Our ADHD treatment program consists of 4 stages. Not everyone will need to complete all stages, and in fact most people only complete 1-2 before finding most of their symptoms are highly manageable. Various stages are recommended and discussed following assessment, or if you have already been diagnosed, as part of an initial consultation.
STAGE 1: BRAIN OPTIMISATION PROGRAM
Module 1: Neurofeedback
Neurofeedback is a form of EEG biofeedback, that aims to regulate brain waves through a process of learning called operant conditioning. To perform neurofeedback you first need a QEEG brain scan. This scan looks at various brain-waves (slow to fast) and identifies areas of the brain that may have too much or too little of a certain brainwave. Your brainwaves are compared to people the same age, as children have differing patterns of brain waves to adults. When too much slow wave is present in the brain, lower levels of brain arousal are noted, including inattention, sluggishness, poor memory, and low levels of motivation. When too much fast wave is present this can be associated with higher levels of energy, problems falling asleep, a racing mind and even anxiety. Of course this is a simplification, and it all depends on where this dysregulation is found in the brain.
A neurofeedback session consists of having sensors placed over the regions in your brain that were dysregulated, and showing you your brainwaves on a computer screen. We then train you to change the required brainwave on the screen by rewarding you for changing the brainwave. For example, if you produce too much slow wave (as often seen in ADHD), a Pacman on the screen will move. Over time your brain learns to produce less of this brainwave, which then results in more focused attention. Typically the results from a single training session (once the correct protocol is identified) can last around 24 hours. Then after several training sessions the results will go longer and longer, until they are back-to-back between training sessions. Once the results are 24/7 we then continue training until the brainwaves are stabilised and the training can stop, with benefits still maintained. Research has shown that approximately 40 sessions are required to train the brain and achieve long-lasting results. Individuals may vary according to the initial amount of brain dysregulation noted on the brain scan, and some people may need less sessions and some more (also depending on comorbidities). To find out more about the scientific evidence for neurofeedback visit www.neurofeedbackalliance.org which has a summary of the research in various disorders, including ADHD.
Module 2: Sleep treatment
ADHD is very often associated with several types of sleep disorders. If there is a query of sleep apnoea (obstruction of airways during sleep) you will be referred for a full sleep assessment. Most types of sleep issues are much more mild. Issues with falling asleep (ie. sleep latency) is very common and can be assessed via an actigraphy watch. We have a sleep consultant at our clinic who can work on helping you fall asleep quicker. If the issues are related to anxiety, our psychologist can also give strategies to reduce the anxiety. In addition, issues with sleep maintenance are also common (ie. staying asleep and waking in the night). We can monitor this and we have therapies available to enhance sleep quality, duration and fatigue levels. Even a minimal loss can have significant impacts of energy levels and focus. Often treating sleep issues is one of the first stages in ADHD management.
Module 3: ADHD Diet & Nutrition
Over the past few decades given the concerns about the long-term use of medication, there has been increasing research and awareness into the importance of nutrition and the effects on ADHD symptoms. Research has looked into vitamins, minerals, phytonutrients, amino acids, EFAs, phospholipids, and probiotics. Whilst the literature is not conclusive about any of the above, it appears most likely that children and adults with specific deficiencies are likely to benefit from supplementation. Research studies with a double-blind methodology that randomly select anyone with ADHD are unlikely to take into account the individual, and at our centre we prefer a more personalised, individualised approach to therapy so that each individual can maximise their potential.
Module 4: Medication Monitoring
Whilst our philosophy at our clinic is 'Skills not Pills', we do recognise that medication may be required for some individuals who are failing out of school, about to be fired or can't hold down a job, or are engaging in dangerous behaviours that can't be controlled otherwise. In these situations we work with paediatricians/psychiatrists to find the correct type of medication that has a high level of efficacy for the patient. We perform baseline tests (if not already conducted) and then send the patient for medication with a specialist, then conduct monitoring of medication. This monitoring is done through various means: standardised questionnaires, formal cognitive testing and if desired we can even perform QEEGs brain scans. Note: If you are only after medication then please get a referral directly to a paediatrician or psychiatrist from your GP as we only work holistically with patients at our centre. We do work with patients who are medicated, but typically aim to add additional therapies so that medication can be reduced or even hopefully removed. Medication monitoring is mainly accessed by our patients who are already on medication, but are not certain that there are benefits and want more objective evidence that the skills are being normalised. It is noted that for many patients we offer this service to, medication is found to be reducing certain types of processing skills such as speed of processing. In these cases medication is revised or removed and an alternative therapy or medication recommended.
STAGE 2: COGNITIVE ENHANCEMENT PROGRAM
Module 1: Mindfulness-based Cognitive Training
One easy to learn skill which has been shown to help attention skills in people with ADHD is mindfulness. Mindfulness reflects the ability to shift one's mind from ruminating on the past, worrying about the future, to being in the present moment. Mindfulness is a skill that empowers a person to bring their focus of attention and thinking under their own control, through increased awareness of where their thoughts are being placed. Mindfulness has been associated with an increase in relaxation, and reduction in stress in the general population. However, for people with ADHD, it has much more significant benefits in relation to attention skills. Mindfulness has been shown to improve attention, working memory and executive functioning. Mindfulness training can also be done with families as mindfulness has also been shown to help parenting and stress levels associated with bringing up children with ADHD, and likewise would be helpful for partners of people suffering from ADHD.
