New study on ADHD released

by Robin Wulffson, M.D.

LA Health Examiner

This article and more can be found at http://www.examiner.com/article/new-study-on-adhd-released.

On November 13, the findings of a new study on attention deficit hyperactivity disorder (ADHD) were reported at a conference held by the Society for Neuroscience (Washington, DC; November 12-16). According to the Los Angeles County Department of Public Health, 4.6% of children between birth and age 17 have been diagnosed at least once with attention deficit hyperactivity disorder (ADHD). Researchers from Wayne State University (Detroit, Michigan) noted that a brain area that helps coordinate mental activity works overtime in children with ADHD, reflecting the internal struggle to hold more than one concept in mind at a time. The researchers used a functional magnetic imaging scanner to track signs of neural activity among 19 affected children and 23 other children who were asked to remember a simple sequence of letters. A research team led by biologist Tudor Puiu discovered that a critical mental control area, called the dorsal anterior cingulate cortex, worked significantly harder and, perhaps, less efficiently among children with ADHD. They noted that this fundamental difference in brain function might be an underlying cause of the inattentiveness, impulsivity and focus problems that make it difficult for children with ADHD to concentrate in the classroom. Piuu noted, “Our findings suggest that the function as well as the structure of this brain area is different in children with ADHD.” He added, “It might explain the cognitive problems we see in the classroom.”

ADHD can be diagnosed in preschool-age children as young as four, according to new treatment guidelines issued by the American Academy of Pediatrics. Currently, the basic neurobiology responsible for the mental disorder is not understood; furthermore, the number of affected children has increased since 2003, according to a survey by the U.S. Health Resources and Services Administration. Furthermore, according to a National Institutes of Health (NIH) reported released in September, the portion of those children with the most severe symptoms who are treated with prescription stimulants, such as methylphenidate (Ritalin) and amphetamine (Adderall), has continued to increase.

The new findings add to growing biomedical evidence that those diagnosed with ADHD have unusual patterns of brain function that can persist well into adulthood. In general, the brain of child with ADHD matures normally; however, it may take up to three years longer to fully develop, particularly in areas at the front of the brain's cortex, which controls attention, reasoning and planning. Researchers have also reported a range of specific anatomical differences among ADHD children that may be linked to behavioral problems. Earlier this month, researchers at New York University's Langone School of Medicine reported that ADHD children appeared to have a significantly thinner cortex and less gray matter than other children in some areas involved in regulating attention and emotion. In another study, researchers noted that they had determined that ADHD children have differences in the caudate nucleus, which is involved in learning and memory, compared to other children.

Overcoming Sleep Disorders in Children

This Story Appeared in

June 04, 2012|Deborah Kotzt

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Justin Colamaria with his mom, Tina Foye, and the breathing machine that… (Victoria Arocho for The…)

Chandra McGuire thought she’d have to learn to live with her 2-year-old son’s snoring and pauses in breathing that roused him, and her, two to four times a night. “He’s always been hyperactive and had a very quick temper,” McGuire said. “His doctors kept telling me it was colic, but when you can’t sleep it affects everything else.”

Lately, though, her son Francis Massey V has been sleeping through the night for the first time in his life, two months after his enlarged tonsils and adenoids were surgically removed at Boston Children’s Hospital, a procedure his doctors hoped would open his airways and help him breathe better during sleep.

“His personality before and after the surgery is night and day,” said McGuire, 36, a massage therapist from Middleborough. “He’ll pay attention to me reading a book, and he’s awesome in day care. He’s not set off by the smallest things like he used to be.”

While nearly one-third of children experience sleep issues at some point in their lives, about 2 to 4 percent have structural defects such as Francis had that cause breathing difficulties during sleep, often marked by snoring, gasping for breath, or pauses in breathing. The condition, called sleep apnea, is being treated more frequently at Boston Children’s and other pediatric sleep centers because of increased screening by pediatricians — who are advised by the American Academy of Pediatrics to ask about snoring at well visits — and a tripling in pediatric obesity, a known risk factor for sleep apnea.

