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In The News

December 10th, 2007

New Book Release!

Unlocking the Potential of Patients with ADHD: A Model for Clinical Practice has just been published by The American Psychological Association as a guidebook for educators, health care providers, counselors and parents. This book provides a foundation for patient care that care be used to guide comprehensive treatment in community settings.

Dr. Eric Braverman (PATH Medical) described the book as "the most comprehensive, neuropsychiatric social review of the widespread problem of attention-deficit disorders". Dr. David Rabiner (Duke University) noted that Dr. Monastra's book "provides insights that add substantially to published guidelines from professional organizations on the evaluation and treatment of ADHD". Dr. Will Canu (University of Missouri) reported that "this resource will be of tremendous value to practitioners, researchers, and graduate-level trainees across medical and psychological service settings.

Comprehensive in perspective, engaging in tone, this book is now available through www.apa.org, www.amazon.com, or on our website.

February 20th, 2005

Book Review: Attitude Magazine

Lois Gilman, reviewer for Attitude Magazine, and author of The Adoption Resource Book, describes Parenting Children with ADHD: 10 Lessons Medicine Cannot Teach as "enlightening", noting that she "picked up quite a few tips" from the book. To read the complete review go to www.attitudemag.com

February 20th, 2005

Dr. Monastra's book wins iParenting Award

The iParenting Media Award for "Best Parenting Book of 2004" was given to Dr. Monastra for his book, Parenting Children with ADHD: 10 Lessons Medicine Cannot Teach. For more information about this award, visit www.iparentingMediaAwards.com

December 13th, 2004

ADHD Expert Writes Book on Parenting

Press & Sun Bulletin, November 23, 2004

BY BILL WINGELL, Correspondent

When Dr. Vincent J. Monastra leads his two workshops in early December, he will share some of his more than two decades of experience dealing with the issues that confront parents of children with attention deficit hyperactivity disorder. And some of what he says will be from his recently published book, Parenting Children with ADHD: 10 Lessons that Medicine Cannot Teach.

Monastra directs the FPI Attention Disorders Clinic on Main Street in Endicott. The upcoming workshop, according to Monastra, will "provide an overview of strategies that can help your child succeed at home and school." The psychologist will present what he describes as "practical techniques" for working with ADHD children based on his experience in evaluating and treating more than 10,000 afflicted youngsters.
Monastra's new book "represents a compilation of the lessons I learned about ways to help children with ADHD succeed," the psychologist writes. "It is an effort to synthesize available medical, nutritional, educational and psychological research into a format that can be used as a guidebook for parents of health care professionals conducting parenting classes."

The psychologist said he began his clinical and research work about 25 years ago when he noted that "there was a group of kids that had neurological or medical conditions that were not responding to psychotherapy, and I felt definitely that we were missing the boat by trying to treat them with traditional psychotherapy."

Working with Dr. Joel Lubar of the University of Tennessee, Monastra developed a test to evaluate activity in the frontal portion of the brain responsible for concentration and attention. Actually, the test, using a quantitative electroencephalograph (QEEG), measures "under-activity" in the frontal lobes that result in a child being unable to concentrate or focus on a task.

Using an "attention index" provided by the QEEG and after eliminating such causes as anemia, diabetes and thyroid disorders, Monastra is able to accurately medicate the patient using stimulants that cause an increase in the flow of neurotransmitters, specifically dopamine, between brain cells. In children with ADHD, the stimulants, such as Ritalin and Concerta, prevent the reabsorption or re-uptake of the dopamine by the cells that produced it in the first place.

Noting that dopamine is derived from protein, Monastra emphasized the importance of a protein-rich diet. "If you don't eat protein, you're not going to have enough neurotransmitters, and that's a fact," the psychologist asserted. On the day he was interviewed, Monastra said he had consumed chicken breast for both breakfast and lunch -- it was a "chicken day," he laughed -- along with glasses of orange juice and milk, salad and fruit.

Upwards of 10 percent of the nation's children suffer from ADHD, according to Monastra, who notes that "that rate increases dramatically in families where there is at least one parent who also has this disorder.

"About 57 percent of adults with ADHD will have at least one child with this condition," he writes. "If you have a child who has been diagnosed with ADHD, the chance that another of your children will have ADHD increases to about 33 percent.

"The evidence to date indicates that patients with ADHD are likely to demonstrate atypical genetic characteristics on chromosomes that are responsible for creating dopamine transporters and dopamine receptors," Monastra explains. "That is what is believed to cause the 'under-arousal' of the brain."

While most of his patients receive some form of medication for their ADHD, Monastra noted that about five percent are treated with biofeedback. Using a computer monitor, these patients learn to regulate -- and improve -- their frontal brain activity in half-second increments through a series of reinforcing tones and pictures.

Patients using biofeedback "have shown significant gains on computerized tests of attention," according to Monastra. In some patients who received both medication and biofeedback treatment, the improved brain activity continued after medication was discontinued, the psychologist reports.

After evaluating a child with ADHD and establishing a treatment regimen, Monastra "works on nutrition and makes sure we've got an educational plan in place that supports the kid's functioning in school.

"Then," he said, "you begin to look at parenting these kids. The biggest mistake I think that's made in people that have written parenting books and in people that try to treat kids with ADHD is that they don't insist on a foundation before they start working with the parents on framing the house. And, so, the house is typically very shaky."

