Re.: A Study on ADHD

[David1]

Thanks to Bill, Tim, Jeff and Bruce for reponding to my post.

One of the things I will be doing after the initial selection of
children (which will by based on social agreement among parent, doctor,
teacher), is to give the children some special testing.

I will be giving the children a QEEG on and off the drug. This will
allow me to say how their brainwave properties (relative power,
coherence, phase, amplitude asymmetry) compare to a normative group on
and off the drug. If the QEEG off the drug does not show a large number
of out of range values, Bill's point would be supported. On the other
hand if the QEEG off the drug shows a large number of out of range
values, his point would be put into question. I will be able to find
out what percentage of children actual show abnormal QEEGs and what
percentage show normal QEEGs.

More accurately stated, for each property, say coherence, I will be
able to look at the distribution of the number of out of range values.
I expect that the ADHD cases will be bunched over on the higher side and
that the non-ADHD cases will be bunched on the lower side. This might
be true for all four properties, three properties, two properties, one
property or none of the properties. If none of the properties, this
would support Bill's statement that there is no neurological difference
between the two groups. If all four properties are different, this
would provide strong support for the idea that the there are
neurological differences between the two groups.

This research study is very traditional. It is designed to address the
question whether the diagnostic category does or does not reflect a real
physiological/brain difference. Seems like traditional research designs
may have a useful purpose after all. If the diagnostic category proves
real and not imaginative, the PCT question of how does a person with
ADHD control differently can be asked.

I suppose I should choose an equal number of children, say 10, in which
there is social agreement that they do not have ADHD. This would be a
control group.

I would expect a much larger percentage of abnormal QEEGs among the
identified children, 100% versus 0% would be nice. Something close to
this would support the idea that there is something different about the
brains of ADHD children even when they are just sitting in the chair
with eyes closed for about five minutes (the circumstances of the QEEG
test).

Actually, studies like this have been done. Maybe not with the
particular software and norms I will be using.

···

From: David M. Goldstein
Subject: Re.: A Study on ADHD
Date: 12/4/97

[Bill_Powers1]

[From Bill Powers (971205.09338 MST)]

From: David M. Goldstein
Subject: Re.: A Study on ADHD
Date: 12/4/97

One of the things I will be doing after the initial selection of
children (which will by based on social agreement among parent, doctor,
teacher), is to give the children some special testing.

I will be giving the children a QEEG on and off the drug. This will
allow me to say how their brainwave properties (relative power,
coherence, phase, amplitude asymmetry) compare to a normative group on
and off the drug. If the QEEG off the drug does not show a large number
of out of range values, Bill's point would be supported. On the other
hand if the QEEG off the drug shows a large number of out of range
values, his point would be put into question. I will be able to find
out what percentage of children actual show abnormal QEEGs and what
percentage show normal QEEGs.

I hope you will have some way to distinguish among the out-of-range
subjects, so you can treat only those who deviate from the normal in a way
indicating below-normal rather than above-normal functioning.

More accurately stated, for each property, say coherence, I will be
able to look at the distribution of the number of out of range values.
I expect that the ADHD cases will be bunched over on the higher side and
that the non-ADHD cases will be bunched on the lower side. This might
be true for all four properties, three properties, two properties, one
property or none of the properties. If none of the properties, this
would support Bill's statement that there is no neurological difference
between the two groups. If all four properties are different, this
would provide strong support for the idea that the there are
neurological differences between the two groups.

I would be extremely surprised to find no neurological differences among
individuals. Some people are good at mathematics, others at art, others in
social interactions, and others in solitary occupations. Some people
develop a high degree of skill at the lower levels of organization;
dancers, athletes, woodcarvers, circus performers. Others focus on higher
levels of skills, often at the expense of lower levels: scientists,
philosophers, poets, priests, and politicians come to mind. Some people use
mental images, others do not. Some people take a systematic and organized
slow-but-sure approach to problems, while others depend on intuitive leaps
and subsequent cleanup operations. Some people depend heavily on memory;
others find it easier to learn principles and work things out from scratch.

