Understanding Your Child’s Concentration Problems

As the mid-year exams loom, children will write tests to measure how much they remember what they have learnt. Being able to concentrate in class is a critical step in the learning process and is fundamental for success at school. When a child struggles to concentrate, a worried teacher may approach parents to discuss types of intervention. 

“When it comes to lack of concentration in the classroom, there are various options available to help learners to focus their attention better. The difficulty however, is knowing which one will really help your child,” says Susan du Plessis, Director of Educational Programmes at Edublox.

A research study to test treatment of Attention Deficit Hyperactivity Disorder (ADHD) with prescription medication showed that “only 56% of the patients in the medication group met the definition of success at the end of treatment.”* Researchers list concerns about the use of such medication in children: side effects have been reported, for some serious and life-threatening; insufficient evidence of long-term efficacy of medication; and “symptoms of ADHD reappear after discontinuing drug treatment.”

There are a variety of neurofeedback approaches offered for children with attention problems which claim to enhance concentration and optimise brain performance after multiple consultation sessions. In some cases devices like headbands are worn to measure blood oxygen levels in the brain; if these levels decrease below optimal performance when watching a DVD, the volume or brightness of the screen is reduced, sending feedback to the viewer that their concentration is waning.

In 2013 the Journal of Clinical Psychiatry published the results of a clinical trial** that tested the efficacy of electroencephalographic (EEG) neurofeedback in reducing ADHD symptoms. Forty-one children between the ages of 8 and 15 years who were diagnosed with ADHD participated; one group received EEG neurofeedback treatment while a placebo group were given treatment with random feedback. If the results achieved in the placebo group are similar to the results achieved with the group who had proper treatment, it means that it was not the treatment that made them better. This was the result in the research study, and the researchers concluded that “EEG-neurofeedback was not superior to placebo-neurofeedback in improving ADHD.”

Du Plessis explains that there are three types of attention: “When a child is easily distracted by a pencil falling off their desk or sounds outside the classroom window, they lack focused attention. Sustained attention is required to focus for long periods of time. Then there is divided attention,” says du Plessis, “which is quite similar to multi-tasking. It’s a higher-level skill where you have to perform two of more tasks at the same time. If the task is to write a story, a learner must be able to think about their characters and plot, as well as spelling and punctuation rules that apply.”

Lack of concentration is often linked to poor memory, says du Plessis. Parents may think that their child has a concentration problem, du Plessis however cautions that the root cause is often a memory problem. Working memory is the cognitive system responsible for the temporary storage and manipulation of information. Du Plessis describes three other types of memory: “If a child struggles to copy work from the board into their workbook, they struggle with visual memory. If they find it difficult to remember a number of verbal instructions, their auditory memory may be weak.” Sequential memory, says du Plessis, is remembering the order in which events take place.

There are practical cognitive development exercises that can be introduced in the context of a learning environment, which can help improve one’s memory and ability to concentrate with long-term results, says du Plessis. A research study conducted last year, sponsored by natural medicines company Flordis SA, and analysed by the Centre for Evaluation and Assessment at the University of Pretoria, showed a significant increase in focused attention among children who had participated in a five day cognitive development training course. The effect of such training on visual memory has also been examined in an unpublished study by Dr Jaiden May from the University of Johannesburg where children’s visual memory increased by 1.3 years after 22 hours of cognitive training.

Du Plessis offers tips for parents looking for intervention programmes for their child: “Solve the cause of the concentration problem. Avoid programmes that operate in a secluded environment. Rather choose a programme that replicates a classroom because it is at school that your child’s concentration will eventually be tested.” In-house measures that track intervention performance are not sufficient, says du Plessis. “Intervention programmes should be based upon scientific research with proven results. Improved grades on a school report card are an excellent, unbiased indicator to show that an intervention programme is working.”

There are a variety of ways to help your child improve their attention and memory at home, says du Plessis. “Parents can help their child improve sequential memory by asking them to re-tell a story that they have just listened to.” The Stroop Test helps improve divided attention. Du Plessis explains, “The test is to look at the words and say the colour of each word. You will struggle at first because you’re more likely to read the word.” Images for the ‘Stroop Test’ can be found by conducting an online search, an example of one is illustrated below.

Edublox are leading specialists in cognitive development with 22 reading and learning clinics across the country. Edublox offers multisensory cognitive training, aimed at developing and automatising the foundational skills of reading, spelling and Mathematics. For more information about Edublox visit www.edublox.co.za.

 

* http://repository.ubn.ru.nl/bitstream/handle/2066/125153/125153.pdf

** http://www.ncbi.nlm.nih.gov/m/pubmed/24021501/

 

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Alternative Therapy For ADD / ADHD?

Neurofeedback is a non-invasive learning strategy that works to improve the brains ability to produce certain brainwaves without the need for medication. You can think of it as “exercise for the brain”. By creating awareness about your own brainwave characteristics, you can learn to change them. Neurofeedback instruments show the kind of waves a person is producing, making it possible for the individual to learn to change in ways that improve attention and facilitate learning. It is essentially self-regulation training ideally suited to those with ADHD, ADD and specific learning disabilities.

