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Abstract

Infinite Potential Program's Treatment of ADD/HD in Children by
Cortical Integrative Therapy: A Pilot


By James Paicopolos
School Psychologist





Background: The treatment of children with Attention Deficit Disorder/Hyperactivity Disorder (ADD/HD) has been problematic because methylphenidate (MPH)-the most commonly used drug to treat ADD/HD -has been linked to hand tremors, difficulty sleeping, weight loss, stunting of growth and tachycardia. Higher doses of methylphenidate the chief ingredient in Ritalin, Concerta, Adderall and Adderall XR have been linked to brain atrophy. A warning label has also been placed on yet another drug, Strattera, which has been linked to liver damage.

The Infinite Potential Program utilizes Cortical Integrative Therapy (CIT) in this pilot to treat ADD/HD. "ADD/HD is a dysfunction of the frontal lobe of the brain, which interferes with normal expression of function of that area of the brain. Many of the important functions of humanism, such as cognition, executive function, ability to stay on task, focus, concentration and conversation are controlled by the frontal lobe." Cortical Integrative Therapy does not involve the use of any medications and serves as an effective treatment for individuals with ADD/HD.

Methods: A 12-week program in which children with ADD/HD were treated using Cortical Integrative Therapy delivered by the Infinite Potential Program.

Results: Based on our primary outcome measure of ADD/HD (Conners' Parent Rating Scale- Symptom Questionnaire), significant improvement occurred for all participants treated with Cortical Integrative Therapy. Out of ten participants in the pilot, five were on medication, the continuing need for medication has been eliminated. Post treatment T scores placed six participants out of range for having ADD/HD, all others improved. Several participants demonstrated immediate increase in scholastic performance.

Cortical Integrative Therapy was helpful for impulsivity, hyperactivity and inattentiveness. There was also a marked reduction in social problems and oppositional behavior.

Conclusions: Cortical Integrative Therapy is effective for treating children with ADD/HD.


INTRODUCTION

The purpose of this summary is to report the results of a pilot project that was undertaken to demonstrate the effectiveness of treating ADD/HD through the Infinite Potential Program. The pilot project was funded by a grant of $150,000 received from the Rhode Island Legislature for their 2004-2005 budgetary year. All of the funds received, less an administrative fee, were used to purchase capital equipment and materials that provided free treatment to ten children diagnosed with ADD/HD. We are grateful for this grant and believe that the results of this pilot program demonstrate that the confidence, commitment, and generosity of the Rhode Island Legislature were justified.


BACKGROUND

Dr. Russell Barkley states that many children with ADD or ADHD lag behind their peers developmentally by as much as 30 percent in certain areas, translating into a delay of 4-6 years for teenagers. Resultantly, they may present as irresponsible and immature.Chris A. Zeigler Dendy, M.S. notes that in the classroom setting this manifests itself as the student being less likely to remember their assignments, complete their homework independently, acting or speaking out impulsively before thinking and being variable in the amount of learning they can experience from day to day. They will consequently often result in underperformance.

The treatment of children with Attention Deficit Disorder/Hyperactivity Disorder (ADD/HD) has been problematic because methylphenidate (MPH) -- the most commonly used drug to treat ADD/HD -- has been linked to hand tremors, difficulty sleeping, weight loss, stunting of growth, damage to the cerebellum and tachycardia. Higher doses of methylphenidate, the chief ingredient in Ritalin, Concerta, Adderall and Adderall XR, have been linked with brain atrophy. A warning label has also been placed on another drug, Strattera, that is used to treat Attention Deficit Disorder/Hyperactivity Disorder is linked to liver damage.

The Infinite Potential Program employs Cortical Integrative Therapy or CIT to treat ADD/HD, which is a dysfunction of the frontal lobe of the brain that interferes with the expression of many important functions. Particularly cognition, executive function, ability to stay on task, focus, concentration, eye movements and conversation are controlled by the frontal lobe. Cortical Integrative Therapy via the Infinite Potential Program utilizes a non-pharmacological, non-invasive treatment program to treat this malady.


