Psychful

Parents of children suspected of having ADHD would never provide their children a breakfast of cookies and potato chips. Intuitively parents know this isn’t healthy and might aggravate the symptoms of ADHD. Yet millions of kids in this condition eat breakfasts of toasted oat cereals and juice and are off to school only to bounce around the classroom and get into trouble for inattention and hyperactivity. It turns out that cereals and fruit juice are only marginally better than cookies and potato chips when it comes to fueling the ADHD child.

To understand all the physiology of these nutritional decisions may require a college degree, but to prevent these dietary errors does not. A good starting point for preparing meals for youngsters suspected of having ADHD or SPD (sensory processing disorders) is the 20/20 Protein Rule.

The 20/20 Protein Rule recommends that you feed your child 20 grams of protein (“brain food”) at breakfast and 20 grams of protein at lunch in order to improve his or her mental and behavioral functioning. Rather than going into a discourse on glycemic indexes and other nutritional issues, the 20/20 Protein Rule provides a simple guideline to start parents thinking about how to prepare healthier meals for their children so that symptoms of ADHD and SPD are at least minimized.

How do you provide 20 grams of protein to your child at breakfast or lunch? In the simplest of terms, avoid “filler” food like cereal from a box and provide higher quality meals from food groups like meat and dairy. For example, a 1 ounce (1/4 cup) serving of most meats and fowl yields about 7 grams of protein. The same goes for lunch meats, an egg, and an ounce of cheese or a hot dog, 2 tablespoons of peanut butter or a ¼ cup of cottage cheese. You get about 8 grams of protein from an 8-ounce cup of milk or yogurt. Combine a few of these options and you can quickly get to 20 grams of protein.

Proteins do not make you fat like simple carbohydrates (cereal, bread, toaster treats) and protein keeps your blood sugar more stable. Having a stable blood sugar helps with focus and attention, prevents moodiness and also prevents hunger pangs a few hours after a meal. This is critically important for youngsters who are especially sensitive to blood sugar levels and have no access to corrective nutrition while in school. A small snack of jerky and a few macadamia nuts can tide an adult over between meals but children do no have this option during school.

Relying on school lunch programs to provide 20 grams of protein in a meal is unrealistic. Protein is more expensive than carbohydrate and when schools provide meals under Federal guidelines, the protein requirements are extremely low. In order to help your child sustain attention and focus after lunch at school, it may be necessary for you to pack a lunch that contains the needed 20 grams of protein.

It will also be critical to monitor your child’s consumption of these higher protein meals. Just because you pack the lunch doesn’t mean it gets eaten, and even if it was eaten, it may not have been eaten by your child! Trading lunch components for sweets is a common problem with carbohydrate-craving ADHD children.

The 20/20 Protein Rule is not meant to be carved in stone. It is a starting guideline for parents who struggle with doing the best they can for their children who have become the focus of teacher attention in the classroom. Before you ever consider medication for ADHD, try feeding your child by the 20/20 Protein Rule and monitor the results. If your child’s mood and behavior improve by only 20%, that may be enough to curb the school’s desire for you to medicate your child.

Gary Taubes had the decency to present the issue in the form of a question in his excellent and heavily read New York Times article “Is Sugar Toxic?” As an award-winning science journalist and author of the popular “Why We Get Fat: And What to Do About It” which he wrote for mainstream readers who might not handle his previous tome “Good Calories, Bad Calories”, Taubes knows the answer to the question about sugar’s effects on our health but maintains his professional stance by presenting solid research evidence in a somewhat balanced format. His work is compelling reading.

I first heard of Taubes when searching for an eating lifestyle that had solid scientific research without a commercial interest. Taubes has collected the research and has nothing to sell, short of his book. Without endorsing specific diets, Taubes’ research concluded that a low carbohydrate diet was the best for what ails us, meaning obesity, heart disease, and cancer. Since only carbohydrates trigger the release of insulin, and the ailments with which we struggle are related to insulin resistance, the apparent solution is avoiding simple carbohydrates. This conclusion flies in the face of FDA recommendations which still focus on fats as culprits for obesity. But after decades of low fat eating and low fat foods, the obesity and diabetes rates have steadily increased. Which leads one to consider carbs.

