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The role of somatosensory feedback in Attention Deficit Hyperactivity Disorder: three cases treated

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Title: The role of somatosensory feedback in Attention Deficit Hyperactivity Disorder: three cases treated


1
The role of somatosensory feedback in Attention
Deficit Hyperactivity Disorder three cases
treated with Mindfulnessintegrated CBT
Bruno A. Cayoun, PsyD
APS Conference 2008 - Hobart Australia
2
Attention 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

3
ADHD 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)

4
Mindfulness
  • 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).

5
Practice 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

6
General 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)

7
Main 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

8
Neuroplasticity 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

9
Somatosensory Networks And Body Scanning
Techniques
10
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11
Somatosensory Cortex and Body Scanning Techniques
WEEK 1
WEEK 2
WEEK 3
WEEK 4
12
Case 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

13
Behavior Rating Inventory of Executive Functions
(BRIEF)
Child
Adult Male
14
Behavior Rating Inventory of Executive Functions
(BRIEF) 2 Adult Females
15
Relationship between Global EF and Somatosensory
Feedback
16
Summary
  • 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
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