:) Hi-I would like to bring to your attention a new concept in ADD testing. An objective physiological measure of ADHD has been elusive. However, research by Jason Alster MSc has shown that when ADD persons try to sit still, do a boring task, or concentrate- they actually enter stress as measured by labile electro - dermal activity

(EDA , GSR ). Whereas the GSR was traditionally used to teach relaxation it was overlooked as a tool to teach relaxed concentration being dwarfed by the popular and successful neurofeedback.

Measuring electron flow in a circuit the body operates largely by a series of electrical impulses which have been shown to follow certain pathways and measure changes in the electrical resistance or the ability of the tissue to conduct electricity. The GSR activity marker is positive in the majority of ADD clients tested. Once tested, then the GSR biofeedback may be used to improve the stress result with different techniques. A protocol using this valid objective physiological marker has just been published in a video- "Guide for GSR Biofeedback Techniques for the Natural ADHD Practitioner" (Amazon.com).

Using the GSR protocol only takes 10 minutes to perform. The test is valid for children as well as adults and helps parents determine if their ADHD children need intervention. The measure may then be used to match a personal technique protocol to the client depending on what type of technique helps improve the GSR from lability to stability during rest.

The GSR is measured as labile and steadily increases in amplitude when the ADHD child tries to sit quietly for 2 minutes. The GSR is then increasingly more labile during an eyes closed condition. This is in contrast to the GSR in anxiety where there is usually a decrease during a relaxing eyes closed baseline condition. In some instances- the GSR in ADHD is stable - however, will not return to baseline after prompted with a mild stimulus like noise. This shows that a symptom of ADHD when trying to sit quietly and concentrate -is acting like a stress-or for him her. This is not unlike the "disorientation" experienced in dyslexics when trying to read.

Many ADHD clients- upon producing a stable GSR after a biofeedback assisted relaxed concentration technique - will claim when asked-that this is the first time ever they felt what relaxation /concentration is. This may be compared to someone not having ever tasted a tasty food like an orange. You can't describe it to them. However, once they taste it- they know what it feels like. So too, it turns out, with the sense of relaxation, focus in ADHD. When asked to compare this sensation with the sensation of an ADHD medication- the majority of ADHD people will say that the natural biofeedback induced sensation is better than medication- and medication does not "feel well" even though it does help them concentrate. This shows that medication like Ritalin has a different mode of action working to help ADHD than natural and behavioral methods.
The relaxation and relaxed concentration response is natural and seems to be lacking in many people with ADHD. These responses might have been lacking at birth or were compromised with an unbalancing childhood medical problem (Ears nose and throat, asthma,-sleep disorder-medical operation). However, once re-learned or acquired - the ADHD person can re-produce this
"sensation" upon need. Like learning art or music- some are born with it- but all can learn to be artists or musicians with the proper instruction. This objective physiological test is easy to replicate only with the most sensitive /graphic GSR biofeedback equipment(like Thought Stream or Mindlife for example). My hope is that this simple and valid measure will be used as a future screening test in ADHD clinics and schools as well as by biofeedback practitioners helping ADHD.

A bit of the history in how this method was developed. I began treating children with ADD quite unexpectedly in 1991. As a biofeedback practitioner and part of an anxiety clinic in Tel Aviv, Israel, I had absolutely no experience in treating children but was doing quite well with adults suffering from stress disorders and teenagers who had test anxiety and social phobias. The biofeedback clinic had just opened and each type of patient was a new experience.

With medical- technological training in neuro-electrodiagnostics and sleep/wake disorders, I was more into the neurological and psycho- physiological disorders. A child psychologist working with me wanted to try biofeedback on ADD. Then he had said that there was no treatment and no objective test for this poorly understood syndrome. The only remedy at the time was Ritalin although reports about EEG (electroencephalogram) neuro - biofeedback and Joel Lubar's research with Neurofeedback were just coming out (1991) demonstrating that ADHD can respond to a behavioral method. At first I found that EMG (testing muscle tension)was increased in ADHD and there was already a study showing that EMG biofeedback did not help in ADHD.

However, I found that found that GSR ( electrodermal resistance) was better and easier to use in ADHD than EMG. At the time there were no studies of GSR biofeedback for ADD- so I had to go it alone. After starting to treat a handful of children with biofeedback, the psychologist I was working with had to leave the unit and I had to suddenly take over his patients. All I knew then about ADD was from a television program showing a hyperactive child literally jump off the walls and I worried about what this child would do to the biofeedback equipment! I had absolutely no knowledge of learning disorders either. I mention this lack of knowledge for a reason. I had to begin treating ADD without a prior predisposition to what was written in the literature and had to see for myself what worked and fast.
On my very first ADD client I performed a regular biofeedback stress baseline for anxiety.

That is, I hooked the child up to galvanic skin resistance (GSR) sensors, muscle and peripheral temperature monitors, but not EEG. I had to start to treat ADD with what I knew and that is how to treat stress and anxiety. I was lucky. My very first patient's baseline EMG (electromyogram or muscle activity potential) showed that the more she sat quietly the EMG gained in amplitude over time. That is, sitting quietly was tense for her. I tried relaxation training and she improved her baseline in just 6 sessions and began to do better both at home and in school. This was not supposed to happen. Biofeedback in ADD was supposed to be a stubborn neurological problem that takes 40- 60 EEG biofeedback sessions to treat. Wanting to find an effective, alternative method to offer those young people and especially parents who wouldn't, or didn't want to use medication for ADHD. At least these children wouldn't be left untreated.

In my readings at the time, a number of avenues were being pursued in the treatment of ADD. Some of these were nutritional, sensory integration, guided imagery, art therapy, natural meditation, yoga, Bach flower remedies, homeopathy, chiropractic, and the use of aromatic oils. In biofeedback, animated computer games were just being introduced like Mindlife/Ultramind and Thought Stream.

I decided I could use each method and observe its effectiveness. I could try and develop an integrated and holistic approach matching the method to each child individually and determining the results by the GSR.
One of the first things that I found that can cause the GSR to become stable in ADD children and adults is holding a soft or smooth stone in your hand and studying a liquid water timer or sand clock. Other techniques include using the senses to relax like self massage, abdominal breathing, seated yoga, listening to a metronome, listening to a sea shell, guided imagery, smelling aromatic oils, and more.

Later, I found that by integrating accelerated learning techniques and study strategies such as speed reading, associative memory, mind mapping , and time management - children with ADHD and test anxiety began to reach their full potential and receive very high grades in school.

Included in the CD ROM video kit are the book BEING IN CONTROL, and the video BEING IN CONTROL:NATURAL SOLUTIONS FOR ADHD DYSLEXIA AND TEST ANXIETY.
The videos play on Windows Media Player.



:)

My very first patient's baseline EMG (electromyogram or muscle activity potential) showed that the more she sat quietly the EMG gained in amplitude over time. That is, sitting quietly was tense for her.


This may help with hyperactive impulsive ADDers in the area of diagnosistics how ever I fail to see where "training" me to sit quietly would be of any benefit. I was not hyper because I did not know how to make my self sit quietly I did not sit still long because doing so hurt inside. It also made my head feel tired and weird.

Inattentive do not seem to have the same problem sitting still it is keeping their attention tuned into the out side world as oppose to the tuning out they normally experience.

Here is my description of what it is like to be hyperactive from the inside out. You seem to have a different approach on this let me see what you generate okay?


My hyper discription (http://www.addforums.com/forums/showpost.php?p=290224&postcount=148)


I am still not sure the wording “feel the need to move” doesn’t convey enough emphasis of what is going on inside of wiggly wiggly wiggly meadd! I know I am thick skulled! Believe it or not I am trying to help ….. some things I do understand how it feels to be me is one of them!


To those who think I feel the need are you saying you understand my wiggles like this…. Imagine the below in the mind because it aint safe to really try this…

You light up the ole gas stove the flames touch just above the metal black thing……now keeping your hand parallel with the stove top (do not come from above you’ll screw it up) slide it steadily but not fast over the flame aprox 3 inches above the tip of the fire………………………………………………………………..

NOW when you jerked your hand back did ya move it because you felt like you had to or because it hurt??? There is a difference THUS MY point!

There is a difference and I am trying to offer a key to those like me. A majority don’t end up on message boards ( as Scuro has pointed out) but sure seem to populate jails! See I do understand what I am told, I think. Never know, but do please hear me out. The nagry impulsive people spend a life time of understanding only the frustration being misunderstood, the answer to why some hyper impulsive types “stand out like a dirty shirt”.

To make the movement stop hurts like the flames will your hand and for much the same reasons toooooooo

I think I am going to respond later LOL:p there are a few lines I can reply to now though..I know I should sit down and shut up and be a good little moderator but then sitting down and shutting up has never been my strong suite. The moderator will depends on the day as long as shutting up without physical movement doesn’t enter the picture then I have a chance!