And the ultimate carb is sugar. Once a part of diets only as fruit, sucrose (sugar you sprinkle on cereal) and its now more villainous cousin high fructose corn syrup (HFCS) are seen as the primary culprits for these lifestyle ailments along with high glycemic simple carbohydrates that rapidly break down into sugar in the body. Simple carbs are where bread, pizza, pasta, rice and a host of other non-Paleolithic “foods” come into our diets to satisfy our hunger and fill our tummies, only to whack our blood sugar levels and contribute to hypoglycemia and poor memory.

If you are new to some of these dietary considerations but have your curiosity piqued by this thread, start with Taubes New York Times article to see if you enjoy his writing style. What he and many other researchers are concluding is that the biggest contribution to the rise in lifestyle ailments of heart disease, obesity, diabetes, and cancer is the amount of sugar and simple carbohydrates that we consume. Taubes’ article concludes with a quote from Lewis Cantley, director of the Cancer Center at Beth Israel Deaconess Medical Center at Harvard Medical School:  “Sugar scares me”.

In a statement made before the US Senate this week, Arizona Senator Jon Kyl asserted that abortions are “well over 90% of what Planned Parenthood does”. This figure, it turns out, is extremely inaccurate. According to Planned Parenthood, only 3% of the organization’s budget is used for abortions, while the remaining 97% is used for broader medical services to as many as 1 in 5 American women.

We do not expect perfection from our politicians in this country. Anyone can make a mistake. And when we make a serious mistake, as in the case of Senator Kyl, the appropriate thing to do is to admit the mistake, perhaps apologize, and move on. This was not the solution chosen by Senator Kyl.

When confronted with the inaccuracy of his statements, Senator Kyl’s office repeatedly informed news sources that his statement was “not intended to be a factual statement”. His position is that the testimony he provided before the US Senate was intentionally false! Fascinating.

Critical thinkers Richard Paul and Linda Elder published a wonderful little pamphlet called Fallacies: The Art of Mental Trickery and Manipulation. In this discourse about errors in logic and manipulation, Paul and Elder report 44 different “dirty tricks” often used by persons who would rather win an argument than deal with the facts. Nowhere in their text do they cite the “not intended to be a factual statement” technique. So it appears we have a 45^th dirty trick to add to the growing list of subversion, deceit and distortion used by people intent on winning without regard for the truth.

This outrageous response offered by Senator Kyl has not escaped the media. Initiated by comedian Steven Colbert, the Twitter world is now awash in ridiculous tweets covered by the hashtag #NotIntendedToBeAFactualStatement. Americans can spot hypocrisy and enjoy slamming those who would rather “spin” (Dirty Trick #37: Spin, Spin, Spin) their behavior than admit their error.

But wait a minute! What may be most outrageous about Kyl’s behavior is that he is actually being honest by admitting that he lied! The NITBAFS (new acronym!) response is an admission of lying, dressed up in nice words, and nothing else.  Going one step further it also addresses motive: he did not intend to tell the truth about Planned Parenthood! By resorting to the NITBAFS response, Senator Kyl has admitted intentionally lying in testimony on the floor of the United States Senate.

Now that I think about this, I’m not sure whether to criticize Senator Kyl for his dishonesty before the Senate (Dirty Trick #40: Tell Big Lies) or applaud his rare disclosure of intentional lying with the NITBAFS response. What do you think?

Soemtimes a picture is worth a thousand words, and sometimes that single picture can explain a very complex subject so that the average person can make sense of the data. An example of that is the Clusterstockchart shown here that was originally posted last summer. In an effort to explain the dreaded US deficit in terms the common man can understand, Clusterstock produced this image using information obtained from the Congressional Budget Office (CBO). 

