Factors that support brain development and contribute to the possible development of ADD/ADHD is the focus of my recently article, Support Healthy Brain Development: Implications for Attention Deficit/ Hyperactivity Disorder, published in Psychophysiology Today,9(1), 4-15. The article takes an evolutionary perspective of development and suggests that our lifestyle interacting with the digital devices has implications for our health. This blog extracts some parts of the published article. For the complete article with references see: http://biofeedbackhealth.files.wordpress.com/2014/04/support-healthy-brain-development-psychophysiology-today.pdf
In class, he fidgets, every auditory and visual stimulus distracts him– he gets up, talks to other students and disrupts the class. Nothing seems to hold his attention, he looks at the page and moments later turns around and disturbs the boy behind him. At home, he grabs his food and leaves the table. He is continuously distracted. The only thing that seems to capture his attention is his computer games.
ADD/ADHD has become an epidemic in the last 30 years. Now one in seven boys by the time they reach the age of 18 have received this diagnosis according to the Centers for Disease Control and Prevention, as shown in Figure 1.
Figure 1. Rate of office-based visits per 1000 US population aged 5 through 18 with diagnosis (Dx) of ADHD and rate of use of medication (Rx) for boys and girls. Redrawn from: Sclar, D. A., Robison, L. M., Bowen, K. A., Schmidt, J. M., Castillo, L. V., & Oganov, A. M. (2012). Attention-Deficit/Hyperactivity Disorder among Children and Adolescents in the United States Trend in Diagnosis and Use of Pharmacotherapy by Gender. Clinical pediatrics, 51(6), 584-589.
The increase in ADD/ ADHD diagnoses cannot be explained by genetics alone. It may depend upon the interaction of genetics and the environment. It may develop into a disorder as a result of disrespecting and not understanding our evolutionary background during our development. We attempt remedy them with medications (e.g., Adderall, Concerta and Ritalin) that provide an 8 billion dollar revenue stream for pharmaceutical companies. Yet, there is little or no evidence of long term benefits. Self-mastery approaches such as Neurofeedback have demonstrated long term benefits in improving reading, writing, and mathematical scores as well as decreasing impulsive behavior. Neurofeedback training teaches children how to control their brain function.
Our modern lifestyle has compromised the healthy development of the brain and behavior. To prevent this we need to support those factors that during the course of evolution increased survival, reproductive fitness and promoted healthy brains.
1) Breast feed children at least for one year and concurrently introduce new foods slowly after 6 or 8 months to reduce the risk of developing food allergies.
2) Respect the importance of face-to-face contact to provide safety, develop empathy and nurture social connection.
3) Encourage motor development such as crawling, playing in nature, and physical movement that occurs while playing games support brain development instead sitting and being entertained by smartphones, computers, tablets or TV screens. Physical movement during play– without being distracted by the overwhelming rapid changing stimuli shown on LED and TV screens–is necessary for brain development.
4) Reestablish circadian (daily) rhythms. Until the 19th century our biological and activity rhythms were controlled by natural light. It is hard to imagine not having light at night to read. When the sun went down, we went to sleep. Light not only illuminates, it affects our physiology by regulating our biological rhythms by blocking melatonin production which interferes with sleep.
5. Support touch and movement with vision and sound to develop the brain. During the first years of life, the baby/toddler integrates the visual and auditory world with touch and movement. Motor development is the underpinning of brain development..
6. Provide constancy and reduce novelty. When reading a bedtime story, the child wants to hear the same story again and again. If part of the story is skipped, the child interrupts and reminds us to read correctly. When the child is stressed, it wants to hear a past story for comfort and safety. Repetition while feeling safe allows memory to create appropriate neural connections. Neural growth depends upon the appropriate level and type of stimuli.Too few stimuli hinders brain development and too many novel stimuli may decrease brain development.
