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.