Regardless your politics or party affiliation, it is easy to see that the largest contributor to our country’s financial deficit remains the tax cuts to wealthy Americans. That loss of revenue contributes more to the US deficit than even the wars in Iraq and Afghanistan. One need not be an economist to understand the implications of these data included in the chart.

Critical thinking, especially in visual form, reveals. It does not conceal.

Although joblessness in the US is still in a very bad place and much progress needs to be made, one can gain some understanding of how the jobless rate has changed in recent years by reviewing the following chart, also from Clusterstock.

Any further explanation would be superfluous, so I rest my case.

Telephony is primarily an instant communication service. When you are ready to talk to someone, you phone them. If your party is sitting next to their sufficiently charged phone and they are not busy doing something else at that precise moment in time, and if you and they are in an area of sufficient signal strength, they may answer your call. Aren’t you surprised! You got through! You won’t have to leave a voicemail!

People are too busy today to use their telephones to talk to people. That is why texting and email have become so prominent in peoples’ communication styles. Leaving a text message or email allows your message to get through and the recipient can read and reply and their leisure. How considerate!

Are you among the many that have lowered their number of minutes each month because phoning is so frustrating? You need the data plan to continue texting, emailing, and surfing the web, but phoning? Isn’t that getting old? How presumptuous are we to expect that someone else will be ready at the precise moment we decide to call?

I call my friend John to ask him about motorcycle batteries; he doesn’t answer. I call his office phone and he is not there. I send an email and within 30 minutes I have my reply! I call Sears about getting a battery and I am immediately put on hold. And as I wait on hold I realize the signal strength is not good, so discussing parts numbers with a weak connection will not work. I’ll order online.

And this amazing device I hold in my hand which allows me to text, email, surf the web, take photos and videos which I can post to Facebook or Twitter, play games, tune my guitar, use as a flashlight, and read books from Kindle on is still called a phone.

I’m not sure the telephone as we know it can survive. And now they want us to do instant video conferencing from our phones and tablets! Who is available to answer the video conference call? Am I missing something here?

One of the biggest complaints about neurofeedback training for ADHD is the cost of the treatment. Despite her being “a particular fan of neurofeedback”, Katherine Ellison in her book “Buzz: A Year of Paying Attention” frequently cites the “drawbacks of how much time and money it requires.” Most neurofeedback providers do charge hourly fees for training that can be daunting to anyone, but there exist some providers who combine neurofeedback with individual or family psychotherapy and then bill the health insurance companies as they would for any psychotherapy. The neurofeedback becomes an adjunct treatment to psychotherapy.

Despite the overwhelming research evidence supporting the effectiveness of neurofeedback training for ADHD, costs can prevent many people from seeking the help they need. Many are unaware there are cheaper alternatives to brain training than neurofeedback. For those who cannot afford neurofeedback or do not live close enough to a provider, consider some of the alternative brain training technologies that exist today.

If cost and convenience are overriding considerations, consider audiovisual entrainment (AVE). AVE is an established technology with decades of use and some good research evidence to support its utility and effectiveness for ADHD, sleep issues, Seasonal Affective Disorder (SAD), and even chronic pain. The way it works is really quite simple.

We know that symptoms of conditions like ADHD reflect brainwave patterns that are dysfunctional. Usually this means the person has an excess of slow brainwave activity (theta) in areas of the brain (prefrontal cortex) where we need higher brainwave activity (beta) in order to concentrate, focus and pay attention. The challenge is to train the brain to produce more of the higher brainwave activity so that the symptoms of inattention and impulsivity are diminished. AVE is one way of entraining (forcing) the brain into a more functional brainwave activity.

The typical arrangement for AVE is a pair of special glasses with built-in light emitting diodes (LEDs) combined with headphones connected to a small computer box. To reduce symptoms of ADHD, the computer box is programmed to produce flashing lights and binaural beats (tones) of a frequency in the medium to high (beta) range.  The trainee puts on the glasses and headphones and sits back to relax to flashing lights and sounds reminiscent of a 60’s psychedelic experience. The flashing lights and beating sounds entrain the brain to a higher brainwave range which, in the case of ADHD, allows the trainee to then focus and concentrate better due to the changes in the brainwave activity.

