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Inattentive ADHD and Interactive Metronome Therapy

Posted Sep 07 2012 9:33am
Inattentive ADHD and Interactive Metronome Therapy
I often get asked about Interactive Metronome therapy for the treatment of Inattentive ADHD and I realized that I have not written much lately  (there is an older post about Metronome therapy here)  about this particular treatment. Interactive metronome therapy is always administered by a therapist, usually an Occupational Therapist but trained therapist with other specialties can also administer it.

The therapy is performed using headphones that are connected to a computer. The patient keeps time with the sounds coming from the headphones while doing other physical actions. Typically, therapy is done 3-5 days a week for one hour for a total of 12 weeks.

Several studies have been done looking at the benefits of Metronome Therapy for the treatment of ADHD and Inattentive ADHD. Interactive Metronome therapy seems to help attention by improving the speed and control of visual processing. I have listed several study abstracts below.

I believe that anything that makes you practice "attending" improves attention. Interactive Metronome therapy is this kind of practice. In people with visual control and coordination issues, this type of therapy is especially useful. Some studies have pointed out that only people with Combined Type ADHD are more likely to have visual control and coordination issues but other studies have indicated that people with Inattentive type ADHD and Combined type both are more likely than other children to have motor timing issues. Motor timing is also involved in coordination but also affects your reaction time and your ability to attend appropriately.

I have discussed this therapy with 4 different Occupational therapist and three out of the four said that it works well in children who will cooperate and actually do the therapy but that it is a hard sell for most kids as it is very tedious and boring. The fourth therapist said that she would not recommend it for ADHD because she had not seen much benefit from the therapy and that most of her patients did not complete the treatment. I think the bottom line is that it probably helps some if the child or adult will complete the therapy.


Int J Rehabil Res. 2009 Dec;32(4):331-6.
Interactive Metronome training in children with attention deficit and developmental coordination disorders.
Cosper SM, Lee GP, Peters SB, Bishop E.
Source
Department of Occupational Therapy, School of Allied Health Sciences, Medical College of Georgia, Augusta, Georgia 30912, USA. scosper@mcg.edu
Abstract
The objective of this study was to examine the efficacy of Interactive Metronome (Interactive Metronome, Sunrise, Florida, USA) training in a group of children with mixed attentional and motor coordination disorders to further explore which subcomponents of attentional control and motor functioning the training influences. Twelve children who had been diagnosed with attention deficit hyperactivity disorder, in conjunction with either developmental coordination disorder (n=10) or pervasive developmental disorder (n=2), underwent 15 1-h sessions of Interactive Metronome training over a 15-week period. Each child was assessed before and after the treatment using measures of attention, coordination, and motor control to determine the efficacy of training on these cognitive and behavioral realms. As a group, the children made significant improvements in complex visual choice reaction time and visuomotor control after the training. There were, however, no significant changes in sustained attention or inhibitory control over inappropriate motor responses after treatment. These results suggest Interactive Metronome training may address deficits in visuomotor control and speed, but appears to have little effect on sustained attention or motor inhibition.

Int J Adolesc Med Health. 2010 Apr-Jun;22(2):275-83.
The effect of hemisphere specific remediation strategies on the academic performance outcome of children with ADD/ADHD.
Leisman G, Melillo R, Thum S, Ransom MA, Orlando M, Tice C, Carrick FR.
Source
The FR Carrick Institute for Clinical Ergonomics, Rehabilitation and Applied Neuroscience, Mineola, New York, USA. drgersh@yahoo.com
Abstract
The development and normal function of the cerebrum is largely dependent on sub-cortical structures, such as the cerebellum and basal ganglia. Dysfunction in these areas can affect both the nonspecific arousal system and information transfer in the brain. Dysfunction of this sort often results in motor and sensory symptoms commonly seen in children with ADD/ADHD. These brain regions have been reported to be underactive, with that underactivity restricted to the right or left side of the sub-cortical and cortical regions. An imbalance of activity or arousal of one side of the cortex can result in a functional disconnection similar to that seen in split-brain patients. Since ADD/ADHD children exhibit deficient performance on tests thought to measure perceptual laterality, evidence of weak laterality or failure to develop laterality has been found across various modalities (auditory, visual, tactile) resulting in abnormal cerebral organization and associated dysfunctional specialization needed for lateralized processing of language and non-language function. This study examines groups of ADD/ADHD elementary school children from first through sixth grade. All participants were administered all the subtests of the Wechsler Individual Achievement Tests, the Brown Parent Questionnaire, and given objective performance measures on tests of motor and sensory coordinative abilities (interactive metronome). Results measured after a 12-week remediation program aimed at increasing the activity of the hypothesized underactive right hemisphere function, yielded significant improvement of greater than two years in grade level in all domains except in mathematical reasoning. Results are discussed in the context of the concept of functional disconnectivity in ADD/ADHD children.