GOALS OF THE PILOT PROJECT WERE:


1. To purchase capital equipment and materials necessary to provide treatment for ten (10) children previously diagnosed with ADD/HD,

2. To demonstrate the effectiveness of Cortical Integrative Therapy, as delivered by the Infinite Potential Program, as a primary treatment modality for ADD/HD,

3. To demonstrate the cost effectiveness of the Infinite Potential Program and potential savings to Rhode Island taxpayers by utilizing Cortical Integrative Therapy as a primary care modality for attentional disorders.


Methods:

Applicants for this pilot program were selected on a "first come, first served" basis following a public service announcement aired by WJAR 10, Rhode Island's NBC television affiliate inviting applicants to participate in the study.

Ten children were selected who had a prior diagnosis of ADD/HD from their primary health care physicians. They were carefully evaluated using a variety of neurological and functional tests including: T.O.V.A. (Test of Variables of Attention), Conners' Rating Scale, Video Nystagmography, C.A.P.S. Balance Assessment, a clinical neurological examination and a functional medicine examination.

Upon completion of the above intake evaluations, which determined the functional deficit of each child, participants began a 12-week treatment program designed to remediate their specific dysfunctions.

In simplistic terms, the treatment program stimulates the cerebral cortex -- the outer layer of the brain -- with a variety of sensory therapies. These modalities may include vestibular, oculomotor, kinesthetic, visual, auditory, and olfactory stimulation. The frequency, duration and intensity of these therapies are UNIQUE to each individual and predicated on the initial evaluation.

The program included educational sessions for family members. Parents were a critical component because changes in home environment - changes in diet and nutrition and enforcement of "homework" -- must be made in order to convert short-term goals into long-term, permanent gains. The pilot commenced September 1, 2004 and was completed on May 10, 2005.


DATA: Study Participants:

1. Profile prior to treatment: Participant One was a 19-year-old male suffering from Attentional Deficit Disorder (ADD) and chronic depression. In addition to ADD, his initial evaluation sheet indicated that he was experiencing severe depression, had difficulty making friends, demonstrated serious anger issues, and showed a propensity for immature and, at times, violent behavior. Because of his ADD, he experienced difficulty staying seated in the classroom, he was easily distracted, required assistance to accurately complete assignments, and would stare for long periods of time into space. He was prone to be disorganized, he would often lose things needed for tasks, and was slow to begin or finish schoolwork. His memory was often poor when he applied himself to academics, and his penmanship left much to be desired. These were long-standing and chronic symptoms.

At age 10, he was diagnosed as suffering from ADD/HD (Attention Deficit Hyperactivity Disorder) indicated by a significant difference on tasks involving attention and focus. A psychological evaluation further revealed inconsistent memory in the verbal and visual domains and that he experienced acute information retrieval problems when presented with complex material. Of special note and concern with this individual were several prior suicide attempts including a recent one.

Profile subsequent to treatment: Participant One's concentration and attention deficits were dramatically improved while his co-morbid depression was simultaneously resolved. He was able to discontinue his prescribed medication and enroll at the Community College of Rhode Island (CCRI). He succeeded in completing his first semester and obtained part-time employment. He also became demonstrably more social, according to one examiner, being observed to smile for "the first time ever." His mother is an educator and healthcare professional in the public school system. She highly recommends the program. A testimonial letter is attached.


       Participant One Outcome: Need for medication resolved. Participant One's concentration and attention deficits, as well as co-morbid depression, were dramatically improved. He enrolled at CCRI and obtained employment.       
   



2. Profile prior to treatment: Participant Two was a 10-year-old female previously diagnosed with ADD. An initial Conners' Teacher Rating Scale indicated that she would forget things that she had already learned. A Conners' Parent Rating Scale completed by her parents was considerably more negative. They indicated that their 5th grade daughter had difficulty doing or completing homework, that she was timid or easily frightened, that she needed close supervision to get through assignments, that she didn't follow instructions, that she failed to finish schoolwork and chores, and that she had difficulty organizing tasks and activities. She was frequently irritable and afraid of being alone.

