T.R.A.I.N^TM

T.R.A.I.N & ADHD

Brain Neuroplasticity is the change that comes about in the neural structure and function of the human brain in response to experience or the environmental stimuli that it is subjected to.

How much does the environment influence the development of the brain is of interest as we are witnessing a surge in issues related to child development, education, and child psychopathology.

T.R.A.I.N^TM as a neuroplasticity based cognitive intervention programme for Learning Disabilities has been shown to cause activity-dependent plastic responses in the brain structure, such as an increase in the (scientifically expected) hippocampal volume (which is involved in spatial navigation) in children who have finished the Intervention programme , and the level of observable changes correlate to the amount of time spent by these children in remediation.

Observable visible changes in children who are put through a fine motor programme, indicate that there may have been more basic neural alterations in the motor cortex, cerebellum, and basal ganglia and children who are trained in handling objects using simultaneous use of the vision and upper limb gross motor movements may have demonstrated these improvements based on transient activity-dependent structural changes in their visual motor cortex.

NeuroPlasticity can be used to a certain extent to help children with ADHD as dynamic age-related changes can occur in the human brain and though these vary with intelligence, clinical status, and/or treatment - along with long-term outcome - using targeted intervention techniques, supplements and behaviour modification has benefited a number of children.

Considerable changes in brain anatomical structure and connectivity occur as a child develops and there is growing evidence for plasticity induced brain changes along the way. As research progresses the mechanisms of human neural circuitry development are increasingly being understood, and ‘sensitive periods’ are being taken advantage of in terms of brain plasticity with the recognition that we can undo - to some extent the variance in the pattern of neural consolidation that has already taken place.

These observations have also led to the hope that treatment of cognitive or behavior disturbance during the childhood years might be more effective in reshaping trajectories of early development and neural consolidation either to normalize or compensate for earlier abnormalities.

The T.R.A.I.N^TM Programme bases the remediation of Attention Deficit Hyperactivity Disorder or ADHD on adaptive plasticity in the child’s brain, which has been particularly well researched in relation to language functions and which is being used for our Dyslexia Intervention programme. As an example when a child is subjected to a fall or gets hurt and suffers unilateral brain damage with focal brain injury to the left cerebral hemisphere it can cause aphasia in adults but not in infants and young children - and in general, we observe strikingly less impairment to language function when such injuries are in early childhood. This is the reason why some children roll off the bed and though they have a severe fall on a hard floor, with time and nursing care they tend to not develop long term brain damage.

The T.R.A.I.N programme for ADHD induces experience-dependent plasticity, which shapes the developing child’s brain, to metacognitively understand an action-reaction response consequence - and initiate - inhibitor inducement tasks, which prevent the translation of the urge into action.

The mature cerebellum in a human brain may represent only about 10% of the total brain volume, but this region contains more than half of the neurons of the central nervous system. This highly dimorphic part of the brain (the only regional volume remaining significantly larger in males after controlling for total cerebral volume) -the cerebellum is critical for motor learning in humans and is evolutionarily conserved. Although it is one of the first brain structures to differentiate, it is one of the last to achieve maturity as cellular organization of the cerebellum continues to change for many months after birth. This protracted developmental process not only creates a special susceptibility to disruptions but also suggests its relevance to cognitive functions that develop during adolescence.

Multiple plasticity mechanisms contribute to the cerebellum-dependent learning and this region of the brain also has important cognitive roles, which are required by a human child. The way this region develops results in differences in cognition, behavior, and emotion between children and adolescents and also determines how children will change over time and what is the extent of variability between these children. In fact research now validates that the grey matter in the brain has a non-linear manner of development. This means that the grey matter in the cerebellum, which is simplistically associated with intelligence, does not continue to increase in volume and having a lot of grey matter does not make a child more intelligent.

In fact grey matter increases during childhood and adolescence and then decreases with peak ages differing between the lobes, whereas the white matter myelination process appears to continue well into adulthood. In fact structural brain development parallels functional milestones in the brain, and this represents a complex interplay between programmed development and environmental inputs.

Sometimes when parents of children who are later discovered to have ADHD complain, that their son or daughter just does not go to sleep on time it would be enlightening learn that such children are being studied and it is being noticed that a considerable number are being discovered to have lower synaptic density than their normally developing peers. Research now claims that synaptic over production and pruning may be responsible for this noticed synaptic density and that this may have a relationship with the sleep pattern of the specific child. On a very fundamental level, increased and well developed synaptic density would mean steeper correlation between the areas of the brain like the anterior cingulate and the parietal regions and the lateral frontal cortex which are implicated in the allocation of attentional resources, planning and cognitive control in the human brain.