7. Limit hours of watching or playing computer games that trigger orienting and activation. The rapidly changing visual stimuli from these screens evokes the biological reflexes to attend– there is something new and it could be safe, dangerous or life threatening. The physiological processes and the important implications for health and illness have been elucidated by the polyvagal theory developed by Professor Stephen Porges.
Over-stimulation with digital devices has been associated with impaired learning and decreased ability to self-regulate. The flood of novel visual and auditory stimuli trains the brain to react, to react again, and again. The ongoing external novelty captures the child’s attention, instead of directing attention from within.
8. Provide face to face safety as infants begin to explore the world. In the last 50 years we have radically increased the visual and auditory input to a developing baby following the concept of more is better. Babies are now exposed to visual and auditory stimuli which rapidly pass by them without repetition or the ability to interact kinesthetically with them. Babies are often carried on the chest or in baby carriages/strollers facing forward- leading the charge into the unknown–instead of receiving face-to-face reassurance from the parent, touching the parent, or hiding behind the parent for safety.
In a study of 2722 observations of parent-child pairs by developmental psychologist Dr Suzanne Zeedyk, parents talked twice as much to their baby when it faced them than when the baby was facing forward in the stroller. The impact of stress was measured by the decrease in baby laughing. Babies who faced their mother/caretaker while being pushed laughed 90% more than those who faced forward. As babies become older they do want to face the environment as it is more interesting; however, when the infants feel overwhelmed or threatened there is an opportunity to automatically reconnect with the caretaker to feel safe.
In summary, do not park children in front of smart phones, tablets, computer games, and television screens that flood the auditory and visual senses without the ability to integrate the information through touch and movement. Although TV and computer games are superb baby sitters, it is not the same as interacting and playing with a baby and toddler to develop the appropriate motor and emotional control. Let’s create an environment that is in harmony with our evolutionary background–An environment where infants play interactively with objects, explore nature and have face-to-face contact with their caregiver.
Even if the initial conditions during growing up were less than optimum, the brain can change—a process known as neuroplasticity. Thus, nurture inner directed attention by having the child develop skill mastery. Learning these skills can include neurofeedback training, back-to-nature explorations, learning to play a musical instrument, practicing a sport or martial art technique, or participating in yoga and meditation. These and many other practices will change the neural structure: it is never too late to learn, change, and optimize health.
To view or download the whole article with references: http://biofeedbackhealth.files.wordpress.com/2014/04/support-healthy-brain-development-psychophysiology-today.pdf
*I thank Drs. Stephen Porges, Linda Thompson, Michael Thompson, Monika Fuhs, and Annette Booiman for their constructive feedback.
Willem Kloosterboer describes his successful recovery of end-stage liver cancer with the Gorter protocol. The concepts and treatment protocol of this non-invasive treatment with hyperthermia and dendritic cell vaccination is described our book Fighting Cancer: A non-toxic approach to treatment. The short documentary is in Dutch with English subtitles.
Video link for this video: https://vimeo.com/63555498
Additional documentaries from cancer patients sharing their experience as they experienced total remission. All these patients were in the final & last stages of their disease and are now have lived for years and years cancer free. These patients are followed up every two years.
One of the remarkable documentary is of a boat tour through the Amsterdam canals with about 50 Dutch patients. These are all people who had stage four terminal cancer are interviewed while on the boat. It is heart warming to hear them say: “8 years ago I was told to have 2 to 3 months maximum to live and now I am cancer free since years and never thought I could make a boat trip like this at that time” To see the videos click on the following link:
We park children in front of tablets, smartphone, computers and TVs. The visual and auditory stimulation captures their attention. It is a superb baby sitter. We substitute electronic displays for human attention.
To distract the baby at dinner in a restaurant, we hand the baby a smartphone. To have some private time, we let the child play games on the tablet. To reduce stress before dinner, we hand the child the tablet to watch video clips or play games. The short term benefits of letting handheld devices capture the child’s attention may have long term costs.
