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Mind & Brain, the Journal of Psychiatry BEHAVIORAL INTERVENTIONS FOR ADHD


Since ADHD may reflect a lag in natural brain devel- opment,1113 can stalled brain development be jump-started in some way? Brain circuits are highly plastic and are continually sculpted with each experience.3437 Thus, behavioral inter- ventions that activate frontal-striatal circuits could potentially facilitate brain development in ADHD populations and so improve executive function and cognitive performance during tasks.


As mentioned, the key brain circuits that are underdeve-


loped in ADHD populations include frontal areas (major integrative centers), cingulate gyri (attention switching), parietal areas (concrete experience centers), and striatum (motor activation). One class of behavioral interventions exercise the motor node in this circuit. For instance, the Interactive Metronome, which involves matching a computer- generated beat, would exercise motor circuits. This interven- tion, however, has had limited benefits on reducing ADHD symptoms in clinically controlled studies.38 Neurofeedback is another nondrug intervention that teaches children to control theta and/or beta brain activity by interacting with a computer game. Although requiring many training sessions*45 sessions lasting 40 minutes each*neurofeedback is reported to reduce ADHD symptoms39 and reduce amplitude of theta EEG with no effect on beta amplitude.40


Meditation as a Behavioral Intervention Meditation practices activate distinct brain areas, which


makes these areas progressively more available during tasks after meditation.4143 For instance, Mindfulness Meditation, in comparison with mental math, leads to increased blood flow in prefrontal areas,44 and to thickening of brain areas involved with attention switching and perception of bodily states.43 Preliminary research investigated effects of mind- fulness training on 24 adults and 8 adolescents diagnosed with ADHD, who received an 8-week mindfulness-training program involving 2.5 hour sessions once/week and 45-min daily meditation sessions at home. Seventy-five percent of these individuals finished the 8-week program. After the mindfulness training, both adults and adolescents exhibited significant decreases in inattention and hyperactivity. Only the adults also showed significant reductions in depression and anxiety.45


Another form of meditation, the Transcendental Meditation


(TM) technique, is reported to lead to increased cerebral metabolic rate in frontal and parietal attentional areas in a PET study46; greater activity in prefrontal executive circuits and anterior cingulate attention circuits in a MEG study47; and higher frontal alpha1 power and coherence and higher beta1 power in EEG studies.48 Preliminary research with a single group design with 10 ADHD children age 1114 years reported that 3 months of TM practice resulted in significant reductions in anxiety and depression and significant im- provements in executive function and behavior regulation.49


The current study extends the preliminary findings of the effectiveness of TM practice on reducing ADHD symptoms by


M&B 2011; 2:(1). July 2011 74


using a random-assignment delayed-start design to assess effects of TM practice on performance on standardized measures of executive functioning and on brain wave patterns (EEG) during a computer-administered choice reaction time task. In this study we hypothesized: If TM practice activates and strengthens frontal executive circuits, then ADHD students who practice the TM technique, compared to delayed-start students, should exhibit (1) lower theta/beta power ratios, indicating greater brain activation during tasks; (2) higher frontal, parietal, and anterior/posterior coherence, indicating greater communication between brain areas during a visual-motor task; and (3) improved performance on executive functioning tests.


METHOD


This is a pilot test of effects of TM practice on ADHD symptoms. It tests whether middle school students diagnosed with ADHD can learn and practice the TM technique, and it investigates effects of TM practice on executive functioning and brain functioning in these students.


Subjects All students attended an independent school for children


with language-based learning disabilities in Washington, DC. All students received two clinical diagnoses. First, licensed psychiatrists identified students with ADHD according to the DSM IV-TR criteria and recommended that they attend this school. Second, professionals in the school verified the clinical diagnoses and placed them into their school system. The curriculum at the school is designed to help students with ADHD and other learning disabilities.


Twenty-four families responded to an information letter


about the study and volunteered to participate. Twenty-three chose to participate in the study; the 24th student learned TM but did not participate in assessments. Four students were not part of the randomized study, because their parents asked that they learn the TM technique immediately. The remaining 18 students were stratified by age, and randomly assigned to learn TM immediately (TM group: 6 boys, 3 girls, average age 12.991.3), or learn TM in 3 months (delayed-start group: 7 boys, 2 girls, average age 13.091.6).


Table 1 presents the DSM-IV clinical diagnoses and medica-


tion use for the 18 randomized students. Comorbidities included General Anxiety Disorder (3 subjects), Obsessive Compulsive Disorder (1 subject), and Autism (3 subjects). In each group, five of the nine subjects were on ADHD medication.


As seen in this table, random assignment placed more subjects with comorbidities in the TM group (4) than in the delayed start group (1). Subjects with comorbidities may be more resistant to change. Thus, this was a conservative test of effects of TM practice on brain and executive functioning in an ADHD population.


Written informed consent was obtained from the parents


and students before pretesting. The Maharishi University of Management IRB approved the research.


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