Techniques that "work with everybody else's kids" will not work with ADHD children, Monastra asserted. These children will not develop "motivational systems" at the same pace as other children, he said, given that children with ADHD often have not only frontal brain dysfunction but cerebellum impairment as well. The cerebellum, according to the psychologist, is involved with social judgment and postural control.

In his parenting classes, Monastra said, he advises parents of ADHD children to use a motivational system based not on long-term rewards but on simple "daily pleasures" -- such as being allowed to watch television or attend a soccer game.

Janis Corey of Apalachin, whose 12-year-old son, Dylan, was diagnosed with ADHD at the age of 7, has attended Monastra's parenting class. "He changed our home life around tremendously," she said.

Corey said Monastra gave her "strategies to deal with Dylan's behavior -- my way was always yelling. It was terribly unproductive."

"We fought about everything -- homework, bedtime," Corey noted. "The more I engaged in it, the more it occurred. Sometimes it was very difficult not to engage."

Monastra's advice "gave us the least confrontational way to get there," the mother related. "I was able to exhibit more control so my son was able to respond appropriately. If I kept my cool, he kept his."

Corey's son attended a 10-week social skills course taught by Monastra. Covering issues such as bullying, anger, conversing with other children and making friends, the classes have resulted in a "tremendous improvement" in her child's behavior and schoolwork, Corey said.

Monastra "talks to kids like he's one of them," Corey observed. "He relates to them, and I think they relate to him."

Wingell is a free-lance writer and photographer in Apalachin.

June 27th, 2004

ADHD Breakthrough Hailed

Tier psychologist pioneers new guideline

By DOM YANCHUNAS
Press & Sun-Bulletin

ENDICOTT A Southern-Tier psychologist is helping mental-health professionals learn how to measure a child’s brain activity to more accurately diagnose a common attention disorder. His work may help ensure that patients aren’t prescribed too much medication.

Dr. Vincent J. Monastra, who runs the FPI Attention Disorders Clinic in Endicott, is using a quantitative electroencephalogram to help determine whether a child truly has attention deficit hyperactivity disorder. The process can assist a physician in deciding whether stimulant medications like Ritalin would be necessary.

ADHD affects 3 percent to 5 percent of U.S. children, according to the National Institute of Mental Health. Symptoms can include a short attention span, being easily distracted, acting impulsively and having trouble with study skills or socialization.

The brain activity measure often called QEEG or brain mapping spells out rates of electrical output in the front of the brain. Monastra is using the data to identify children with ADHD symptoms who have slower brain-wave rates than normal and may benefit from stimulant medications. Others - maybe 10 percent - who meet the diagnostic criteria for ADHD have faster rates and should not be given stimulants, Monastra’s research has found.

“So we can predict who will respond to a stimulant with a high degree of accuracy”, Monastra said. “That’s a very useful service. One of the primary worries that parents have when they think about ADHD is, ‘Why should I use medication for my kid, and why they should get stimulants’.”

“The QEEG analysis also should prevent a wrong diagnosis of ADHD in a child with similar symptoms, when the real culprit may be related to allergies, anemia, thyroid problems, vitamin or mineral deficiency, illicit drug use, anxiety, depression, or oppositional defiant disorder”, Monastra said.

“There is evidence that people who are exposed to the stimulant who don’t have ADHD can develop addictive propensities”, Monastra said. “We can’t be so cavalier.”

Monastra presented his findings at a recent meeting of the Association for Applied Psychophysiology and Biofeedback. The association presented him with two awards for helping make ADHD treatment more quantitative and precise. A 50-page article by Monastra will be published in Child and Adolescent Psychiatric Clinics of North America.

About 5,000 patients from Greater Binghamton and the U.S. have been evaluated in Monastra’s Endicott clinic, making it one of the nation’s most active research programs for attention problems.

“Dr. Eric Braverman, a physician and director of Path Foundation, a New York City-based research organization devoted to brain health”, said Monastra, “is right on target in applying his quantitative approach to attention problems.”

“There’s no question it has great utility”, Braverman said. “Monastra is part of this (vanguard) where eventually every person will have a brain health checkup, and no part of the population is more important for a brain health checkup than the kids.”

“After a diagnosis of ADHD, continued QEEG tests can help doctors determine whether and how much medication should be prescribed”, Monastra said.

“If we can get normal scores on the EEG, then you know that you don’t need a higher dose”, Monastra said.

Other recent developments:

- Monastra’s nutrition research has found ADHD patients who eat high-protein meals at breakfast and lunch don’t need as much medication for normal EEG scores. That’s because protein is a necessary component in brain activity. Children who didn’t eat enough protein sometimes needed twice as much medication, and suffer more side effects.

- New findings are confirming Monastra’s earlier research on the effectiveness of biofeedback treatments for ADHD. While hooked up to an EEG, children can see their own brain waves and learn to concentrate during a variety of tasks resembling a video game. New data are reinforcing earlier research showing that treatment including medication and biofeedback showed better results than medication alone.

- Next week, Monastra will travel to Chicago to produce a video on his biofeedback techniques for the American Psychological Association. In September, the association will publish his book, Parenting Children With ADHD: 10 Lessons That Medicine Cannot Teach.