I think I get it:D

To those who listened and understood-or at least tried words aren't my specialty (good thing huh) I am not trying to be mean but I simply want to make sure the distinction between “want to” “felt the need” to wiggle and “have to” wiggle because if we don’t parts of our mind “die” and we “feel” it inside…..now you know why the spankings, punishments, threats, never worked to stop wiggle wiggle wiggle move about behavior = now that I DO GET!!!
:p :p I am crap with words!!! I hear you....they are in my head too, I just can't get them out:faint:


typed up a response after #277 when my DSL decided to go AWOL.....it was a couple of pages in Word lucky me I save it down so it did't get ate so if my response is "off-line" possibly because I was...internet with draw Gary and I may have to actually talk to each other...oh saved by the Verizon tech...who's first question after hearing my version of event

"Was on line went to pastse a post and the machine gave me the can not be displayed page. The internet botton is flashing in stead of a solid green as it should be.....by the way this is going to be hard."

Her first question was "Is your modem / rounter plagged it?"

Okay that was a wtf moment----my understanding was if the little green light is flickering then the thing must be recieveing power from some where other wise the would be no green light."

So nice to see an ADD moment that isn't mine....I assured the lady "it will be harder than that".....

Okay that was two hours ago......it was hard.....I did do the easy stuff....gravy........I am back I hope!!!! So yes there are many things that I fail to understand in this life...flickering light with out power would be one!

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Okay seven people can type faster than one dyslexic can read so out of frustration I am going backwards so I have absolutely no idea of above post and won’t for a while….why screw with the drawkcab metsys that has models my own consciousness, well at least the expression thereof!

Quote:
Such models might very well be implemented in the newer logical form; the utility of such faux ‘flat’ models is they maintain the status quo, and don’t motivate the social impulse to corrective action.

Are you talking about “turning up the contrast” thus decreasing shades of grey and increasing black and white (in your mind)?



Quote:
If space is curved, why don’t we see it?

???? For the same reason the Earth looks flat but is really round???

I get the above from reading the below……


Quote:
One valid view of the answer to Bry’s question involves curved ’us’ floating in curved space gazing about with a curved view that exactly matches the curve of the space in any direction we turn, apparently by magic.

So everything looks straight, and actually is according to most tests we apply, pretty much as Newton’s equations described. The only problem is that ‘magic’, which goes away once we begin to look at how such constructs as ‘gaze’ actually arise.


Flat round world = straight curved universe!!! Haven’t we been here before? Now my brain is really going round and round!!! Think I am getting dizzy!

Has any one seen Cham? I think I need to join her at the kiddy table with hula hoops and bubble gum! I seem to be having an especially hard time with my s…..l…o….w… t….o… s……..n…….a……..p…… today! Fear not I will probably get it three hours after I post some thing like totally silly!



Quote:
At this precise moment in time feel as though the motion:cognition connection is a legacy of evolution, however moreso, that kinda like some vestigial relationship ... some element of functionality is gained through the association.


Thank you! ?I think?…..still looking for cham…hope she likes swing sets I loved those!!!

Crap my mind is doing some kind of winding winding up and it’s SBs fault……no telling what will pop out……early apologies to allllllllllllllll


Quote:
evolution of movement mechanisms assisted in the switch from 'motor' to a motor for cognition, where the motor for cognition (i.e. the stuff about learning upon which I Billy bore on about constantly) ... data ... the sense stream ... data ... leading to a data driven architecture for the brain.

I just know it hurt …..I do not wish to cause problems here

I am still not sure the wording “feel the need to move” doesn’t convey enough emphasis of what is going on inside of wiggly wiggly wiggly meadd! I know I am thick skulled! Believe it or not I am trying to help ….. some things I do understand how it feels to be me is one of them!

I am not looking for validation, ,look at the hyper=pure impulsive ADDErs we make up the smallest percentage of our own group especially in places like this because so many are “broken” but not because they were born that way!

Now to emphasis the point I can’t seem to let go through metaphors. I aint as good as SB but will try!

To those who think I feel the need are you saying you understand my wiggles like this…. Imagine the below in the mind because it aint safe to really try this…

You light up the ole gas stove the flames touch just above the metal black thing……now keeping your hand parallel with the stove top (do not come from above you’ll screw it up) slide it steadily but not fast over the flame aprox 3 inches above the tip of the fire………………………………………………………………..

NOW when you jerked your hand back did ya move it because you felt like you had to or because it hurt??? There is a difference THUS MY point!

There is a difference and I am trying to offer a key to those like me. A majority don’t end up on message boards ( as Scuro has pointed out) but sure seem to populate jails! See I do understand what I am told, I think. Never know, but do please hear me out. The nagry impulsive people spend a life time of understanding only the frustration being misunderstood, the answer to why some hyper impulsive types “stand out like a dirty shirt”.

To make the movement stop hurts like the flames will your hand and for much the same reasons toooooooo



Okay I am through I can take what ever is hurled at me because I have said what I came to say and done what I needed to do the rest is up to people like you who are smart and have benefited from education!

Thank you:
connect the dots. It don’t get any rrrealer than this. Ya can’t see the feeling perhaps the chemical movement physical properties proposed by “main steam of that I do not dispute…question yes but aint quiet figured how else to get answers…not yet any way! Interpretation well it would be hard to observe the inside from the out I am asking ever so politely why is it seen as “the feeling of needing to wiggle” explain the difference between that and the feeling of pain…..if I did not move.


Perhaps this point is already understood like I have been told ( I still struggle with words and so many of them wow) if this is so please forgive my redundancy


My mind won’t shut up too many thoughts pictures brain impulses……dot connecting going every which way!

See if those glucose shortages seen in ADHDers brain remain with the ADHDer wiggling all about that should do the trick of increase that which is deemed low…..…..wiggle=alert / like SB said! Motor cortex goes all over the brain including but not limited to frontal lobe = home of EF and if you can “see ” what I saying your going the right way…..exercise butt = exercise brain…..For some physical movement means KEEP brain alive and developing right!! Wiggle part of EF this you can bank upon because that which doesn’t wiggle wiggle wiggle grows roots! Wiggle is attention via movement= in time and space is logical spatial learning / think stimulant meds through body *** natural movement wiggle sore butt, risk taking and am I hallucinating when I see the big picture emerging (word so contagious I can even spell it) To those who teach…… sorry if we can’t help but disrupt class rooms, annoy teachers we don’t want to but we can sit still or focus but not both!!! I know that I know that I know what I am talking about remember I live there and have for over 40 years!

My mind keeping going and going kind of like my buttttttttt


Aren't yall glad you got the abridged version????

