Title: The role of somatosensory feedback in Attention Deficit Hyperactivity Disorder: three cases treated
1The role of somatosensory feedback in Attention
Deficit Hyperactivity Disorder three cases
treated with Mindfulnessintegrated CBT
Bruno A. Cayoun, PsyD
APS Conference 2008 - Hobart Australia
2Attention Deficit Hyperactivity Disorder (ADHD)
Definition Subtypes in DSM-IV
- A major disorder of self control (Barkley,
1999). - Predominantly Inattentive (ADHD-PI)
- deficits in selective and sustained attention,
speed of information processing and memory
retrieval - Predominantly Hyperactive-Impulsive (ADHD-HI)
- persistent and maladaptive symptoms of
hyperactivity and impulsivity - Combined type (ADHD-C)
- All symptoms are present
3ADHD Causes and Deficits
- Etiology is essentially unknown (NHMRC, 1997)
- Genetic, neurophysiological, cognitive, familial
and environmental factors - Current views (Barkley, 1997 Sergeant, 2000)
- Inhibitory dysfunction as a primary deficit
- Decreased ability to regulate motor output or
inhibit a response - Associated deficits
- Deficit in sustained attention (Heaton et al.,
2001) - Dysfunctional reinforcement (Zentall, 1985
Johansen et al., 2002) - Slower general processing speed (Cayoun et al.,
2008) - Deficit in Cognitive Flexibility (Tannock et al.,
1995 Cayoun et al., 2008)
4Mindfulness
- Three complementary definitions
- Sustained attention paying attention on
purpose, from moment to moment, and
nonjudegmentally (Kabat-Zinn, 1994). - Cognitive flexibility a state of continuous
category formation. A mindful individual creates
new approaches to events and situations. He or
she is not bound by previously formed rigid
attitudes rather, the mindful person, situated
in the present, explores a situation from several
perspectives (Margolis Langer, 1990). - Inhibitory control mindfulness is achieved
through the development of experiential awareness
and equanimity, which is the ability to remain
unperturbed by an event experienced within the
framework of ones body and thoughts as a result
of objective observation (Cayoun, 2003).
5Practice Operationalisation 2 Main Aspects
- 1. Concentration on breathing (shaping
attention) - Training in sustained attention, meta-cognitive
awareness, inhibitory control and attention
switching - Benefits include decreased distractibility from
irrelevant thoughts and sensory stimuli and
cognitive flexibility - 2. Systematic body scanning to develop equanimity
- A generalised interoceptive exposure and response
prevention procedure - Requires inhibitory control to prevent learned
responses and foster acceptance - General Aims
- Develop greater self-awareness, objectivity,
acceptance and detachment with each experiences
6General Benefits of Mindfulness Training
- Development of metacognitive awareness
- Awareness and acceptance of ones thoughts
- Maladaptive thoughts are reprocessed more
neutrally (Teasdale, Segal, Williams, 1995
Chambers, Chuen Yee Lo, Allen, 2006) - Development of experiential acceptance (i.e.,
awareness and acceptance of thoughts and body
sensations) - Practice of systematic body scanning (two 30-min
sessions per day) - Unilateral, Bilateral and Sweeping methods
- Facilitates skill transfer
- Promotes neuroplasticity in prefrontal inhibitory
networks and somatosensory pathways (Davidson et
al., 2003 Carey, Bhatt Nagpal, 2005 Lazar et
al, 2005) - Increases internal locus of control (see
Witkiewitz, Marlatt, Walker, 2004)
7Main Associated Brain Structures
- Parietal Lobe (Interoceptive Awareness)
- Plays a major role in
- the overall allocation of attention
- Monitoring of body sensations
- Frontal Lobe (Metacognitive Awareness)
- Plays a major role in
- control of attention
- online decision and execution of behaviour
- Inhibitory control of reactive behaviour
-
8Neuroplasticity Research
- Lazar et al. (2005)
- Anatomical MRI measured cortical thickness in 20
long-term mindfulness meditators and 20 matched
controls. - Cortical thickness was greater (P lt 0.0001) in
the prefrontal (BA 9/10) and somatosensory
cortices of the meditators relative to controls. - These areas correlated with Mf practice
experience - Since behavioural inhibition lies particularly
within the orbital-frontal regions of the
prefrontal cortex (Barkley, 1999) there may be
implications for ADHD - Between-group differences in prefrontal areas
were most pronounced in older adults, suggesting
that mindfulness might offset age-related
cortical thinning - There may be implications for dementia
9Somatosensory Networks And Body Scanning
Techniques
10(No Transcript)
11Somatosensory Cortex and Body Scanning Techniques
WEEK 1
WEEK 2
WEEK 3
WEEK 4
12Case Study (N 4)
- Participant 1
- 12 year-old boy
- Referred by his GP for ADHD-HI leading to peer
rejection, anxiety and depression - Father diagnosed with ADHD-C
- Participant 2
- 38 year-old male
- Referred by her GP for severe depression and
ADHD-C - Participant 3
- 31 year-old female
- Referred by her GP for depression and ADHD_PI
- Participant 4
- 58 year-old female
- Referred by her GP for depression, anxiety and
ADHD_HI
13Behavior Rating Inventory of Executive Functions
(BRIEF)
Child
Adult Male
14Behavior Rating Inventory of Executive Functions
(BRIEF) 2 Adult Females
15Relationship between Global EF and Somatosensory
Feedback
16Summary
- Mindfulness training was effective in addressing
ADHD symptoms in half the clients despite high
comorbidity - Effectiveness of treatment was dependant on
ability to feel body sensations and prevent
reactivity - A gender effect?
- Need for research