What are brainwaves?

Brainwaves are the electrical wave patterns found in every person’s brain. Through EEG technology we can determine the strength and frequency of brainwave activity as it flows through the different areas of the brain.

  • Beta is the fastest brainwave and is produced during focused activities and is essential for attentiveness and learning.
  • Alpha is a slightly slower brainwave and is associated with a relaxed yet alert state of mind.
  • Theta is an even slower brainwave and is associated with dreaminess, relaxation and sleep.

Research indicates that children with ADHD are less able to produce Beta activity and experience excessive slow wave activity. In fact, when challenged with academic tasks, such children show greater increases in Theta activity and a decrease in Beta readings. In order for your brain to concentrate and learn, your brain needs to emit a high level of Beta waves, which the ADHD child is unable to do. No wonder children with ADHD have trouble concentrating!

Other children become increasingly anxious in exam situations, generating too much Beta activity which also interferes with the learning and retrieval process, creating increased levels of anxiety.

Assessment & Treatment

The assessment procedure begins when a teacher / parent becomes concerned about a child’s ability to concentrate and learn.

A thorough evaluation must be carried out in order to determine whether the clinical picture is consistent with ADHD. A useful tool for Neurofeedback practitioners is the involvement of a QEEG (quantitative electroencephalogram – computerized EEG evaluation). If the pattern of ADHD brainwave activity is detected, and fits in with the clinical picture, Neurofeedback training can commence.

Through Neurofeedback training it is possible to increase Beta and decrease Theta, allowing for more focused learning in most children.

How does one “train your brain”?

Much like a clinical EEG sensors / electrodes are placed on the child’s scalp and fed through an amplifier into a computer programme. The child then proceeds to play computer games or watch a movie, the only difference is that the child must use their own brainwaves to control the game / show. When the child is focused in the correct way i.e. producing the perfect amount of Beta and Theta brainwave activity, the game / movie will play, if not, the screen will fade and the brain will know to readjust.

The treatment is non-invasive and does not involve any medication. Individuals learn to voluntarily control their brainwave activity through operant conditioning.

Is this a cure for ADHD?

Neurofeedback never claims to “cure” any diagnosis. The goals of Neurofeedback are to teach the child to become increasingly self-aware and to train the brain to be more flexible. The goal of Neurofeedback training is not to change the child, but to make the child more self-aware and provide tools for the brain to re-organise itself and quickly shift into a more focused mode when required.

It is important to remember that as humans we operate within a system and, as with more traditional therapies, additional support and guidance will be needed to treat the person as a whole. With Neurofeedback the child can still be the person they are, but with increased focus and awareness and an ability to “change gears” without relying on medication, thereby learning valuable and lasting skills.

What are the results?

• Finishing tasks
• Listening better
• Less impulsivity
• Greater motivation and focus • Higher self-esteem

 

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Learning Difficulties Linked To Headaches

It is the start of the school year and many children are refreshed after the summer holidays. Unfortunately some children are frustrated by learning difficulties or Attention Deficient Hyperactivity Disorder (ADHD). A recent study found something noteworthy: There is an association between headache diagnosis and school achievements.

The study, published in Pediatric Nursing, found that learning disabilities and ADHD are more common in children and adolescents who are referred for neurological assessment due to primary headaches than is described in the general pediatric population.

Dr. Elliot Shevel, a South African migraine surgery pioneer and the medical director of The Headache Clinic, says the research shows poor to average school academic performance were more prevalent among children with headaches. “We should look deeper at poor performance. It might be more complicated than parents think,” says Shevel.

A retrospective review of medical records of children and adolescents who presented with headache to outpatient pediatric neurology clinics during a one year period was done. Demographics, Headache type, attention deficit disorder (ADHD), learning disabilities and academic achievements were assessed.

A total of 243 patients met the inclusion criteria and were assessed: 135 (55.6%) females and 108 (44.4%) males. 44% were diagnosed with migraine (35.8% of the males and 64.2% of the females), 47.7% were diagnosed with tension type headache (50.4% of the males and 49.6% of the females). Among patients presenting with headache for the first time, 24% were formerly diagnosed with learning disabilities and 28% were diagnosed with ADHD.

When to see a doctor

It is crucial that if your headaches persist, you should get to the root of the problem. The longer the headache persists, the more damage will be done to the underlying structures. “A multidisciplinary assessment will need to be done,” is Shevel’s advice. Contact The Headache Clinic for help in this regard.

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When should a child be referred to an occupational therapist?

 

Following is a few easy questions that could help you to determine if a child should be referred to an O.T.

 What is fine eye-hand coordination?

This is the ability to use eyes and hands together to perform a task.  We all use this skill every day in all different kinds of situation:  tying shoe-laces, writing, cutting, dressing, the list is endless.

How will I know if a child has a problem?

  • Drawing shows poor orientation on the page and the child is unable to stay within the lines when colouring/writing.
  • Your child will struggle with activities that kids the same age finds easy e.g. buttoning small buttons when dressing, picking up small objects
  • Your child will rather get involved in gross motor activities e.g. swinging than doing colouring, pegboard tasks, etc.
  • Threading activities will be difficult or avoided
  • Child will find it difficult to cut neatly on a line
  • Handwriting won’t be neat.