__________________
Tammy


~~~~~~~***-***~~~~~~~***-***~~~~~~~***-***~~~~~~~
Out of my mind, feel free to leave a message!
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OK, now where was I???:faint:

are you seriously asking anyone with ADHD to READ all of that???:faint:



:) Hi-I would like to bring to your attention a new concept in ADD testing. An objective physiological measure of ADHD has been elusive. However, research by Jason Alster MSc has shown that when ADD persons try to sit still, do a boring task, or concentrate- they actually enter stress as measured by labile electro - dermal activity

(EDA , GSR ). Whereas the GSR was traditionally used to teach relaxation it was overlooked as a tool to teach relaxed concentration being dwarfed by the popular and successful neurofeedback.

Measuring electron flow in a circuit the body operates largely by a series of electrical impulses which have been shown to follow certain pathways and measure changes in the electrical resistance or the ability of the tissue to conduct electricity. The GSR activity marker is positive in the majority of ADD clients tested. Once tested, then the GSR biofeedback may be used to improve the stress result with different techniques. A protocol using this valid objective physiological marker has just been published in a video- "Guide for GSR Biofeedback Techniques for the Natural ADHD Practitioner" (Amazon.com).

Using the GSR protocol only takes 10 minutes to perform. The test is valid for children as well as adults and helps parents determine if their ADHD children need intervention. The measure may then be used to match a personal technique protocol to the client depending on what type of technique helps improve the GSR from lability to stability during rest.

The GSR is measured as labile and steadily increases in amplitude when the ADHD child tries to sit quietly for 2 minutes. The GSR is then increasingly more labile during an eyes closed condition. This is in contrast to the GSR in anxiety where there is usually a decrease during a relaxing eyes closed baseline condition. In some instances- the GSR in ADHD is stable - however, will not return to baseline after prompted with a mild stimulus like noise. This shows that a symptom of ADHD when trying to sit quietly and concentrate -is acting like a stress-or for him her. This is not unlike the "disorientation" experienced in dyslexics when trying to read.

Many ADHD clients- upon producing a stable GSR after a biofeedback assisted relaxed concentration technique - will claim when asked-that this is the first time ever they felt what relaxation /concentration is. This may be compared to someone not having ever tasted a tasty food like an orange. You can't describe it to them. However, once they taste it- they know what it feels like. So too, it turns out, with the sense of relaxation, focus in ADHD. When asked to compare this sensation with the sensation of an ADHD medication- the majority of ADHD people will say that the natural biofeedback induced sensation is better than medication- and medication does not "feel well" even though it does help them concentrate. This shows that medication like Ritalin has a different mode of action working to help ADHD than natural and behavioral methods.
The relaxation and relaxed concentration response is natural and seems to be lacking in many people with ADHD. These responses might have been lacking at birth or were compromised with an unbalancing childhood medical problem (Ears nose and throat, asthma,-sleep disorder-medical operation). However, once re-learned or acquired - the ADHD person can re-produce this
"sensation" upon need. Like learning art or music- some are born with it- but all can learn to be artists or musicians with the proper instruction. This objective physiological test is easy to replicate only with the most sensitive /graphic GSR biofeedback equipment(like Thought Stream or Mindlife for example). My hope is that this simple and valid measure will be used as a future screening test in ADHD clinics and schools as well as by biofeedback practitioners helping ADHD.

A bit of the history in how this method was developed. I began treating children with ADD quite unexpectedly in 1991. As a biofeedback practitioner and part of an anxiety clinic in Tel Aviv, Israel, I had absolutely no experience in treating children but was doing quite well with adults suffering from stress disorders and teenagers who had test anxiety and social phobias. The biofeedback clinic had just opened and each type of patient was a new experience.

With medical- technological training in neuro-electrodiagnostics and sleep/wake disorders, I was more into the neurological and psycho- physiological disorders. A child psychologist working with me wanted to try biofeedback on ADD. Then he had said that there was no treatment and no objective test for this poorly understood syndrome. The only remedy at the time was Ritalin although reports about EEG (electroencephalogram) neuro - biofeedback and Joel Lubar's research with Neurofeedback were just coming out (1991) demonstrating that ADHD can respond to a behavioral method. At first I found that EMG (testing muscle tension)was increased in ADHD and there was already a study showing that EMG biofeedback did not help in ADHD.

However, I found that found that GSR ( electrodermal resistance) was better and easier to use in ADHD than EMG. At the time there were no studies of GSR biofeedback for ADD- so I had to go it alone. After starting to treat a handful of children with biofeedback, the psychologist I was working with had to leave the unit and I had to suddenly take over his patients. All I knew then about ADD was from a television program showing a hyperactive child literally jump off the walls and I worried about what this child would do to the biofeedback equipment! I had absolutely no knowledge of learning disorders either. I mention this lack of knowledge for a reason. I had to begin treating ADD without a prior predisposition to what was written in the literature and had to see for myself what worked and fast.
On my very first ADD client I performed a regular biofeedback stress baseline for anxiety.

That is, I hooked the child up to galvanic skin resistance (GSR) sensors, muscle and peripheral temperature monitors, but not EEG. I had to start to treat ADD with what I knew and that is how to treat stress and anxiety. I was lucky. My very first patient's baseline EMG (electromyogram or muscle activity potential) showed that the more she sat quietly the EMG gained in amplitude over time. That is, sitting quietly was tense for her. I tried relaxation training and she improved her baseline in just 6 sessions and began to do better both at home and in school. This was not supposed to happen. Biofeedback in ADD was supposed to be a stubborn neurological problem that takes 40- 60 EEG biofeedback sessions to treat. Wanting to find an effective, alternative method to offer those young people and especially parents who wouldn't, or didn't want to use medication for ADHD. At least these children wouldn't be left untreated.

In my readings at the time, a number of avenues were being pursued in the treatment of ADD. Some of these were nutritional, sensory integration, guided imagery, art therapy, natural meditation, yoga, Bach flower remedies, homeopathy, chiropractic, and the use of aromatic oils. In biofeedback, animated computer games were just being introduced like Mindlife/Ultramind and Thought Stream.

I decided I could use each method and observe its effectiveness. I could try and develop an integrated and holistic approach matching the method to each child individually and determining the results by the GSR.
One of the first things that I found that can cause the GSR to become stable in ADD children and adults is holding a soft or smooth stone in your hand and studying a liquid water timer or sand clock. Other techniques include using the senses to relax like self massage, abdominal breathing, seated yoga, listening to a metronome, listening to a sea shell, guided imagery, smelling aromatic oils, and more.

Later, I found that by integrating accelerated learning techniques and study strategies such as speed reading, associative memory, mind mapping , and time management - children with ADHD and test anxiety began to reach their full potential and receive very high grades in school.

Included in the CD ROM video kit are the book BEING IN CONTROL, and the video BEING IN CONTROL:NATURAL SOLUTIONS FOR ADHD DYSLEXIA AND TEST ANXIETY.
The videos play on Windows Media Player.



:)

[font=Verdana][size=2]:) Hi-I would like to bring to your attention a new concept in ADD testing. An objective physiological measure of ADHD has been elusive. However, research by Jason Alster MSc has shown that when ADD persons try to sit still, do a boring task, or concentrate- they actually enter stress as measured by labile electro - dermal activity


Here is the "study". I gave it a quick glance and noticed that it is not even dated. There have been no citations either with this work. Not a good sign. I had to chop off the intro because it looks like we now have a word limit. Quick observations here:
- this is not a double blind study. T
-they didn't give the Conners checklist to the teachers. That setting is where you normally do see ADHD and they would be more objective then the parents with there observations.
-there is a set of 13 questions that ask "leading" type questions.

http://scholar.google.com/scholar?hl=en&lr=&q=cache:g0AJS15zCR8J:www.geocities.com/jasonalster/researchgraph.doc+%22Jason+Alster%22+and+adhd

Multimodality Integrated Biofeedback Therapy (MIBT)

in the Treatment of ADHD
Jason Alster,
Center for Biofeedback Psychophysiology and Self Regulation,
Zichron -Yacov
MERAV - alternative and natural medicine centers, MACCABI Health Systems
Yacov Sokol,
Child Developmental Center, Hillel Yafe Medical Center
Leora Shachter, Ilan Eldar , Ruth Edri
MERAV complimentary medicine, MACCABI Health System


1 Correspondence or reprint requests should be addressed to Jason M. Alster M.Sc, The Center for Biofeedback and Psychophysiology, Zichron -Yacov, Israel, P.O.B, 2130.

Email- Jasona@internet-zahav.net


Abstract:

MIBT is an integrative approach to treating school children with ADHD that combines multimodality (GSR/temperature) and animated biofeedback, learning strategies, family participation and nutritional counseling in one therapeutic location. Improvements in ADHD symptoms were overall and were achieved within a relatively short period of time (from 8 to 12 weeks). Psycho-physiological baselines of attention and relaxation showed that electro-dermal activity activity was significantly more labile in ADHD children than in controls, thereby serving as a valid modality for feedback. Factors in the symptom reduction of ADHD were that common associated medical disorders also affecting attention were alleviated by MIBT. Mainly these were airway-ENT, sleep, and inappropriate nutritional habits. Additionally, accelerated learning strategies combined with stress reduction and parent re-enforcement improved academic performance. This treatment benefited different ADHD types and ages even in instances where stimulant therapy failed. This approach to the management of ADHD should be considered when a natural treatment for ADHD is preferred.

Keywords: attention deficit disorder; hyperactivity; GSR biofeedback; natural medicine; accelerated learning.

METHODS

Subjects and Intake

The study spanned over 5 different geographical locations in Israel. The different subjects were seen at a private clinic, The Center for Biofeedback and Psychophysiology in Zichron -Yacov in conjunction with the Child Development Institute, Hillel Yafe Medical Center, Hadera. Different subjects were also seen at the Maccabi natural medicine health clinics (Merav) in Tel-Aviv, Netanya, and Haifa. Patients were referred for treatment by their parents, physician, or school. Reasons for referral were non-compliance with medication, limited symptom reduction, unacceptable side effects from medication and a preference for natural treatments.

