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Showing Teeth By: Kimberly Larochelle

admin — Thu, 05 May 2011 20:48:02 +0000

Can Emotion Be Taught???

Can you teach someone to feel?

Is it a “Heart-Felt Smile” or are we just “Showing Teeth”?

“Smile Sweetie…please smile…” I would plead to my little boy, before his Granny would come for a visit. The result was always the same…a very stiff showing of teeth, not a real smile, and nothing about it was emotional in any way. It was just something that he had to do, whenever he saw his grandmother. It was kind of like Pavlov’s Dog…with my little boy…”I see Granny’s Face — I Smile”. And, I taught him well because he remembered every time…yes…the stiff showing of teeth, a very robotic gesture indeed.

I would marvel at the difference in the reunion, as I watched my younger child, who is not on the Autism Spectrum; react when his Granny came for a visit. “Granny!” The shout was gleeful, like pure Happiness had filled the air…and his face…his face held the most heartfelt and emotionally charged smile that spread to his entire body, as it flowed from it’s emotional center. I never had to teach him this display…he just knew it, and came by his emotional gestures, and social graces very naturally. For most of us, this does not need to be taught.

Deep remorse over what my little boy could not feel, or experience depressed me deeply. Our greatest gift as human beings is emotion, and it is also the greatest tragedy in that, for many on the Autism Spectrum, this emotional aspect of their lives is missing, diminished, or inappropriate in some way. In much of the therapy that we would try…there would be at its core…a reward system. If you smile…you can play with that toy. If you say “Thank You”, I’ll give you a cookie.

My little boy loved rewards, and he was quite good at completing whatever tasks were required in order to receive it. And so…He would “Smile”…and he would get to play with the toy. And…He would say, “Thank You”…and he would get the cookie. And…I guess that I should have been happy with that…after all he was responding to the “Social Graces” of

Society, right???…well maybe…It’s just that, while he said the right words, and made the right gestures…he didn’t…“Feel It”… and it never hit his emotional center…at least from all outward appearances. He couldn’t mirror the faces of the people that loved him and would smile at him, and just long for him to smile back.

I desperately wanted so much more for my little boy, than just to be able to respond robotically to social situations. I wanted to somehow find something or someone who could reach the emotional center of his little brain…so that he would be able to “experience” emotion. I wanted him to “feel” the smile, the hug, the emotion.

And now the emotion is here! When I put down his plate of supper in front of him, he looks up at me, straight into my eyes, and with a warm smile, he says, “Thank you, Mommy”…and, I didn’t have to promise a toy…When I give him a smile, and a thumbs – up…he knows what that means, and he gives me a smile…and real one…and a thumbs – up right back.

Best of all…are the times that Granny comes over…Wow!!! I can’ t believe my eyes, as this child, that would formally, stand back, smile stiffly (because that was what he was supposed to do), and say “Hi, Granny” in a rather monotone voice….THIS SAME CHILD…runs to the door, and embraces his grandmother with the most loving emotion that rivals even his little brother. And I watch this reunion through the bleary eyes of tears that overwhelm me with a tremendous sense of happiness and joy.