The child sits, sits and sits while being captured by the rapid changing visual scenes and auditory sounds instead of playing and enhancing motor development. The addictiveness of electronic devices occurs because we automatically attend to and are captured by rapidly changing stimuli—it is new and could be dangerous. This reaction to attend which is continuously evoked by the handheld devices may occur at the expense of developing self-directed attention.
The handheld devices expose the brain and dividing cells to electromagnetic radiation which can harmful. This is the radiation by which hand held devices communicates with connect cell phone towers or the server as it connects to the web.
From the precautionary principle and the numerous research studies, young children should limit the use of hand held devices. I totally agree with Cris Rowan’s superb blog, 10 Reasons Why Handheld Devices Should Be Banned for Children Under the Age of 12, which is reprinted below with her permission.
Cris Rowan pediatric occupational therapist, biologist, speaker, author
The American Academy of Pediatrics and the Canadian Society of Pediatrics state infants aged 0-2 years should not have any exposure to technology, 3-5 years be restricted to one hour per day, and 6-18 years restricted to 2 hours per day (AAP 2001/13, CPS 2010). Children and youth use 4-5 times the recommended amount of technology, with serious and often life threatening consequences (Kaiser Foundation 2010, Active Healthy Kids Canada 2012). Handheld devices (cell phones, tablets, electronic games) have dramatically increased the accessibility and usage of technology, especially by very young children (Common Sense Media, 2013). As a pediatric occupational therapist, I’m calling on parents, teachers and governments to ban the use of all handheld devices for children under the age of 12 years. Following are 10 research-based reasons for this ban. Please visit zonein.ca to view the Zone’s Fact Sheet for referenced research.
1. Rapid brain growth
Between 0 and 2 years, infant’s brains triple in size and continue in a state of rapid development to 21 years of age (Christakis 2011). Early brain development is determined by environmental stimuli or lack thereof. Stimulation to a developing brain caused by overexposure to technologies (cell phones, internet, iPads, TV), has been shown to be associated with executive functioning and attention deficit, cognitive delays, impaired learning, increased impulsivity and decreased ability to self-regulate e.g. tantrums (Small 2008, Pagini 2010).
2. Delayed Development
Technology use restricts movement, which can result in delayed development. One in three children now enter school developmentally delayed, negatively impacting literacy and academic achievement (HELP EDI Maps 2013). Movement enhances attention and learning ability (Ratey 2008). Use of technology under the age of 12 years is detrimental to child development and learning (Rowan 2010).
3. Epidemic Obesity
TV and video game use correlates with increased obesity (Tremblay 2005). Children who are allowed a device in their bedrooms have 30% increased incidence of obesity (Feng 2011). One in four Canadian, and one in three U.S. children are obese (Tremblay 2011). 30% of children with obesity will develop diabetes, and obese individuals are at higher risk for early stroke and heart attack, gravely shortening life expectancy (Center for Disease Control and Prevention 2010). Largely due to obesity, 21st century children may be the first generation many of whom will not outlive their parents (Professor Andrew Prentice, BBC News 2002).
4. Sleep Deprivation
60% of parents do not supervise their child’s technology usage, and 75% of children are allowed technology in their bedrooms (Kaiser Foundation 2010). 75% of children aged 9 and 10 years are sleep deprived to the extent that their grades are detrimentally impacted (Boston College 2012).
5. Mental Illness
Technology overuse is implicated as a causal factor in rising rates of child depression, anxiety, attachment disorder, attention deficit, autism, bipolar disorder, psychosis and problematic child behavior (Bristol University 2010, Mentzoni 2011, Shin 2011, Liberatore 2011, Robinson 2008). One in six Canadian children have a diagnosed mental illness, many of whom are on dangerous psychotropic medication (Waddell 2007).