The patients undergoing MIBT were 20 children, 18 boys and

2 girls ages 7 - 15 years with a mean age of 10.7±2.58. All ADHD patients had been diagnosed either by an independent child neurologists or psychiatrists. The DSM-IV definition of ADHD is used in Israel so there was no need to re-diagnose the patient at intake. Most of the patients had also received school psychological testing and/or testing by remedial practitioners so the histories of ADHD were well substantiated. For many of the children, a diagnosis of ADHD had been made a few years before seeking MIBT and they have undergone various other therapies before MIBT. Sixteen of the 20 subjects were diagnosed as ADHD type hyperactivity disorder and 4 as ADHD type AD. The two girls were diagnosed as ADHD type AD. Ten patients had exposure to stimulant medication before MIBT. Of the 10 patients not previously medicated, 5 patients had not been recommended stimulant medication by their physician. In the other 5, stimulant medication had been recommended but the family had refused. In the 10 patients with a history of stimulant medication usage, 5 had been on medication previously and terminated usage before MIBT due to side effects or lack of response. The other 5 patients were on stimulant medication at the time of beginning multimodality biofeedback but were not totally satisfied. The reported side effects of stimulant medication reported on by our patients were a decrease in appetite, hyperactivity, tiredness, and apathy. Apathy and tiredness were the main reasons for patients to decide to terminate stimulant medication and the stated reason was that this interfered with the patient’s social activities. Of note, is that the patients' decision about medication compliance was not connected, at the time of referral, to the availability of biofeedback. Rather, the decision to not medicate was related to their own convictions and experiences with stimulant medication.

Since over-diagnosis of ADHD is an important concern today we wondered if our sample was from a particular sub-category of ADHD patients who poorly responded to stimulant treatment or alternatively were misdiagnosed. A number of factors tended to support the notion that our population was not from a sub-category of ADHD patients misdiagnosed. This because our patient referral was diversified and a diagnosis of ADHD had been made by a number of physicians. The subjects also came from different geographical locations and the preponderance of learning disorders, dysgraphia and dyslexia, which were associated with ADHD in 30% of our patients is similar to that stated in the literature (Sharma et al., 1997). Furthermore, the higher proportion of male patients (18 M vs. 2 F) in our sample is in concordance with other findings in the literature (Lufi et al., 1997) for Israel and abroad.

Procedures

Questionnaires: During the initial interview and at the termination of therapy, parents filled out the short form of the IOWA-Conners’ Teacher/Parent Behavior Rating Scale. This is a 10-item scale designed to provide a standard measure of attention, hyperactivity and impulsive behavior in children (Linden et al., 1996). It takes only 7 minutes to administer. Items are scored usually by a teacher and parent as occurring on a continuum, 0=absent 1=mild 2=moderate 3=severe.

During this study, teachers were not requested to fill out the Conners’ questionnaire. The reason was that some parents did not want the teachers to know that their children were undergoing therapy; alternately, some parents wanted to independently determine the results of MIBT without teacher bias. However, teachers' comments about regular progress were noted and were queried for in the interview. Pre therapy Conners’ scores were compared to a control group of age matched normal siblings of ADHD children (n=15) as well as to other patients who had received stimulant medication (n=15) before referral to MIBT. Conners’ scores were also compared for post therapy scores and long term follow-up after one year. Although the Conners' evaluation is widely considered to be sensitive to stimulant medication effect (Lufi et al., 1997; Conners, 1969), nonetheless, there are shortcomings in the use of this questionnaire. For example, it lacks measures for social and health factors (Conners, 1969) and does not include self-assessment. Therefore, to further evaluate MIBT outcome, a subjective questionnaire the Zichron Yacov Questionnaire for ADHD was compiled. This questionnaire also relates to ADHD associated factors as well as the particulars of the MIBT therapy- items that are not covered in the Conners' evaluation form. The oral questionnaire is completed with the therapist by the patient and parent as part of the clinical interview. To eliminate patient bias and verify the validity of each response, answers had to be backed up with concrete examples of improvements. For example, an answer of "My sleep is more efficient" had to be validated with an example as "it now takes me less time to fall asleep now".

The 13 questions are as follows:

1: Is there an improvement in your nutrition. Describe.

2: Is there an improvement in your sleep. Describe.

3: Is there an improvement in uncontrolled motor activity. Describe.

4: Is there an improvement in your breathing. Describe.

5: Is there an improvement in your feeling of being healthy. Describe.

6: Is there an improvement in your general mood. Describe.

7: Is there an improvement in your concentration and wakefulness.

8: Is there an improvement in your confidence. Describe

9: Is there an improvement in your relationship with your teachers.

10: Is there an improvement in your relationship with your friends.

11: Is there an improvement in your relationship with your family.

12: Is there an improvement in your school work.

13: Do you practice relaxation/focusing exercises at home or school.

Thus, the questions touched upon general health and well being, social relations, academic progress, and compliance for relaxation exercises.

In this study, treatment lasted between 8-12 sessions. The first MIBT session is a baseline session of 60 minutes. This is broken into a 15-20 minute interview. Baseline GSR and temperature measures are for 15 minutes, followed by measurements of memory and reading rates for 15 minutes. A biofeedback modality demonstration for the final 10 minutes. Subsequent sessions were of 30 or 60 minutes depending on location of the given therapy. During the subsequent sessions, multimodality biofeedback was combined with learned relaxation techniques, learning strategies, and parental and nutritional counseling. A synopsis of the different relaxation/ focusing techniques and learning strategies as adapted for use in children can be found in the graphic self-help booklet -BEING IN CONTROL -Natural techniques for increasing your potential for success in school. The booklet was published as an outcome of this study (Alster, 1999) and incorporates the ideas of the therapy in integrating relaxation techniques, proper nutrition, social skills, and learning strategies. The therapy was designed to be both rewarding and enjoyable each and every session.

MEASUREMENTS

GSR signals, animated GSR games (Ultramind), and temperature biofeedback were used during therapy because both relaxation and concentration can be trained with these parameters. The GSR is easy to train in children and the different animated games make learning fun for the patient. This is important for treatment compliance because ADHD children display fewer behavioral and attention problems in one-to-one interactions, in novel situations, and in situations they find inherently interesting or rewarding. Conversely, their attention and behavioral problems escalate in situations that are boring or repetitive (Murphy and Barkley, 1996).

Both the raw GSR signal and the animated GSR games were used for feedback. The raw signal is useful in training for 2-3 minute focusing techniques while the animated games help train for overall attention and relaxation. Levels of difficulty for the animated games can be adjusted so that progress can be obtained each session. Mastering the animated games was helpful in preparing for training on the raw GSR signal. The awake resting tonic GSR or electro-dermal signal (EDA) is generally stable but can be abnormally labile in patients with certain disorders such as anxiety. The EDA has also been used clinically as a measure of pyschophysiological change following therapeutic intervention (Rabavilas 1989, Hoehn-Saric et al., 1989). EDA lability has been demonstrated to reflect arousal differences both within and between subjects (Lacey and Lacey, 1958). Also, EDA lability is related to peculiarities in orienting response, the speed and accuracy of performance in verbal and spatial tasks (Schulter & Papousek, 1992), the allocation of attention capacity to environmental events, and to the ability to respond to changing demands in an attention situation (Crider 1975). Therefore, GSR/EDA stability is a known measure of attention and it is reasonable that biofeedback training with the GSR should improve attention ability.

Skin temperature is also a widely used signal for physiological monitoring and assessment of psychophysiological reactions. It is considered to be influenced by a combination of different physiological processes i.e. perspiration and vascular tone, which determine the response of thermo-regulation. Temperature ranges are thought to reflect changes in sympathetic vasoconstrictive tone and in the concentration of circulating vasoactive substances occurring during both relaxation and stress (Shusterman & Barnea, 1995). Although thermal biofeedback training is oriented toward attaining states of deep relaxation, physiological studies of EEG activity recorded during thermal feedback have also revealed focused attention. An increased density of 15-20 cycles of beta EEG activity reflecting focused attention has been recorded together with concurrent slow-wave EEG activity reflecting deep relaxation (Norris & Fahrion, 1993). Thus, it could be expected that thermal biofeedback would also be a tool for training both attention as well as relaxation.

Two measures of GSR skin conductance levels (SCL) were used in this study. One was the nonspecific skin conductance (SC) electrodermal fluctuation rate (SCFr) (Kushniruk et al., 1985; Dolu et al., 1997) as a measure of GSR lability. This was the number of nonspecific SC responses and fluctuations occurring during the resting period minute. Normal baseline SCFr in adults has been reported to be about 2.86 fluctuations/min for resting eyes open and lower with 2.32 fluctuations/min for resting eyes closed in adults (Alster et al., 1994 ). This is a measure of GSR intensity. Another measure used for the direction of GSR change with time was the maintained directional deflection of the GSR graph over time. By option, an upward deflection of the GSR activity was represented as increasing arousal and a downward deflection as increasing relaxation (Fig. 2a). A downward deflection for relaxation was chosen because this is easier for the subject to conceptualize. According to Ultramind, which markets a computerized dedicated GSR/animated telemetric biofeedback device, “the processed data (Ultramind device values) are translated into uS/cm2 (Micro Siemens per square cm) skin conductance level (SCL)". The Ultramind device is dedicated to GSR biofeedback and its GSR signal is very sensitive compared to many other non-GSR dedicated biofeedback monitors.

