What is attention deficit hyperactivity disorder, ADHD, and attention deficit disorder, ADD?
Children who are inattentive, easily distracted, quickly tire of what they are doing. have problems to organise their activities and to control their impulses are considered to suffer from attentive deficit hyperactivity disorder (ADHD).
According to experts this is a genetically conditioned disorder which often causes deficient professional and educational accomplishment and a lifelong handicap. If there are problems of attention without hyperactivity the condition is called ADD. However there is no scientific evidence that ADHD is genetically caused and in the year 2000 the American Paediatric Association concluded that there is no convincing scientific proof that ADHD even has biological causes.
An alternative way of looking at attention disorder.
You can have another angle of approach on attention deficit disorder and how it can be remedied by studying our smallest children. Normal children around the age of one year, who are allowed to move around freely and not forced to sit in baby sitters or car chairs for long periods have a similar behaviour to that of children with ADHD.
They move around, cling and climb and have problems to sit still. They do not follow instructions and have problems to organize their activities and control their impulses and they are easily distracted. However, unlike children who are labelled as suffering from ADHD, normal children all on their own manage to overcome their attention disorder and hyperactivity as they grow older. How are normal children different from children who develop ADHD and what secret knowledge, unknown to the experts, do they have that enables them to prevail over their attention problems?
The infant´s brain is undeveloped
The brain of the infant is undeveloped and needs to mature. In the new born baby only the brainstem functions properly while the other parts are made use of only to a small extent. Before an individual is able to bring into play all of his brain the nets between the nerve cells of the brain must develop by growth of branches from the nerve cells and the nerve fibers must develop an isolating sheath of myelin. This maturing of the brain will take place all through childhood and the very first year is the most crucial period which lays the foundation for later development. It has been estimated that every minute in the life of a new born baby 4,7 million new nerve cell branches are created in the brain of the infant.
But this process does not happen by itself. The brain needs stimulation from the senses for the branching off and the myelinization to occur, especially stimulation from the vestibular, the tactile and the kinaesthetic senses. The infant gets such stimulation by being touched and rocked by its parents and by continually making rhythmic baby movements on its own. Such movements develop in a certain order according to an inborn program with individual variations. Turning around, crawling on the stomach, rocking on hands and knees and crawling on hands and knees are some important milestones in this development. The stimulation the brain of the infant gets from such rhythmic baby movements during the first year of life is fundamental for the future development and maturing of the brain.
In children who have not recieved sufficient stimulation of this kind the maturing of the brain is retarded or impaired. Such retarded development can appear as attention disorder with or without hyperactivity.
The triune brain
The American scientist Paul McLean has studied the development of the brain in reptiles, mammals and humans. According to him the human brain consists of three layers that surround the brainstem, which he also calls the fish brain because it roughly corresponds to the brain of the fish. These layers surround the brainstem like layers of an onion.
Next to the brainstem is the reptilian brain which corresponds to the brain of reptiles. In humans the reptilian brain is called the basal ganglia, one task of which is control of our postural reflexes, i.e. our ability to stand and walk and keep our balance. The reptilian brain must also inhibit the primitive reflexes which are inborn, stereotyped movement patterns controlled by the brainstem. The primitive reflexes constitute the movements of the fetus and the newborn infant and must be transformed into the postural reflexes in order for the infant to be able to rise and walk and keep its balance. The basal ganglia also regulate the level of activity of the child and ensures that the child can adapt his activity according to the situation instead of being either hyperactive or underactive.
Outside the reptile brain is the mammalian brain or the limbic system, which controls among other things our emotions, memory, learning and play.
On the outside is the neocortex or the human brain. Signals from the sense organs must reach the neocortex and be processed there in order for us to be aware of what happens around us and to be able to act consciously. The very front part of the neocortex, the prefrontal cortex is of crucial importance for our executive functions such as judgment, attention, power of initiative and control of impulses.
The importance of the rhythmic baby movements for the linking up of the brain.
When we are born all parts of the triune brain have been set up but are not yet working properly. In order for all the parts of the brain to function as a unit they must be developed and linked up to each other. This is achieved by the rhythmic infant movements that stimulate the growth and the branching off of the nerve cells and the myelinization of the nerve fibers.