In addition to this we know from mixed model regression analysis studies that the trajectories of cortical thickness differs significantly for the children who are assessed to have ADHD in the right parietal cortex, an area known be important for attentional control. Imaging gives us data that in children with ADHD, the age-related thinning in the cortical regions appears to be slowed resulting in a relatively spared regional thickness. This spared thickening along with variable synaptic density differs from more intelligent children who demonstrate a particularly plastic cortex with an initial accelerated and prolonged phase of cortical increase followed by a particularly vigorous phase of cortical thinning.

T.R.A.I.N^TM using specialized methods of cognitive and behavior modeling - along with supplements works in the aforementioned areas to bring about a higher degree of neural plasticity so that appropriate functional areas can be supplemented with a wider network of pathways to raise the metacognitive ability of the child to respond differently from the initial trigger response. The eventual goal of the intervention being for the child to exhibit compensatory right parietal ‘slowing’ of the normal response system.

This intervention focus is supported by worldwide research and functional studies indicating that ADHD children have excess activation in this posterior parietal region. Activation of the right parietal cortex during tasks of alerting and reorienting of attention is not fully mature until adulthood, and this component of the attentional network is what is focused on to and developed along with the normal age related development.

Thus, the cerebellar hemispheres, like the right parietal region may show a plastic, state-specific response and possibly be targets for intervention via the modality of neuroplasticity that is used in cases of ADHD.

T.R.A.I.N^TM is a very specific programme and children with ADHD are given their own specific set of intervention plans as these children have impaired inhibitory control based within dorsal frontostriatal circuits as well as disturbances in motivational and reward processes based within ventral frontostriatal circuits, which together may conspire to produce dysfunction in reward learning, delay tolerance, and goal-oriented activity that characterize this disorder.

The T.R.A.I.N^TM programme aims to ensure that the multimodal intervention that is provided via cognitive rehabilitation and nutraceuticals - works towards normalizing the brain environment, so that it can maximize natural healing, which in turn would facilitate rehabilitation and neuromodulation of specific areas that are responsible for behavioral inhibition which is associated with cognitive processes - that may mediate the goal directed behaviour of the specific child.

In fact attention plays a central role in social behavior and academic performance. Due to brain plasticity, training can alter the neural correlates of attention and improve attentional control

A student’s attentiveness is essential to achieve positive and productive classroom dynamics and plays a fundamental role in shaping the scholastic performance that the child will display.

When we consider the learning approaches that are employed by children, we notice that child attentiveness is directly co-related with academic competence and achievement, as well as the strength of positive relations that develop with both teachers and peers. When a particular child demonstrates a degree of variability in attentiveness this may account for differences in the child’s learning speed or the amount of information children can extract from an event. Research on children with ADHD, moreover, reveals co morbidities between the disorder and a number of learning difficulties, especially pertaining to reading ability). Children with ADHD not only face the prospect of a complex association between scholastic impairment and ADHD symptomatology, but also are more prone to a 2- to 10-fold increase in impairments of reading, writing, and mathematics if the symptoms relate more strongly to inattention.

When a child starts his school from the first grade, it is noticed that the children exhibiting strong effortful control are more likely to express social competence and have fewer behavior problems, whereas those who struggle to control attention and behavior tend to develop impaired relationships with teachers and peers, and have greater risk of developing academic difficulties. When we speak of scholastic impairment, parents should know that if the child manifests a lack of effortful control and other self-regulatory skills at this-age the correlation to higher grades, especially in mathematics and literacy will not be there right from the start of the academic life of the child.

Likewise, if we have a child who has no attention-related disorders such as ADHD he generally will not be impaired in social, academic, familial, and occupational areas of life.

Acquiring proper social and academic skills during childhood is essential for shaping appropriate behavior and ensuring healthy development. T.R.A.I.N^TM teaches children to exhibit effective social skills and to improve their social knowledge and assertiveness, and may further generalize to the school setting as improved attention and better grades. T.R.A.I.N^TM believes that social skill training may be particularly relevant for children with impulse-control disorders such as ADHD, who often experience peer rejection and social isolation due to aggressive behavior and lack of inhibitory control and aims to promote constructive peer interactions among children.

Most children who are brought to the Dyslexia Association of India^TM show evidence of genetic and environmental factors - which may have impacted on the development and physical structure of their brain as is observable in the results of the cognitive assessments that are carried out. The results seen uncover notable disparities associated with socio-economic status that these children come from - even when performance levels between two sets of children are comparable. In fact we also witness children who have undergone severe mental stress - and find that severe stress and maltreatment which has been experienced early in life by such children may have severely impacted on their brains neuroanatomy, which will probably show up as reduced volumes and attenuated development of several neural structures. A developing brain is susceptible to change in response to environmental stimuli and this evidence of the neuroplastic processes present in the child’s brain form the basis of the intervention provided by T.R.A.I.N^TM - and that is - to induce lasting changes within the neural structure of the child’s brain.