In patients, before therapy, baseline psychophysiological measures of GSR were recorded for 2 minutes of eyes open and 2 minutes of eyes closed. Ample time was set for an adaptation period. GSR electrodes were placed on the medial phalanx of the fore and middle fingers. Following GSR measures, peripheral temperatures were recorded from the forefinger. For a control of the GSR and temperature baselines, measures were taken from 20 age matched normals. Since, at the time of this study, there was scant data on GSR activity or GSR biofeedback in children for comparison this necessitated the control measure.

Memory enhancement techniques are advised in college counseling programs today. The common ones use visualizing a picture of what we want to recall (in contrast to rote memory), word linking that forms associations linking one idea to something already stored in memory, and increasing the sensory experience and interest incorporated into memories (Rose, 1987; Davis, Sirotowitz, Parker, 1996). For

visual memory, baselines were evaluated by having the patient memorize 12 picture game cards (from a child’s memory game), each shown for

10 seconds. Pictures were neutral daily objects such as -- phone, shoes, bird. Auditory memory was evaluated by using similar neutral words. During training, the items could be increased to 15.

Proponents of basic rapid reading techniques point out to a close relation between reading speed and understanding, pointing out that slow readers are not automatically good readers. Concentration and reading efficiency are improved by reducing subvocalization, word by word analysis, and eye regression, while increasing a wider eye span and improving reading posture (Schaffzin, 1996; Rose, 1987). For Reading rate reading material was matched to the age of the patient and was from storybooks or children’s magazines. Patients were asked to read as fast as they could within one minute but not faster than their comprehension level. To train for increasing reading rate and efficiency, consideration was paid to subvocalization, regression, re-reading, relaxation, and developing a wider eye span.

Relaxation exercises included an abbreviated progressive muscle relaxation technique , (Smith et al., 1996), and cognitive-behavioral relaxation which defines relaxation in terms of arousal reduction, learning passivity and receptivity. Muscle relaxation stretches including a combination of seated yoga stretches (Folan, 1994) and progressive relaxation on the computer based Ultramind de-Stress system. Abdominal breathing exercises and guided imagery were also taught. Focusing exercises consisted of sustained focusing on a relaxing object like a scenic picture or looking at a water clock for at least two minutes. The GSR was used to determine if the patient was doing the focusing exercises properly. At home, between sessions, patients were requested to practice a minimum of 2-5 minute relaxation or focusing exercises of their choice at least once a day. It was determined that consistency was more important than the amount of time spent doing exercises. Although there is some debate about the benefits of allowing parents to participate during treatments, it was decided early on that parent participation would be necessary. Subsequently, parents were requested to be present during the sessions in order to help with exercise compliance at home and better understand the process. Parents, at times, could also hook up and compare results with their children.

Nutrition: Since associative medical disorders and stress were to be targeted, proper nutrition had to be taken into consideration. Eating a balanced nutritious diet and keeping good eating habits is important for staying healthy, maintaining an alert state, and combating stress in the classroom. Basic principles that most nutritionists now agree on are to reduce the intake of fats and simple sugars, increase intake of complex carbohydrates, decrease deficiencies and diversify food intake. A well balanced diet includes consuming vegetables, fiber, fruit, meat and fish while avoiding processed food (Kirsta, 1986). Combining biofeedback and dietary counseling in a treatment plan has been done in the recent past (Leung et al., 1996), and this combination should help control impulsive eating in ADHD. Nutritional advise consisted of making sure that the child was eating all meals and had a well balanced, diversified, and natural diet. This included fruits vegetables, fish and meats, but reduced chemical additives, processed foods, and foods with a high fat and salt content. To increase awareness and identify irregularities, the child had to compile a

3 day list of all things consumed. Helping the family find healthy food alternatives would be part of the counseling.

Results

Figure # 1 shows 10 associated factors that were presented by our patients with ADHD. It was not unusual for a patient to have a combination of as many as 3 or 4 associated factors in addition to the ADHD. Ear, nose and throat (ENT) and airway disturbances (asthma, sinusitis, ENT obstructions, polyps, and chronic ear infections) were the most common present or past symptoms in 14 patients (70%). This was followed by both sleep disturbance and inappropriate nutrition in

10 patients (50%). Reported sleep disturbances included mid-sleep awakenings, enuresis, poor sleep habits or long sleep latencies as a result of anxieties and airway disturbances. Inappropriate nutritional habits included skipping breakfast, consuming large amounts of processed foods with high fat content (chocolates, fried foods, yellow cheeses, cold-cuts). There was also avoidance of nutritional basics like vegetables, fruits, and fish because the child had a bad first experience with the taste or texture of the food. By advising parents to prepare the avoided foods in a different way like softening vegetables by cooking in soups or steaming and eating tuna or sardines, then the child agreed to consume vegetables and fish.

Baseline EDA/GSR was measured for 4 minutes of which 2 minutes were for quiet sitting with eyes open (EO) and 2 minutes were for eyes closed (EC). This was then followed by a measure of peripheral temperature and served as an adaptation period. The deflection and lability of the GSR was used as a measure of sustained quiet sitting ability. Figure #2a is an example of a quiet and stable GSR in a normal subject while Figure #2b is a representative example of a labile and upward deflection of the GSR in a patient with severe ADHD. Figure #2c is an example of the sustained stability and downward deflection of the GSR during an

8-minute relaxation with guided imagery. A downward and stable deflection of the GSR was similar for both focusing and relaxation. The baseline values were then compared to normal controls by paired t-tests. Normals were 20 youngsters (5 M, 15 F) ranging in age from 6 - 17 years (mean age, 11.2 ± 3.3). There were no differences found between boys and girls in their GSR resting activity for age and sex and this is similar to the findings of others (Lee et al., 1996). Table I. compares the GSR baselines for both normals and patients. In regards to the deflection of GSR flow during EO and EC conditions, almost all of the controls had a downward relaxed deflection of the GSR for both EO and EC conditions (17 and 18 controls respectively). Lability scores as mean fluctuation rates were 4.5/ min ± 1.9 for EO and 3.66 /min ±2.0 for EC. As can be seen, there were more patients than controls who had unstable GSR activity during quiet sitting and this was especially evident during EC for GSR lability. The significant difference between controls and patients for GSR deflection in EO was t=2.35, df 19, t=0.03, and in EC, t= 4.82, df 19, p< .001. Lability (using a 4.5/min cutoff criterion) in EO was not significantly different from controls but more patients than controls had lability scores for EC t= 3.33 df 19, (p = 0.004). There was no correlation between age and GSR values. Thus, the GSR was found to be a valid indicator of the ability to maintain a focused and quiet state that was significantly missing in ADHD patients.

There were no significant differences between controls and patients for baseline peripheral temperatures. Temperatures were 29.9° ± 3.72 and

31.5° ± 3.04 respectively for controls and patients. There were also

no correlation’s between GSR values and temperatures in either the patients or controls. However, temperatures in-patients after thermal biofeedback were significantly increased to

34.6°± 2.58 (t=5.62, df=19, p<.001). This was also significantly higher than control baselines (t=5.31, df =19, p<001). Therefore, the demonstrated ability to self-regulate temperature is most likely a better indicator than the actual baseline levels themselves.

For the application of different relaxation techniques it was found that for almost all the patients, the feeling of deep relaxation was a novel and positive experience. All patients reported that they were able to be progressively more relaxed with each session. A decreasing and stable GSR was found to be a valid indicator of deep relaxation that could generally be reached within 6-8 minutes (Figure #2c). This was similar to findings in adults (Alster et al., 1994) where chronic insomnia sufferers reported that their ability to relax with biofeedback was a novel or uncommon experience. Thus the ability to be relaxed is an important skill that is natural for some but must be learned by others. ADHD patients were successful in reaching this sustained relaxation after training. When asked to compare to the effect of relaxation to stimulant medication, patients said the effect was similar in that stimulant medication also had a relaxing effect. During sessions, all patients were able to comply with the brief focusing techniques while improving their GSR signals early on in treatment. Only one patient could not improve his GSR for the 2-minute focusing exercise.

The ability to sit quietly and focus for 2 minutes (as measured by a stable GSR) was a training pre-requisite in order to achieve a deeper relaxation within 6-8 minutes. Children with ADHD could achieve this in stages by practicing 2 minute focusing exercises at home (with parental help if needed) and then increase the length of the exercise. A two or

3-minute sand or colorful water clock was useful to help the child focus on and time himself (Alster, 1999). Different focusing as well as relaxation exercises could be matched to the patient for later home practice and be validated by a stable GSR response. Another tool that was helpful for home practice was the use of finger size crystal temperature biofeedback strips (SHARN) given to each patient to practice thermal biofeedback. A common complaint by therapists is that their patients do not do exercises at home and an exercise as Jacobson's Progressive Relaxation or meditation take as long as 20 minutes. Therefore, in keeping the exercises simple and brief compliance was good. The concept of time and inhibition of behavior has been theorized to be deficient in ADHD (Barkley, 1997). The exercises help in teaching behavioral control during the periods of time monitored by the stable GSR.

Both visual and auditory memories were significantly increased using associative memory techniques generally in just one session. Picture card memory was increased from memorizing 6.28 ± 2.82 cards to

11.33 ± 2.28 cards, t=7.19, df 19, p< .001; and auditory word memory was increased for number of words memorized from 6.8 ± 2.14 to

11.3 ± 2.76 words, t=8.80, df 17, p<.001. At baseline, all patients initially used rote memory and were not aware of associative memory techniques. Thus, memory could be enhanced by using alternate methods to complement rote memory. Reading rate and comprehension were also significantly improved using speed-reading techniques. This could also be done in just one or a few sessions. Reading baselines were 89.82 ± 47.40 words/min and were increased to 130.77 ± 67.98 words /min, t =3.23,