Muscle tone 

Muscle tone refers to the natural stress in the muscle when at rest. It is not the same as muscle strength. A child with a natural lower tone in his muscle will use his muscles with more effort than a child with a natural higher muscle tone.

How will I know if a child has a problem?

  • Tires easily / or moves around the whole time to maintain muscle tone
  • Appear clumsy / uncoordinated
  • Child will over emphasize movement / use exaggerated movement patterns
  • Lean on to objects
  • Find it difficult to maintain one position for a long time
  • Slouch in chair
  • Use broad base of support when sitting
  • Drool
  • Fidgety – uses this to build up tone when sitting for long periods of time
  • Usually doesn’t part-take in endurance sport

What are visual perceptual skills?

These skills are necessary to interpret seen information in the brain.

These skills are the building blocks for reading, writing and maths.

How will I know if a child has a problem?

  • Kids who struggle with foreground-background will ‘steals’ words/letters from other sentences/words and add it to the word/sentence they are busy reading.  They also find it difficult to find specific words/numbers on a page.
  • Kids with a limitation in position in space and/or spatial-relationships will confuse p/b/d, switching of words in a sentence or switching of syllables.
  • Kids with a limitation in form-constancy will struggle to read different types of fonts/hand writing and to copy writing from the black board.
  • Kids with closure impairment will confuse letters with each another when different fonts of writing are used e.g. a/d; u/a; c/e.
  • Kids with impairment in discrimination will for example struggle to find words/numbers that is the same.
  • Kids that struggle with analysis and synthesis finds it difficult to read words that they have to spell
  • Kids with a limitation in memory will for example struggle to copy work from the black board
  • Kids that struggle with consecutive memory will for example find it problematic to copy words/sentences/numbers correctly from the black board.

What is bilateral integration?

That is the ability of both sides of the body to work together to perform a task.

How will I know if a child has a problem?

  • Appears to be uncoordinated when doing tasks
  • Difficulty in performing gross motor tasks e.g. skipping, galloping, jumping-jacks, etc.
  • Prefers not to cross the imaginary midline of the body
  • Not choosing a dominant hand to write/draw/colour (after age 5)
  • Swapping hands when doing tasks

What is dyspraxia?

Praxis (a.k.a motor planning) is the ability of the brain to conceive, organize, and carry out a sequence of tasks/actions.

Praxis is the ability to self-organize.

Praxis includes motor planning, cognitive events and communication.

The child may present with the following:

  • Appear clumsy
  • Poor balance
  • Difficulty with riding a bike
  • Poor handwriting
  • Difficulty with remembering instructions and copying from the blackboard
  • May have difficulty with speech and the ability to express themselves
  • Bumping into objects
  • Late establishment of laterality (right- or left-handedness)
  • Poor sense of direction
  • Difficulty in learning new motor skills (crawling, using utensils and tools, catching a ball, penmanship)
  • Difficulty in completing tasks with multiple steps (playing board games, sports,  solving puzzles and learning math skills)
  • Difficulty in doing tasks in the proper sequence (dressing, or following directions with multiple steps, putting together words and sentences in the right order)
  • Difficulty copying designs, imitating sounds, whistling, imitating movements
  • Difficulty in adjusting to new situations or new routines
  • Difficulty in judging distance in activities (riding bicycles, placing objects) or with others (standing too close or too far away)
  • Present with delayed skills – remaining in the early stages of skill acquisition
  • Poor at holding a pencil
  • Forgetful and disorganized
  • Have a poor attention span
  • Need to go right back and begin again at the very beginning of the task when experiencing difficulty, instead of just ‘getting on with it’
  • Have difficulty using tools – cutlery, scissors, pencils – lots of handwriting problems (although not all handwriting difficulties are the result of motor Dyspraxia) poor balance;
  • Have poor fine and gross motor co-ordination
  • Have poor awareness of body position in space
  • Have difficulty with reading, writing, speech and maths

Other signs/symptoms

  • Child acts immature (cries easily, separation anxiety, etc.).
  • Concentration difficulties / easily distracted by things/people/sounds around himself/herself.
  • If a child is struggling with reading, writing, spelling, maths.
  • If a child’s school progress is behind the other kids in the class.
  • If a child has a physical impairment that is influencing his/her playing, walking, running, etc.
  • Hurts himself or other children / appear to be aggressive  –  when children struggle with certain developmental skills they may become angry easily because of frustration.  Kids who have poor self-control/impulsivity often cannot control themselves physically when angry.
  • Hyperactive child / child who fidgets / cannot sit still / talks non-stop – this child may have ADD or ADHD
  • Children who turn the paper when drawing/colouring/writing – this may be because the child is avoiding to cross the imaginary midline of the body

A complete occupational therapy assessment will be done to determine any limitations.

If therapy is recommended it is usually for once a week for 6 – 12 months, according to the progress of each child.

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