We are not just “Showing Teeth” anymore…

Sincerely,

Kimberly Larochelle

Methylphenidate Not Effective For Executive Functions

admin — Thu, 10 Feb 2011 21:31:20 +0000

One in 10 school age children have ADHD and half of those children will grow up to have ADHD as an adult. ADHD is defined as having difficulty with inattentiveness, hyperactivity and impulsivity. This tends to lead to children having difficulty in school and adults having difficulty with employment. Those with ADHD, particularly adults, commonly complain of difficulties with executive functions. The medical dictionaries defines executive function as ” the cognitive process that regulates an individual’s ability to organize thoughts and activities, prioritize task, manage time effectively and make decisions.” One can easily see how this would make it difficult to maintain and progress in a job especially one that requires any type of managerial duties. By the time those suffering from ADHD become adults most have tried the stimulant medications which are commonly prescribed for this condition. Having treated many adults with ADHD is very common to hear that the medication does not help them with organizational type skills and other types of skills which are executive function type task. A recent study in the European Journal of Neuropsychopharmachology seems to confirm what those of us that treat ADHD and those that have its already were aware of. The study found that methylphenidate the chemical compound in many of the commonly prescribed stimulant medications was not effective in moderating psychometric measures dealing with executive function. Translation- methylphenodate did not help with executive functions such as organization, planning and regulating inappropriate actions. Recently, there was a study published using children but not adults that found that a restricted elimination diet was effective in dealing with symptoms related to ADHD. Also studies relating to physical activity have been published which have demonstrated improvement in ADHD symptoms. There is also literature published which reflects that certain nutritional supplementation can at times be as effective as the stimulant medications. Hemispheric Integration Therapy also recently published a study in which significant objective progress with psychometric testing was made in a 12 week period. Most of the research is done on children and many times the adult with ADHD has been forgotten. In this case, it was nice to see a study done with adults. So there are alternatives available to treat adults with ADHD. For those who would like to simply manage their ADHD as adults, there are certain organizational skills which can aid you with executive functions. These include things such as using list, setting up a filing system, prioritizing your list and your activities, using a calendar or day planner and limiting your activities so as to not become overwhelmed.If you’re interested in improving your situation and not just managing it, consult a physician that is familiar with not only ADHD but the treatment interventions listed above.

Eur Neuropsychopharmacol.2011 Feb 7. [Epub ahead of print]

Are stimulants effective in the treatment of executive function deficits? Results from a randomized double blind study of OROS-methylphenidate in adults with ADHD.

Biederman J, Mick E, Fried R, Wilner N, Spencer TJ, Faraone SV.

Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD at Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry at Harvard Medical School, Boston, MA, USA.

Abstract

The objective of this study was to evaluate the association between executive function deficits (EFDs) and response to methylphenidate treatment in ADHD in adults. We conducted a 6-week, parallel design, randomized, placebo controlled study in adults with DSM-IV ADHD. Our psychometric index of executive function used standardized neuropsychological testing. We assessed behaviors reflective of EFDs using the Behavior Rating Inventory of Executive Function – Adult Version (BRIEF-A). Subjects with available measures of executive functioning (OROS-MPH N=40; Placebo N=47) were included for analysis. There was no difference in the percent of subjects completing the 6-week acute efficacy Phase I of the trial (100% (N=40) vs. 98% (N=46), p=0.4). The mean daily dose at Phase I endpoint was 84.6±31.6mg (1.04±0.29mg/kg) OROS-MPH and 100.5±21.9mg (1.20±0.11mg/kg) placebo (p=0.0007). Based on the neuropsychological testing at the baseline assessment, 40% of the ADHD subjects (N=35/87) were considered to have EFDs but 93% (N=81) of subjects had ≥2 BRIEF-A clinical scale T-scores >65. Regardless of the definition used, however, EFDs did not impact the clinical response to OROS-MPH. This randomized clinical trial showed that executive function deficits do not moderate the response to methylphenidate and measures of executive function deficits are not associated with response to OROS-MPH.

PMID: 21303732 [PubMed - as supplied by publisher]

ADHD and Bedwetting

admin — Tue, 25 Jan 2011 16:27:12 +0000

Parents who have children that suffer from ADHD as well as doctors and therapists who treat these families are well aware that there is a higher rate of difficulty with regard to bladder control for these children. This most times is at night but may also be a problem throughout the day as well. In addition to an obvious sign of delayed development, this also has considerable social stigma attached to it. A recent study in the Journal of Urology confirms and brings into objective evidence what those of us in the field already know. Yes, children who have ADHD are far more likely to have issues with bladder urgency and eneuresis ( bed wetting.) In fact, the higher the child scored on the Connors Parent Rating Scale a psychometric tests for ADHD, the more likely he or she was to have urgency.