df 16, p =0.005. Evaluation of reading comprehension revealed that comprehension was not compromised rather enhanced with an increased reading rate. Since memory and reading were improved during the session they were taught, time or mere repetition training effect could not have been factors. Furthermore, poor concentration could not be a sole factor in memory or reading difficulties. Rather, the usage of alternate or different learning styles were needed to improve memory and reading.

Figure # 3 compares the Conners' scores for ADHD symptoms before MIBT, after MIBT treatment and at long term follow-up

(1-year). These scores were further compared to normal sibling controls from families with ADHD and with ADHD patients receiving stimulant therapy at the time of seeking MIBT treatment. As can be seen, overall improvements in attention, hyperactivity, and impulsive behavior after therapy and at long term follow-up were significant. Mean total scores comparing pre and post therapy showed a significant overall decrease in symptoms at the termination of therapy (paired t-test) with

2.76±0.34 vs. 2.13±0.253 (t=8.82, df 9, p<.001). Mean Conners’ scores were further improved at long term follow-up, however, these were still significantly higher than siblings with 1.73±0.28 compared to 1.45±0.177 for controls (t=2.76, df 9, p <.02). As can also be seen, patients with MIBT had significantly lower Conners' scores than patients receiving stimulant therapy (n=15) with 2.75± 0.21

(t =7.46, df 9, p< .001). When observing the individual items (multiple paired t-test with a strict criteria of .025 for significance) post therapy scores were significantly lower (p < .025) on 7 out of ten items while being very significant (p < .001) in 4. These were 1- restless,

2- oversensitive, 4-does not complete tasks, 6-distractibility. Parent scores were less than p <.01 in 3. These were 3- bothers other children,

9- moody, 10- anger. Individual scores for 5- hyperactivity, 7-needs attention, and 8-emotional crying were not significant. The most common responses in which parents wrote about the effects of treatment were that the children were more relaxed at home and that social relations were improved.

In addition, physiological baseline data for GSR and temperature scores were correlated with Connors’ outcome to determine if physiological indicators of stress and attention could be predictors for outcome. There was no correlation found between physiological baselines and patient outcome.

Subjective improvements (Figure #4) were reported in more than half of the patients for as many as 10 of the 12 self-questionnaire items. As can be seen, the highest rates were for nutrition, attention and scholastics. Since self-questionnaire answers had to be validated by example, the following is a representative example of the type of answers obtained.

Case #1. One of the best responses was from a patient

(age 9, and whose twin brother also has ADHD) receiving Ritalin at the time of MIBT therapy. His main complaints were behavioral, disturbing others, and hyperactivity. He was a good student and his mother was a teacher at the school where he attends. Previous therapies for his behavioral problems did not alleviate his problem. His baseline GSR deflection was high and labile during eyes open but stable for eyes closed. His peripheral finger temperature was low and below 25°. The child had a history of respiratory problems that would disturb his sleep and was treated with ventolin. His diet consisted of high amounts of fried foods, hard cheeses. He also refused to eat vegetables. During therapy he was able to regulate his GSR and temperature, achieve deep relaxation in the lab and at home, improve his memory, reading comprehension and penmanship. His self-questionnaire responses were

1: Proper nutrition- “Improved, I have began to eat vegetables.”

2: Sleep- “Improved, I now fall asleep in 10 minutes instead of 30 minutes." 3: Hyperactivity- “Improved, I have quit hitting my brother."

4: Respiration- “Improved, I now breathe without hearing my own breathing." 5: General Health- “Improved, I have not been sick since

I began therapy. I use to be ill frequently." 6: General mood- “Improved,

I am no longer sad." 7: Attention and concentration- “Improved, I am more awake when I use to want to sleep." 8: Self confidence -- “Improved, I am now first in line for sports activities when I use to be last." 9: Teacher relations- “Improved, the teacher calls on me now when I raise my hand in class." 10: Social relations - "Improved, I am included more in play activities.” 11: Family relations - “Improved, I play more with my family." 12: Scholastics- “Improved, grades improved and I try to learn more."

13: Home exercises - “Yes, especially self-stretching”. Following MIBT, the patient was then taken of ritalin by his neurologist and remained drug free 6 months later at follow-up.

This type of self-questionnaire was effective in increasing awareness for the patient and family as to the different aspects of his condition and where improvement may be gained. Although there was general agreement between parent and child about improvements, some differences between parent and child were evident. This was especially for observations about hyperactive behavior. Parents did not always notice improvements in hyperactive behavior even though children reported on reductions. This might be expected as the parent is not always with the child and the reductions might be only subtle. Although teachers' observations were not compiled by questionnaire for reasons mentioned above, teachers evaluations were referred to in the self-questionnaire by the questions on child-teacher relations and scholastic ability. In the instances where teachers’ evaluations were obtained, they generally substantiated the parent/child report. Teachers then served as a source for later referrals, which further substantiated the results. In conclusion, all 20 patients reported subjective improvements while 19 patients were able to demonstrate self-regulatory control over GSR and Temperature modalities. Objective reports by parents were positive in 19 patients.

Long-term follow-ups from 4 months to one year after the termination of therapy were done for all 20 patients. Parents responded both by telephone interview and Connors’ questionnaire.

Long term outcome was considered a success and met parents expectations in 10. The Conners scores for these can be seen in

Fig 3. When looking at the effect MIBT had on stimulant medication usage, 2 of the good outcome patients were able to reduce their stimulant medication level and another 3 were able to cease stimulant medication usage altogether. Out of the patients with only short-term improvement, two patients had to return to stimulant medication yet one patient was able to reduce his medication usage, and one patient had quit medication usage. In all, there was a reduction in stimulant medication usage in 8 of the 10 patients following MIBT. Positive outcomes were not related to age, or physiological baselines. It could not be determined at the start of therapy who would succeed. Conners' scores and self-report could not determine long term outcome.

Discussion

A main finding of this study was that both GSR and temperature biofeedback were valid and effective modalities in the treatment of ADHD. That is, relaxation techniques were as important to train for as was sustained attention and both temperature and GSR were revealed to be valid physiological modalities to use for this training. Furthermore, baseline EDA/GSR was found to be more labile in ADHD than in normal controls and EDA measures in ADHD were normalized during training sessions. Thus, the EDA could also be used as an objective physiological measure of attention in school children. Although GSR and temperature biofeedback proved to be useful in the treatment of ADHD these modalities have been overlooked in the past. Yet, studies have shown a connection between GSR measures of lability and central arousal states, accuracy of information processing (Crider 1975), attention span in ADHD children (Shibagaski et al., 1993); and frontal EEG asymmetries in the brain (Schulter & Papousek, 1992; Papousek and Schulter 1997). For example, Lacey and Lacey (1958) demonstrated that GSR labiles made more commission errors to peripheral stimuli than did stables, a phenomenon the Lacey’s referred to as ‘motor impulsivity’. They related this to individual differences in arousal state. All this supports the use of the GSR as a viable modality in ADHD. Additionally, it points to a central relationship between arousal, attention, and GSR. At the time of this study, other investigators are also examining the effectiveness of using animated/GSR biofeedback in the treatment of ADHD and similar to our findings, they also report that GSR can be used to treat ADHD. Subjects attending under 10 sessions have had improvements in behavior, hyperactivity, tics, and sleep (Lombard G., et al. 1998).

Another important finding was that the treatment of associated medical factors in ADHD clearly helped reduce ADHD symptoms. Medical histories and outcomes in our patients revealed that indeed associated medical factors are not uncommon in ADHD and if these could be alleviated the ADHD symptoms would be reduced. Tannock

(Tannock, 1995; Tannock et al., 1995) notes that and as many as 50% to 80% of children with ADHD meet diagnostic criteria for other disorders. In our study, ENT/ respiratory, sleep disturbances, and nutritional irregularities were the three associated factors most common in our patients with ADHD. Each in it’s own could aggravate attention and hyperactivity symptoms and/or be a source of additional stress in the ADHD child. The implication for respiratory problems is heightened when there is the possibility that a child with learning difficulties might experience dyspenic-fear associated with classroom stresses especially during exams or when being called upon in class. The finding that the GSR was especially labile during an eyes closed condition in ADHD would support vestibular imbalance associated with ENT problems. The relationship between disturbed sleep, daytime fatigue, diet, and respiration is well known. For instance, obstructive sleep apnea syndrome or asthma in sleep have been identified as producing ADHD symptoms in children. Although complaints of sleep disturbances associated with ADHD have not produced significant polysomnographic abnormalities in the past, nevertheless, symptoms of sleep deprivation (irritability, attention difficulties, and listlessness) share some overlap with ADHD symptomatology (Dahl et al., 1989). Another similarity, is that the baseline daytime GSR has also been found to be labile in patients suffering from hyperarousal and insomnia (Alster et al., 1994). That is, insomnia patients suffering from daytime hyperarousal have baseline EDA/GSR similar to our ADHD patients. It is feasible that an airway/ sleep/nutrition triad effecting attention and hyperactivity is an occult non-neurological basis for a subgroup of ADHD patients. The high number of ADHD patients with airway, ENT disturbance and nutritional irregularities has led Crook (Freed & Parsons, 1998) to suggest that proper diet be used to reduce the need for stimulant medication. He also makes a relationship between the high number of ear infections in ADHD children and their being treated with antibiotics which kill friendly digestive germs. Therefore, ADHD is a multifactor problem and probably no one variable will tell the whole story. .

