Your health: Treating ADHD

Book promotes behavioral therapy in addition to medication

By Malka Eisenberg

Issue of Nov. 7, 2008 / 9 Cheshvan 5769

A treatment for ADHD that combines physical and mental exercise is promoted in a new book that empowers parents to take charge of their child’s care.

“Brain Exercises to cure ADHD,” by Dr. Amnon Gimpel is based on research that indicates that the brain continues to grow and develop in response to stimulation.

“This completely changed the treatment for many conditions such as strokes, heart attacks, brain injury as well as ADHD,” said Dr. Gimpel in an e-mail from his home in Israel. “It is now possible to show a measurable increase in the size and weight of specific areas of the brain following targeted stimulation. This is one of the most exciting discoveries in neurology. The potential good to come from this is enormous.”

ADHD, Attention Deficit Hyperactivity Disorder, is a neurological biological condition where a child or adult exhibits symptoms of poor concentration, impulsiveness and hyperactivity, typically lagging in social, emotional and organizational skills.

The diagnosis should be made after thorough assessment of the child’s behavior and ruling out any medical possibilities. Although medications such as Ritalin are effective and improve concentration, said Gimpel, “it doesn’t solve the problem. Once the Ritalin wears off, so does its effect on enhancing concentration.”

“The mainstay of treatment [of ADHD] is medication, preferably in combination with behavioral therapy as shown in a major study by the National Institute of Mental Health,” said Dr. Leon Zacharowicz, a child neurologist in the Five Towns, and a consultant for the Board of Cooperative Educational Services of Nassau County. “Willpower and wishful thinking alone will not benefit the patient, and there may be a negative aspect to behavioral therapies when used alone: those who fail at improving significantly may very well come to believe their failure was due to a personal flaw or a character defect, rather than the fact that they have a brain based disorder which is difficult to counter without medications.”

In his book and in seminars he conducts in Israel, Gimpel trains parents to coach ADHD children in activities to better develop their brains, helping them to gain confidence and self esteem. He hopes to offer seminars in America in January.

Gimpel struggles with his own ADHD and begins each day with exercise, jumping rope, to improve his concentration. His prescribed method involves physical activities to build motor skills and balance such as aerobics, swimming, skating and running.

“Kids with ADHD need a multi-disciplinary approach because the issues are not only inattention and hyperactivity, but also emotional immaturity, poor working memory and a lack of age-appropriate organizational and planning skills as well as sophisticated decision making,” he explained.

“This is not to say that there is not a role for behavioral management,” Zacharowicz said. “Relaxation, meditation, concentration exercises, cognitive behavioral therapy, and even martial arts training all may play beneficial roles in some cases.”

“It takes additional things to function aside from medicine,” agreed Dr. Marc Krauss, a school psychologist for the Hewlett-Woodmere Public Schools with practices in Cedarhurst and Israel. He said that it is important to teach the child “executive functioning, to be organized with work, good time management and how to study.”

Dr. Michael Herskovics, a clinical psychologist in private practice in Brooklyn and Woodmere noted that with “a family with eight kids it’s hard to put in the time if one kid has ADHD, but with two or three kids it can be done; it depends on the family.” He suggests enlisting the help of organized high school students to help out for chesed hours.

"I’m definitely open-minded,” said Krauss about Dr. Gimpel’s work, pointing out that medicines have “unpleasant side effects on appetite and sleep and also trains the child to take a pill to solve a problem. It takes more than just medication to help a child with ADHD.”

Krauss also stressed that although “most doctors spend time to evaluate a child adequately, there are some who are too quick to write a prescription.”

“Mis-diagnosis is a major problem,” said Zacharowicz. “Children with features of ADHD may in fact have a mood disorder, anxiety, a learning disability, or another problem, or they may have both ADHD and another disorder. Evaluation by a specialist is often warranted.”

Gimpel cautioned parents to react responsibly to a diagnosis of ADHD and to provide children with appropriate treatments.

“Clearly, it is a bad idea to just hope the child will outgrow this condition [as some do] because by that time, they have a lousy academic record, inadequate social skills, poor self esteem and no confidence,” he advised. “The good news is that the brain is healthy — there is no disease process. It is quite possible to gradually eliminate the use of Ritalin as the child builds a better, quicker, more flexible brain.”

"While I am not aware of any proven cure for ADHD, I would be thrilled if Dr. Gimpel would publish data in the professional literature supporting his claims," Dr. Zacharowicz responded.

Learn more at www.tocureadhd.com or www.aacap.org