Therapeutic Use of Auditory and Visual Stimulation in the Treatment of Attention Deficit Hyperactivity Disorder
Ruth Olmstead, Ph.D. 
Abstract
Attention deficit hyperactivity disorder (ADHD) is a learning disorder that is becoming increasingly prevalent amongst school-aged children. Scientific studies have implicated brainwave irregularities and various neurobiological abnormalities within the prefrontal cortex of the brain in those exhibiting symptomology of this disorder. Treatment strategies for ADHD are typically behavioral approaches to address the problem behaviors associated with the disorder, and a pharmacological approach to treat the hyperactive and impulsive symptoms. The use of auditory and visual stimulation (AVS) has been found to have efficacy not only addressing the symptoms of this disorder, but may be a method of treatment that directly regulates brainwave activity and affects the physiology of the brain. Though current research is limited, studies utilizing AVS on children have demonstrated significant changes in academic performance, and in the reduction of the behavioral symptomology and cognitive deficits associated with ADHD and other disorders that are neurologically based. There is also some promising evidence that AVS may be an effective substitute for neurostimulant medication.
Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent and intensely studiedsyndromes in child psychology and is characterized by deficits of poor attention, impulsivity, and hyperactivity (American Psychological Association, 1994). Children who demonstrate ADHD characteristics generally score seven to 15 points lower than peers on standardized intelligence tests (Barkley, Anastopoloulos, Guevermont, & Fletcher, 1991). Common treatment interventions are behavioral modification techniques to address the problem behaviors of hyperactivity and impulsivity, and pharmacology to address the attentional deficits in the in the form of stimulant medications. Due to medication cost, possible psychostimulant side effects, and compliance, many individuals are interested in a safe, effective, and less costly alternative treatments for this disorder.
Auditory and visual stimulation (AVS) therapy has been used to alter brainwave irregularities and increase brain activation in those with ADHD characteristics. Research is being conducted using this technique as a non-drug approach to aid in regulating brainwave function, decreasing medication intake, increasing concentration and academic performance, and decreasing problematic behavior.
Neurobiological Aspects of ADHD
Neuroimaging studies have implicated deficits in frontal lobe functioning, differences in corpus callosum measures (Giedd et al., 1994), decreased brain volume (Castellanos et al., 1996; Filpatrick et al., 1997; Hynde et al., 1991), impaired cognitive and behavioral functioning, and other brain abnormalities in those with ADHD. Although none of the current findings result in locating a primary cause of the pathophysiology of ADHD, many studies do contend that there are fundamental neuroanatomical abnormalities within the developing brain of those individuals with ADHD that effect cognitive functioning. The use of auditory and visual stimulation has been found to be effective in aiding in brainwave irregularities in those with ADHD (Lubar, 1991; Othmer, 1992), and findings suggest that AVS initiates dendritic enhancement as evidenced by cognitive increases and higher scores on standardized testing (Carter & Russell, 1981, 1993, 1994; Micheletti, 1999; Patrick, 1994).
Earlier studies found that electrical stimulation administered to the frontal cortex in animals demonstrate significant enhanced recovery of neurons in the visual cortex, suggesting increases in visual input processing and improved attention paid to external stimuli (Spinelli & Pilbram, 1967). Diamond (1988) discovered that challenging environmental stimulus result in increases in dendritic growth, brain weight and density, as well as changes in molecular, synaptic, and behavior in animal studies resulting in increased memory and maze learning. Later, Diamond, Kolb & Whilshaw (1990) found greater dendritic length and structural changes in the cortex of postmortem humans who had lead more challenging lives. These physiological brain studies demonstrate that various forms of stimulation produce increases in dendritic growth and length which can be associated with enhanced cognitive abilities and functioning. Auditory and visual stimulation appears to be another promising method that can effect changes within the brain’s physiology.
Recent Studies Utilizing AVS to Enhance Cognitive Abilities and Behavioral Functioning
In a recent study by Micheletti (1999) utilizing AVS with ADHD children demonstrated both enhanced cognitive and behavioral changes. Micheletti (1999) compared four treatment groups of 99 ADHD children ranging from seven to 13 years of age. The treatment groups consisted of an AVS Group, an AVS and Stimulant Medication Group, a Stimulant Medication Group, and a Self-Selected Comparison Group. All groups were tested off medication to evaluate differences at baseline. Cognitive functioning was evaluated using achievement tests in Reading, Spelling, and Arithmatic from the Wide Range Achievement Test-Revised (WRATR). Listening comprehension and verbal ability was measured using the Peabody Picture Vocabulary Test (PPVT). The Raven Progressive Matrices (Raven’s) was used to measure reasoning ability and the ability to organize spacial perceptions into systematically related wholes. Behavioral changes were changes were noted using the Intermediate Visual and Auditory Continuous Test (IVAC) and the Attention Deficit Disorder Evaluation Scale (ADDES).
