CASE REPORT
A.D. is a 20-year-old right-handed Caucasian male with Attention Deficit Hyperactivity Disorder (ADHD) and associated depression. Prenatal trauma was noted. Mother experienced a severe fall, inducing premature labor convulsions, precipitating birth three weeks early, at 36 weeks. Developmental milestones were attained within expected age-limits. Attentional deficits were initially noted at age 5 when A.D. was observed by parents to stare into space for long periods. Homeopathic remedies were utilized between ages 6 and 9. These treatments achieved a moderate degree of improvement (some remission of symptoms) in early school performance, but were discontinued when severe sinusitis resulted. By age 10, distractibility, inattention, failure to complete work without considerable supervision, and organizational problems were often noted. Testing at this age was conducted, revealing a significant difference between Verbal and Performance IQ scores – a primary if not always reliable indicator of ADHD.
Specifically at age 10, A.D. was administered a battery of tests, including the Wechsler Intelligence Scale for Children-Third Edition, Wide Range Assessment of Memory and Learning, Bender Gestalt Test of Visual Motor Integration, Beery Developmental Test of Visual-Motor Integration, Rey Osterrieth Complex Figure Design Test, Clock Drawing Tests, Symbol Digit Modalities Test, selected sections of the Reitan-Klove Sensory-Perceptual Examination and Lateral Dominance Examination, the Stroop Color Word Test, Trail Making Test-Part B, Projective Drawings, and the Child Attention Profile. On the Wechsler, A.D.’s Verbal IQ of 126 scored in the 96th percentile while his performance IQ of 99 was placed much lower in relation to his tested peers, in the 47th percentile. These results were deemed highly significant because of the large discrepancy. An examiner commented, “The variability observed in these two tests is substantial and suggests that A.’s visual-motor output is likely to be highly inconsistent depending upon the nature of the task.” Other significant results included memory lapses in the Rey Osterrieth test, difficulties in visual tracking in the Reitan-Klove Sensory-Perceptual Examination, and poor performance on the Stroop Color Word test. During the latter exam, A.D.’s performance suffered as complexity and organizational demands increased. Several behavioral observations also proved significant. While A.D. was observed to be an intelligent, engaging, and communicative child, able to express himself in a clear and lucid manner, possessing an excellent sense of humor and energetic demeanor, he was prone to spontaneously offer self-deprecating statements, often anticipating that he will not be able to demonstrate sufficient competency with various tasks. His teachers in the classroom and his parents at home also noted behavioral deficits around age 10 that A.D. was observed to be “easily frustrated,” unable to complete his academic work in a “reliable and independent” manner, is “restless and fidgety,” easily distracted and frequently daydreaming. Social interaction concerns were also quite significant at this age. He tended to become embroiled in conflicts with his peers resulting in peer isolation and diminished self-concept. Subsequent testing and observational analysis only tended to reinforce self-concept issues and ADHD related deficits of similar nature. After fourteen years of special education and pharmacological interventions with limited improvements in most measurable areas of function, and also with depressive episodes co-mingled with ADHD symptomology hindering function drastically at times in later adolescence (including at least one suicide attempt), a multimodal approach using techniques purportedly aimed at facilitating inter-hemispheric communication was provided.
METHOD
12-week program of Cortical Integrative Therapy
RESULTS
At the conclusion of the 12-week treatment program, A.D. showed considerable gains in his ability to persevere in academic pursuits. He also improved considerably according to demeanor (he was seen to smile for the first time ever, according to one examiner) and was less depressed, in fact, has ceased taking antidepressants. His overall academic performance has improved to the extent where he has successfully completed his first semester of college – a considerable achievement in its own right for the formerly beleaguered A.D. He was also able to obtain and maintain a part-time job. No additional suicide attempts have been noted since his completion of Cortical Integrative Therapy.
DISCUSSION
ADHD is often associated with serious impediment to academic success. A.D. had been significantly impeded throughout his academic career by this disability compounded by his depressive tendencies, and his quality of life was severely restricted. But when a multimodal approach using techniques aimed at facilitating inter-hemispheric communication was provided, evidence was produced to indicate that when such techniques are applied, the prospect of indirect neuronal or network modulation occurring as cortical pathways are stimulated becomes a real possibility worthy of further investigation. In addition, there are valuable intangibles effecting quality of life. Prior to participation in Cortical Integrative Therapy, A.D. often grew frustrated with simple homework tasks and academic work. His written expression and spelling errors made communication a challenge. It seems that his written skills have now significantly improved, and he is less frustrated while communicating. He can also smile, and seems to be doing so more frequently.