Brad Oostindie, MA, LLP
800 Ellis Road, Suite 245
Norton Shores, MI 49441
Toll-free: 1-800-850-0535
Appointments: info@readytofocus.com
Billing: billing@readytofocus.com
BRAD OOSTINDIE, MA, LLP
800 ELLIS ROAD SUITE 245, NORTON SHORES, MI 49441
Schedule an appointment today! 1-800-850-0535
Posted on December 16 2009
Find out what the Mayo Clinic says about using Biofeedback for stress, anxiety, and other related conditions such as chronic pain or sleep related problems. This quick article summarizes the effectiveness of using Biofeedback for these conditions.
Posted on April 21 2009
How does neurofeedback work? What is neurofeedback training? Download this informative PDF chapter from William Sears and Lynda Thompson’s book - The A.D.D. Book: New Understandings, New Approaches to Parenting Your Child (posted with permission from Lynda Thompson) to learn more about neurofeedback, it’s uses and applications in treating a number of psychological conditions. As always, please feel free to contact us with any of your questions or concerns. Brad Oostindie highly recommends this book for your reading!
Posted on March 12 2010
Written By Clinical Director Brad Oostindie, MA, LLP:
Over the past several years I have seen many people respond favorably to using biofeedback/neurofeedback in addressing their migraine headaches. This would include young children, adults, those with severe migraines, and those with mild or less intense migraines. There are a number of ways biofeedback/neurofeedback helps reduce the intensity and frequency of migraines. Biofeedback/Neurofeedback helps a person learn to control their breathing, relax muscle groups, reduce stress, and can reduce stressed brain wave activity that contributes to migraines occurring. The treatment can be done in your own home and there are no known dangers or side effects to the treatment. Many people can reduce or eliminate medications they need to use to control migraines by utilizing this treatment method as well. Major treatment centers such as the University of Michigan use this as part of their migraine treatment care. Also, I have posted an article outlining how Mayo Clinic views the use of biofeedback/neurofeedback for treatment of certain medical conditions.
At Ready To Focus we have developed a specific protocol for addressing migraine headaches. This involves use of both biofeedback and neurofeedback programs for the individual that they can utilize in the home based program. If you would like more information about this please contact Clinical Director Brad Oostindie at brad@readytofocus.com or by calling 1-800-850-0535. Lastly, check out the success stories on the readytofocus.com website for specific stories from people on how they used the biofeedback/neurofeedback program to stop their migraine headaches.
Posted on September 28 2009
Posted by Brad Oostindie, MA, LLP - Chief Clinician and Founder of Ready To Focus
Although many studies exist showing the efficacy of Neurofeedback treatment in ADHD there have been criticisms of these studies due to their smaller sample sizes, lack of a control group, among other issues. This recent study published in the Clinical EEG and Neuroscience Journal (July 2009) addresses those issues and shows Neurofeedback as a Level 5 (efficacious and specific) treatment for ADHD. Level 5 criteria means the treatment (in this case neurofeedback) “needs to be demonstrated to be statisically superior to a credible sham therapy, pill, or bona fide treatment in at least two independent studies.” This current study, which is a meta-analysis of several studies, shows this level 5 criteria to be met. The study also addresses other issues related to Neurofeedback including long-term positive effects (such as 3 month, 6 month, and 2 year follow up studies) and issues related to pre and post QEEG studies and pre and post continuous performance testing studies. I believe this study to be the most comprehensive and conclusive in terms of addressing the issue of whether or not Neurofeedback is a scientifically “proven” treatment.
Posted on July 7 2009
Since Neurofeedback and QEEG diagnostic evaluation maybe new to you, attached is a document listing research results (1970 to present) supporting both of these as scientifically valid interventions. These research results include controlled studies, peer reviewed published studies, and general references.
Posted on May 7 2009
By Brad Oostindie, MA, LLP
Over the past week I have been approached by three separate families all with the same question for me, “How do we go about getting a good ADHD assessment for our child?” In all three situations the child is struggling at school with academics, appears unfocused, and in some of the situations is dealing with anger issues and low frustration tolerance. In all three situations there is noticeable anxiety on the part of the parents about what to do and a desire to do the right thing for their child.
I really like the fact that in all three of these families their question reflects an understanding that not all ADHD evaluations are created equal! There is also a strong appreciation of the need to get the evaluation right because of the fact that significant treatment decisions might occur as a result of the evaluation as well as the fact that if nothing is done things could get much worse.
Over the course of my career I have had the opportunity to do a number of ADHD evaluations for both children and adults. Prior to being in private practice, I spent several years as a staff psychologist at the DeVos Children’s Hospital. Each week I had the opportunity to work with a great team of psychologists testing and evaluating several children in the “ADHD clinic.” Over the course of several years we evaluated hundreds of children in this specific clinic and I believe we followed a good model to accurately diagnosis (or not diagnosis) the condition. Since leaving the children’s hospital and beginning private practice, I have come across additional methods to evaluate the condition with even higher accuracy.
Before I get into discussing what I believe to be a good testing protocol for ADHD, let me first explain how ADHD evaluation is usually done and some of the problems associated with this method. Unfortunately, a typical evaluation for ADHD usually includes only the following: First, identification of the need for assessment typically comes from a teacher or parent who notices distraction, inattention, or moodiness on the part of a child. Next, a trip to the pediatrician or family physician’s office occurs where perhaps a behavioral checklist and clinical interview is conducted to evaluate the symptoms. In some cases a teacher will also complete a behavioral checklist to gain an understanding of what he or she is observing of the child in the academic setting. Finally, a diagnosis is determined (more often than not as an ADHD diagnosis) and a prescription for medication occurs based on the information gathered from the behavioral checklist and the interview alone.