One of the most respected providers of AVE equipment is Mind Alive, Inc. in Alberta, Canada. David Siever, the founder of Mind Alive, has refined his AVE products over three decades and participated in published research demonstrating the safety and effectiveness of AVE technology. His devices have been used in school systems in Canada and the U.S. with considerable success in reducing inattention, increasing focus and concentration, and improving academic performance for children. A basic David Pal AVE device can be purchased online for less than $300.

If purchasing a reputable AVE device is still too expensive, and you own an Android phone, then consider the AVE application available for less than $5 called aDose. By using your smartphone and the aDose software, you can entrain your brain for greater focus and attention in a manner similar to the David Pal. Simply sit back, place the phone over your eyes, plug in some headphones and start the program. I know of nothing cheaper when it comes to brain training for ADHD. As always, results may vary, and you get what you pay for.

A recent CNN/Health.com story “FDA mulls future of electroshock therapy” reports an FDA advisory panel will decide if ECT (electroconvulsive therapy) machines should become more tightly regulated. Like gun control, the debate is not whether ECT is safe, cost effective or therapeutic, but whether the machines need more regulation. And like gun control debates, the advocates are quick to reveal how the new machines are safer and don’t cause as much damage as previous models.

ECT advocates, mostly psychiatrists who make $200 every time they press the ECT button, believe the FDA should not interfere with their lucrative practice of shocking people’s brains into a seizure state. Hospitals and nurses may also advocate for ECT because the insurance reimbursement also pays for the hospital shock room, nurses to prepare the patient for ECT, nurses to care for the patient after ECT, and another hospital room for the patient to recover enough to receive yet another shock of ECT.  

Patient rights organizations and advocacy groups want a review of the entire ECT process by the FDA. Think about that.  The patients who might benefit from ECT are objecting and do not want the procedure to be used without further evaluation. It’s the providers who want to continue to administer ECT, not the patients! Where is the advocacy from satisfied patients whose lives have been saved by ECT?

A review of the limited published research on the use and effectiveness of this 80 year old procedure reveals:

• ECT is no longer reserved for those patients for whom all previous treatments have failed.
• ECT is now used freely and frequently whenever antidepressants have failed to lift someone’s mood.
• ECT alone is generally ineffective and is routinely combined with follow-up prescriptions of antidepressants.
• Repeated administrations of ECT are routinely needed to achieve and maintain “results”.

Summary: When antidepressants, which are only marginally better than sugar pills, fail to correct depression, the psychiatric solution is repeated ECT administrations and more antidepressants. Not psychotherapy. Not neurofeedback. Not an Alpha-Stim™ (an FDA-approved home medical device shown to be 2-6 times more effective than antidepressants). No, we need expensive/lucrative ECT, something only MDs can do.

Rather than focusing on the machines, perhaps the FDA should be asking more germane questions:

• Is ECT more effective than placebo (sham ECT treatment)?
• Is ECT more effective than alternative therapies that are non-invasive, do no damage, and can be performed less expensively by non-medical professionals?
• What is the relapse rate for ECT?

I have watched bright psychiatrists and struggling psychiatric hospitals change their practices and hospital space utilization to accommodate greater use of ECT, and it wasn’t done because of ECT’s treatment effectiveness. As long as the FDA is considering gun control, perhaps they should consider whether or not we really need the guns.

For the 2-5% of children who struggle with the most common psychiatric disorder ADHD (Attention Deficit Hyperactivity Disorder) there exist, broadly speaking, three main avenues of treatment: behavioral , pharmacological, and biological interventions. Although all three avenues have their supporters and research to demonstrate their effectiveness, only one avenue of treatment treats the condition of ADHD, the rest treat only the symptoms.

Imagine a child with ADHD and farsightedness (hyperopia or presbyopia) that can see things that are far away but struggles to see objects nearby. This child will have difficulties reading, writing, and doing math all because he cannot focus on books and papers. As a result of unwanted genetic influences, the child’s cornea is too flat or the eye is too short, a biological problem. The same is true of this child’s unwanted ADHD disorder. Genetic and other influences have created a biologically-based condition that does not respond to interventions of, “Try harder”, “Sit still”, or “Just focus” anymore than it would for the child’s farsightedness. Because of unwanted biological conditions, this child cannot see properly or mentally attend to boring material. How might we treat these conditions to help this child?

A behavioral approach for the farsightedness might be to teach the child to squint his eyes in an attempt to improve his vision or to push the textbook or paper further away from him in hopes he could better focus on the material. Hardly satisfying, but it might help some children in some instances cope with their biologically-based vision problem. Behavioral approaches for ADHD attempt to teach children to stop and think before acting, to plan and organize better, and other strategies designed to help children cope better with their biologically-based ADHD. Behavioral approaches are primarily for coping, not correcting.

Giving this child glasses with the correct prescription is the standard of care in ophthalmology. This treatment is equivalent to giving the child medication for ADHD, also the standard of care. The treatment works only as long as the child wears the glasses or takes the medication. If he loses his glasses, he reverts to farsightedness. If he fails to take his medication, he reverts to full ADHD. Glasses for farsightedness and medication for ADHD treat the symptoms of the problem but neither corrects the condition.  

Biological treatment for farsightedness might involve laser surgery. The goal of the intervention is to correct the condition at the biological level, not simply treat the symptoms. Biological treatment of ADHD might include changes in diet, chelation to remove toxic metals, or neurofeedback. Only biologically-based interventions like these treat the condition, not just the symptoms. When children with ADHD are treated with a multimodal approach that addresses the biological basis of ADHD, only then are they receiving treatment for the condition, not just the symptoms.

Charles Ferguson used his acceptance speech for winning the Academy Award for best documentary (“Inside Job”) to remind us about the absence of changes and accountability since the financial crisis. Three years after Wall Street gambled the world into the Great Recession, there have been no major changes in financial regulations and no individuals have been held accountable for the free-market behavior that toppled too-big-to-fail banks and insurance companies.

Change comes slow these days when both sides of the political aisle are beholden to powerful business interests and corporate entities that now have unlimited sway when it comes to campaign contributions. Our Supreme Court has ruled that corporations are like people; they shouldn’t be prevented from the free speech of making unlimited financial contributions to buy the votes they desire in Congress. And so we continue to wait for change.

A poignant article “Regulation is born from fire” by brooklynbadboy in the Daily Kos makes a tremendous point to consider in this predicament. The second worst fire in US history occurred at the infamous Cocoanut Grove Nightclub in Boston in 1942. Nearly 500 people died because the business owner had used his Mob connections to avoid fire-safety standards. Exit doors were welded shut so customers could not leave the nightclub without paying their tabs, and the only way out of the club, a revolving door, served to trap the customers and employees inside during the fire. After the fire, major regulatory changes were made in the interest of public safety, and the club owner went to prison. From the article:

The fire led to active involvement of government in the regulation of private property. Property owners were told how their doors would swing, and how many people could be inside a building at any given time. They were told to build portals for escape and to mark them clearly. They were told what to do with their property, on terms they were not allowed to set, by an intrusive, activist government acting on behalf of the people.

With the unemployment rate hovering around 9% and bankruptcies at the highest rate since the Great Depression, the American economy has suffered a blow at least equivalent to the Cocoanut Grove Fire, but there have been no regulatory changes. Government is failing to act to protect the public. And the financial practices that caused the crash of 2008 continue unabated by regulatory reform.  

Consumers and bank depositors cannot change the way the financial markets operate. Only Congress can halt the casino practices of the American financial markets that threaten to burn down again taking more homes, more jobs, and more security from the American taxpayers. Just as in 1942, private business interests don’t want an intrusive government interfering with their right to earn stunning profits in the free marketplace. Without the vigilance of legislators for public protection, however, our democracy moves further toward a plutocracy controlled by Wall Street banks and insurance companies, the Cocoanut Grove nightclubs of the 21^st century.