The infant needs to have sufficient muscle tone in order to be able to move around and stimulate the linking up of the different parts of the brain. Also, for sufficient muscle tone to be established, the infant must be touched, hugged, rocked and allowed to freely move around. Such stimulation sends signals from the sense organs of the tactile, vestibular and kinaesthetic senses to the centers of the brainstem, the task of which is to regulate muscle tone. Insufficient stimulation from these senses may cause difficulties for the baby to lift its head and chest and move around, further reducing the stimulation from the vestibular, tactile and kinaesthetic senses, leading to a vicious circle.
When the baby is unable to move around freely too little stimulation is conveyed to the neocortex via the reticular activation system (RAS) of the brainstem. The task of this system is to arouse the neocortex. When there is insufficient arousal of the neocortex the child will become sluggish and inattentive to sensory signals. Moreover the nerve cells and the nerve nets of the neocortex will not develop properly.
The importance of the cerebellum
The cerebellum is also important for the linking up of the brain and for the power of attention.
The task of the cerebellum is to make our movements rhythmic, coordinated and smooth. From the cerebellum there are important nerve connections to the prefrontal cortex and the speech areas in the left hemisphere.
At birth the cerebellum is undeveloped and it grows substantially after the age of six months. The rhythmic baby movements develop the nerve nets and nerve cells of the cerebellum and its connections to the frontal lobes. That is one reason why the rhythmic baby movements are so important for the linking up of the frontal cortex and the development of the power of attention and the speech.
Why babies have problems to sit still and be attentive
The fact that the nerve nets of the brain have not developed and the different levels of the brain have not been linked up explains why infants do not behave like small adults. Infants are not good at maintaining their attention and concentrating on a specific task or controlling their impulses due to the fact that the nerve nets of the neocortex and especially the frontal lobes have not developed.
Infants have problems regulating their level of activity and normally by the age of 10/12 months they move around most of the time and find it difficult to sit still. One task of the basal ganglia is to regulate the level of activity. Since the basal ganglia have not yet developed properly and are not linked up with other levels of the brain, most normal babies are hyperactive at this age.
On the other hand, babies who are not able to move around sufficiently due to low muscle tone or other circumstances get too little stimulation of their neocortex and frontal lobes and will become sluggish, hypoactive, inattentive and late to develop.
Attention disorder as delayed maturity of the brain
As we have seen the experts consider ADHD to be genetically caused. An alternative explanation would be that it is a delayed or thwarted maturity process of the brain. For some reason the brain of the child has not got sufficient stimulation from the senses for the nerve nets to develop and the different parts of the brain to link up.
This may be caused by many circumstances that obstruct the motor development of the baby such as prematurity, brain injury inflicted during delivery, hereditary factors or disease. Other such factors may be electromagnetic irradiation, heavy metals and vaccinations, which are known to affect the brain. Such factors may cause the infant to omit important steps of its motor development, in that way hampering its motor development and the maturing of its brain.
Lack of stimulation from those closest around the child, being left alone without tactile or vestibular stimulation or forced to spend its time in babysitters and car chairs instead of moving around on the floor will also prevent the brain from maturing properly.
Similarities between infants and children with ADHD
As has been shown attention deficit problems and hyperactivity are common features in infants and children who have been identified as suffering from ADHD. In both groups there are many signs that the basal ganglia do not function properly, i.e. difficulties to regulate the level of activity, active primitive reflexes and balance problems.
It is also common that children with attention disorder have an inability to make simple movements in a rhythmical and smooth way, which indicates that the nerve nets of the cerebellum have not been properly developed. Since the cerebellum is of crucial importance for the proper functioning of the frontal lobes this inability can be an important contributing factor behind attention problems and impulsivity.
Many children with ADHD have low muscle tone and shrunk up posture causing shallow breathing and insufficient arousal of the neocortex. Such children may alternate between hyperactivity and passivity, the hyperactivity being a way to stimulate the neocortex by moving around.
An active Moro reflex may contribute to attention problems
Many children with ADHD have an active Moro and Fear Paralysis reflex. The Fear Paralysis is a reflex that normally should be integrated in the womb within twelve weeks after conception. The Moro is a primitive reflex which is normally integrated before the age of six months. If these reflexes are retained the child will be easily disturbed and hypersensitive to impressions from the senses, for example the visual, auditory and tactile sense and they will have a heightened level of stress. These children are easily distracted and quickly get tired especially in noisy surroundings where they may either act out and become disturbing or may withdraw into themselves.