Such lasting changes that the neuroplasticity programme works to induce are not unitary as attention may contain multiple varieties of attentional deficits which may be defined via the - alerting, orienting, and executive attention systems. Changes that are observable are ultimately visible in the altered mental states that children begin to exhibit mainly through the medium of differential control over the orienting and interrelated executive networks and these eventually prove important for modulating behavior and emotion. This modulation when seen from a neural perspective is indicative of changes that may be beginning to occur at the neural level due to induced neuroplasticity.

Why T.R.A.I.N^TM

ADHD affects neural structures associated with attentional processes and imaging research has proved that children with ADHD have smaller global brain volumes compared to typically developing children, in addition to localized decreases in pre frontal cortex, caudate, cerebellum, and the corpus callosum size. Not only this it is now believed that there is diminished activity in the neural circuits underlying executive attention, including regions of the pre frontal cortex and ACC which may bring about the observed differences in cognitive control for such a child. Developmental manifestations of ADHD can be extremely pronounced and involve the memory capacity of the child, speech internalization, modulation of goal-directed behaviors, as well as self-regulation of drive and affect

The marked difficulties that children exhibit with interpersonal relationships when they are afflicted with Attention Deficit Hyperactivity Disorder is so crucial that over 70% of parents report significant emotional and behavioral difficulties in their children, with nearly 80% who come to us reporting deficits in aspects of daily living. When an ADHD child has an inferior capability to distinguish emotionally charged facial expressions or high inability to accept peer-rejection, which may be due to increased aggression, poorer social skills, and inflated self-perception the net outcome can only be a vicious circle from where it is very difficult for your child to get out.

Treatment options for ADHD are sparse and most commonly comprise psychostimulant medication, which show marginal effectiveness. Improvements in the conduct and academic performance of medicated children confirm the short-term efficacy of psychostimulants, of which methylphenidate and amphetamine are most commonly prescribed. Current ADHD medication has several limitations and while the short-term effects of these drugs are well documented, there is ongoing debate regarding the effects of long- term psychostimulant consumption. Even the positive short-term benefits of psychostimulant drugs come at the price of unwanted side effects and potential long-term risks. Both methylphenidate and amphetamine trigger similar, dose-dependent, adverse effects, of which insomnia and diminished appetite are the most common. Reports also identify cardiovascular problems such as elevated resting heart rate and blood pressure, in addition to stunted growth and the development of tics. Another concern pertains to substance abuse, highly co morbid with ADHD and sometimes triggered by continued stimulant-use. Finally, not all individuals respond to psychostimulants.

Given the potentially noxious effects of psychostimulant medication and the relative ineffectiveness of other drug types, providing a more structured and supportive environment may offset conditions that play a role in triggering the onset of ADHD symptoms in children, and has potential to markedly improve the pathophysiological course of the disorder. This is where the T.R.A.I.N^TM programme steps in.

The Cognitive treatments for ADHD via the T.R.A.I.N^TM brain training programs shows promising effects in children and we have seen reported improvements in both cognitive ability and behavioral symptoms of ADD.

This programme also facilitates increased cognitive performance and attentional ability in children and the effects of neuroplasticity-based training, are comparable with the effects of medication. The programme is supplemented by interpersonal interaction awareness and allows children to receive behavioral monitoring and continual feedback, thereby teaching them to monitor their actions and respond in a situation-appropriate manner.

ADHD is one of the most heritable neuropsychiatric disorders with high heritability with respect to developmental trajectories and change in regional heritability, which may vary across the developmental period of the child. The probable plasticity and late maturation of the human cerebellar lobes is what the T.R.A.I.N^TM programme focuses on in relation to the clinical and cognitive status and the observable results, where children are able to switch from being reactive to consciously active indicates possible plastic brain responses in the cerebellar lobes and posterior parietal cortex. It is possible that some children with a developmental lag have slower cortical development and therefore timing of peak volumes in relation to amelioration is very crucial. This is reason why parents are always encouraged not to ignore symptoms of inattention or lack of attention or the inability of their child not to sit still and pay attention to the task on hand. Being naughty and mischievous is different from being in a state where everyday hyperactivity and agitation at school and home are beginning to become a nightmare.

Remember being naughty, as a child is different from being hyperactive and there is a very fine line between naughty and hyperactive. A mothers love see’s a naughty child while a teacher see’s a hyperactive difficult to manage child.

To know more about the T.R.A.I.N^TM programme, please e mail The Dyslexia Association of India^TM at info@dyslexiaindia.org.in or you can even call us on 88260 – 22886 to speak to us freely and set up an appointment to meet us.

The T.R.A.I.N^TM Neuroplasticity Programme is a copyright programme of the Dyslexia Association of India^TM and protected by the relevant provisions of the Copyright Act. Please do not use information gained from this programme to misrepresent any instructional course or programme being delivered by a third party vendor. The T.R.A.I.N^TM programme is available only at the DAI™ Intervention Centre and it has not been franchised out to any vendor.