Violent media content can cause child aggression (Anderson, 2007). Young children are increasingly exposed to rising incidence of physical and sexual violence in today’s media. “Grand Theft Auto V” portrays explicit sex, murder, rape, torture and mutilation, as do many movies and TV shows. The U.S. has categorized media violence as a Public Health Risk due to causal impact on child aggression (Huesmann 2007). Media reports increased use of restraints and seclusion rooms with children who exhibit uncontrolled aggression.
7. Digital dementia
High speed media content can contribute to attention deficit, as well as decreased concentration and memory, due to the brain pruning neuronal tracks to the frontal cortex (Christakis 2004, Small 2008). Children who can’t pay attention can’t learn.
As parents attach more and more to technology, they are detaching from their children. In the absence of parental attachment, detached children can attach to devices, which can result in addiction (Rowan 2010). One in 11 children aged 8-18 years are addicted to technology (Gentile 2009).
9. Radiation emission
In May of 2011, the World Health Organization classified cell phones (and other wireless devices) as a category 2B risk (possible carcinogen) due to radiation emission (WHO 2011). James McNamee with Health Canada in October of 2011 issued a cautionary warning stating “Children are more sensitive to a variety of agents than adults as their brains and immune systems are still developing, so you can’t say the risk would be equal for a small adult as for a child.” (Globe and Mail 2011). In December, 2013 Dr. Anthony Miller from the University of Toronto’s School of Public Health recommend that based on new research, radio frequency exposure should be reclassified as a 2A (probable carcinogen), not a 2B (possible carcinogen). American Academy of Pediatrics requested review of EMF radiation emissions from technology devices, citing three reasons regarding impact on children (AAP 2013).
The ways in which children are raised and educated with technology are no longer sustainable (Rowan 2010). Children are our future, but there is no future for children who overuse technology. A team-based approach is necessary and urgent in order to reduce the use of technology by children. Please reference below slide shows on www.zonein.ca under “videos” to share with others who are concerned about technology overuse by children.
Problems – Suffer the Children – 4 minutes
Solutions – Balanced Technology Management – 7 minutes
The following Technology Use Guidelines for children and youth were developed by Cris Rowan, pediatric occupational therapist and author of Virtual Child; Dr. Andrew Doan, neuroscientist and author of Hooked on Games; and Dr. Hilarie Cash, Director of reSTART Internet Addiction Recovery Program and author of Video Games and Your Kids, with contribution from the American Academy of Pediatrics and the Canadian Pediatric Society in an effort to ensure sustainable futures for all children.
Technology Use Guidelines for Children and Youth
Follow Cris Rowan on Twitter: www.twitter.com/zoneinprograms
In the late 19th and early 20th century, numerous people with schizophrenia recovered and lived functional lives without receiving pharmaceutical treatment (Whitaker, 2011). The spontaneous recovery has changed since advent of barbiturates and the use of antipsychotic medications. With medication, the initial schizophrenic crises can be more easily managed– patients have less disruptive symptoms although they slow down and often life in a mental fog. Now there is new doubt about the efficacy of long term use of antipsychotic medication treatment as reported by science writer Clare Wilson in her New Scientist article, “Rethinking schizophrenia: taming demons without drugs”. She point out that there have been no long term comparative outcome studies between continued drug treatment and stopping drug treatment except for observing the increase in serious side effects such as tardive dyskinesia.
Psychiatrist Wunderlink and colleagues (2113) in the Netherlands have just published an outstanding controlled study. They showed that when the people were assigned to either a medication or stopped medication group, the stopped medication group did nearly twice well over the long term. In the short term, the stopped medication group had a higher relapse rate. However, at the end of seven years they showed significant lower relapse rate and double the rate of having functional lives (e.g., holding down a job and looking after themselves) than the group that continued to take medication as shown in figure 1 and 2.
Figure 1. Long term study showing the benefit of minimal or no drugs after the initial schizophrenic episode as compared to continued medication. From: Wilson, C. (2014). Rethinking schizophrenia: taming demons without drugs. New Scientist, 221(2955), 32-35; based upon the published research by Wunderink, et al, 2013.