All these differences, I presume, reflect differences in brain organization
and activity, some of which may be innate and others of which reflect the
results of interactions with other people and the nonliving environment.
The activities in various parts of the brain will reflect a person's
present-time preoccupations, such as conflicts, interests,
reorganizations, feelings -- or in general goals, perceptions and actions
at many levels.

The EEG, of course, cannot distinguish among brain activities in such
detail; it is like an antenna that picks up emissions from thousands of
radio and television stations at the same time, adding up all the signals
and reporting only the total modulation and carrier features that are
predominant among them, all mixed together. It averages together your
reaction to Beethoven, your worries about your parents, the taste of
chocolate, and the color of the walls, mixing these signals with your
thoughts, your fears, and your memories of yesterday and last year.

The "normal" EEG is the average of many samples of these average signals,
over many individuals. Its features average together the brain-waves of
geniuses, retardates, jealous husbands, philanthropists, criminals,
artists, terrorists, Enlightened Ones, and the mentally ill.

This research study is very traditional. It is designed to address the
question whether the diagnostic category does or does not reflect a real
physiological/brain difference. Seems like traditional research designs
may have a useful purpose after all. If the diagnostic category proves
real and not imaginative, the PCT question of how does a person with
ADHD control differently can be asked.

We can ask that question anyway, can't we? It seems to me that the main
problem, the main responsibility of the researcher that has to be fulfilled
before any decision about treatment can be made, is to distinguish among
those who have been diagnosed the same way. Some of them may well need help
to bring them up to normal functioning, but the rest do not need help to
bring them DOWN to normal functioning. Normal means nothing but average; it
does not mean "good". What we need is an instrument that can distinguish
bad deviations from good deviations. The EEG, in my opinion, is not that
instrument -- and neither are the crude diagnostic categories of the DSM.

Best,

Bill P.

[David_Wolsk2]

At 21:21 04/12/97 -0500, >From: David M. Goldstein

I will be giving the children a QEEG on and off the drug. This will
allow me to say how their brainwave properties (relative power,
coherence, phase, amplitude asymmetry) compare to a normative group on
and off the drug.

I suppose I should choose an equal number of children, say 10, in which
there is social agreement that they do not have ADHD. This would be a
control group.

I would expect a much larger percentage of abnormal QEEGs among the
identified children, 100% versus 0% would be nice. Something close to
this would support the idea that there is something different about the
brains of ADHD children even when they are just sitting in the chair
with eyes closed for about five minutes (the circumstances of the QEEG
test).

DW
Once a child gets a label, I would assume that their brain processing and EEG are different. Even with all the mathematical techniques for analysing the EEG, it is a very crude measure with more unknowns then knowns. It totally ignores the fact that neurochemistry is as important as neuroelectrophysiology .... and both interact in highly complex, mostly unknown, ways.

I say all this not too discourage you but to share my sense that you should see yourself embarking on a long detailed research process that needs much caution re conclusions.

Most of the group of kindergarten failures I looked at many years ago had birthdays in Nov-Dec. Thus, they were the youngest kids in the kindergarten ....and, since most were small, scrawny immature boys, the major problem was that the kindergarten teacher feared they couldn't hack the rigid atmosphere in Grade 1, sitting at your seat most of the day.
Despite the excellent Junior One programme they went into, checking their records 8 years later, indicated that most still carried their labels and were getting a variety of special needs interventions and classes.

good luck, best wishes,
David Wolsk
Victoria, BC Canada

···

at 11:00 05/12/97 David Wolsk wrote:

[David1]

12/5/97

Bill,

Thanks for your always thoughtful reply.

The QEEG is based on the EEG. Four properties are calculated: relative
power, coherence, phase, amplitude asymmetry. Just as with blood tests,
each of these properties has a normal range. A person can be outside of
the normal range by being above the normal range or below the normal
range. Just as with properties of blood, say sugar, it can be bad to be
too high or too low.

The norms are based on a large number of people of different ages who
were screened to not have medical or psychological problems. A person is
compared to people of the same age.

In your post, there is an interesting suggestion. Suppose that we
chose a group of talented painters, writers, etc., and gave them the
QEEG test. How would they compare to the normative group. The answer
is that this has not been done and no one knows. Doing this kind of
study follows a very traditional research design.

