEAMS Intervention Specifics

The TEAMS intervention was conducted in a 90-minute group format (between 5 and 10 group meetings were held) that included 3-5 families per group.

In each group, children and parents were introduced to a predetermined set of games chosen to target an array of neurocognitive skills.

  • For example, to target inhibitory control, i.e., the ability to refrain from responding impulsively, games would include variations of “Simon Says” and ‘freeze dance’.
  • To develop working memory skills, games would include things like remembering shopping lists or the locations of ‘hidden treasures’ under cups.
  • Other targeted cognitive skills were visual-spatial abilities, planning and organization, and sustained attention.
  • Games to develop motor skills were also included as was an aerobic exercise component.

Between group meetings, parents were instructed to spend at 30-45 minutes each day playing these games with their child. The goal was to provide sufficient stimulation of the underlying neural processes targeted by the games so that these processes were repeatedly exercised and strengthened.

A focus in group meetings was working with parents to identify and overcome difficulties they had experienced consistently implementing the games with their child during the prior week. Parents also learned new games, discussed the cognitive skills being targeted, and were taught how to gradually increase the difficulty level so that children’s cognitive skills were continually challenged.

The importance of regular aerobic exercise was also stressed as there is emerging evidence that this can improve cognitive functioning.

Measures

To assess the impact of the TEAMS program, ratings of core ADHD symptoms and of children’s impairment from symptoms were collected from parents and teachers. Ratings were obtained before treatment began, immediately after the groups ended, and at a 1- and 3-month follow-up. These latter measurement points enabled the researchers to learn whether any gains that were initially evident endured.

In addition, parents completed ratings of how often they engaged in the prescribed games each week and how long they engaged in these games with their child.

Results

Parental acceptance – Only one of the 29 families withdrew during the active treatment phase and this was because of transportation issues. Overall, parents attended 93% of scheduled sessions and nearly 70% attended all sessions. Satisfaction with the intervention was rated very highly.

Engagement in TEAMS activitie – For TEAMS to be effective, children must engage in the prescribed games with considerable frequency. Throughout the intervention period, parents indicated that they engaged in the games nearly every day for an average of 35 minutes. One month after treatment ended they were still playing the games nearly 3 times a week for 30 minutes. At the 3-month followup, this had declined to an average of 20 minutes/day two days per week. Thus, despite the drop-off from the active treatment period, parents and children continued to regularly engage in the games for at least 3 months after treatment ended.

ADHD symptom severity – Significant reductions in parent and teacher ratings of ADHD symptoms were evident from pre- to post-treatment. Furthermore, these reductions remained evident at the 1- and 3-month followups. Equivalent reductions were found for inattentive and hyperactive-impulsive symptoms. The magnitude of the reductions were in a range that would be considered large for parents and moderate for teachers.

Impairment from symptoms – Ratings of impairment from symptoms declined significantly for both parents and teachers. Interestingly, these declines were not significant immediately following treatment, but became evident at the 1-month follow-up for parents and at the 3-month follow-up for teachers. The magnitude of the decline was in a range that would be considered moderate.

Summary and Implications

The premise of TEAMS is that consistently engaging children with ADHD in activities that challenge and exercise particular neurocognitive functions can strengthen the underlying neural activity that support these functions and thereby diminish ADHD symptoms.

  • This premise is consistent with the rationale underlying neurofeedback treatment, working memory training, and other approaches to computerized cognitive training.
  • What is unique about the TEAMS approach, however, is the idea that such stimulation can occur in the context of game like activities between parents and children that are inherently enjoyable and that also promote positive parent-child interactions.

In my view, this is a very exciting study and the kind of work the field really needs. For years, evidence that ADHD is strongly influenced by genetic factors may have undermined efforts to examine whether experiential factors – particularly the ways that parents interact with their child – could play an important role in addressing core ADHD symptoms. What these researchers have suggested, and provided preliminary evidence of, is that this may be possible.

Note that their approach is very different from using behavioral principles to manage ADHD symptoms and encourage desired behavior.

While behavioral management approaches are important and helpful, the focus is on symptom management and not on changing children’s underlying capacities. Here, in contrast, the idea is that parents can provide ongoing opportunities to help children exercise neurocognitive functions that can lead to enduring benefits.

Also note that the TEAMS approach in no way implies that parents are somehow responsible for their child’s development of ADHD. Instead, TEAMS strives to teach parents how to provide children with experiences that may lead to enduring reductions in ADHD symptoms over time.

While I found this to be an exciting study, it is important to emphasize that this is only an initial ‘proof of concept’ of the approach.

As the authors note, the absence of any control group makes it impossible to determine why children seemed to improve. Although the theory underlying TEAMS is that the children’s ongoing involvement in the prescribed games and exercise program alters their underlying neural functioning, no such assessments were conducted. The sample size was also relatively small.

