Case Study: mental paralysis, not neurological dysfunction

Jerrod was a nine-year-old academic failure. When he arrived in my office, his parents, Lisa and Allen, presented me with a thick file of medical assessments, psychological testing and learning disabilities evaluations. These were intended to document his ADHD and learning disabilities. The evidence presented therein was thorough. It implied that he lacked the ability to attend to tasks and had a variety of academic deficits. He had been on several stimulant medications that had been temporarily helpful, but ultimately his behavior problems returned. The necessity for increasing dosage levels and resulting mounting side effects had convinced his parents to stop them.

In a voice weary from the struggles with her son, Lisa explained that as homework time would approach, Jerrod would complain of stomachaches and headaches and would become agitated and depressed. Dutifully, she would sit down with him at the kitchen table to do his assignments. Jerrod would stare at his book, with pencil in hand, oscillating between paralysis, anger and hopelessness. He would make a few stray marks on his paper trying to get started. Soon Lisa would try to help him by reading the problem to him. He was so upset that he could only hear the sounds of her words, but the sounds were not words to him, so nothing she said made any sense. He just drew a blank.

Lisa explained that when she would try to explain the problem, sometimes he would explode in frustrated anger, other times he would just sit and cry helplessly. At times, after crying or an angry outburst, the release of emotion would allow him to make a tiny step forward. He and his mother would spend many painful hours every evening cycling through anger, crying and tiny steps forward.

After years of this, and many other attempts at therapy, Lisa and Allen brought their son to me for treatment.

Jerrod was a tense, thin boy who had a frightened aura about him. He appeared to be trying desperately to control his behavior and speech. He would sit stifly in one chair then abruptly move to another. His legs would bounce, then he would move again. He watched his parents and me carefully as we discussed his problems. Every few minutes something we said would trigger emotion in him, and he would argue that what we said was not true. He was a pressure cooker trying not to explode by squirting occasional jets of steam.

While treatment involved many family issues, I will describe here the specifics of treating Jerrod’s academic problems to demonstrate how quickly supposedly “neurological” ADHD behaviors can change. I assigned Jerrod a series of math problems he had brought with him. As his mother had reported, he immediately began to get upset. His face became tight and tense. His right leg began to bounce up and down. Though his pencil was properly placed below the problem, it did not move. I could see his tension mount as he became more rigid while he struggled to restrain a home-style emotional explosion.

I asked him what it felt like to work on his math. From his tense state, he croaked, “hard,” but did not look up from the problem. I said, “let’s work on that hard feeling in the pod.” (The “pod” is the nickname for my patented psychotherapy machine. The process is called Computer Aided Emotional Restructuring (CAER), and will be explained in detail later in another section of this site). As I put him in the CAER machine, I asked him to trace that “hard math feeling” to all the other places he had ever felt that same feeling.

While he was in the machine, several times I asked him where else he found the “hard math feeling.” He said he found it in many more places than just this math assignment. He remembered it from math at school, math tests, and reading in class. It was a common feeling cross-cutting much of his current and past school experience. After about 20 minutes in the CAER machine, he said that the feeling had gone away and he could not remember any other places where he had felt the feeling.

After he came out of the CAER machine, I had him continue to work on his math problems. He immediately began making progress, even though I had done no math instruction. The problem that had been completely bewildering to him was now easily solved. His demeanor was also quite different. He was much calmer. However, as he continued to work problems, he slowly became more agitated and frustrated. When he was again clearly in the grips of emotional paralysis, I asked him to take that feeling into the pod and do as he had done previously; think of the times he had felt that feeling.

This time in the pod, he found another layer of bad feelings about school work. He had developed a pattern of making negative self statements such as “I am dumb, I am not as smart as other kids, I hate myself, no one is as stupid as I am, there is no way I can ever learn this stuff.” This was his, what I call, “Dumb Kid Story.”