Other important outcomes of the study were that improvements in ADHD symptoms could be achieved in just 8-12 sessions of MIBT. This is important because it makes the therapy feasible financially and also lets a natural therapy become an option to the parents when time concerns are being weighed in light of loss of academic achievement or when there is behavioral disturbance to the school invironment. Although short-term outcome was positive subjectively and objectively in most of our patients, only 10 of our patients met parents expectations at the long term. On the other hand, it was also surprising to find that the Connors’ score in the 10 children with a good long-term outcome had approached those of normal controls. As a result, periodic booster sessions are now recommended to our patients to maintain the results achieved during therapy. Our present experience is that the booster sessions model is quite effective and will increase long term outcome. Also, since the parents actively participated in the treatment process they are well equipped to judge when the child needs booster sessions. In all, family participation in the treatment process was found to improve family relations, reduce stress, and help the family become better advocators in the school system. It is probably for this reason that physiological baselines were not predictors for positive outcome as ADHD is a true bio-social disorder. Better predictors in the future for outcome would have to include social factors as well.

A positive aspect of MIBT is that it collaborates differing theories about ADHD and it’s treatment. For instance, some investigators propose that ADHD is not a primary disorder of attention, but one of response inhibition (Murphy & Barkley, 1996). Barkley (Barkley, 1997) has determined that inattention, impulsiveness, and hyperactivity can be reduced to a delay or deficit in the inhibition of behavior and an altered sense of time. Others consider ADHD a problem in

attention inconsistency, having different learning styles

(Freed & Parsons, 1997). In this respect the self-regulation and focusing techniques with alternate learning skills training addresses this concept. From a psychosocial aspect of where the responsibility lies for the management of ADHD. This therapy incorporates elements of Carl Rogers’ Client Centered Therapy

(Hjielle, 1981) where the patient is considered an active and important part of a process to help him self-actualize and take responsibility for himself.

Conclusion

The preliminary results of this study recommend that the GSR assessment of attention deficits should be adopted as a screening procedure for ADHD and that GSR/TEMP feedback were good tools to train for attention and self-regulation in ADHD. MIBT as an holistic approach has been effective even when stimulant treatment has failed. MIBT also presents an effective approach to helping a wide range of ADHD type patients even from an early age. The core elements integrate multimodality and animated biofeedback, relaxation and focusing exercises adapted for children, parental participation, nutrition, and accelerated learning into a relatively short therapy. A main purpose of the treatment was to provide self-sufficient techniques to the client. The therapy has been well received by the community where it is given including the school systems, the allopathic and alternative medical community, and the families of the patients themselves. Since this study over 150 children with ADHD, test anxiety, and learning difficulties have undergone MIBT in Israel. Future studies can better define how MIBT may be combined with other treatments found to be helpful in ADHD such as neurofeedback, stimulant medication, homeopathy, or reflexology.

Whip out the sources like Scuro dude. We have a length limit? No wonder I had to take my pills and introduce music in order to sit long enough to read source material.


Although thermal biofeedback training is oriented toward attaining states of deep relaxation, physiological studies of EEG activity recorded during thermal feedback have also revealed focused attention. An increased density of 15-20 cycles of beta EEG activity reflecting focused attention has been recorded together with concurrent slow-wave EEG activity reflecting deep relaxation (Norris & Fahrion, 1993). Thus, it could be expected that thermal biofeedback would also be a tool for training both attention as well as relaxation.

They got the hyper active ADDers to sit still long enough for this how??? Hyper active minds want to know. I had to take medications to sit long enough to learn to sit- then a secondary sensory stimuli had to be introduced apparently my brain requires a lot of stimuli to focus on one thing, the study in the post.




Combining biofeedback and dietary counseling in a treatment plan has been done in the recent past (Leung et al., 1996), and this combination should help control impulsive eating in ADHD. .

Impulsive eating ???? See food diet = I see food I eat it. When I was younger any way now I don't do this as much older slower matabolism. :o




bad first experience with the taste or texture of the food. .

Okay no slimy stuff I know few hyperactive that eat slimy stuff but unless one over cooks vegetable they are really sort of crunchy!

So much for that poor memory theory!




A positive aspect of MIBT is that it collaborates differing theories about ADHD and it’s treatment. For instance, some investigators propose that ADHD is not a primary disorder of attention, but one of response inhibition (Murphy & Barkley, 1996). Barkley (Barkley, 1997) has determined that inattention, impulsiveness, and hyperactivity can be reduced to a delay or deficit in the inhibition of behavior and an altered sense of time. Others consider ADHD a problem in attention inconsistency, having different learning styles. .

I vote for others on this either or

Others consider ADHD a problem in attention inconsistency, having different learning styles. .


Although attention control decreases with requirements to be still and shut up because to do so requires attention then comes the discomfort that accompanies the sitting still- :faint:

Yes I have my own sources to “validate” this point of view.


“Fidget to Focus”

Page 23

Some adults believe that if children are moving about they can not be paying attention. Williams and Shellenberger point out that to the contrary, most children can either sit still or pay attention. They actually need to move, need sensory-motor input to pay attention. It is really no different for adults. However, the adult’s slight movements while sitting and listening are rarely considered rude or a sign of inattention. This is probably because these slight movements are both less obvious than the sensory-motor activities engaged in by children and, because these movements are so universal they are socially acceptable.


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Distractibility is really attractability. Our sensory input goes into over time trying to activate an under-active brain. For some of us, this sensory-motor input may take the form of a wiggly foot or doodling on a scrap piece of paper .For others it may be suddenly noticing the familiar sound of Muzak. Some of us may find that this is a time when internal distractions like daydreams or worries engage us. We may even create excitement by tilting our chairs back on two legs and working to stay balanced for seconds at a time.

So why do we wiggle and fidget?. Well obviously we wiggle and fidget to remove the tedium of the moment. This is true for every one. However and more importantly for those of us with ADD brains, the rhythmic simultaneous sensory stimulation of a jiggling foot or doodling take this process one step further. Because the sensory-motor activity engages our brain, quickly stimulating the frontal lobes, we literally fidget to focus!
***End Quote



Conclusion

The preliminary results of this study recommend that the GSR assessment of attention deficits should be adopted as a screening procedure for ADHD and that GSR/TEMP feedback were good tools to train for attention and self-regulation in ADHD. MIBT as an holistic approach has been effective even when stimulant treatment has failed. MIBT also presents an effective approach to helping a wide range of ADHD type patients even from an early age. The core elements integrate multimodality and animated biofeedback, relaxation and focusing exercises adapted for children, parental participation, nutrition, and accelerated learning into a relatively short therapy. A main purpose of the treatment was to provide self-sufficient techniques to the client. The therapy has been well received by the community where it is given including the school systems, the allopathic and alternative medical community, and the families of the patients themselves. Since this study over 150 children with ADHD, test anxiety, and learning difficulties have undergone MIBT in Israel. Future studies can better define how MIBT may be combined with other treatments found to be helpful in ADHD such as neurofeedback, stimulant medication, homeopathy, or reflexology. .

Underlining mine....I underlined the parts I agree with the most.

All in all I agree with the conclusion of this, especially sense it is not an either or world using a variety of approaches seems to be a logical move (pun intended) :soapbox: I have always felt more effort should be directed in the area of helping those with ADD symptoms who can not take medications. So far we have zip or barly above zip to offer them in the way of help.

NOW I remember what I was going to say when I first saw this topic!!:p

I did a bio-feedback test...I was wired all over my head and they played a music video of my choice...The music was going on and off and on and off, and fading in and out...I was getting SO frustrated/annoyed/angry/..:mad: so when the lady finished, I was quite snappy, and I said
"were you turning that UP and DOWn just to ANNOY me?" :mad: and she said "no, you were doing it!" ..I was like.."oh no I wasn't, I can't even reach the volume switch!!".. :mad: and she said, as your brain gets distracted, the music turns off, and when you pay attention to it again, your brain sends out signals that you are now paying attention and it turns it back on!!!" :eek:

I went bright red, and said "oops, sorry" and she said that's ok..you have ADD:p
If I go to bio-tuning 2 times a week, you train your brain not to lose focus, and you are cured:D
so, my point is...is that what the original poster was talking about?

BTW..I haven't been back

good investigating Scuro:p
Here is the "study". I gave it a quick glance and noticed that it is not even dated. There have been no citations either with this work. Not a good sign. I had to chop off the intro because it looks like we now have a word limit. Quick observations here:
- this is not a double blind study. T
-they didn't give the Conners checklist to the teachers. That setting is where you normally do see ADHD and they would be more objective then the parents with there observations.
-there is a set of 13 questions that ask "leading" type questions.

Quackwatch doesn't think too highly of biofeedback.

http://www.quackwatch.org/01QuackeryRelatedTopics/electro.html

This is the opening salvo of the article.
The devices described in this article are used to diagnose nonexistent health problems, select inappropriate treatment, and defraud insurance companies. The practitioners who use them are either delusional, dishonest, or both. These devices should be confiscated and the practitioners who use them should be prosecuted. If you encounter any such device, please report it to the state attorney general, any relevant licensing board, the FDA, the FTC, the FBI, the National Fraud Information Center, and any insurance company to which the practitioner submits claims that involve use of the device.

I just saw that :-)