In the functional neurology model, this association between ADHD and bladder control makes perfect sense. An under developed cortex or higher brain is going to give one less ability to resist a socially inappropriate urges as well as a lower reflexes such as relating to your bladder. Let’s combine the two situations to make an example. When your bladder fills, you will have the urge two empty your bladder. This is what you do as an infant. It is a reflex. As your higher brain develops you become aware that it is socially inappropriate to empty your bladder whenever it feels full. It is your higher brain which is able to inhibit the bladder reflex to empty your bladder. Thus, if you’re higher brain is not developed sufficiently you will not be able to inhibit the lower bladder reflex and you will have urgency and daytime as well as night time accidents. Now, let’s look a situation in which the child is able to control his bladder during the day but has issues with bed wetting at night. In this situation, your cortex or higher brain is less active at night when you are sleeping. Therefore, you have less ability to inhibit the lower bladder reflex and thus your bladder empties. In the second case, the child’s cortex is sufficiently developed to inhibit the bladder reflex during the day however with decreased cortical activity at night, his ability to inhibit the bladder reflex falls below threshold and he loses his ability to inhibit.

The trick of course is to find the appropriate exercise to stimulate the under functioning area of the brain (the area of dysfunction must be localized) in order to accelerate its development and address both the issue with ADHD and bladder control. This of course is the job of the functional neurology practitioner.

J Urol. 2011 Feb;185(2):663-8. Epub 2010 Dec 18.

Lower urinary tract conditions in children with attention deficit hyperactivity disorder: correlation of symptoms based on validated scoring systems.

Burgu B, Aydogdu O, Gurkan K, Uslu R, Soygur T.

Department of Urology, Ankara University School of Medicine, Ankara, Turkey.

Abstract

PURPOSE: We investigated whether certain voiding problems have a higher incidence in patients with attention deficit disorder with hyperactivity compared to age matched controls.

MATERIALS AND METHODS: We used the Conners Parent Rating Scale-revised for attention deficit disorder with hyperactivity and lower urinary tract symptom score to evaluate voiding problems. A total of 62 children with attention deficit disorder and 124 healthy controls were enrolled. We evaluated uroflowmetry patterns in both groups. Residual urine volumes and Bristol stool scale were noted. We examined the correlation between total Conners Parent Rating Scale-revised and lower urinary tract symptom score in patients with attention deficit disorder. Additionally we analyzed each index of the Conners Parent Rating Scale-revised separately in terms of correlation with symptom subgroups for lower urinary tract symptom scores.

RESULTS: Mean ± SD total lower urinary tract symptom score was 11.1 ± 2.9 in patients with attention deficit disorder with hyperactivity and 3.2 ± 1.3 in controls, a difference that was statistically significantly (p <0.001). With the exception of constipation, mean scores of all lower urinary tract symptom subindices were significantly higher in patients with attention deficit disorder compared to controls. Symptoms evaluated in lower urinary tract symptom score were mostly correlated with attention deficit disorder index of the Conners Parent Rating Scale-revised. If a child with attention deficit disorder has a high index in the Conners Parent Rating Scale-revised, he or she is more likely to have urgency. Also, if a child with attention deficit disorder has a high hyperactivity subscale score, he or she is more likely to have enuresis.

CONCLUSIONS: Voiding problems are more common in children with attention deficit disorder with hyperactivity than in age matched controls. Urgency and enuresis are the outstanding problems in children with attention deficit disorder. Simultaneous use of the Conners Parent Rating Scale-revised and lower urinary tract symptom score questionnaire should be encouraged in patients with attention deficit disorder to allow a structured and quantitative evaluation of these overlapping problems.

PMID: 21172714 [PubMed - in process]

New ADHD Study Supports Hemispheric Integration Therapy

admin — Mon, 23 Aug 2010 23:52:43 +0000

Tampa, Aug 23,2010

Improvements as much as 2 to 4 grade levels upon pre-and post-WIAT (Wechsler Individual Acheivement Test) with regard to reading, comprehension, written and oral expression and math reasoning were observed after a 12 week program of Hemispheric Integration Therapy. The program consisted of procedures such as aerobic and strength conditioning exercises, motor training including rhythm and timing exercises, sensory stimulation as well as academic training. A WIAT is a common test used by psychologist and the school systems to assess children with ADD and ADHD as well as other learning disorders. The WIAT includes subtest such as word reading, reading comprehension, math reasoning, spelling, written expression, listening comprehension and oral expression. The Brown Scale an ADHD assessment tool also showed improvements. The study was conducted by the F.R. Carrick Institute for Clinical Ergonomics, Rehabilitation and Applied Neuroscience, University of Haifa, DeMontfort University, and the Carrick Institute for Graduate Studies.