Because the CAER machine is based on extinction of negative affect, the procedure entails bringing up in an emotionally intense way, whatever feelings and thoughts you want get rid of in real life. Thus, I asked him to repeat these and similar statements to himself while he watched the moving lights. He was to “beat up” on himself by repeating his Dumb Kid story to himself as he regularly did in daily life. This led to a much broader array of bad feelings in many settings, particularly social.

Jerrod perceived that his peers thought he was dumb because of his many obvious failures in school. He generally felt he was “less than” other children he knew, as if they were smarter, and more popular than he. His underlying depression was surfacing. In another 45 minutes in the CAER machine, he said that those feelings were gone. When he got out of the machine, there was buoyancy in his manner and a smile on his face. Once his negative Dumb Kid story was extinguished, the underlying happy Jerrod that had always been there, but been suppressed, surfaced. The angry tense demeanor of his Dumb Kid story was also gone.

He now did the math problems with ease, so we began to work in a similar manner on his reading out loud. Because we had dealt with many of the broader issues while working on his math, reading went much faster. The best part of the process was his quickly improving mood and self-confidence. When his mother came out of her CAER machine, he wanted personally to open the door for her. As his mother emerged from the darkness of the CAER machine and was still adapting to the room light he blurted out to her “I can read!” Before being willing to go to lunch, he insisted on showing off his new skills by reading to her. Rather than his typical fumbling with his third grade book, he read articulately to her out of a Harry Potter book, which has a reading level of grade 6.8. He had advanced well beyond the third grade material he had previously struggled with.

Why had Jerrod changed so much, so quickly? Obviously, I had not done brain surgery to alter his supposed “neurological deficits.” Instead, the CAER machine had extinguished the negative emotions that had inhibited his performance and placed an emotional drain on his attention. Without this encumbrance, he had more available attention and was able to access the reading and math skills he already possessed. Previously, these skills had been invisible because of his emotional block to performance. His parents, teachers, and psychologists thought he lacked the necessary math and reading skills.

Jerrod and his parents finished their three days of therapy sessions as happy campers. I have been following Jerrod for over two years and his performance continues to be very good. He now gets mostly A’s and is in several advanced placement classes. He behaves very well and his mother no longer suffers from the Homework Help Hell she had experienced for years.

Is this magic? No. It is all based on careful observation and intervening on the real problems, not high fallutin’ garbledy gook like “neurological deficits” when the kid is just anxious as all get out.

Are ADHD brains different or studies fLawed?

Though the popular press seems to be excited by the magic of neuroimaging and the truths it can discover, some in the scientific community are not as persuaded. Popular articles purport to establish that there are neurological differences between ADHD and non-ADHD children. However, rigorous scientific review of these studies concludes, “The principal conclusion is that the neuroimaging literature provides little support for a neurobiological etiology of ADHD”. The two primary reasons for their lack of confidence in these studies are 1) lack of rigorous experimental design and statistical analysis, and 2) about 77% of the ADHD children in the studies had previously been on ADHD medication.

The second problem is very serious and thus deserves examination. Many animal and human studies investigating numerous psychotropic medications, including the stimulants commonly used with ADHD children, consistently reveal both short and long term changes in brain function and structure.

For example, in rats, “long-lasting changes in the development of the central dopaminergic system [are] caused by the administration of methylphenidate during early juvenile life”. Methylphenidate administered to young rats results in persistent lowered density of striatal dopamine transporters. It is reasonable to expect similar changes in children who are given stimulants. Thus, the differences found in the brain imaging studies are likely due to medications rather than ADHD. In sum, it is premature to conclude that ADHD children’s brains are different from those of normal children.

To the extent that the above cited neuroimaging research studies have meaning, it is as a map of how ADHD thought and behavioral patterns are represented in neural structures and neurochemistry. It is just a description of how ADHD looks at the neurological level. One must remember that for all of us, not just ADHD kids, every thought, feeling, perception and behavior has a neurochemical representation in the brain. If anything, that is what this research describes.