The study also evaluated the effectiveness of the stimulant medication (Ritalin and Adderall) and the efficacy of combining AVS and medication. Both the AVS and the AVS/Stimulant Medication Group demonstrated significant statistical cognitive and behavioral changes at p < .05, p < .01, and p < .001 level. The AVS training Group demonstrated statistical changes in five out of nine tests or 55.6 % of the time. The AVS/Stimulant Group demonstrated changes on eight out of nine tests or 88.9 % of the time. The Stimulant Only Group demonstrated less change when compared to the AVS and AVS/Stimulant Groups. This group showed only change in three out of nine tests or 33.0 % of the time. The Self Selected Comparison Group indicated no statistical change on cognitive or behavioral defendant measures over time.
This study findings indicate that the use of AVS appeared to impact the neurological functioning of the ADHD individual as evidenced by increases in cognitive functioning levels as demonstrated by increased performance in Reading, Spelling, and Arithmatic as evidenced by WRAT-R scores and improved behavioral functioning as evidenced by behavior rating scales (ADDES; IVAC).
An earlier Canadian study investigated the efficacy of AVS in decreasing stimulant medication intake and ADHD symptomology in subjects diagnosed with ADHD (Olmstead, 1997). The study consisted of 65 participants, 55 males and 10 females between the ages of six and 45 years of age who met the DSM-IV (APA, 1994) criteria diagnosis of ADHD. Twenty five of the subjects were on stimulant medication when beginning AVS treatment. Results demonstrated that of the 65 subjects undergoing AVS treatment, 68% noted moderate to significant reduction in negative behavioral symptomology according to ADHD diagnostic criteria checklists.
A chi-square test (1 df) was statistically significant x^ (1) = 8.14, p<.01. indicating a sig nificant difference from the 32% who noted no reduction in symptomology. The significant effectiveness of AVS on those subjects taking stimulant medication was concluded due to decrease in medication intake as correlated to the reduction of ADHD symptomology. Analysis of data gathered using a chi-square test (1 df) was significant x^ (1) = 13.0 p<.001.
Of the 25 subjects taking stimulant medication prior to beginning AVS treatment, 76% of the subjects were able to reduce or completely discontinue medication and 24% did not. Though this study did not conduct a formal follow up to measure sustained results, these findings suggest that an AVS treatment program can lead to significant reduction in ADHD symptoms and may be a viable non-drug approach to treating this disorder as evidenced by the significant decrease in medication intake.
Both of these studies indicate that auditory and visual stimulation is effective in producing academic enhancement (WRAT-R), as well as increases in verbal ability and non-verbal reasoning ( Raven’s, and PPVT). AVS was found to decrease problem behaviors such as impulsivity and hyperactivity as noted on parent and teacher behavior rating scales (ADDES, IVAC), and the ADHD diagnostic checklist (DSM-IV).
The above findings suggest that auditory and visual stimulation may be a viable replicable physical phenomenon that increases brainwave activity, resulting in neuronal changes and dendritic growth. Such findings are important and have significant application to the intervention of individuals diagnosed with ADHD and other learning and neurological disorders. Due to the promise of increased cognitive functioning, research studies have begun to investigate the efficacy of AVS, thus the use of such devices in clinical settings is broadening.
Additionally, compact, portable, low-cost devices are now available with specific programs and instructions for use as an intervention for specific symptom reduction. These are important developments for the ADHD individual who can now utilize this technique safely and relatively inexpensively at home.
Ruth Olmstead Ph.D. has developed a number of intervention programs for ADHD that have been duplicated for use with various light and sound devices. She has utilized AVS for many years in a medical setting as a method of intervention for a number of psychological and neurological disorders such as brain trauma, migraine, learning disabilities, and stress related disorders. She currently uses AVS in conjunction with psychotherapy in a clinical setting as an adjunct intervention for learning disabilities, anxiety, trauma, and depression. She is currently completing her Doctorate degree in Clinical Psychology, and trains licensed therapists in the clinical application of AVS stimulation and brainwave entrainment.
Copyright AVS Journal / Michael Landgraf, Publisher and Ruth Olmstead, Ph.D., Author. All rights reserved.