Rhythmic movement training
As has been shown there are many similarities between infants and children with ADHD both regarding behaviour and immaturity of the brain.
One must therefore ask if children with ADHD or ADD can improve by imitating the rhythmic movements that infant spontaneously make. As a matter of fact such a movement training has been used in Sweden for more than 25 years.
Rhythmic movement training has been developed by Kerstin Linde and is founded on the natural rhythmic movements of the infant. To be effective these exercises must be done daily for 10-15 minute. The exercises are done in lying or sitting position or on hands and knees.
The sensory stimulation caused by the rhythmic movements stimulate the nerve nets of the brainstem, cerebellum, basal ganglia and neo cortex to develop. This causes attention and concentration to improve and hyperactivity and impulsivity to decrease.
The rhythmic movements also increase the muscle tone of the extensor muscles that straighten the back and keep the head in an upright position. Body posture, breathing and endurance will improve and the neocortex will be aroused by stimulation via the brainstem, which will improve attention and concentration.
The rhythmic movement training will stimulate the cerebellum and its nerve paths to the prefrontal cortex, which also will improve attention and concentration and diminish impulsivity.
The rhythmic training will also stimulate the basal ganglia to mature and integrate the primitive reflexes, which will facilitate the ability of the child to regulate its level of activity and be still.
Two case reports will illustrate the effects of the rhythmic movement training in attention disorder. The first case shows how muscle tone, body posture and attention improve in a child suffering from crippling attention disorder without hyperactivity. In the second case not only attention improves but also impulsivity, distractability and hyperactivity.
Case report: Anna
A case report may illustrate the effects of RMT in attention disorder. It shows how the rhythmic movements improve attention and diminish impulsivity and hyperactivity.
Anna was ten years old when she began Rhythmic Movement training. Her motor development had been normal except for fine motor development. She crawled on hands and knees as a baby and walked at the age of one year. She had great problems concentrating and sitting still at school. She was easily distracted and had very poor perseverance. She had no problems reading and writing but had great problems with mathematics. She had her own assistant during mathematic lectures and if the assistant was absent she would do nothing but run around disturbing the other students.
She acted on impulse and had great problems paying attention and following instructions, especially during PE lectures which she did not want to attend. Her ankles were weak and she easily sprained them. She had greater fine motor problems, especially tying shoe laces and doing up buttons. Her hand writing was bad.
Anna had emotional problems. She was afraid of the dark, anxious and apprehensive, especially at night. She had severe difficulties in her peer relations. The girls in her class used to tease her and then she used to run away and hide.
At her first visit I tested for her primitive reflexes, many of which were active. The Spinal Galant Reflex was especially active explaining her inability to sit still and to wear tight clothes. Her Moro Reflex was also extremely active causing sensitivity to sounds and touch and many of her emotional problems. Her Palmar and Grasp Reflexes were also active causing problems with fine motor ability.
Anna visited me about once a month for little more than a year. She did rhythmic exercises at home for ten to fifteen minutes every day. At her visits she got new rhythmic exercises to do. Some of the rhythmic exercises she continued to do most of the time. She got assistance to correct them in order to do them as exactly as possible. In addition she got special exercises for reflex integration that her mother used to help her with.
After four months her mother noticed that she had become more defiant and ill-tempered than before. After five months these symptoms had decreased and she was more self-confident. She could concentrate better at school and school work including mathematics improved. A few weeks later she had caught up with her classmates in mathematics. Also physical education went better and she liked to attend. She especially enjoyed long jumping and high jumping.
After half a year she changed to another school after summer vacation and her mother chose to say nothing about her problems. It turned out that she could concentrate well and no longer needed an assistant. She had no problems in her relations with her classmates and she was no longer teased. Her ankles had become much stronger and she then started football training. Her fine motor ability had improved considerably.
After a little more than a year of movement training she was no longer afraid of the dark. She was no longer hypersensitive to sound and touch and not so easily disturbed. She had no problem to sit still or wear tight clothes. Her fine motor ability had improved considerably although she still had some problems doing up buttons. She had practically no difficulties with concentration and her endurance was good.