It is very similar to the one I am proposing. Do people who are
talented song writers have brains which are different from the normative
group on the QEEG test? There would be no reason to "treat" such a
person unless she were severely upset because she was " a talented song
writer " and the impact this was having on her life was considered to be
very negative in some ways.

I thought that the point of your first post was that the category of
ADHD was a bad category and probably did not reflect a brain difference.
The stuff on the QEEG was only a means of finding out whether your point
was correct. If the QEEG of ADHD people were not distinguishable from
non-ADHD people in a convincing way, then you are correct.

By comparing the QEEG on and off the drug, we could find out if the
drug induced changes are consistent from person to person, and if so,
what are the changes.

Yes, we could ask how a person with the diagnosis ADHD controls
differently than a person without this diagnosis. The problem is that
except for your tracking tasks, we don't have a set of tests to
describe this.

I was thinking about trying out this one: Remember the game of pick up
sticks? I have used this situation in a play therapy situation. I
think it is very clinically rich. We could video tape a child playing
the game solo and then see if we couldn't identify what each child was
controlling. We might apply a set of rating scales to score the video
tapes based on ADHD characterstics: (a) impulsiveness, (b)
inattention, (c) motor activity, (d) organization in time, (e)
organization in space, etc..

Another interesting situation is the Sokoban game on the computer.
Remember that one? Again, video tape, guess control variables, rate
the video tape on certain ADHD scales.

David

···

From: David Goldstein
Subject: Re:Re.: A Study on ADHD

[Bill_Powers1]

[From Bill Powers (971205.1942 MST)]

From: David Goldstein
Subject: Re:Re.: A Study on ADHD
12/5/97

It is very similar to the one I am proposing. Do people who are
talented song writers have brains which are different from the normative
group on the QEEG test? There would be no reason to "treat" such a
person unless she were severely upset because she was " a talented song
writer " and the impact this was having on her life was considered to be
very negative in some ways.

But, if we draw a parallel with at least some children in ADHD studies, she
might become a candidate for treatment if she is aggressive in trying to
get recognition, practices her song-writing at odd times like on the subway
or late at night in an apartment building, writes songs that others
consider offensive, or says insulting things about talentless songwriters
whose recitals she is forced to sit through. One does not have to have a
disorder in order to be put through forcible treatment. All that's
necessary is that someone in authority _says_ you have a disorder.

I thought that the point of your first post was that the category of
ADHD was a bad category and probably did not reflect a brain difference.
The stuff on the QEEG was only a means of finding out whether your point
was correct. If the QEEG of ADHD people were not distinguishable from
non-ADHD people in a convincing way, then you are correct.

My point was that even if they are distinguishable, the difference may not
be due to a "disorder" in the person. Perhaps some of them are, but how do
you tell the difference? Neither the EEG nor the diagnostic category can
tell you.

I was thinking about trying out this one: Remember the game of pick up
sticks? I have used this situation in a play therapy situation. I
think it is very clinically rich. We could video tape a child playing
the game solo and then see if we couldn't identify what each child was
controlling. We might apply a set of rating scales to score the video
tapes based on ADHD characterstics: (a) impulsiveness, (b)
inattention, (c) motor activity, (d) organization in time, (e)
organization in space, etc..

Good idea. Or, as Tim Carey suggested, try giving the children with
attention deficits a video game to play. In those ADHD children who show
close attention, persistence toward a goal, organized progression through
the game, and good spatial control, you could conclude that the diagnosis
was incorrect and look for the real reason for the inattention and such.

Another interesting situation is the Sokoban game on the computer.
Remember that one? Again, video tape, guess control variables, rate
the video tape on certain ADHD scales.

All good ideas. You don't really need a computer -- try any game in which
the child is interested, and use your PCT eyes.

I once suggested that since you have some prowess with statistics, you
investigate the studies with ADHD children to find out the chances that a
given child does not actually have any disorder, or _that_ disorder. The
result would surely influence your willingless to give a child Ritalin on
the basis of the kinds of test results that you're using. Have you given
any thought to doing that?

Best,

Bill P.