These limitations not withstanding, this initial effort demonstrated that TEAMS was experienced positively by parents who continued to engage regularly in the treatment exercises up to 3 months after treatment ended. And, beneficial effects as rated by parents and teachers remained evident after 3 months. The authors conclude by noting that a larger randomized trial is planned so that the potential benefits of TEAMS can be better understood. This is important work and I look forward to reviewing it for you Attention Research Update when it becomes available.

P.S. Please feel free to forward this [content] to others you know who may be interested. If  you would like to receive Attention Research Update on a regular basis, just visit http://www.helpforadd.com to subscribe or CLICK THIS LINK.

*************************************************************************************************************
Sponsor’s Message from Cogmed

Cogmed Working Memory Training – Learn about providing this research-supported cognitive training program to your clients

Cogmed Working Memory Training is an excellent option for professionals looking to integrate evidence-based cognitive training into their practice. There has been more published research on Cogmed than on any other cognitive training program and more than 300 clinical practices in North America now offer Cogmed Working Memory to their clients with working memory and attention difficulties.

In terms of research support, more than 20 studies of Cogmed Working Memory Training have already been published in peer reviewed scientific journals and over 50 additional studies are currently underway around the world. No other cognitive training program has such an extensive research base.

You can begin investigating the benefits of offering Cogmed Working Memory Training to your clients by clicking HERE, [www.helpforadd.com/cogmed.htm] to request additional information about the program. Even if you decide not to work with Cogmed at this time, you will enjoy learning about this intensive training approach that has strong and growing research support.

Note from David Rabiner:  I have consulted with Cogmed for over 5 years and remain impressed by their strong and ongoing commitment to research. I encourage you to evaluate the program yourself and draw your own conclusions about the potential benefits of providing Cogmed Working Memory Training in your practice.

About Madelyn Griffith-Haynie, MCC, SCAC
Founder: ADD Coach Training Field; Co-founder: ADD Coaching; [life] Coaching pioneer -- Neurodiversity Advocate, Coach, Mentor & Poster Girl -- Multi-Certified -- 25 years working with Executive Functioning struggles in hundreds of people from all walks of life. I developed and delivered the world's first ADD-specific coach training curriculum: multi-year, brain-based, and ICF Certification tracked. In addition to my expertise in ADD/EF Systems Development Coaching, I am known for training and mentoring globally well-informed ADD Coach LEADERS with the vision to innovate, many of the most visible, knowledgeable and successful ADD Coaches in the field today (several of whom now deliver highly visible ADD coach trainings themselves). For almost a decade, I personally sponsored and facilitated seven monthly, virtual and global, no-charge support and information groups The ADD Hours™ - including The ADD Expert Speakers Series, hosting well-known ADD Professionals who were generous with their information and expertise, joining me in my belief that "It takes a village to educate a world." I am committed to being a thorn in the side of ADD-ignorance in service of changing the way neurodiversity is thought about and treated - seeing "a world that works for everyone" in my lifetime. Get in touch when you're ready to have a life that works BECAUSE of who you are, building on strengths to step off that frustrating treadmill "when 'wanting to' just doesn't get it DONE!"

5 Responses to Is Your Child on the TEAM?

  1. Valentina says:

    Great article! This is the type of information that are supposed to be shared
    around the net. Shame on Google for not positioning this submit upper!
    Come on over and talk over with my web site . Thanks =) Valentina

    • Sorry for the delay in approval and response. I have been at the ACO Conference [<==link] and *just* returned, playing catch-up as quickly as I am able.

      For me, managing at a conference (especially when I am one of the presenters) takes ALL available cognitive bandwidth, so I have *finally* learned to set my systems up in accordance to what I know, avoiding that “failure feeling” most of us know so well by avoiding overpromising and the resultant underdelivering (at least where keeping up with the blog during a conference is concerned ::BIG grin::)

      Thanks for visiting, and especially for letting me know that you DID — keep coming back, and don’t be shy about sharing YOUR expertise, even if you disagree with one or more of my assertions. I welcome with open arms ALL reports of functioning “causes and cures” for attentional dysregulations. (DO keep your links to one per comment or you’ll get spammed, however, no matter how helpful the links might have been. I can’t approve them if I don’t see them.)

      ANYWAY, as soon as I have caught up with the to-do’s that accumulated from a week away, I’ll hop over to see what YOU are up to.

      xx,
      mgh

  2. H. Vibholm says:

    I would like to know if the treatment manuel for TEAMS is obtainable and where?

    • I don’t know, but if you click the link to Rabiner’s site, HE would. (remember – links are dark grey to reduce distraction potential for readers who struggle (slightly lighter than text) – roll your mouse over one and it turns red with an underline)
      xx,
      mgh

  3. Pingback: TEAMS: A Treatment for Preschoolers | memoryenhancement

And what do YOU think? Ring in below.

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Follow

Get every new post delivered to your Inbox.

Join 777 other followers

%d bloggers like this: