Does ADHD Mean I Have Less Attention?

Does ADHD Mean I Have Less Attention?
You’ll be surprised by the answer

It’s ADHD Awareness Month. Spread the word.

Read More: http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

ADHD key symptoms include inattention, hyperactivity, and impulsivity. It is normal for all children to exhibit these behaviors, but for children with ADHD, these behaviors are more severe and occur more often. According to the National Institute of Mental Health, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age.

But do children with ADHD really have less attention than their peers? Attention deficit is actually a misnomer of sorts; ADHD children do not have less attention or a ‘deficit’ of attention. Actually their attention is quite substantial, however their ability to direct it or manage it at will is very difficult.

Try to imagine this: four television stations playing in your mind at one time. A lot of information is pouring in, but it’s difficult for you to pay attention to any one thing for very long. That’s the typical mind of an ADHD person. Thus, their attention is not deficit, but it is fleeting; it’s directed quickly from one thing to another.

Think of it like this: you enter a cave with a flashlight (the flashlight will serve as a metaphor for attention). It’s very dark, but you very carefully shine the flashlight in the cave, directing it on the floor to carefully navigate. Your ADHD child enters the same cave with that same flashlight. He constantly shines it all over the cave as he walks forward. So, it’s clear, same flashlight (same attention), but his is scattered or diffused.

Now you know why he’ll walk through the living room time after time and bang his shin or knee on the same coffee table for years.

Now you know why, when you ask him to go to his bedroom, put on his pajamas, and get ready for bed, you find him sitting on his bed a half hour later playing a Game-boy. He processed the, “Go to your bedroom” part. His brain is not yet equipped to process multiple step directions. When that happens in school, it’s a mess.

But why can they play their Xbox or Play Station for hours on end? I literally have to yank the controller from my son’s hand to get him to come to dinner. A characteristic of ADHD is hyperfocus, the ability to tune out everything else and attend to only a particularly engaging stimulus. Video games use high intensity graphics and sound and are loaded with action. Your ADHD child’s mind is tuned for this type of stimulation. They can hyperfocus on this for hours on end. Unfortunately, your classroom teacher cannot compete on this level. As we’ve mentioned before, limit the use of high intensity video games.

Knowing your child’s mind is integral to understanding your child’s behavior. At times they may not respond to your demands and it creates a conflict, but it’s not due to defiance necessarily. It’s often due to the way they process or don’t process information. Knowing this can reduce your conflicts and improve your family life.

Introducing Dear Sheer Genius

Dear Sheer Genius,

We are pleased to introduce our new advice column, Dear Sheer Genius. This advice column will be sent out every week and we invite all of you to write to our very own attention specialist, Sheer Genius. You may write Sheer Genius and ask questions about Play Attention, attention problems, education, behavior shaping, parenting concerns, peer relationships etc.!

Sheer Genius is here to help!

Who is Sheer Genius?

Sheer Genius is the virtual member of the Play Attention family. His outstanding knowledge and experience is incorporated into Play Attention to help guide you through our program every step of the way!

How do I submit a question?

To submit your question please click here or email sheergenius@playattention.net. If your question is selected you will receive a personal email from Sheer Genius and your question/answer will be posted on our website as well as our Facebook page. We will only use your first name if you provide it.

Sheer Genius looks forward to hearing from you!

Photo: Introducing Dear Sheer Genius,
We are pleased to introduce our new advice column, Dear Sheer Genius.  This advice column will be sent out every week and we invite all of you to write to our very own attention specialist, Sheer Genius.  You may write Sheer Genius and ask questions about Play Attention, attention problems, education, behavior shaping, parenting concerns, peer relationships etc.!
Sheer Genius is here to help!
Who is Sheer Genius?
Sheer Genius is the virtual member of the Play Attention family. His outstanding knowledge and experience is incorporated into Play Attention to help guide you through our program every step of the way!
How do I submit a question?
To submit your question please click here or email sheergenius@playattention.net.  If your question is selected you will receive a personal email from Sheer Genius and your question/answer will be posted on our website as well as our Facebook page.  We will only use your first name if you provide it.
Sheer Genius looks forward to hearing from you!

Crime, ADHD, & Medication

Study by: Paul Lichtenstein, PhD, of the Karolinska Institutet in Stockholm, Sweden

Read full article: http://www.nytimes.com/2012/11/22/health/adhd-study-suggests-medication-may-reduce-crime.html?_r=0

A new Swedish study says that ADHD people who take medication for symptom control may be less likely to commit crimes. Previous research has indicated that people with ADHD are more likely to have substance abuse issues, are likely to experience difficulty in school, maintain a steady job, and sustain personal relationships. Previous research also indicates that they are also at greater risk for depression, anxiety, and may be more likely commit crimes. Paul Lichtenstein, PhD, of the Karolinska Institutet in Stockholm, Sweden studied more than 25,650 people with ADHD. Lichtenstein and his associates then compared medication history with criminal records from 2006 to 2009.They found the during times when they were taking medication for ADHD, men were 32% less likely to commit a crime and women were 41% less likely to do so compared to when they were not taking ADHD medication. The subjects included in the research were prescribed a variety of medications, thus the type of ADHD medication did not affect the results. “The most probable interpretation would be that medication reduces symptoms like impulsivity, and that would be similar regardless of country or culture,” Lichtenstein says. While the study didn’t examine why, he says it’s likely because medication reduces symptoms related to ADHD, such as impulsivity, restlessness, and irritability, that could lead to criminal acts. The study did not conclude why medication may reduce the commission of crime. One obviously has the problem of antecedence; does taking medication reduce the chance of crime commission or is that the person who’s taking medication more motivated to make a change in his/her life and become organized, and productive? This study does not answer this question.

ADHD’s Genetic Link

What causes attention-deficit hyperactivity disorder – ADHD? Research in the English medical journal, The Lancet, says it’s not too much sugar, bad diet, or poor parenting. Professor Anita Thapar, lead author of the study, says it’s likely genetic.

Thapar and her group of scientists at Cardiff University in Wales compared 366 children with ADHD to 1,047 kids without ADHD. In particular, the researchers examined differences in the children’s DNA. They found that kids with ADHD were more likely to have small segments of DNA that were duplicates or missing (copy number variants or CNVs — either a deletion or duplication of genetic material).

"We hope that these findings will help overcome the stigma associated with ADHD," Professor Anita Thapar, the study’s lead author, said in a written statement. "Too often, people dismiss ADHD as being down to bad parenting or poor diet. As a clinician, it was clear to me that this was unlikely to be the case. Now we can say with confidence that ADHD is a genetic disease and that the brains of children with this condition develop differently to those of other children."

While being media friendly, Thapar’s last statement is a stretch in relation to her research. People and the media love statements that provide seemingly conclusive answers.

Let’s go beyond the media hype that says this research concludes there is a definite genetic link. The researchers really only say there seems to be a possible “genetic link.”  However, their research did not conclude that it is purely or even primarily genetic. What they truly are saying is that this study is evidence that ADHD is not purely social.

The authors conclude:

    “Our findings provide genetic evidence of an increased rate of large CNVs in individuals with ADHD and suggest that ADHD is not purely a social construct.”

This is logical because only 15% of the research subjects with ADHD demonstrated increased CNVs. So is it safe to conclude that genetic makeup may contribute, at least in some particular cases, to ADHD? Yes, but to be clear,  this research did not conclude that it is entirely genetically based and was only partially genetically based in a small segment of their study population. This is very similar to other genetic research.

Why is it, if ADHD is genetically based, at least in part, that 30% don’t have it as adults when diagnosed as a child? What happened? Where did it go? This is what is most  important to parents and professionals.

Epigenetic theory, now being widely embraced by the scientific community, maintains that human development  includes both genetic origins of behavior and the direct influence that environmental forces have on the expression of those genes (nature/nurture). Epigenetic theory regards human development as a dynamic interaction between these two influences.

Simply put, how our genes express themselves is greatly impacted by environment. This is likely why, over time, 30% of children don’t display symptoms as adults. The brain changes, rewires, or (a radical version of epigenetic theory) their genes change.

Do tools exist to do this? Yes. See support.playattention.net.

If I may quote Dr. Theodore Dalrymple, “What seems to have happened is that parents have lost the awareness that they had for decades – if not for centuries – that concentration and self-discipline do not come naturally to children, and have to be taught (as well, sometimes, as enforced).”

Is ADHD all in your head?

A study published in the June 14 edition of the Journal of Developmental and Behavioral Pediatrics has sparked controversy regarding ADHD medication and the brain’s power to regulate itself.

The study was funded by the National Institutes of Health and conducted by Dr. Adrian Sandler, a developmental-behavioral pediatrician and medical director of the Olson Huff Center for Child Development at Mission Children’s Hospital in Asheville, North Carolina.  The research was performed over the course of eight years using 99 patients from Western North Carolina.

Sandler found that children with ADHD can do just as well on half their medication when the medication is combined with a placebo. They performed as well even when parents and children had full knowledge they were taking a placebo.

[Placebo –  A substance containing no medication and prescribed or given to reinforce a patient’s expectation to get well. The placebo in this research was akin to a harmless inert pill].

Previous studies have shown that common stimulant medication causes side-effects like tics, weight loss, stunted growth, and even heart complications in some instances. This often causes trepidation in parents afraid of the possible side-effects on their children.

Sandler compared fully medicated children, children on reduced medication, and children on reduced medication with a known placebo. The results were quite intriguing.  Both the fully medicated and reduced medication groups had increased side-effects while the reduced medication with placebo demonstrated decreased side-effects. Furthermore, the reduced medication group reported decreased control of their ADHD symptoms. However, the control of ADHD symptoms was no different in the reduced medication with placebo group than in the full dose group, i.e. the reduced medication with placebo performed as well as the fully medicated group with less side-effects as well.

“I’ve been getting a lot of calls and e-mails,” said Sandler,, who conducted the research with James Bodfish, a professor in the departments of psychiatry and pediatrics at UNC Chapel Hill School of Medicine, and study coordinator Corrine Glesne.

“Medications work,” Bodfish said in a statement. “The question is whether we always need to use them at the highest dose. Many parents are concerned about placing their child on medication. Some choose not to treat their child because of concerns about side effects.”

While the research doesn’t address it, the obvious question is, Why? Parents and children in this study knew they were taking a placebo. Why then did they perform as well as their peers without the side-effects — at essentially half the dose as their peers? While the placebo effect has been studied widely, the exact mechanisms are unknown. We do know that the mechanism is governed by the brain. This clearly tells us that having ADHD or not, our brain is still a powerful weapon in our arsenal.

We also cannot exclude the influence of the parents during this research. Did they expect their child to do better? The authors suggest that this was so. This dynamic cannot be overlooked in your family either.

The bottom line is that we likely have far more control over our behaviors and cognitive processes than we are given credit for. Modern medicine, as this research suggests, is just beginning to understand the brain’s role in shaping our lives. We’ve known this for years at Play Attention. Cognitive training. Memory training. Motor skills. Attention training. Behavioral shaping. It’s time to take control over our lives. We’ve all got the power to do it. It lies right behind our eyes.

Meditation & ADHD

Sunset & Sky 098 Researchers, Dr. Zylowska, et al from the University of California-Los Angeles conducted a feasibility study of an 8-week mindfulness training program for adults and adolescents with ADHD. Their report was published in The Journal of Attention Disorders (2008 May;11(6):737-46. Epub 2007 Nov 19).

The researchers sought to inquire whether mindfulness meditation could improve attention, reduce stress, and improve mood. The researchers recruited 34 adults and 8 adolescents. Study participants were given a weekly training session. They were also required to practice daily starting with 5 minutes of meditation per day and gradually increasing to 15 minutes per day.

The majority of participants (after dropouts) reported improvements in self-reported ADHD symptoms. Independent tests on tasks measuring attention and cognitive inhibition also indicated improved symptom outcomes. Improvements in anxiety and depressive symptoms were also observed.

In yet another pilot study conducted by Sarina J. Grosswald, Ed.D., a George Washington University-trained cognitive learning specialist, a group of middle school students with ADHD were required to meditate twice a day in school. After three months, researchers found over 50 percent reduction in stress and anxiety and improvements in ADHD symptoms.

"The effect was much greater than we expected," said Sarina J. Grosswald, Ed.D., a George Washington University-trained cognitive learning specialist and lead researcher on the study. "The children also showed improvements in attention, working memory, organization, and behavior regulation."

Due to the neuroplasticity of the brain, better attention can be attained through meditation. Buddhist monks have been doing it for centuries. This seems to be true of ADHD persons as well. However, it is quite apparent that attention difficulties are just the tip of the ADHD iceberg. Other skills including organization, filtering out distractions, memory, time on-task, motor skills, visual tracking, etc, are typically diminished in ADHD persons. A complete program like Play Attention is required to teach these skills.

As for meditation, it is likely a good supplement to training in the aforementioned skill areas, but given the nature of the cited studies, a controlled clinical study is warranted.

Dopamine & ADHD

thinkingm4  The Journal of the American Medical Association (JAMA. 2009;302(10):1084-1091) recently published work by Dr. Nora D. Volkow, MD, et al regarding evaluation of the biological bases that may reveal a reward/motivational deficit present in the brains of persons with ADHD.

Volkow and her colleagues theorized that ADHD may be connected to reward-motivation deficits. Volkow investigated whether lack of motivation and its relationship to reward could be traced to depression of dopamine in various areas of the brain.

To determine whether dopamine was depressed in ADHD persons, the researchers used positron emission tomography (PET scans) to measure dopamine levels in 53 nonmedicated ADHD adults and 44 healthy non ADHD adults between 2001-2009.

Since the biological mechanisms of ADHD are unknown, studies of this type have become the holy grails of research. While Volkow’s credentials are quite impressive (NIH, NIDA, etc.) this research is not new or conclusive. The theory that dopamine dysfunction/depression may be involved with ADHD symptoms has been researched for many years.

Furthermore, Volkow’s  small sample size consisted only of adults and therefore should not be extrapolated to include the child population. The small sample size alone should prevent it from being generalized to the entire adult ADHD population. One has a problem of antecedence here; is ADHD caused by dopamine depression in the brain? Or is the dopamine depression the result of ADHD that was acquired by other biological means? This research cannot answer that question.

What does the research tell us? It tells us that for some adults, dopamine may play a role in ADHD. For those adults, taking a stimulant medication may increase dopaminergic activity thus increasing reward/motivation responses and thus increasing attention to task. That might be a stretch.

On the downside, persons with depressed dopamine levels would probably greatly enjoy using stimulants. Study participants reported this. This may contribute to the frequent incidences of substance abuse among ADHD persons.

The authors write,"Despite decades of research, the specific neurobiological mechanisms underlying this disorder still remain unclear. Genetic, clinical and imaging studies point to a disruption of the brain dopamine system, which is corroborated by the clinical effectiveness of stimulant drugs (methylphenidate hydrochloride and amphetamine), which increase extracellular dopamine in the brain."

Unfortunately, the study leaves us with more questions than answers. Does it tell us what happens long term? Does it tell us of side effects?  Does it tell us if this actually applies to children? Can we conclusively determine a causal relationship between reward/motivation and ADHD? Does it solve the problem of antecedence? Do we know anything conclusively about all ADHD adults. No. There’s still a long road ahead.

Adult ADHD and Job Performance

As I reported earlier (Do ADHD Adults Really Lose 3 Weeks of Work Each Year?), a study published in the journal Occupational and Environmental Medicine, found that ADHD adults worked 22.1 days less than other workers each year. Furthermore, the study found that they were unable to carry out normal work activities an average of 8.4 days per year, 21.7 days of reduced work quantity and 13.6 days of reduced work quality.

However the study actually begs the question of what is adult ADHD. If you’ve found that it’s difficult to concentrate because you may be hyperactive, have trouble remembering appointments or finishing a project once the challenge is gone, are easily distracted, or avoid tasks that require concentration the World Health Organization (“WHO”) says that you may have adult ADHD! The WHO also thinks that many adults do not know they have the condition.

Who (no pun) hasn’t felt easily distracted or avoids boring tasks? I wonder if the shaky diagnosis of adult ADHD – which by the way, is totally subjective – is being exaggerated so that more people can be ‘treated’ i.e. prescribed medication.

The researchers (World Health Organization (“WHO”) research consortium at Harvard Medical School in Boston Medicine) formed their conclusions by evaluating data from 7,075 adult workers in several countries. The workers ranged in ages from 18 to 44 and were screened for ADHD as part of the World Health Organization World Mental Health Survey Initiative. The researchers surveyed the workers about their performance at work in the last month.

Both the media and the pharmaceutical industries have helped spur the diagnosis of ADHD by clinicians. However it will remain a controversial diagnosis shrouded by concerns about context; we are now required to sit and perform focused and organizational tasks more now than ever before in history. This has changed greatly from work at standard manual labor and assembly lines of the past. Is it natural for us to become distracted at tedious or boring jobs? Do we need medication to improve our work? For whose benefit? Furthermore, an ADHD diagnosis can be symptomatic of personal learning problems or family dysfunction among many other scenarios that comprise the human situation.

Adult ADHD is caught in the midst of a tug-of-war between pharmaceutical marketing, changes in the workplace, and a very loose, subjective diagnosis. Buyer beware.

Women with ADHD affected more?

In most clinical settings, boys are treated for ADHD at least 4 to 1 over girls. Boys, it is thought, tend to present symptoms outwardly more than girls resulting in physical behaviors that are easily noticeable (hyperactivity).

In an article reported in the Journal of Clinical Psychiatry, February 2008, author of the University of Utah in Salt Lake City and his colleagues find that the roles are reversed in adults; females seem to be more impacted than men.

“We found that adult women with ADHD frequently have high levels of emotional symptoms as well as the cognitive problems found in ADHD,” Dr. Frederick W. Reimherr told Reuters Health.

Reimherr’s conclusions were drawn from analysis of data from two clinical trials of Strattera. Strattera is a non-stimulant medication for ADHD produced by Eli Lilly, a pharmaceutical giant.

ADHD symptom data were collected ADHD on 515 individuals. Approximately one third of this population were women. Seventy-five percent of the women in this population had a combined-type ADHD as opposed to only 62% of the male population represented in this study.

Women also presented more problems with sleep than did males in the study. Women had higher scores measuring both anxiety and depression than did their male counterparts.

Women presented poor temper control, mood volatility, and emotional over-reactivity than did their male counterparts (37 % in women as opposed to 29 % of males).

In an interview with Reuter’s Health correspondents, Reimherr cites that, “these symptoms – depression, temper control problems, feelings of tension, and over-reacting to life stresses – might cause a doctor to miss the diagnosis of ADHD … We feel that this will lead to problems in treatment for such women.”

Such studies are limited to the initial data collected by the original researchers at Lilly. Therefore, one is not able to draw positive conclusions regarding the origins of the differences cited by Reimherr. For example, do hormones, age differences, economic statuses, education, or marital statuses, affect the data? We cannot know due to the limitations of the data in this study.

Can ADHD be identified in blood?

Researchers Sharon A. Murphy, MD, and Douglas Woodruff, MD, psychiatrists in private practice in Baltimore, Maryland presented their findings at the 160th annual meeting of the American Psychiatric Association (APA). Their work is based a particular technique called cell membrane potential. They propose that use of this technique may help medical professionals clearly identify attention deficit hyperactivity disorder (ADHD), bipolar disorder, and possibly major depressive disorder.

According to investigators, this physiologic property of cells differs among these disorders and is also differentiated from that seen in healthy controls. This is an interesting theory which has some credibility from years of previous research on manic and depressed persons. To extrapolate this theory to ADHD persons is intriguing.

The theory is a little complex, so I’ll attempt to simplify it. Cells contain energy. In that regard, they are like little batteries. If you attach a voltmeter to two terminals of a battery, a voltage difference will be measured across the two terminals. If you have a battery tester that lights up, you’re actually testing the voltage difference between the positive and negative ends of the battery. Since a cell is like a battery, if you attach a voltmeter to measure voltage across the cell membrane (outside of a cell) you’ll find that the inside of the cell has a negative voltage (measured in millivolts; mV) with respect to the outside of the cell (which is referenced as 0 mV).