Profile subsequent to treatment: Participant Two was treated with resulting improvement in her attentional abilities. She achieved a notable improvement in her overall scores on the Conners' Parent Rating Scale, which is a significant evaluative marker in the diagnosis, treatment, and monitoring of both ADD and ADD/HD (Attentional Deficit Hyperactivity Disorder). Negative scores previously regarded as "very much true" improved to "not true at all." In addition, significant improvement was noted in areas of academic achievement. These positive outcomes were noted and considered remarkable by her teachers and parents. This child had encountered difficulties with her medication and had stopped taking it before enrolling in this pilot program. It should be noted that her success was achieved without the need for medication. A testimonial letter from her parents is enclosed.


       Participant Two Outcome: Need for medication resolved. The Conners' Parent Rating Scale indicated that Oppositional Behavior, Cognitive Problems with attention, hyperactivity, social problems, psychosomatic illness, and hyperactive impulsive behavior improved dramatically from the significant/very significant range to falling into the normal range. Additionally, significant improvement was noted in areas of academic achievement. These positive outcomes were noted and considered remarkable by her teachers and parents.       
   



3. Profile prior to treatment: Participant Three was an 8-year-old female diagnosed with ADD and co-morbid speech pathology issues. An initial Conners' Parent Rating Scale indicated that Participant Three showed pronounced difficulty in doing or completing homework, that she expressed a reluctance to engage in tasks requiring sustained mental effort, that she had difficulty in sustaining attention for play activities, that she had trouble concentrating in class, that she demonstrated anger issues, that she needed close supervision to complete assignments, that she exhibited a failure to understand instructions, and that she had difficulty organizing tasks and activities. She was also frequently irritable and restless in the "squirmy" sense. A similar Conners' Teacher Rating Scale noted that she often would forget things that she had already learned, that she was inattentive and easily distracted, and that her reading was not up to par. Although she was considered a "bright" child, another evaluator remarked about her difficulty in comprehension and in areas of expressive and receptive language. She was also prone to hysterical crying jags to the extent that she was often unable to catch her breath.

Profile subsequent to treatment: A Conners' Parent Rating Scale indicated most problem areas that existed prior to treatment (34 areas which were rated as either a "3" or "2") were now rated as "just a little true." (Please note that the scale runs from 0 to 3 with "0" representing the best outcome and "3" the worst outcome.) Parents and teachers noted overall success including marked improvements in her abilities to concentrate and remain on task. The follow-up Conner' Rating Scales indicated that a majority of her scores after treatment were "0s" with several "1"s, two "2"s and no "3"s. Improved fine motor skills were noted. The attentional component of the participant's presentation was successfully resolved leaving the left hemispheric language issue to be addressed at a later date.


       Participant Three Outcome: The Conners' Parent Rating Scale indicated significant improvement with Oppositional Behavior, hyperactivity, psychosomatic illness, inattentive behavior, and hyperactive impulsive behavior. Symptoms improved dramatically from the significant/very significant range falling into the normal range. Parents and teachers noted overall success including marked improvements in her abilities to concentrate and remain on task. The attentional component of the participant's presentation was successfully resolved leaving the left hemispheric language issue to be addressed at a later date.       
        



4. Profile prior to treatment: Participant Four was a 10-year-old male previously diagnosed with ADD/HD. According to a Conners' Parent Rating Scale, Participant Four had difficulty listening, was afraid of new situations, was excitable and impulsive, had trouble concentrating in class, was often restless in the "squirmy" sense, and had difficulty following through on instructions. A similar Conners' Teacher Rating Scale indicated that he was easily distracted. He also demonstrated recurrent insomniac episodes, exacerbated facial tics and was observed to have a moderately impaired sense of balance.

Profile subsequent to treatment: Marked improvements were noted in his abilities to concentrate, relax in stressful situations enabling improved performance, and remain on task. Significant improvement was noted in his fine motor control and his nervous facial tics were ameliorated. Gains with his attentional component have resulted in higher academic achievement as evidenced by a recent school report card and attached test scores. His parents consider the program to be a success. A testimonial letter is attached.


       Participant Four Outcome: The initial Conners' Parent Rating Scale indicated cognitive problems with attention, hyperactivity, restless impulsive behavior, inattentive behavior, and hyperactive impulsive behavior which improved dramatically falling into the normal range post treatment. Gains with his attentional component have resulted in higher academic achievement as evidenced by a recent school report and enclosed test scores.       
   