Figure 2. Long term out of the ability to hold down a job or look after themselves. Those who were assigned to the minimal or no drug group had a significant improvement in functional recovery. From: Wilson, C. (2014). Rethinking schizophrenia: taming demons without drugs. New Scientist, 221(2955), 32-35; based upon the published research by Wunderink, et al, 2013.
This study points out the importance of not generalizing from short term benefits which are so often augmented by active placebo factors. As the Dutch study showed, there is more harm than benefit from long term medication use in the treatment of schizophrenia. Similar results have also been reported in long term use of sleeping medication—it increases mortality risk by 25%. Long term chronic medication may cause different outcomes than for short term crises use. When medication is taken over an extended period of time, the body will adapt to achieve homeostasis. Namely, it will reduce or increase endogenous neurotransmitters or receptors to compensate for the increase presence of the drug. When the medication is withdrawn, the symptoms are now worse because the neurotransmitter or receptor have been changed and they takes time to regenerate. This process is similar to having a caffeine withdrawal headache. Drinking caffeine, induced vasoconstriction, the body compensates by reducing its own vasoconstriction. Then, when caffeine is stopped, the blood vessels dilate too much and a headache results. It usually resolves itself in a few days as the body rebalanced.
The reported results that the minimal or no drug group did so much better confirms the observations that numerous people with schizophrenia in the late 19th century and early 20th century could regain functional recovery unlike what occurred after the use of antipsychotic medication treatment (for more discussion on this topic see the superb book by Robert Whitaker, Anatomy of an Epidemic.
Finally, this post is a reminder to doubt the benefits of medication for ongoing long term use based upon short term studies.
Whitaker, R. (2011). Anatomy of an epidemic: Magic bullets, psychiatric drugs, and the astonishing rise of mental illness in America. Random House.r
Wunderink, L., Nieboer, R. M., Wiersma, D., Sytema, S., & Nienhuis, F. J. (2013). Recovery in remitted first-episode psychosis at 7 years of follow-up of an early dose reduction/discontinuation or maintenance treatment strategy: long-term follow-up of a 2-year randomized clinical trial. JAMA psychiatry, 70(9), 913-920.
One of the most powerful pieces of the book that resonated with me was its focus on resilience, the ability to bounce back after a setback/disaster, with total commitment towards achieving a specific. For young students searching for a career, parents of children who are striking out on a career, teachers who counsel students on career choices and clinicians who help clients learn work/life balance and enhance health, they may be unaware of the dynamic emotional and commitment struggles that underlie successful entrepreneurship.
Uncommon Stock explores many of these themes and how they impact our next generation of leaders. Once I started the book, I was captured and did not put it down. When I finished I realized that not only was it a great entertainment for my plane ride, it also gave me remarkable insight in the trials and tribulations of my students and many young adults who are the new Silicon Valley entrepreneurs.
It is a must read for any student thinking about striking out on their own and creating a business. Every business major should own a copy. Finally, it provides constant insights for adults who teach or counsel young people and parents trying to understand their children. Plus, it’s perfect entertainment for a rainy afternoon.
Having the right equipment doesn’t mean we use it correctly. It turns out that usage patterns matter just as much as fancy new office furniture. This post was inspired by a wonderful article that David Kadavy generously interviewed me for. His article explores split keyboards and working wellness. In this post, I go in-depth on some complimentary workplace tools and techniques.
After working on a laptop, smartphone or computer, many people experience discomfort and exhaustion. Back and neck pain and vision problems are very common. Although there are many components that contribute to maintaining health and productivity with digital devices, two factors stand out:
- Ergonomic arrangement: the way the physical environment forces the person to adapt, such as bending over to read and perform data entry with a tablet.
- Work style: the way the person manages themselves to perform the tasks.