Module 2: Attention & Executive Training
Cognitive training at the BrainX ADHD Clinic is highly individualised according to the precise cognitive profile noted on testing. Cognitive training involves a three-step process. The first stage is to have people perform various tasks which were found to be personal areas of weakness (e.g.. working memory, auditory sustained attention, visual sustained attention, divided attention etc). We then teach people to develop strategies to complete these tasks more competently, and have them learn to identify poor habits and perform these tasks better. We do not use online games which are set programs as we find little utility in being able to teach people the skills they need to perform these games better. That is, when performing online games through repetition you may improve, but without working with a cognitive trainer you may not be utilising the best strategy to perform them.
The most important aspect of cognitive training is actually having these skills generalise to real life (which online games cannot do). We have the individual identify functional areas where these cognitive problems create problems (school, workplace, home life, relationships), and then discuss ways of utilising the strategies taught in the first stage to be used in everyday life. The individual will practice these strategies in various situations throughout the week and then return to the cognitive trainer to identify what worked and what didn't work. The program is about teaching people how to develop various strategies, test these strategies, and then modify these strategies if they don't work out. One of the key issues in ADHD is executive management. To train people in these skills they need to be aware of where they are struggling, generate strategies to enhance performance, mindfully apply the strategies and then self-monitor their efficacy. Self-monitoring and cognitive flexibility is a key goal trained in people with ADHD.
Lastly, depending on whether there are any academic issues, we may also train various academic skills like writing and approach to maths, not at a tutoring level, but more at an executive level. For example, people with ADHD often have very scattered thoughts and may have problems getting them down on paper. We teach mind-mapping and essay planning. We also show people how to break down large projects and time manage. People with ADHD have been shown to have very poor recognition of the passage of time (underestimating the amount of time required to complete tasks and tending to run late). This is often another key skill targeted in our program. Approaches to maths tasks can also be very haphazard, with poor working out (over-relying upon working memory) and incorrect strategy approaches. We can teach our 'cookbook' approach to numeracy, which is based on memorising various sequential steps to complete certain problems.
STAGE 3: ADHD PSYCHOTHERAPY PROGRAM
Resilience Training and Psychological Strategies
Psychological issues such as anxiety, depression, low self-esteem and emotional dysregulation are very common in people with ADHD. It can be very hard to be bright, yet due to the ADHD symptoms to have issues being able to perform to the same level as peers. This can result in feelings of insecurity, depression and low self-esteem from quite a young age. The world can also feel like quite an unpredictable place, as poor awareness of the passing of time can make you continually run late, forgetfulness can create issues with friends and school/work. You may feel like you are continually disappointing others or making others frustrated. This can result also in anxiety, and constantly feeling that you need to be alert to dangers.
At the BrainX ADHD Clinic we like to give our patients lifelong strategies to be able to manage their emotional regulation. We have preferred modalities of Cognitive Behavioural Therapy and ACT, and we aim for shorter-term therapy and skills rather than just a talk-based therapy.
STAGE 4: ADHD BEHAVIOUR PROGRAM
The behaviour management training module differs significantly according to age. This type of treatment involves identifying functional issues at home, school, socially or in the workplace. Strategies are then devised to compensate for these issues or behavioural difficulties as required. This type of therapy pulls upon strategies from traditional psychological Behaviour Therapy as well as the newer Acceptance and Commitment Therapy. For children, strategies are given to parents to help modify behaviour at home. For adults, especially ones in relationships or with families, skills are taught around home-based systems and structures are put into place to help limit the impact of ADHD upon family life.
Module 1: Educational, Classroom or Workplace Modifications
Modifications for management with specific strategies can be taught according to the functional weaknesses noted in various settings in the community such as school, university or the workplace. Strategies can be formulated for use in the classroom, by liaising with the teacher/school and putting various systems into place. This may include an Individual Education Plan (IEP) or just simple strategies for a teacher to incorporate in the classroom, such as cues to focus attention, limit impulsivity or redirect hyperactivity. For adults, strategies can be given to use in the workplace according to the demands and functional weaknesses noted. As every classroom, school and workplace is so different, these strategies are highly personalised.
Module 2: ADHD Coaching
ADHD coaching aims at supporting our patients with ADHD in developing a comprehensive understanding of both the nature of ADHD and the impact of ADHD on their own quality of life. We work with our clients to create structures, support, skills, and strategies. The coaching aims to assist teens and adults with ADHD to stay focused on their goals, face difficulties, as well as address typical ADHD-related issues like time management, organisation, and general executive skills needed to be successful.
Many people with ADHD lack organisational skills, often losing their belongings and become easily overwhelmed by their everyday activities. They may struggle with managing their time, prioritising tasks, planning out their goals at school or work, persevering with tasks and staying motivated. Our ADHD coaches provide a supportive partnership in which the client is encouraged to set reasonable and attainable goals, and to create an action plan to reach those goals. The coaching process aims to increase self-awareness, self-esteem and self-reliance, all vital aspects to overall well-being and quality of life.
Module 3: Social Skills Training
People with ADHD often struggle socially due to their issues with inattention (missing social cues and zoning out in conversations), impulsivity (butting into conversations and presenting as rude), and hyperactivity (having problems sitting still when expected, and standing out as quirky and different). Executive issues can also create social issues as you may run late, be disorganised and forgetful, which may significantly frustrate and anger others. Improvement in social skills needs to incorporate other forms of training to improve core attention skills, impulsivity and executive abilities. However, many people with ADHD actually develop poor social skills and these also at times need to be trained. For example, skills can be trained in listening skills, conflict resolution, reading body language and picking up social cues, eye contact, sharing etc. We assess areas of impairment, and then work on each of the areas in an individualised program. We also offer group programs at various times throughout the year so call us to find out more.
ADHD Treatment & ADHD Therapy: THE SCIENCE
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