Tampa Dr. Nelson Mane D.C., is a pioneer in the use of functional neurology and Hemispheric Integration Therapy for the treatment of ADHD, learning disabilities and autism spectrum disorders said “ This is definitely a great day for functional neurologist applying the concepts of hemispheric integration to neurobehavioral disorders!” This type of treatment is growing in popularity due to the improvements that parents are seeing their children make. There is a great amount of research behind the concepts of Hemispheric Integration Therapy, last year the concept of functional disconnection syndrome was presented in the scientific literature and now the first outcome study was published in the “International Journal of Adolescent Medicine and Health.” I have personally seen many children go from worst to first in their class and have standardized testing scores improved. Parents are most impressed with how quickly their children can make gains. In the world of ADHD and learning disabilities to see such significant improvement in a 12 week period amazes many parents and teachers alike. I am a clinician and am grateful to the researchers providing outcome studies which will advance these procedures into the mainstream for the one in ten children with ADHD and the one in six children with a learning disability. As this is a drug-free approach, funding from the large pharmaceutical companies is not available and so it will probably take many years for Hemispheric Integration Therapy to become a standard practice. This is a great first step.

Dr Nelson Mane a Board Certified Chiropractic Neurologist has been interviewed by Spectrum Magazine, and the Tampa ABC, CBS, NBC affiliates as well as Bay News 9 for his work applying Hemispheric Integration Therapy and functional neurology for children and adults with ADHD, learning disabilities and autism spectrum disorders. He was featured in the Autism documentary “Walking in the Dark: Finding the Light in Autism.”

ADHD: Will my daughter be depressed and have less relationships?

admin — Wed, 23 Jun 2010 20:51:24 +0000

The latest statistics suggest that 10% of school age children have ADHD. As A doctor that treats learning disabilities as well as ADHD and Autism spectrum disorders on a daily basis it is common to here parents say things such as ” well its only ADHD, so its not such a big deal.” At presentations that I have presented on learning disabilities and spectrum disorders, I term this low spectrum comfort. Meaning that because children with ADHD have no speech delay, tics or compulsions for example some parents are not too concerned with the issue. But in reality children with ADHD have been implicated in the past to have issues such as higher substance abuse rates, incarceration rates and pregnancy rates. A new study published in June of 2010 adds fuel to the fire with findings that late adolescent girls teens to have more issues with depression as well as relationships including with mom and boyfriends. So the message becomes more compelling, ADHD is associated with many negative social issues and therefore is a condition that should be taken seriously and addressed by parents. Whether you choose to address you child condition with the standard pharmaceutical approach or with a drugless option such as Hemispheric Integration Therapy, please take action as it appears to be a factor that a parent can take on and make a difference in your child’s life. As a side note, most children present with combinations involving ADHD, tics, OCD etc and not solely with ADHD.

J Atten Disord.2010 Jun 18. [Epub ahead of print]

Late Adolescent and Young Adult Outcomes of Girls Diagnosed With ADHD in Childhood: An Exploratory Investigation.

Babinski DE, Pelham WE Jr, Molina BS, Gnagy EM, Waschbusch DA, Yu J, Maclean MG, Wymbs BT, Sibley MH, Biswas A, Robb JA, Karch KM.

Abstract

Objective: To characterize the late adolescent and young adult outcomes of girls diagnosed with ADHD in childhood. Method: The study included 58 women from a larger longitudinal study of ADHD. A total of 34 (M = 19.97 years old) met DSM criteria for ADHD in childhood, whereas the remaining 24 (M = 19.83 years old) did not. Self- and parent-reports of psychopathology, delinquency, interpersonal relationships, academic achievement, job performance, and substance use were collected. Results: The findings suggest that girls with ADHD experience difficulties in late adolescence and young adulthood, such as more conflict with their mothers, being involved in fewer romantic relationships, and experiencing more depressive symptoms than comparison women. However, differences did not emerge in all domains, such as job performance, substance use, and self-reported ADHD symptomatology. Conclusion: The findings of this study add to the literature on the negative late adolescent and young adult outcomes associated with childhood ADHD in women. (J. of Att. Dis. 2010; XX(X) 1-XX).