5. Profile prior to treatment: Participant Five was a 13-year-old male previously diagnosed with ADD/HD. According to an evaluation sheet completed by his father he had anger issues and often seemed depressed. He required assistance to accurately complete assignments and was subject to a host of academic problems. He exhibited dis- organization, lost things needed for tasks, responded slowly to begin or finish schoolwork, had a poor memory especially about school assignments and tasks, demonstrated poor penmanship, and routinely made careless errors or mistakes. He had slipped at least one grade level in four out of six subjects and had failed one. A Conners' Teacher Rating Scale corroborated the father's evaluation responses and also indicated concerns about impulsive behavior, which included being restless in the "squirmy" sense, poor listening skills, and general sassiness.

Profile subsequent to treatment: Although his impulsive behavior remained at issue, Cortical Integrative Therapy resulted in noticeable improvements in his ability to concentrate and remain on task. His parents were pleased with his progress in several domains. Significant improvements were observed in his fine motor control and attentional attributes. He is also improving in sports, most notably in soccer.


       Participant Five Outcome: Prior to treatment, his Conners' Scale fell into the borderline range for Oppositional Behavior, Cognitive Problems with attention, and inattentive behavior. Significant improvement was noted in all of the above areas placing him out of the range on T scores for having an Attention Deficit. His motor improvement was quite evident early in treatment as well as in sports, most notably in soccer.       
        



6. Profile prior to treatment: Participant Six was a 12-year-old female previously diagnosed with ADD/HD. According to a Conners' Parent Rating Scale, Participant Six demonstrated severe manifestation of ADD/HD with restless-impulsive, emotional affect, inattentive, and hyperactive-impulsive behaviors all charted near the top of the scale. While a similar Conners' Teacher Rating Scale was less extreme, problems of inattention and hyperactivity remained prominent. An evaluation sheet completed by her mother essentially corroborated these ratings and, in addition, she mentioned other negative assessments including excessive fidgeting, distractibility, impulsive thinking, excessive talkativeness including interruptive and inappropriate vocal communication, and the commission of careless errors and mistakes - especially in the school setting. Her mother characterized her as a willful child who "seemed to have her own agenda."

Profile subsequent to treatment: According to her mother, Participant Six showed significant improvement in her attentional deficits. Both her mother and father completed post- treatment Conners' Parent Rating Scales, which indicated that she was no longer in the ADD/HD range based on tabulation.


       Participant Six Outcome: The Conners' Parent Rating Scale indicated that Oppositional Behavior, Cognitive Problems with attention, hyperactivity, anxious shy behavior, restless impulse behavior, psychosomatic illness, and hyperactive impulse behavior improved very dramatically from the very significant range to falling into the normal/borderline range.       
   



7. Profile prior to treatment: Participant Seven was a 14-year-old male previously diagnosed with ADD and possible co-morbid depression. According to the Conners' Teacher Rating Scale, Participant Seven demonstrated a subtype of ADD co-morbid with some type of anxiety or depression. This evaluation revealed an avoidance of sustained mental effort, a failure to finish projects, inattentiveness and a general distractibility, difficulty organizing tasks or activities, and a general difficulty in sustaining attention to tasks or even during play activities. A Conners' Parent Rating Scale also drew attention to characteristics such as difficulty in completing homework, frustration with even minute changes of order, and a need to be closely supervised if assignments were to be completed.

Profile subsequent to treatment: Although compliance was the primary issue with this patient, improvement in his attentional deficits had occurred. A subsequent Conners' Parent Rating Scale completed by his father demonstrated significant positive changes in this area. Of particular consequence was the indicator "has trouble concentrating in class," which became "just a little true." Both his mother and father completed post-treatment Conners' Parent Rating Scales, which indicated that Participant Seven was no longer in the ADD/HD range.


       Participant Seven Outcome: The Conners' Parent Rating scale indicated that Cognitive Problems with attention, hyperactivity, anxious shy behavior, social problems, psychosomatic illness, and inattentive behavior improved significantly. His T scores revealed resolution of ADD.       
        