Many in our country love technology so much that they stop thinking critically when introduced to the latest technological devices. Now John Cloud of Time is enamored with the Quotient ADHD system, a $20,000 biomedical device because it “generates such a large body of statistics and because it’s nearly impossible to cheat” when diagnosing ADHD. His assumption is that more precise behavioral data means a better system for unraveling the mysteries of ADHD.

Technology is impressive. I know this because for the last six years I have been utilizing neurofeedback in my private practice to treat children and adults with ADHD. My client parents and children are very impressed by the computer software of my Cygnet system which reveals the brainwave activity of the person training, and the fact that I use alcohol and paste to attach EEG leads to the scalps of the person training. You know you’re dealing with “real medicine” when you have an alcohol pump bottle on your desk and you attach electrodes to the scalp!

I’m sure John Cloud would be impressed by neurofeedback if he had the opportunity to experience the training. It still impresses me that with this fairly simple, and by comparison, very inexpensive neurofeedback system we can slowly train the human brain out of impulsivity, hyperactivity, and improve attention, focus, and concentration, among other things. And neurofeedback works. The American Academy of Pediatrics cites “biofeedback” (meaning EEG biofeedback, or neurofeedback) as having “Good” research support in treating child and adolescent ADHD.

The problem with Cloud’s techno-fascination is that the Quotient ADHD system measures symptoms of ADHD with greater specificity and precision than even the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) provides for diagnosis of the condition.  This is technological overkill.  It gives us more precise diagnostic data for a condition that cannot yet be described precisely. And worst of all, it assumes that ADHD can be measured with precision and once-and-for-all determine who has ADHD and who does not. Herein lies the problem with psychiatric diagnoses.

The pitiful DSM attempts to provide diagnostic criteria for all sorts of psychiatric conditions so as to mimic the nosological precision of other “real” branches of medicine. And it cannot. The DSM notwithstanding, we do not yet have the means by which to precisely define who has ADHD and who does not. The DSM attempts to provide a behavioral observation system to classify and diagnose, but it is so primitive in its design as to be barely worthwhile. OK, it is better than nothing.

The truth is that ADHD and most other psychiatric conditions reflect symptoms that range in severity on a continuum from occasional symptoms to frequent symptoms. As my psychology professor taught me years ago, the only thing that makes something a psychiatric condition is the frequency and severity of the symptoms.  And frequency and severity are continuum measures.  Lots of hyperactivity and impulsivity means ADHD; less means “boys will be boys.” It all rests on a continuum and there is no line in the sand which one crosses to “have” ADHD.  

Let’s be practical. Assume your “busy” child aggravates his teacher and it is recommended that you have your child tested for ADHD. You love your child and want the best for him, so you pack him up and travel to the nearest provider with the Quotient ADHD system. Your child completes the assessment and you are told he is more impulsive, inattentive and hyperactive than others his age but he does not meet the criteria for a diagnosis of ADHD. Now what? He doesn’t have ADHD, but he is still driving the teacher and his classmates crazy. Can you now get a pediatrician to prescribe a stimulant medication for ADHD in an effort to improve his condition?  Perhaps not. He has just been diagnosed by the most supreme black-and-white technology as not having the condition.  If he doesn’t “have” ADHD he can’t be treated for ADHD.

As Daniel Amen so frequently says, psychiatry is the only branch of medicine that does not look at the organ it purports to treat. Until the American Psychiatric Association tackles diagnosis with more precision regarding brain functioning, the battle over who “has” what condition will rage on. Technology firms will continue to pump out impressive, and more importantly, expensive systems to provide faux precision to compensate for psychiatry’s lack of clarity in diagnosis. And writers like John Cloud will continue to be dazzled by high-tech low-value diagnostic equipment that does nothing to treat the person in need of help.