ADHD Overfast Response to Tapping

When I have children with ADHD get started on an IM program, I automatically adjust the tempo to 63 beats per minute rahter than the standard tempo of 54. Why, they almost always over-anticipate the beat with the standard tempo and so miss clapping or tapping in rhythm. But when I change it to 63, most find their sweet spot and can perform admirably. IM's recently released bibliograpy of temporal studies points to research that came to the same conclusion. Check it out. That paper and others are found at this site. Here is the citation:

Hilla Ben-Pazi, Ruth S. Shalev, Varda Gross-Tsur, and Hagai Bergman. (2006). Age and medication effects on rhythmic responses in ADHD: Possible oscillatory mechanisms? Neuropsychologia 44: 412–416

This question came up for me recently. Does ADHD meds suppress timing? In this case, the meds are Adderall. I see a 6 year old girl who had excellent scores on IM prior to starting Adderall. Afterward, her score fell into the severely deficit range. Interesting. The above study found that there was no difference in timing skills for those on Methylphenidate (i.e. ritalin). I'd love to see a study on Adderall. Adderall is a combination fo amphetamine and dextroamphetamine. It has a known side effect of appetite suppression.

Timing Literature Review Source

Improved brain timing is at the heart of most of the big breakthroughs for clients in my practice. I've tried to keep up with the literature, but it is vast and complex. Now Kevin McGrew and Amy Vega have put together a review of theory, diagnosis and treatment research. It is available here in PDF format. There are additional appendices for those who wish to delve deep into the literature. The appendices can be accessed via Kevin McGrew's August 14th blog. In that blog, he gives an interesting introduction to the paper. Check it out.

More on Calming Rhythms

I was recently asked about using Calming Rhythms by REI Institute in the school setting, so I revisited the REI Inst. site to see what is new. Jeff Strong has updated his web site and formalized his program offerings. He offeres customized programs for children, training for therapists and non-customized CDs that can be used for calming.

The REI program is noteworthy because it does not require headphones. The thearpy is less for auditory processing than for rhythm and structure. OTs and SLPs that have clients using the program say that the children are more grounded, calmer and happier. The customized CDs been used for many children with autism and ADHD.

A therapist can get trained for $275. Parents can have a 10 week custom program created (and edited, if necessary) for their child for $495. Not bad. I would try the custom program on children from whom the traditional sound therapy does not work (due to head phones).

As for non-customized solutions: The "Calming Rhythms" CD is a powerful recording that I found to work for some children and to be counter-productive for others. It is not a one-size-fits-all solution. REI Institute claims that it can be used with groups, but from what I've seen, it is not appropriate for the classroom. In any event, at $35, it may be worth a try. Here is my earlier blog entry on the Calming Rhythms CD.

Finding Words for the First TIme

George is a third grader with special needs. He says just a few words: yes, no, mad - simple words. However, he reads, writes and spells. He is in love with art history and can spell some very long words correctly. His mother was concerned about his fine motor skills and behaviors. He had had OT services in the past. She had purchased a listening therapy, but he had refused to listen to it. George listened to the Early Mozart CD (therapeutic Listening) in my office, and so we decided to try him on it to help with behaviors.

As part of the fine motor therapy, we decided to add into the mix a little Interactive Metronome (IM). The IM was tricky. George became rigid. He had no rhythm of his own, and was reluctant to do hand-over-hand clapping with me. Desperate to engage him, I began to make faces at him in a mirror placed behind the IM unit. He made faces back at me, and then we continued for 200-300 repetitions of IM (about 5-6 minutes).

The next week, we tried it again. But before we had gotten very far, George burst out with a littany of art history names. I looked at his mother who had wide eyes. This was a first. The following week, his mother gave a report. After they had gotten home that day, he pointed to all of the things in the living room and named them. He had never done that before. He was now speaking 2 word sentences. Needless to say, we continued with IM during that session. Before he left, he spoke a 3 word sentence: noun, verb, and adjective. Wow.

I am used to seeing great results from IM and slower but great results from Therapeutic Listening. This one blew me away.

12 year old boys with autism

Fortunately, I like adolescent boys with autism, because I see quite a few of them. In fact, I really like them. They see that they have some catching up to do personally and socially and suddenly they care (just like their typical peers) about bathing, dressing and getting it right. So I get compliance from them and they, in turn, make gains. One of my guys is willingly learning to fold towels and make his bed (honest!), another is trying new foods and weaning himself off of the "white foods" diet, another is working hard to keep up in a private school where he tries to fit in. I've written about all of these (and a few other) guys before, but they never cease to amaze me.

Recently, I started one boy on Somanos CDs. He had been through Therapeutic Listening as a child, and completed an IM program this past year. His dad told me the other day that his YMCA swim instructors want to know what happened to him. Suddenly, he is swimming like a champ, and has good form, too. I told dad it was the Samonas. In particular, Carulli. This same boy (who was a true couch potato just a few months ago) is now dribbling a basketball all around the house. His father is amazed at this, and is installing a hoop in the yard.

Then there is the other 12 year old, who only pretended to listen to his Therapeutic Listening CDs. In fact, he turned the CD player off within seconds of putting the headphones on. I had asked dad, "How is he doing". Dad said, "Well, we can see some changes, but it's subtle. " Subtle indeed, a few seconds of listening makes for very subtle changes. Mom caught him out. The boy was chagrined, but took it well. He started over with his listening program about 6 weeks ago. Last week he told me that his emotions felt a lot calmer, and that his aggressiveness (a problem for him) was going away. Not so subtle any more.

Finally, there is the boy who acted like his body weighed a ton. He just drooped to the floor when asked to stand. He is now proud of his strength and shows off exercises that he can perform.

It's hard not to like these guys.

Autism and IM

I found a new case study about IM and autism. Here is the link. The 12 year old girl in this study had 25 sessions of IM over 9 weeks. Her results were very dramatic.

Food Chaining

I went to the Food Chaining workshop in Chicago last weekend put on by Cheryl Fraker and colleagues. She uses a fairly simple method of expanding a child's diet by slowly increasing the number of flavors and textures that the child will accept.

There are a number of rules for therapists and parents to follow.

1. All meals (3 meals and 2-3 snacks) are scheduled and limited. 15 minutes for a snack and 20-30 minutes for a meal.
2. Children are fed foods that they like along with the new foods, so there is always something "good" on the plate.
3. New foods are chosen based on a rating system.
4. The child rates new foods on a 1 to 10 scale going from "love it" to "I gagged".
5. Force feeding is not allowed. The child picks up the food and puts it in her mouth.
6. If a child acts out and does not eat, then she must stay in the room until mealtime is over. Then she is not offered food again until the next meal.

It's a reasonable arrangement. The choice of which new foods to try is determined in a fairly simple manner - but I won't try to repeat it here in this small blog entry, you can get their "Food Chaining" book and read about it.

The book and the workshop also cover food allergies, and medical issues related to feeding and nutrition.