8. Profile prior to treatment: Participant Eight was an 8-year-old male with ADD and signs of co-morbid depression. A Conners' Parent Rating Scale completed by both parents indicated that Participant Eight had difficulty sustaining mental effort, had trouble concentrating in class, exhibited anger issues, was often afraid of new situations, did not follow through on instructions and failed to finish schoolwork, had difficulty organizing tasks and activities, and failed to finish projects requiring close supervision and sometimes assistance in completing assignments. It was also reported that he was not invited to friends' houses, which is often a marker for poor socialization skills or a difficulty in making friends. In a lifestyle questionnaire completed by his mother, she indicated, "Participant Seven can be very difficult at times and seems to be bored or disinterested in a lot of things."

Profile subsequent to treatment: His anger and concentration issues have improved, his moods have become sunnier, and his parents successfully removed him from his medication. They reported that they had seen significant progress so that they felt that the medication was no longer necessary. A testimonial letter from his mother is attached.


       Participant Eight Outcome: Need for medication resolved. The Conners' Parent Rating Scale indicated that Cognitive Problems with attention, hyperactivity, anxious shy behavior, psychosomatic illness, emotional lability, inattentive behavior and hyperactive impulsive behavior improved dramatically. His post treatment scores placed him out of range for having ADD/HD.       
        



9. Profile prior to treatment: Participant Nine was a 12-year-old male with ADD/HD. An evaluation sheet completed by his father indicated such characteristics as immature behavior, requires assistance to accurately complete assignments, and severe academic dysfunction - being disorganized, loses things needed for tasks, poor math/science skills, slow to begin/finish schoolwork, poor memory, forgetful about school assignments and tasks, makes careless errors or mistakes, has poor penmanship, and has trouble following teacher instructions or group directions. A progress report completed by his father early in the treatment regime included the following negative observations: "He remains confrontational in everything. He will not respond to a request unless it is made several times or unless you personally impose yourself on him."

Profile subsequent to treatment: When lifestyle changes began to be implemented with his treatment regime, he began improving rapidly. He had been medicated with Strattera, which was discontinued when improvements were observed. Fine motor control improved to such an extent that he became more active in sports during the months coinciding with his treatment regime. The outcome was so successful that his mother has offered the attached testimonial letter.


       Participant Nine Outcome: Need for medication resolved. The Conners' Parents Rating Scale indicated that Oppositional Behavior, Cognitive Problems with attention, hyperactivity, anxious shy behavior, perfectionism, emotional lability, social problems, psychosomatic illness, inattentive behavior, and hyperactive impulsive behavior improved dramatically. Participant Nine is functioning well off medication.       
        



10. Profile prior to treatment: Participant Ten was a 14-year-old male with ADD. Although he was a very engaging adolescent, the Conners' Teacher Rating Scale indicated an abundance of academic, attentional, and social issues. Responses of "very much true" were indicated for such characteristics as: forgets things he has already learned, appears to be unaccepted by group, fails to give close attention to details or makes careless mistakes in schoolwork, avoids tasks that require sustained mental effort, fails to finish things he starts, does not seem to listen to what is being said to him, inattentive, easily distracted, has difficulty organizing tasks or activities, has difficulty sustaining attention in tasks or play activities, and is not reading up to par. A Conners' Parent Rating Scale completed by his mother contained many congruent negative values that his teachers had observed, as well as behavioral characteristics such as being "irritable."

Profile subsequent to treatment: Participant Ten's improvements in attentional deficits as well as gross and fine motor skills were noted. These were documented on the Conners' Rating Scales completed by his parents and further substantiated by a number of extremely positive observations noted in his training achievement diary. According to one lengthy observation recorded by his mother, he asked to be "bumped up" a grade in school so that he could be further challenged in both hockey and academics. He also suddenly expressed an interest in attending college. He was now proofreading his own documents and his paragraph writing had improved. He was on Concerta prior to treatment, resolved need for medication. A testimonial is attached.


       Participant Ten Outcome: Need for medication resolved. The Conners' Parents Rating scale indicated social problems, perfectionism, emotional lability, and inattentive behavior improved significantly. Worthy of note is that hyperactivity and hyperactive impulsive behavior fell well into the normal range on final outcomes of the Conners' Rating Scale. According to his mother, a teacher, he asked to be "bumped up" a grade in school so that he could be further challenged in both hockey and academics. He also suddenly expressed an interest in attending college.       
        