Am J Occup Ther. 2001 Mar-Apr;55(2):155-62.
Effect of interactive metronome training on children with ADHD.
Shaffer RJ, Jacokes LE, Cassily JF, Greenspan SI, Tuchman RF, Stemmer PJ Jr.
Source
College of Human Medicine, Michigan State University, Ann Arbor, USA.
Abstract
OBJECTIVE:
The purpose of this study was to determine the effects of a specific intervention, the Interactive Metronome, on selected aspects of motor and cognitive skills in a group of children with attention deficit hyperactivity disorder (ADHD).
METHOD:
The study included 56 boys who were 6years to 12 years of age and diagnosed before they entered the study as having ADHD. The participants were pretested and randomly assigned to one of three matched groups. A group of 19 participants receiving 15 hr of InteractiveMetronome training exercises were compared with a group receiving no intervention and a group receiving training on selected computer video games.
RESULTS:
A significant pattern of improvement across 53 of 58 variables favoring the Interactive Metronome treatment was found. Additionally, several significant differences were found among the treatment groups and between pretreatment and posttreatment factors on performance in areas of attention, motor control, language processing, reading, and parental reports of improvements in regulation of aggressive behavior.
CONCLUSION:
The Interactive Metronome training appears to facilitate a number of capacities, including attention, motor control, and selected academic skills, in boys with ADHD.

Int J Rehabil Res. 2009 Dec;32(4):331-6.
Interactive Metronome training in children with attention deficit and developmental coordination disorders.
Cosper SM, Lee GP, Peters SB, Bishop E.
Source
Department of Occupational Therapy, School of Allied Health Sciences, Medical College of Georgia, Augusta, Georgia 30912, USA. scosper@mcg.edu
Abstract
The objective of this study was to examine the efficacy of Interactive Metronome (Interactive Metronome, Sunrise, Florida, USA) training in a group of children with mixed attentional and motor coordination disorders to further explore which subcomponents of attentional control and motor functioning the training influences. Twelve children who had been diagnosed with attention deficit hyperactivity disorder, in conjunction with either developmental coordination disorder (n=10) or pervasive developmental disorder (n=2), underwent 15 1-h sessions of Interactive Metronome training over a 15-week period. Each child was assessed before and after the treatment using measures of attention, coordination, and motor control to determine the efficacy of training on these cognitive and behavioral realms. As a group, the children made significant improvements in complex visual choice reaction time and visuomotor control after the training. There were, however, no significant changes in sustained attention or inhibitory control over inappropriate motor responses after treatment. These results suggest Interactive Metronome training may address deficits in visuomotor control and speed, but appears to have little effect on sustained attention or motor inhibition.

 Learn Disabil. 2012 Jul-Aug;45(4):361-70. Epub 2011 Jun 17.
Central processing energetic factors mediate impaired motor control in ADHD combined subtype but not in ADHD inattentive subtype.
Egeland J, Ueland T, Johansen S.
Source
Vestfold Mental Health Care Trust, Tønsberg, Norway. jens.egeland@piv.no
Abstract
Participants with attention-deficit/hyperactivity disorder (ADHD) are often impaired in visuomotor tasks. However, little is known about the contribution of modal impairment in motor function relative to central processing deficits or whether different processes underlie the impairment in ADHD combined (ADHD-C) versus ADHD inattentive (ADHD-I) subtype. The present study analyzes performance on the Visual Motor Integration Test relative to less effortful motor tests as well as on measures of energetics. Both ADHD groups showed evidence of impaired motor function on both visual-motorintegration (VMI) and the less effortful motor tests. The ADHD-C group performed below the ADHD-I group on VMI, but their performance correlated highly with the measures of the energetic pools of arousal and effort. Different mechanisms may underlie impaired fine motor skills in ADHD. Central processing deficits contribute significantly to the deficit of ADHD-C but do not explain the motor impairment in ADHD-I.

Hm Mov Sci. 2002 Dec;21(5-6):919-45.
Timing and force control in boys with attention deficit hyperactivity disorder: subtype differences and the effect of comorbid developmental coordination disorder.
Pitcher TM, Piek JP, Barrett NC.
Source
Research Centre for Applied Psychology, School of Psychology, Curtin University of Technology, GPO Box U1987, Perth 6845, Australia.
Abstract
This study examined the motor and performance outcomes of boys with subtypes of attention deficit hyperactivity disorder (ADHD) (DSM-IV, [American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 4th ed., Washington, DC, 1994]). It also examined the differences between boys with a single diagnosis of ADHD versus those who have the dual categorisation of ADHD and developmental coordinationdisorder (DCD). The participants were 157 boys, aged 7.70-12.98 years recruited from a community sample. Parent report was used to classify 143 boys into either a comparison group or one of the three DSM-IV ADHD subtypes. Participants were given a battery of tests that included the Movement Assessment Battery for Children [Movement Assessment Battery for Children, Psychological Corporation/Harcourt Brace-Jovanovich, New York, 1992], the Wechsler Intelligence Scales for Children--Third Edition [Manual for the Wechsler Intelligence Scale for Children, Psychological Corporation, New York, 1992] and a finger tapping task targeting motor processing, preparation, and execution. Boys with subtypes that includedinattentive symptomatology had significant difficulties with timing, force output and showed greater variability in motor outcomes. Boys with the comorbid condition (i.e., ADHD and DCD) had particular difficulty with force control. These outcomes identify a need for increased recognition of the clinical and research implications of the relationship between ADHD and motor dysfunction. This potentially impacts on assessment, intervention, theoretical modelling and the general interpretation of cognitive abilities research with children with ADHD.


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