ADHD studies 4

Two ADHD media posts I viewed today demonstrate some examples of the right and the horribly wrong ways to deal with children with ADHD. A recent study out of the University of Buffalo shows that praise of the potential for rewards improves the performance of children with ADHD on certain cognitive tasks. Prior to this it was not known if increased motivation accounted for this improvement or if children with ADHD scored lower than other children on these tests so had more room for improvement. This study indicated that increased external motivation is a critical factor in improving the performance of children with ADHD. Positive reinforcement, rather than punishment is the corner stone of behaviour therapy for children with ADHD. The study looked at whether children with ADHD have an increased sensitivity to external motivation and found that this was indeed the case. This would make perfect sense when taking into consideration Russell Barkley’s information on Executive Functioning impairment and the role it plays in self-regulation and motivation.

On the other hand, it seems that many uninformed people still believe that negative consequences are the way to improve the behaviour of children with ADHD. In the news last night and in several posts today including the Huffington Post you can view a very disturbing video of a Sherriff’s deputy placing handcuffs on the biceps of an 8 year old as a consequence of misbehaving in class. Apparently this has happened before and a lawsuit has now been launched.

A new study suggests that we should be encouraging children with ADHD to move more rather than less. When asked to do a cognitive task while seated in a swivel chair, the study revealed that boys with ADHD who moved and spun in their chairs were found to perform better. For boys without ADHD the opposite was true. The proposed theory behind this is that slight movements help to “wake-up” the nervous system and increase alertness for those with ADHD. For those without ADHD, excess movement may just cause distractions for an already alert brain.

Dr. Dustin Sarver reposts that past research demonstrates that when children with ADHD are asked to perform tasks that place demands on their working memory their hyperactivity increases. But, when these demands were not placed on their working memory their activity levels reduced to normal levels. This led the team to wonder whether these movements helped or hurt working memory in those with ADHD.

Dr. Sarver’s research has shown that movement in children with ADHD has a positive purpose and we should be facilitating it for students in classrooms as long as they are not disruptive to others. Dr. Sarver also states that by asking children with ADHD who are hyperactive to sit still and not move we are actually hampering their ability to function, as all of their mental energy goes into sitting still rather than getting the task at hand completed.

Summary article:

http://www.huffingtonpost.com/mark-bertin-md/mindful-eating-adhd-and-n_b_7257190.html

Media release by University of Mississippi Medical Center. https://www.umc.edu/News_and_Publications/Press_Release/2015-04-27-00_Researcher__Hyperactive_movements_help_ADHD_kids_learn.aspx

I have been aware of the connection between ADHD and eating disorders for many years now. I first became aware of this relationship when assisting with a research study that examined the impact of a new medication in adults. On long term follow-up, one particular adult with celiac disease reported that her disease symptoms greatly improved when she was taking the medication versus the placebo. When we discussed why she thought this occurred she said that it was very obvious. When on the medication treatment she was able to resist her impulsive urge to drop into a McDonalds or other fast food restaurants, thus reducing flare-ups of her celiac symptoms. Now, years later and after attending presentation’s by Dr. Lance Levy (for CADDAC ) and by Dr. Brain Stonehawker (for CADDRA) on ADHD and obesity, the correlation between ADHD and eating issues seems like common sense.

A recent blog post by Dr. Mark Bertin (a featured speaker at our next CADDAC conference) directly links poor decision making around food with impaired Executive Functioning (EF) – poor planning and organization, as well as impulsivity, all symptoms seen in those with ADHD. Bertin also points out a link to emotional over-eating due to boredom, stress or overstimulation. Eating disorders associated with ADHD are not only those associated with impulsivity, such as binge eating and bulimia, but also the often overlooked anorexia – seen in those seeking order in their chaotic world. Poor decision making due to EF impairment - lack of thought and structure around meal and eating routines and even hyper-focusing can also lead to poor health even if weight is not an issue.

Dr. Bertin closes out the article with a list of useful strategies that he refers to as “mindful eating”.

To access Dr. Bertin’s full article visit http://www.huffingtonpost.com/mark-bertin-md/mindful-eating-adhd-and-n_b_7257190.html.

The topic of sleep issues frequently comes up during discussions with families impacted by ADHD; lack of total hours slept, difficulty falling asleep and staying asleep, resulting in difficulty getting up in the morning. These problems are reported in both children and adults. When children with ADHD have sleep problems, parents, whether they have ADHD or not, often complain about getting less sleep because their children are awake. This makes for a cranky and exhausted family all around. Less sleep also results in increased attention problems.

Therefore I was interested in finding this article summing up some of the most current research on what has been found to be helpful.

Apparently, a certain aspect of sleep disturbance is common in people with ADHD, delayed circadian preference, which means that one’s body clock is delayed or not in sync with the normal day/night cycle. An example would be the common delay in falling asleep that many adults and children with ADHD complain about. It is definitely a concern for parents of these children.

There are two interventions that have shown some promise: bright light therapy and Melatonin. In an adult study the use of bright light therapy was shown to reduce attentional problems, improve mood and result in subjects going to sleep earlier.

A long term study on Melatonin use in children indicated that even three to four years after Melatonin was continuously used, 90% of parents felt that it still assisted with earlier sleep onset and two thirds reported improved mood and behaviour.

Another study which paired the use of Ritalin and Melatonin as a treatment found increased growth and weight in these children despite no difference in caloric intake. The researchers hypothesised that this might be due to the increase in growth hormone which is released during deep sleep. This is an interesting finding especially for parents concerned about the potential of delayed growth for some children taking stimulants.

To view the entire article visit https://www.psychologytoday.com/blog/mental-wealth/201304/resyncing-the-bodyclock-treat-adhd

Past studies have found that students with ADHD are underrepresented in the field of engineering. Researchers feel that traditional teaching methods are driving away those ADHD “out of the box” thinkers that have the potential to be pioneers in the field of engineering.

Engineer with blueprints and tools

This study is going to compare the creative thinking processes of engineering students with and without ADHD, looking at what might be hindering students with ADHD from being successful in these traditional programs. The principal researcher, Arash Zaghi, is an assistant professor of civil and environmental engineering and was himself diagnosed with ADHD at the age of 32. He feels engineering courses do little to foster creativity.

An article on this study also points out that high school advisors often suggest university engineering programs to students who are creative and express a liking for things that are hands on, often resulting in a bad university program fit and unhappy students.

The study will also be looking to see if medications used to treat ADHD affect a student’s creative thinking. The study hopes to help dispel some of the myths about students with ADHD.

If only more of these types of studies could be funded, ones that provide insight into how students with ADHD can best use their strengths to become successful in their areas of study. Perhaps we need more adults with ADHD such as Arash Zagji, to lead the way.

For more information and to access the original article about this study, please visit:

http://medicalxpress.com/news/2015-02-strengths-adhd-students.html

A new study researching how individuals with low birth weights were impacted found that they had decreased chances of developing alcohol and substance use disorders later in life but an increased chance of developing other psychiatric problems. Funded by the Canadian Institute of Health Research (CIHR), the study followed children into their 30s and found that they were 3 times less likely to develop alcohol or substance abuse issues, but 2.5 times more likely to develop psychiatric disorders such as anxiety, depression, and ADHD. Those born at an extremely low birth weight who received a full course of life saving steroids were nearly 4.5 times more likely to experience psychiatric problems.

Researchers feel that this information will increase awareness amongst parents and medical professionals and allow them to screen and assess for these disorders earlier. Of course it has been known for some time that premature babies have a higher incidence of ADHD, the new information about anxiety and depression is interesting. It would be interesting to find out how many of these adults who were diagnosed with ADHD also had comorbid anxiety and depression since these disorders frequently coexist in the adult ADHD population.

Because only 84 adults were followed all the way into their thirties, this is considered a small study; additionally, factors such as DNA and environment were not controlled and so a larger scale study would need to be completed before any definitive results could be reported.

For more information visit the original article at http://www.sciencedaily.com/releases/2015/02/150209083008.htm.

An interesting survey was recently conducted by Harris Poll for the newly-created Coalition to Prevent Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Misuse (CPAMM), a network of organizations with the shared goal of developing and educational strategy for college students focusing on reducing misuse amongst college students.

The study found that while students generally felt that they are aware of the risks of misusing ADHD medication, further investigation found that this was incorrect. Most expressed understanding why some students decide to use the medication, especially when taking into account the pressure to succeed in today’s post-secondary environments. The majority of students believed that misusing stimulant medication (75%), was unethical and a form of cheating similar to athletes using performance-enhancing drugs. However, almost half of these students also felt that those who do take these medications without the presence of ADHD were doing what was necessary to keep up with extreme pressure. Most felt that the main reasons students were misusing these medications was to get better grades and to succeed.

CPAMM hopes to create peer-to-peer interventions to assist with the common misconceptions that misusing ADHD medications leads to better grades, is not harmful and that “everyone is doing it”, and to provide information of better ways to cope with educational stress.

This certainly looks like a step in the right direction.

For further information on this survey access www.uloop.com/news/view.php/144465/College-Students-Split-On-ADHD-Prescript.

Don't forget to register for CADDAC's upcoming workshop on Adult ADHD, less than two weeks away!