DISCUSSION:

Firstly, the program was made available to participants on a "first come, first served" basis after a public service announcement was aired on NBC Channel 10. There were 16 participants who were initially screened; ten of which were found to be suitable participants. Six children were not selected because of complicating factors (2) or compliance issues (4). It should be noted, that success was achieved in this group of ten children, most of which, presented with documented co-morbid conditions. A criterion for participation in the program was that the diagnoses be made by their primary health care physician and be documented prior to evaluation by the pilot program. The success of this program with participants who had additional complicating factors speaks to the necessity of designing individualized programs and tailoring protocols to meet their specific needs and circumstances.

Secondly, five of the ten participants (#1, #2, #8, #9, and #10) who were on medication prior to start of the program successfully discontinued their medications. Their parents felt that their symptoms had been resolved. The decision to discontinue medication was made by their parents and subscribing physicians. The importance of this result cannot be understated. The ineffectiveness of the pharmaceutical approach as a long-term solution is not disputed. Additionally, the side effects of using certain medications are well documented and are of concern to most professionals who prescribe them. The fact that this is reproducible within a pilot and the wider setting of the Infinite Potential Program is very significant. The improvements noted and documented by parents as well as teachers are not only of a behavioral nature, but include improvement in fine and gross motor skills, academic work, better grades as well as increased self-esteem and improved social skills. A total of 6 of 10 were in the normal range based on the Conners' Parent reporting Scale. Three others improved significantly to borderline and one did not fill it out.

In addition to the Conners' Reporting Scales, parents were provided with satisfaction questionnaires at conclusion of the 12-week treatment period. A review of them indicates that, overall, parents expressed high satisfaction with the program. All would recommend and refer others to seek the Infinite Potential Program as an effective way to treat ADD/HD in their children.

This program is not a duplication of services that are presently available in public school systems. The educational community indirectly and informally embraced this fact since six of the ten participants were the children of educators. These parents who are teachers were aware that non-pharmacological oriented treatment modalities for ADD/HD were not available in the school systems their children were attending. In contrast to management, accommodations, or coaching techniques, the Infinite Potential Program attempted to demonstrate a solution or potential remedy for ADD/HD. In fact, many of these parents had previously attempted to arrange viable treatment/remediation for their children and had received only tacit accommodations in return, without positive gains being achieved. The fact these educators actively sought out this pilot program suggests that there is an absence of such a program in school systems at this time. It should also be emphasized that because of the educational backgrounds of certain participating parents, gains experienced by their children might have been more readily recognized and appreciated.


CONCLUSION:

The goals of the Pilot were accomplished in that the purchase of equipment as a one time capital expenditure will benefit Rhode Islanders for years to come.

In addition, all of the participants showed improvement. Six having resolution of ADD/HD by evaluation utilizing the Conners' Parent Reporting Scale, three others showing overall significant improvement. Most striking is that five participants initially on medication prior to start of treatment successfully eliminated the need for medication. Several demonstrated immediate increase in scholastic performance. The Infinite Potential Program does not involve the use of any medications and proved to be an effective treatment for ADD/HD's impulsivity, hyperactivity, and inattentiveness as well as improving overall social emotional functioning.

The overall financial costs of providing comprehensive services to children with Attention Deficit Disorder/Hyperactivity Disorder through the use of mainstream medical treatment appears to be higher than the cost of the Infinite Potential Program.

Based on the results of this pilot, we believe that the savings that would accrue to both parents and school systems in Rhode Island is incalculable if the program is implemented on a larger scale. As the results of the pilot strongly suggest, the Infinite Potential Program is highly effective as a primary treatment modality for ADD/HD. It is effective in very often resolving the dysfunction in contrast to managing it. From a financial perspective, the one-time cost of resolution is potentially a fraction of the cost of annual maintenance.

Testimonials are attached from parents whose children benefited from this grant. In these letters, they offer their personal thanks and input to the Rhode Island Legislature for the opportunity that was afforded to them and their children.

A sincere thanks to the Northern Rhode Island Collaborative for administering the grant, Maria de Lourdes Serpa, Ed.D., Odete Amarelo, Ph.D. and Helen Giorgio for their many selfless contributions and James Paicopolos for analysis of the pre and post data.