Many problems that are aggravated or caused by inappropriate ergonomics can be compensated by changing workstyle. For example, if you bend forward to read the tablet or squint to see the text on the monitor, you can take many movement and stress reduction breaks to compensate for the challenging ergonomics. Having the right equipment, appropriately adjusted, is the focus of ergonomics. Working so that health is maintained regardless of equipment is the focus of work style.
Shoes are a great example. Healthy shoes would look like duck feet–wider at the ball of the feet and toes and narrower at the heel. However, most shoes have pointy or narrow toe boxes. Over time, incorrect footwear becomes a major cause of bunions, foot, hip and back pain for older adults. It causes physical deformity just as the 19th century Chinese practice of foot-binding crippled many women. If you want to run a 100 meter race or a marathon—running shoes are better than high heels. Adapting the environment to you instead of the other way around is the underlying theme of ergonomics.
But even with correctly fitting shoes many people still experience discomfort. Often this is because of misaligned movement patterns. such as their feet point outward while walking instead of pointing ahead. Or they unknowingly favor one leg over the other because many years earlier they broke that leg and adapted their walking pattern to reduce the pain. After walking to avoid pain for a month, this new dysfunctional pattern became habitual and their gait never returned to normal. Changing how you walk or work is the focus of optimum work style. For useful suggestions about workstyle see Healthy Computer Email Tips by Erik Peper.
Many experts have worked for decades on defining optimal ergonomics for using digital devices. The results are always compromises because human beings did not evolve to sit in a chair for hours without movement or read from a small screen in front of them. Nevertheless, the ergonomic setup while using laptops and tablets can be significantly improved. It is impossible to achieve a healthy ergonomic setup while using a laptop or tablet. If the screen is placed so that is easily readable, then the fingers and hands need to be lifted (which often involves lifting the shoulders) to perform data entry. On the other hand if the keyboard is at the appropriate height then you have to look down on the screen. If you regularly use a laptop or tablet, consider purchasing a separate monitor and/or keyboard to improve your setup.
And if you’re replacing your keyboard, make sure to check out David Kadavy’s excellent blog: This weird keyboard may be the biggest thing since your standing desk.
A major factor that contributes to illness and health is how we cope with stress. Learning stress management techniques and integrating them into our daily life can significantly reduce illness and discomfort. Patients report significant improvement in numerous disorders such as hypertension, headaches, cancer, pain, or arthritis.
A great health resource are the short YouTube videos by Dr. Mike Evans who is founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael’s Hospital. His informative short video clips cover a range of medical conditions from concussions to stopping smoking (see his website: http://www.myfavouritemedicine.com).
Watch the following video presentation on The Single Most Important Thing You Can Do for Your Stress.
Energy Gain Wisdom: Strategies for Maximizing Support and Emotional Wellbeing for Caregivers & PatientsPosted: January 23, 2014
Are you exhausted and not sure there is anything you can do to change it? Learn strategies to mobilize your self-healing potential as you cope with cancer. Regardless of the severity of disease, learn skills to increase energy.
Watch the following presentation by Dianne Shumay, PhD, Associate Director, UCSF Psycho-Oncology, and Erik Peper, PhD, Professor Holistic Health, SFSU. This invited lecture was presented January 19, 2014 at the NorCal CarciNET/UCSF 2014 Patient Conference, hosted by: NorCal CarciNET Community & UCSF Helen Diller Family Comprehensive Cancer Center, at the Krutch Theater (Clark-Kerr) on the UC Berkeley Campus.
In this interview with Dr. Larry Berkelhammer, Dr. Erik Peper discusses the statement from the World Health Organization “Disease is a rupture in life’s harmony”. He also offers two pragmatic behavioral approaches to optimize health:
- Observe energy drains and gains and then decrease energy drains and increase energy gains
- Take movement breaks to increase energy and prevent immobility syndrome