Research Uncovers Reason for Medication Failure in Children and Adolescents with ADHD and Autism
By Ron J. Swatzyna, Ph.D., LCSW and Alexandra Roark, BS
ReOver the last two years, research at the TarnowCenter may have found a major cause for medication failure in children with attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD). Using an electroencephalogram (EEG) and quantified EEG (qEEG) technology, data collected over the last seven years revealed an interesting neurological abnormality that creates or contributes to ADHD/ASD symptoms. Additionally, this abnormality is made worse by the most common medications used to treat ADHD/ASD such as stimulants, antidepressants, and antipsychotics. What we are referring to is seizure activity that is not associated with convulsions.
The literature has several names for this nonconvulsive seizure activity such as intermittent epileptiform discharges (IEDs) and transient discharges; both carry a diagnosis of abnormal EEG without seizures. This activity may never create a seizure in children; however, during puberty, they develop a higher chance of epilepsy as a result of the excitatory nature of sex hormones. We suspect that individuals with this type of activity have a greater potential for developing seizures in adolescence. Our hope is that by treating this activity in childhood, we will prevent these cases from evolving into epilepsy.
IEDs are erratic electrical discharges that interrupt the flow of information in the brain. Depending on where these discharges are centered produces symptoms associated with their location. For instance, if they are located behind the left ear, which so many are, we expect receptive and expressive language issues. Children with these issues are likely to have difficulty with reading and will have to constantly reread information to comprehend it. If these discharges occur primarily in the right temple area, we would expect issues with impulsivity, explosive anger, aggression, and mood instability. Transient cognitive impairment (TCI) is a term now used to explain the elusive nature of these IEDs. Transients are made worse when children are sleep deprived, have high sugar/carbohydrate intake and experience a blood sugar crash, and are exposed to highly stimulating environments.
Neurologists treat seizures with anticonvulsants but, as a rule, do not treat IEDs. Should we be treating IEDs with anticonvulsants? These are decisions that Dr. Tarnow and parents have to make all the time. There is a lot of controversy over this topic. The decision of treating with anticonvulsants is contingent on the severity of the IEDs and the impact to the child’s functioning. When IEDs are impairing their ability to learn, to regulate mood, or to stay focused, normal development is compromised. If the child is on any medications, changes must be considered. One option is to remove the medication that makes IEDs worse and/or consider adding an anticonvulsant, thus lessening the potential for the development of convulsions. If you simply remove medications that increase IEDs and choose not to add an anticonvulsant, you are left with untreated symptoms. This is where neurofeedback may be used as a non-medication approach to treating the IEDs.
In the last year, we completed two studies on the prevalence rate of IEDs in children and adolescents. One study focused on ADHD and the other on ASD. We looked at 257 children with ADHD and 140 with ASD and found a 32% and 36.4% prevalence rate of IEDs respectively. Also, we found that neither age nor gender made a difference in studying IEDs. The majority of those referred to our practice for an EEG/qEEG study failed multiple medication attempts, many of which had negative side effects.
We are currently investigating the results of changing medications based upon the identification of IEDs. The study is not yet complete, but of the 59 charts we have reviewed, 83% were either improved or very much improved in the follow-up medications appointments with Dr. Tarnow. The TarnowCenter has the distinction of being the first private practice in the country to use EEG/qEEG data in medication selection. Also, we are the first to have published our data in peer reviewed journals. Clinical research in this area of study is rare, but we feel it is necessary in helping this process become a mainstream psychiatric tool.
Dr. Swatzyna is the Director of Electro-Neuro Analysis Research at the Tarnow Center. The data for his research comes from the EEG/qEEG studies he has done since 2009. Alexandra Roark (research assistant) joined Dr. Swatzyna a year ago and together with Dr. Tarnow, they have published four studies in peer-reviewed journals in the last year.