If the cell is at rest, it is termed the resting membrane potential. By convention, the potential outside the cell is arbitrarily defined as zero. There exists an excess of negative charges inside the membrane because it is filled with many potassium (K+) and organic ions. Thus, the potential difference across the membrane is expressed as a negative value. The resting membrane potential is disrupted when net flux of ions (charged particles) moves into or out of the cell. Ions flow through various channels constructed of proteins to traverse the cell membrane. These are called, ion channels. Sodium and potassium are known as electrolytes – substances that conduct electrical activity that play a vital role in the normal functioning of the nervous system. There is a higher concentration of sodium outside the nerve cell and a higher concentration of potassium inside. The sodium pump is a process that maintains the normal distribution of sodium and potassium.

The researchers maintain that when cells are placed in a potassium-free buffer, the assay used in their test, cells are stressed. Abnormal regulation of ion distribution and variability in the functioning of the sodium-potassium pump within cells is known to be associated with bipolar I disorder and may also be a hallmark of ADHD, according to Drs. Murphy and Woodruff. I had heard of malfunctioning neuronal sodium-potassium pumps being associated with bipolar I disorder or ADHD, but not blood cells, so this intrigued me.

“While using the membrane potential assay to identify bipolar I disorder, we were intrigued by data that suggested this membrane potential test is also sensitive to presumed malfunctioning of the sodium-potassium pump in ADHD,” the authors reported.

Here’s the theory upon which the researchers are presumably basing their work: Any factor that alters the sodium or potassium pump in a neuron likely alters the neuron’s capacity to respond to stimuli basically affecting the functioning of the neurons. This may then affect the central nervous system and human behavior. Various studies over many years have demonstrated that depressed and manic patients may exhibit disturbances in the distribution of sodium and potassium (pump problems). Some research indicates patients with psychotic depression and mania had higher levels of intracellular sodium. The hypothesis is that manic and depressed people may have a highly excitable (hyperexcitable) central nervous system due to the excess sodium levels. They are treated successfully with lithium salts which greatly reduce intracellular sodium and so may reduce central nervous system hyperexcitability.

Murphy and Woodruff recruited 273 subjects, of whom 123 were controls. Within that group, 55 were identified by the blood work assay as having bipolar I disorder, and 95 were identified as having ADHD. The assay consists of fluorescence intensity of the membrane potential dye in patients’ blood cells. I would truly enjoy seeing fluorescence intensity of membrane potential dye. Fluorescence intensity is widely used in the manner in which the researchers used it. However, fluorescence intensity is a relative measurement which depends on instrument characteristics. This means that different fluorescence measuring instruments or even the same fluorescence instrument produce different data at different times. Additionally, turbidity (similar to muddy water) or the presence of colored compounds in the sample further complicate the interpretation of the measurements.

After all was said and done, the researchers used clinical response to medication to see if their diagnoses were correct. If the patients responded well, then the researchers concluded they were right! I’ve seen many medical practitioners perform this reverse diagnosis; concluding a child has ADHD if he responds well to ADHD medication.

Seems rather ridiculous. Both their methodology and their conclusions seem quite a stretch given the technology they’re working with.

Murphy and Woodruff claim that their test gives “a very clear and distinct difference among the controls, people with ADHD, and people with bipolar I disorder.” The average membrane potential ratio was 0.8, and the average ratio for ADHD was 1.1; the mean ratio in controls was 0.9

Essentially, I have five primary arguments against this type of test presenting any conclusive evidence:

  • It is curious that the researchers used blood cells rather than neurons as previous research upon which their theory is based was produced from neural cell examination.
  • Fluorescence is a relative measurement that varies with each measuring instrument and is highly susceptible to the most minor variations in the substance being measured.
  • Using a reverse diagnosis to verify one’s test data is suspect.
  • Their data don’t seem statistically significant, but since they didn’t provide their standard deviation, one cannot determine significance.
  • Extrapolation to ADHD from bipolar I is quite a stretch.

Again, the Holy Grail of ADHD is to find that true biological marker that absolutely defines the disorder. We haven’t been able to find it for mania, depression, etc. for the past 50 years. I doubt we’ll find one for ADHD for a variety of reasons, but that’s another chapter unto itself.