The limitations with this type of assessment is that although we can get good information from a diagnostic interview and behavioral assessment, we miss out on standardized measures of the brain’s cognitive abilities, processing speed, academic strengths, standardized continuous performance ability, and overall ability of the brain to focus and pay attention. Without this information, we really don’t know what is causing the observed lack of focus or impulsivity. As you may guess, there can be multiple causes for all this, unrelated to ADHD. This might include a number of things including specific learning disorders, processing speed issues, mood related issues, developmental issues and immaturities, among others.
While it is difficult to fully ascertain the amount of misdiagnosis of ADHD that is occurring, it is clear that it is indeed happening and most likely at an alarming rate. The National Institute of Mental Health (NIMH) indicates that approximately 4.1% of adults have ADHD, and approximately 3-5% of children. It seems that boys are diagnosed more frequently (3 times as much as girls). It is very clear that the amount of individuals being treated for ADHD has increased dramatically! In fact, from 1990 to today Ritalin production has increased 700 percent and 50 percent more children are taking the medication than prior to 1990. Has something happened to American children after 1990 that so dramatically increased the need for this medication in order to have them behave and learn, or is there something else at work to cause this unbelievable increase?
Personally, I believe that inadequate assessment has played a significant role in the over-diagnosis and subsequent increased treatment of ADHD and the profound increase in the use of stimulant medication to treat the condition. If we as treatment providers were doing good assessment work we would stop a misdiagnosis from occurring and would figure out the true and complete nature of why someone acts and behaves the way they do.
Another good point to emphasize here is that even if someone does have ADHD (identified via good assessment) it is also likely they may have other conditions (often referred to as “co morbid” conditions) that need to be addressed. In fact, recent studies have shown that up to half of children correctly diagnosed with ADHD have other mental health related issues such as mood issues, learning style issues, and personality issues that significantly impact the behavioral picture. If these issues are not identified and addressed, successful intervention will not occur. In addition, there is strong evidence to support that certain medical conditions can cause “ADHD like behavior” as well as nutritional issues.
So, how do we make sure we get it right? I believe the following methods have a near 100% accuracy rate in correctly identifying ADHD (or ruling it out) as well as other co-morbid conditions. I will now explain the testing methods and how they work to correctly identify the issues:
Diagnostic Interview: A seasoned clinician with plenty of experience in ADHD and other conditions can quickly get a feel for the clinical issues present via clinical interview. However, this method alone will not fully develop the clinical analysis by any means.
Behavioral/Personality Assessment: As previously mentioned, a standardized behavioral assessment can help significantly in understanding the clinical picture. This behavioral assessment should include all aspects of behavior (not just ADHD symptoms) and should ideally be completed by caregivers in two separate settings (typically academic and home). Again, this along with the diagnostic interview will not fully develop the clinical analysis.
Cognitive Assessment: Also referred to as IQ testing, this will evaluate how the adult or child is taking in information or processing information. It can identify cognitive strengths and weaknesses, learning styles, processing speed, short term and long term memory issues, and other cognitive issues that can mimic ADHD or be present in addition to ADHD.
Academic Assessment: These are standardized academic tests that in conjunction with a cognitive assessment can rule out a learning disorder (a common co-occurring condition or mimicking condition of ADHD).
Continuous Performance Testing: A neuropsychological testing measure that objectively measures an individual’s ability to focus and sustain attention, as well as avoid distraction. There are many types of continuous performance tests, with the most recent being computerized tasks that measure sustained effort on a relatively boring task. A standardize score is obtained, by which the individual can be compared to their peer group to identify potential weaknesses.
EEG/Neuronal Assessment: One of the newer methods of identifying ADHD, EEG and neuronal assessment measures the electrical activity of the brain. By using a single lead EEG, we can measure the electrical activity in an area of the brain called the cerebral cortex. The cerebral cortex plays an important role in cognitive functioning, including attention, memory, focus, distraction, and anxiety. Individuals with ADHD show a distinct pattern of electrical activity in the cerebral cortex that is easily identifiable in the assessment as related to ADHD. In addition, this assessment can lead to a good treatment plan to use neurofeedback to help the brain learn to improve focus and thus avoid traditional treatments such as stimulant medication. I would recommend further reading on neurofeedback and EEG if you are unfamiliar with it. On my website, www.readytofocus.com there is a link to a chapter on neurofeedback by Lynda Thompson. Look for it under the News section and Research tab.
To summarize, when you combine the above methods the chances of misdiagnosis and/or under-diagnosis are all but eliminated. I personally believe it is the best manner to conduct an assessment and utilize it in my practice. If it were my own child being evaluated, this is the method I would use. Considering all the risks with incorrect assessment, as well as the risks with the use of stimulant medications and new FDA warnings on the risks of these medications it is clear that we all need to be more through in our assessments and less quick to “pull the trigger” on traditional treatments. In addition, we need to look at other interventions (prior to using stimulant medications) as first lines of treatments to ADHD and other related conditions because of the risks associated.
This type of evaluation typically takes about 2-3 hours to administer and 1-2 hours of feedback and report writing to explain. The costs at my practice for this run anywhere from $250 to $500 for the evaluation and I believe the time and resources needed to complete it are totally worth it. If you have more questions you are welcome to email me at info@readytofocus.com. In addition, visit the Ready To Comprehend section of my website, which explains the assessment and testing program at my practice.