PMID: 20562386 [PubMed

Linda Hurtado From ABC Action News Covers H.I.T

admin — Fri, 04 Jun 2010 15:38:23 +0000

Its has been a very exciting week for me. I started the week doing a brain dissection in San Francisco which was absolutely inspiring to me. To see, hold and feel hold the human brain in your hands is a once in a life time experience. Yes, this is what I consider a great way to spend a three day weekend. Yesterday, Linda Hurtado from ABC Action News came out to the office and did a story about Hemispheric Integration Therapy. She is super and really down to earth and it was truly a pleasure to meet her. That’s a great week for me, here’s the link http://www.youtube.com/watch?v=PHPkaUoNaeI&feature=youtube_gdata

Conference Tomorrow

admin — Fri, 07 May 2010 14:43:53 +0000

Just a reminder that our conference is tomorrow at the Hillsborough County Children’s Board. The Conference is free as everyone including the speakers are volunteering their time. In addition to myself, Dr. Sutton,Suzi Azizi and June Paulsen CLTC. Attorney Mary Greenwood who specializes in special needs planning will also be participating. We have a full house if all the reservations show up but you can call the office , ask for Marilyn and see what the latest head count is. It will be good information for those newly diagnosed as well as more experienced parents.

H.I.T Interview on Disability Radio

admin — Wed, 05 May 2010 15:56:18 +0000

Monica Wharton of Disability Radio was recently kind enough to interviewed me regarding Hemispheric Integration Therapy and our upcoming free ADHD, Autism Spectrum Disorder and learning disability conference coming up this Saturday on May 8th at the Hillsborough County Children’s Board. She also asked me about our support group for parents which is sponsoring the seminar. The support group provides monthly meetings for the parents, families(the kids) as well as the outings and informational conferences like the one this Saturday. Here is the link to the interview http://www.disabilitynewsradio.com/

Neuroplasticity in the Brain

admin — Wed, 16 Dec 2009 20:09:39 +0000

One of the major concepts in functional neurology and hemispheric integration therapy is the concept of neuroplasticity. Thus, whenever I find some information relating to plasticity I like to share it with you. Once again, the video is not related to the treatment of a child with an autism spectrum disorder but is a good example of plasticity and how the brain can rewire based on the circumstances presented to it. In this video the girl has a surgery where half of her brain is removed. Whenever I find examples such as this I like to remind parents of children with autism that if the child in this video can function as well as she does with half a brain then certainly there is great potential for your child with autism who has their entire brain. Here’s the link

http://www.youtube.com/watch?v=TSu9HGnlMV0&feature=related

Hemispheric Integration therapy and a Great Mom

admin — Tue, 15 Dec 2009 17:03:28 +0000

We are currently treating a six-year-old child whose chief complaint upon his first visit was lack of muscle tone, poor vision difficulty processing language. He also has some issues with focus and impulse control. Not all, but many of the techniques and treatments used in functional neurology and hemispheric integration therapy require patient cooperation. That is, many times the patient must mimic movements or patterns. Eye movements and exercises are also frequently used. That is to say that some of the techniques can be done to the patient or for the patient while others have to be done by the patient. This mom clearly loves her child and is trying to get the most out of the treatment sessions each and every time. Originally, the child was fascinated with fish. Therefore mom brought it stickers with fish on them and even created colorful fish drawings and cut outs in order to increase the child’s focus on the particular task at hand. After about an month of treatment the child suddenly switched from fish to dogs. The next day, mom came in with dog stickers as well as home made stickers of the child’s pet dog. This has made a great difference with this child attention and focus. The child is happier, I am happier, and mom is happier. I always say that no one knows your child as well as you do. No one knows when to be firm with the child and how firm to be like you do. And no one knows what will motivate the child like you do. These insider tips from mom and this collaborative effort only benefit the child and increase the chances of a better end result. This is something that as a doctor treating children with autism spectrum disorders is tremendously appreciated. From my point of view, nothing is more valuable than an involved and in tune parent.