Date: Saturday October 4th, 2014.
Location: Centennial College Culinary Arts Centre, 940 Progress Avenue, Toronto Ontario M1G 3T5.
Time: Registration and Breakfast from 8:00AM to 9:00AM. Presentations from 9:00AM to 3:30PM, followed by a Q & A Discussion session.

CADDAC is hosting a full day workshop on Understanding Adult ADHD. Presentations will be geared to adults and their families dealing with adult ADHD. This workshop will also be of interest to health professionals who wish to gain an understanding of adult ADHD and potential treatments.

The morning sessions will cover the medical science of adult ADHD, how it presents itself, how it differs from childhood ADHD, medication and psychosocial treatment options. These sessions will be followed by a unique presentation by adults with ADHD speaking about their own experiences and insights.

The afternoon will include a presentation on emotional dysregulation in adult ADHD and a presentation on ADHD in the workplace, discussing potential strategies and accommodations. An open question and answer and discussion period will follow where attendees can ask questions and share their insights.

For further details and to register please visit www.caddac.ca and select Events followed by Full Day Workshop on ADHD in Adults.

Featured presenters include:

Dr. Flood, is a graduate of McGill University and the University of Manitoba. She is a family physician with a focused practice in Child and Adolescent Psychiatry at the Shoniker Clinic. She has considerable experience working in the field of ADHD, Learning Disorders and Autism. She is a member of CADDRA and on the Advisory Board of CADDAC.

Dr. David Teplin, is an adult clinical psychologist in private practice in Richmond Hill, Ontario. His primary focus is diagnostic assessment, clinical consultation, adult ADHD, and substance use disorders. Dr. Teplin is adjunct faculty in the Doctor of Clinical Psychology program at Medaille College in Buffalo, New York, and is on the editorial review boards of several clinical journals. He is also on the Advisory Board of CADDAC.

Heidi Bernhardt RN, is the mother of three young men with ADHD. She has a background in psychiatric nursing, was the Executive Director of the (CADDRA), a national not-for-profit organization of the leading clinicians and researchers in ADHD in Canada, and a founder of CADDAC and the ADRN. Heidi is presently the President and Executive Director of the Centre for ADHD Awareness Canada (CADDAC).

Anyone working in the field of ADHD, or who has ADHD, is very aware of the continued misinformation and stigma surrounding the disorder. The public seems to have limited awareness of childhood ADHD, typically assuming those affected are the stereotypical hyperactive little boy, and often discounting adult ADHD altogether. Adult ADHD impacts almost all aspects of a person’s life: the home, workplace, and relationships. One of the crucial first steps is the attainment of education about the disorder in adults.

To facilitate this, CADDAC is hosting a full day workshop on Understanding Adult ADHD. Presentations will be geared to adults and their families dealing with adult ADHD. This workshop will also of interest to health professionals who wish to gain an understanding of adult ADHD and potential treatments.

For further details and to register please visit www.caddac.ca and select Events followed by Full Day Workshop on ADHD in Adults.

Featured presenters include:

While it has long been known that smoking during pregnancy is never a good thing, a new study suggests that women who smoke while pregnant have a greater chance of having a child with ADHD. The study also hints, but does not prove, that being on a nicotine patch may also increase the risk. It must be noted however, that there may also be other factors at play. ADHD runs in families due to the strong genetic component, and those families are more likely to smoke than those without ADHD. So, while we know that there is a link between smoking during pregnancy and ADHD we cannot confirm that there is a direct cause. Genetics or being in a smoking environment may also play a role. Do the children of mothers who smoke have a greater chance of having ADHD because their mothers have ADHD and therefore have a greater chance of smoking?

The records of 85,000 children whose mothers signed up between 1996 and 2002 in Denmark were reviewed with the following results:
ADHD rates for children of:

• Non smokers: 1.8%
• Mothers who quit and Father was a non-smoker: 2%
• Parents who both smoked: 4.2%
• Mothers who smoked: 3.4%
• Mom’s who were on nicotine-replacement therapy: 3.8%
• Father’s who smoked and mothers on nicotine-replacement therapy: 2.9%

Since only 29 women in the study were on nicotine-replacement therapy, these small numbers may make findings on the therapy less accurate.

The good news is that smoking prior to pregnancy does not seem to increase the risk, however stopping smoking well before conception will also decrease the risk of requiring nicotine-replacement therapy during any part of the pregnancy. While we are not yet able to show direct causality to ADHD, not smoking during pregnancy is always recommended; this is just one more reason to stop.

To access more detailed information please see:

http://www.webmd.com/baby/news/20140721/smoking-while-pregnant-linked-to-adhd-in-children.