That quackwatch article is talking about devices that 'measure' the body's energy system, it would appear that some of the machines are in reality just measuring the GSR.

As far as I knew, and I could be wrong, I thought that there was nothing dubious about Galvanic skin response and the Galvanic meters that measure it.
http://en.wikipedia.org/wiki/Galvanic_skin_response

:) Hi-I would like to bring to your attention a new concept in ADD testing. An objective physiological measure of ADHD has been elusive. However, research by Jason Alster MSc has shown that when ADD persons try to sit still, do a boring task, or concentrate- they actually enter stress as measured by labile electro - dermal activity

(EDA , GSR ). Whereas the GSR was traditionally used to teach relaxation it was overlooked as a tool to teach relaxed concentration being dwarfed by the popular and successful neurofeedback.

Measuring electron flow in a circuit the body operates largely by a series of electrical impulses which have been shown to follow certain pathways and measure changes in the electrical resistance or the ability of the tissue to conduct electricity. The GSR activity marker is positive in the majority of ADD clients tested. Once tested, then the GSR biofeedback may be used to improve the stress result with different techniques. A protocol using this valid objective physiological marker has just been published in a video- "Guide for GSR Biofeedback Techniques for the Natural ADHD Practitioner" (Amazon.com).

Using the GSR protocol only takes 10 minutes to perform. The test is valid for children as well as adults and helps parents determine if their ADHD children need intervention. The measure may then be used to match a personal technique protocol to the client depending on what type of technique helps improve the GSR from lability to stability during rest.

The GSR is measured as labile and steadily increases in amplitude when the ADHD child tries to sit quietly for 2 minutes. The GSR is then increasingly more labile during an eyes closed condition. This is in contrast to the GSR in anxiety where there is usually a decrease during a relaxing eyes closed baseline condition. In some instances- the GSR in ADHD is stable - however, will not return to baseline after prompted with a mild stimulus like noise. This shows that a symptom of ADHD when trying to sit quietly and concentrate -is acting like a stress-or for him her. This is not unlike the "disorientation" experienced in dyslexics when trying to read.

Many ADHD clients- upon producing a stable GSR after a biofeedback assisted relaxed concentration technique - will claim when asked-that this is the first time ever they felt what relaxation /concentration is. This may be compared to someone not having ever tasted a tasty food like an orange. You can't describe it to them. However, once they taste it- they know what it feels like. So too, it turns out, with the sense of relaxation, focus in ADHD. When asked to compare this sensation with the sensation of an ADHD medication- the majority of ADHD people will say that the natural biofeedback induced sensation is better than medication- and medication does not "feel well" even though it does help them concentrate. This shows that medication like Ritalin has a different mode of action working to help ADHD than natural and behavioral methods.
The relaxation and relaxed concentration response is natural and seems to be lacking in many people with ADHD. These responses might have been lacking at birth or were compromised with an unbalancing childhood medical problem (Ears nose and throat, asthma,-sleep disorder-medical operation). However, once re-learned or acquired - the ADHD person can re-produce this
"sensation" upon need. Like learning art or music- some are born with it- but all can learn to be artists or musicians with the proper instruction. This objective physiological test is easy to replicate only with the most sensitive /graphic GSR biofeedback equipment(like Thought Stream or Mindlife for example). My hope is that this simple and valid measure will be used as a future screening test in ADHD clinics and schools as well as by biofeedback practitioners helping ADHD.

A bit of the history in how this method was developed. I began treating children with ADD quite unexpectedly in 1991. As a biofeedback practitioner and part of an anxiety clinic in Tel Aviv, Israel, I had absolutely no experience in treating children but was doing quite well with adults suffering from stress disorders and teenagers who had test anxiety and social phobias. The biofeedback clinic had just opened and each type of patient was a new experience.

With medical- technological training in neuro-electrodiagnostics and sleep/wake disorders, I was more into the neurological and psycho- physiological disorders. A child psychologist working with me wanted to try biofeedback on ADD. Then he had said that there was no treatment and no objective test for this poorly understood syndrome. The only remedy at the time was Ritalin although reports about EEG (electroencephalogram) neuro - biofeedback and Joel Lubar's research with Neurofeedback were just coming out (1991) demonstrating that ADHD can respond to a behavioral method. At first I found that EMG (testing muscle tension)was increased in ADHD and there was already a study showing that EMG biofeedback did not help in ADHD.

However, I found that found that GSR ( electrodermal resistance) was better and easier to use in ADHD than EMG. At the time there were no studies of GSR biofeedback for ADD- so I had to go it alone. After starting to treat a handful of children with biofeedback, the psychologist I was working with had to leave the unit and I had to suddenly take over his patients. All I knew then about ADD was from a television program showing a hyperactive child literally jump off the walls and I worried about what this child would do to the biofeedback equipment! I had absolutely no knowledge of learning disorders either. I mention this lack of knowledge for a reason. I had to begin treating ADD without a prior predisposition to what was written in the literature and had to see for myself what worked and fast.
On my very first ADD client I performed a regular biofeedback stress baseline for anxiety.

That is, I hooked the child up to galvanic skin resistance (GSR) sensors, muscle and peripheral temperature monitors, but not EEG. I had to start to treat ADD with what I knew and that is how to treat stress and anxiety. I was lucky. My very first patient's baseline EMG (electromyogram or muscle activity potential) showed that the more she sat quietly the EMG gained in amplitude over time. That is, sitting quietly was tense for her. I tried relaxation training and she improved her baseline in just 6 sessions and began to do better both at home and in school. This was not supposed to happen. Biofeedback in ADD was supposed to be a stubborn neurological problem that takes 40- 60 EEG biofeedback sessions to treat. Wanting to find an effective, alternative method to offer those young people and especially parents who wouldn't, or didn't want to use medication for ADHD. At least these children wouldn't be left untreated.

In my readings at the time, a number of avenues were being pursued in the treatment of ADD. Some of these were nutritional, sensory integration, guided imagery, art therapy, natural meditation, yoga, Bach flower remedies, homeopathy, chiropractic, and the use of aromatic oils. In biofeedback, animated computer games were just being introduced like Mindlife/Ultramind and Thought Stream.

I decided I could use each method and observe its effectiveness. I could try and develop an integrated and holistic approach matching the method to each child individually and determining the results by the GSR.
One of the first things that I found that can cause the GSR to become stable in ADD children and adults is holding a soft or smooth stone in your hand and studying a liquid water timer or sand clock. Other techniques include using the senses to relax like self massage, abdominal breathing, seated yoga, listening to a metronome, listening to a sea shell, guided imagery, smelling aromatic oils, and more.

Later, I found that by integrating accelerated learning techniques and study strategies such as speed reading, associative memory, mind mapping , and time management - children with ADHD and test anxiety began to reach their full potential and receive very high grades in school.

Included in the CD ROM video kit are the book BEING IN CONTROL, and the video BEING IN CONTROL:NATURAL SOLUTIONS FOR ADHD DYSLEXIA AND TEST ANXIETY.
The videos play on Windows Media Player.



:)
Dear Jason,

Happy to meet you again. This time I have a different quuestion for you.

My GSR biofeedback equipment apart from red and green signals, it gives the changing resistance levels in kilo ohms also ranging from o to 2048 kilo ohms.

I have observed following categorise of subjects.

1.Exceptionally some start at o kilo ohms basal level.

2.Exeptionally some show 2048 kilo ohms basal level.

3.Otherrs can show basal level anywhere in the range.

4. In due course of the session some are able to raise their resistance level over the base line. Some raise more even upto 2048 and some end at few kilo ohms.

5.Some are completely unable to raise their resistance over the base line.


I think, to cut the long story short, it is more the attention focusing ability one has or gains the more he is able to raise the resistance level over his base line. What is your observation?
regards

***quote from Wikipedia provided by nzguys
GSR is highly sensitive to emotions in some people. Fear, anger, startle response, orienting response and sexual feelings are all among the emotions which may produce similar GSR responses.


GSR is also used by Scientologists, who call their devices E-meters, in their spiritual counseling. They claim to have developed a variety of techniques to improve the reliability and accuracy of the device.
***End Quote


I do not care for scientologist because of the trash they say about psychology and psychiatrist, I guess they are the ones wrong not the machine or other people who use it so I will move on!




biosignal fro UK (http://it.uku.fi/biosignal/research/gsr.shtml)
***quote
Physically GSR is a change in the electrical properties of the skin in response to different kinds of stimuli. In GSR changes in the voltage measured from the surface of the skin are recorded. The main origin of the signal has suggested to be the activation of the sweat glands. The most commonly used stimuli are an electrical shock delivered to a peripheral nerve or auditory stimuli. However, any stimulus capable of an arousal effect can evoke the response and the amplitude of the response is more dependent on the surprise effect of the stimulus than on the physical stimulus strength.
In recording situations some low pass filter can be used to avoid high frequency noise. As the signal-to-noise ratio (SNR) of the GSR signal is high individual responses are usually studied without any signal processing. In some studies several responses are averaged but this can lead false interpretation due to variability of the response. Thus, it is generally suggested that averaging should not be used.

***End Quote


another education source for GSSR (http://affect.media.mit.edu/)

Although I can see some value for this if traditional methods fail I still think some of the more traditional approaches for the treatment of ADD would increase the chances of successful treatment.

Frankly I lack total understanding of how this would be useful to treating ADD so I willing to hear explanations of those who actually have experience using this. So far I am with Tracey I would rather have a volume dial than depend on my brain to keep the music at a constant level. I probably would have had the same reaction she did.