Research

Attention Deficit/Hyperactivity Disorder (ADD/ADHD):
Retroactive Outcomes Study

Prepared by Judith P. Bluestone, PhD (abt), and Marlene C. Suliteanu, OTR

This retrospective outcome study documents how soon after initiating a HANDLE^® program, clients with ADHD behaviors report progress, and with what consistency. HANDLE is an acronym for Holistic Approach to NeuroDevelopment and Learning Efficiency.

One of our goals in presenting these data is to interest collaborators in explicit research to demonstrate how a HANDLE program achieves functional improvement through increased neurological integration and efficiency.

From its inception in 1994 through the end of the year 1997, The HANDLE Institute performed assessments of and provided follow-up on 65 individuals for whom the referral concern was AD/HDundefineda disorder that is currently estimated to affect approximately 15 percent of the school-age population.

The following is a summary of the success rate (Figure 1, below) for those clients, each of whom was provided an individualized treatment program of specific activities, based on the neurodevelopmental profiles that resulted from their assessment by certified HANDLE^®practitioners. Most clients were also advised to drink water and to supplement their diets with essential fatty acids.

Two clients did not return for follow-up for unknown reasons; therefore, we cannot report the effects of their HANDLE program recommendations. Another assessed client reported that he did not implement the recommended program, due to insufficient motivation. (Note: follow-up visits are included as part of the program package of the Institute.) Additionally, one client did not return for two years, at which time improvement was noted. Those four clients, all male, are therefore not considered in this retrospective study. We are reporting on the remaining 61.

All clients sought the Institute’s programs based on a desire to resolve without medication the problems identified as AD/HD. Prior to assessment, the family and/or teachers rated the clients on numerous factors, similar to diagnostic criteria commonly reported on most AD/HD rating scales. These include:

• Ability to attend to school work
• Ability to complete tasks
• Ability to sit still at home or school
• Ability to transition from one activity to another
• Ability to follow directions
• Ability to focus on tasks at hand
• Ability to organize belongings
• Appropriate degree of movement and fidget behaviors
• Ability to fall asleep and sleep through the night
• Other factors.

In addition to collection of this subjectively obtained data, all clients were assessed by a certified HANDLE practitioner, who employed either the HANDLE Learning Foundations Inventory (for clients 5 years and older), or the HANDLE Preschool Learning Foundations Inventory (for younger children). The HANDLE practitioner observed and rated the functioning of underlying neurobehavioral systems to discover the root cause of the aberrant or bothersome behaviors. Based on the resultant profile, the practitioner designed individualized treatment programs to strengthen the weak systems, rather than to control the behaviors associated with AD/HD.

To modify the program in accordance with progress, practitioners encouraged follow-up sessions, recommended at approximately ten days and then at monthly intervals. Like the assessment, each follow-up session was recorded on videotape, and notes were entered in the client file. At each follow-up session, the family was asked to report on any changes, and to share the observations and comments of teachers and other supervisory personnel.

Clients seen during this time frame ranged in age, when first seen, from thirty months to over fifty years of age. 46 of the 61 clients discussed were male, and 15 female. The information regarding age and sex of clients seen is summarized in Figure 2 (below).

For 56 of the 61 clients, improvement was obvious to the parents and/or school staff or community. The 5 exceptions (all males):

• Ageundefined104 months; reached 55 day follow-up without reported change
• Ageundefined30 months; at 17 day follow-up, reported improvement; however, 50 days later reported return to level at assessment
• Ageundefined142 months; at 27 day follow-up, reported improvement; however, 11 months later reported return to level at assessment
• Ageundefined96 months; reached 74 day follow-up without reported change
• Ageundefined154 months; at 76 day follow-up, reported improvement in some areas, decline in other areas.

(Note: All ages refer to assessment date.)

This retrospective study focuses on the time elapsed from the initial assessment to the report of improvement. (Figure 3, below.)

Many of the clients presented with other conditions, including but not limited to: dyslexia, Tourette Syndrome, visual-motor dysfunction, auditory processing disorder, Obsessive-Compulsive Disorders. This is not uncommon in the population of AD/HD clients. In future studies we may explore the efficacy of HANDLE in ameliorating these additional disorders of cognition and behavior. The purpose of this overview is to elicit interest in further research into the effects of HANDLE on the behaviors associated with AD/HD. [The reason we avoid using the terms “symptoms” and “diagnosis” for this population is that HANDLE refers to these concerns as Attentional Priority Disorder. HANDLE purports that each individual is attending to what their body’s priorities require, not necessarily according to expectations. When the weak systems addressed by HANDLE programs are strengthened, the individual can set and sustain attention according to the demands of the task at hand.]

Summary conclusions

56 of the 61 clients for whom follow-up data was available reported functional improvements. No consistent pattern emerged about the other 5: 2 reported no change after 55 and 74 days respectively; 1 reported gains in some areas, decline in other areas; and 2 reported improvement but later reported a return to the level at assessment.
Males outnumbered females 3:1

Progress was reported by week 14 (from initial assessment & start of the program) in all but 4 male and 4 female cases. Age of the client at the time of the assessment did not correlate in any way to how soon they noted progress.

The more significant patterns related to age and sex of the clients when they came to HANDLE. 26% of the males (n=12) came when they were between 90 and 107 months old (approx. 7 ½ - 10 years old). A comparable cluster occurs for ages 108 to 159 months: 31.7% (n=13) were 10.5-13.5 years old. Therefore, nearly 58% of the male population came to HANDLE between second and sixth grade in school. Conversely, the female cases represent a “start” age scattered across the years, with the 1st being 5 years old, the next older one at 71/2, and then all the way up to 4 individuals coming to HANDLE when they were more than 40 years old. That’s 26.6% well into adulthood, probably parents themselves.

Recorded improvements varied from client to client, just as each client initially presented with individualized profiles, despite the commonality of having ADHD as a presenting concern. Areas of progress noted included but were not limited to:

• better sleep
• staying seated to work, to eat, in car
• homework improved
• more motivated
• improvement in mental state
• getting to work on time
• improvement in following instructions
• better attention
• less bedwetting
• improved impulse control
• better reading, math, spelling
• more focused
• off medication
• makes friends more easily
• calmer
• no longer bumps into things and people in path
• school work is faster, with quicker follow-through
• diminished startle response
• tactile sensitivity greatly diminished
• light sensitivity reduced
• auditory distractions reduced
• less dawdling
• more organized
• appetite and range of foods increased
• accomplishing more around the house
• faster response time
• happier.
  

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Copyright © 2001 Bluestone & Suliteanu