Treating ADHD and inattention with auditory noise: Could noise be a non-pharmacological treatment alternative?

Transcription

1 Treating ADHD and inattention with auditory noise: Could noise be a non-pharmacological treatment alternative? Norsk Nevropsykologisk Forening Stavanger 17 November Inattention Göran Söderlund Professor in special needs education Western Norway University of Applied Sciences goran.soderlund@hvl.no

2 Treatment of ADHD

3 Pharmacological treatment Dopamine: Methylphenidate (Ritalin, Concerta, Equasym, Medikinet ) Dextroamphetamine (Dexedrine, Metamina, Dexamin Elevanse) Noradrenaline (Strattera)

4 Medication in Scandinavia, boys vs. girls (Furu et al. 2016)

5 Hazard Ratio (HR) for receiving ADHD medication or diagnosis (Karlstad et al., 2017) Folkehelseinstituttet Boys: N= 261,205 Girls: N= 248,622

6 CBT vs. medication Results: CBT + medication resulted in greater improvements than CBT alone in ADHD symptoms, organizational skills, and selfesteem. Group differences diminished over follow-up, as the CBT alone group continued improving, while the combined group maintained the gains. Conclusion: CBT + medication outperformed CBT alone for ADHD symptoms, organizational skills, and self-esteem, although its superiority tended to decrease over follow-up.

7 Non-pharmacological treatments Meta analysis of 54 selected studies (out of 2904) Omega III fatty acids Synthetic colors: azo-colors Food allergies (Pelsser et al, 2011; Lancet) Sonuga-Barke et al., 2013 American Journal of Psychiatry

8 Neuro-feedback

9 working memory training RoboMemo 25 days 30 min/day

10 CASE CLOSED?

11 Non-pharmacological noise treatment

12 Some experimental data

13 Noise and Speech SNR -1 db Word Recall Auditory noise ADHD diagnosed children ADHD group (21) Control group (21) matched boys 9-13 yrs White Noise 81 db(a)

14 ADHD vs. Control Word recall Percentage correct recall as a function of noise and group p =.006 ADHD N= 14 ADHD med. N= 7 Control N= 21 SNR -1 db (Söderlund et al., 2007)

15 Screened undiagnosed children

16 Assessing the dimension of attention problems SWAN scale screening 150 children (N=90)

17 Recall in standardized score Non-executive functions and noise Word recall, word recognize Performance as a function of attention ability and noise level 0,75 0,5 0,25 * p = ,25 sub-attentive normal-attentive super-attentive -0,5-0,75 65 db 70 db 75 db Noise level

18 Extended test battery Visuo-spatial working memory test spanboard

19 Recall in standardized score Executive functions and noise Go No-Go + Spannboard Performance as a function of attention ability and noise level 0,5 0,25 0 * p =.001 sub-attentive normal-attentive super-attentive -0,25-0,5-0,75 65 db 75 db 85 db Noise level

20 Medication vs. noise Medicated ADHD children

21 Word Recall ADHD on/off medication and Controls Word Recall as a Function of Noise and Medication in ADHD ns. * p =.019 ns. ns. Interaction p =.031

22 Spanboard ADHD on/off medication and Controls Spanboard as a Function of Noise and Medication in ADHD p =.072 ns. p =.016 p=.071 Interaction p =.077

23 Rat model ADHD Kyoto rat ADHD Control SHR = spontaneous hypertensive rat Wistar = Normotensive rat

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25 Montoya staircase - fine motor control (noise - no noise - medication) (N = 32; 4 x 8 rats)

26 Consumed pellets Skilled reach performance as function of noise and strain (SHR vs. Wistar) SH s SH n Wistar s 10 p < Trial day Figure 1. Montoya: noise vs. silence vs. strain

27 RotaRod gross motor skills (noise no noise medication)

28 Time on rod (s) RotaRod performance as a function of noise and strain (SHR vs. Wistar) ** * p = SH noise SH silence Wistar silence Trial day Figure 3. Rotarod: noise vs. silence vs. strain

29 Counts (Open field activity) Locomotion habituation SH s Wistar s SH noise Wistar noise 150 p < Time (min) Fgure 5. Open field activity: noise vs silence; SH vs Wistar

30 So what causes noise benefit? Auditory masking Increased arousal Stochastic resonance

31 Stochastic Resonance noise increases the signal-to-noise ratio

32 Theory The Moderate Brain Arousal model high Control ADHD performance low Noise level

33 Noise Application A non-pharmacological treatment in school

34 Three test: - with and without noise Word recognize Recall the dots Speedy

35 Choose subject Start working

36 Self evaluation Feedback

37 Push-notifications in- or decreasing time use with Smartnoise

38 What causes the effect? The Noise % Problem insight want change Start stop Feedback Monitoring- follow your development

39 Problems 1. Thresholds to get started 2. Persistence to keep on

40 So is this the future??