A March study published in the journal Pediatrics surveyed 8,000 British parents of children ages 7 and under and found that children who snored or had other breathing difficulties during sleep were 50 percent more likely to have a behavioral issue such as hyperactivity, frequent temper tantrums, or anxiety compared with those who didn’t. Researchers speculate that when the brain gets too little oxygen during sleep, it may have less than optimal functioning in areas such as the prefrontal cortex that govern decision-making and self-control. And preliminary results from a new clinical trial conducted by Boston Children’s and Brigham and Women’s researchers show that surgical removal of enlarged tonsils and adenoids in kids with sleep apnea results in marked improvements in behavioral problems compared with those who don’t have the surgery.

Other research, mostly in adults, suggests that sleep apnea, if left untreated, can raise the risk of hypertension, diabetes, and depression; later in life, it’s been linked to heart failure, heart attacks, strokes, and, a new study suggests, cancer.

Communicating ... Mindfully

More articles like this one can be found at  http://adultadhdrelationships.blogspot.com/2012/06/communicating-mindfully.html 

This month's guest post comes to you from Mark Bertin, MD, a developmental pediatrician and author of The Family ADHD Solution: A Scientific Approach to Maximizing Your Child’s Attention and Minimizing Parental Stress. – G.P.

 

If you know you have ADHD, you’re probably aware of how distractibility, impulsiveness or difficulty “keeping track” of everyday life affects you.  But are you aware of how it affects your communication style with loved ones?
 
To address this aspect of ADHD’s potential effect on interpersonal relationships, let’s consider a few examples:  

• Distractibility may cause you to miss what's being said or being asked of you – or to even appear disinterested.
• Impulsiveness and reactivity may change your tone in ways you don’t intend  –snapped responses or flares of anger  – leaving your loved one feeling hurt or confused. 
• A busy mind drowns out the details of the conversation for a few minutes, or plans rebuttals for what it anticipates coming next, or doesn’t fully wait to hear out another person’s perspective.  

None of this is intentional, of course, but all of it influences how you come across and engage with others. 

Whether speaking or listening, we can hone our ability to communicate as we would any other skill. One proven method is through the practice of mindfulness. Think of mindfulness simply as getting out of “autopilot” – that habit of automatically acting and reacting while mentally we are somewhere else entirely.  On the outside, we’re smiling and nodding to someone but inside we’re lost in thoughts of the future, past, or anywhere our mind travels. 
 
By seeking to develop a more mindful perspective, we aim to pay better attention to our conversations and to everything else we do throughout the day.  We try to respond to our life as it happens with clarity and objectivity instead of reacting with kneejerk, automatic responses. Make no mistake: It’s impossible for anyone (with or without ADHD) to be mindful every moment of every day, but practicing improves our ability to stay connected. Bit by bit, we begin to notice more consistently when we’ve “gone away”, and we bring ourselves back.

One way of building mindfulness is through a simple meditation in which we practice focusing attention, which has been shown in the lab to build that exact skill.  Taking some time – even just 10 minutes a day – to pay attention to the sensation of breathing (or eating, or walking, or one of many other possibilities) increases our capacity to attend in other facets of our lives. Without forcing anything, without aiming for any esoteric goal, we improve our ability to stay out of autopilot and be more present in our interactions. 

Despite what you might have heard about meditation, the idea is not to “eliminate thought” or even to sit still. Rather, we expect to get distracted; that’s what the human mind does, with or without ADHD involved. Whenever our attention wanders off once again (and it will), we patiently guide ourselves back, as often as needed. Perfection is not the goal but, whenever we are able, taking a moment to pause and responsively choose what we do next, any step of the day, allows for change. 

Building communication skills starts with stepping out of autopilot, becoming less reactive, and learning our own mental tendencies. With any conversation or interactions, it is typically our expectations that influence how we hold ourselves, our choice of words, and our tone of voice.  By pausing and listening instead of forcing an immediate solution, we allow other plausible outcomes to emerge.

The path of any conversation is steered by much more than our words alone. Before we open our mouths to speak we often anticipate how the discussion will go; in turn, that affects what we choose to say and how we sat it. Our nonverbal language, such as facial expression or posture, generally develops without our awareness and may tell others more about our intention than the words we choose.  For example, we might verbally offer someone an opportunity to explain, but they see skepticism etched in our faces.  Our ability to listen and respond is affected by our acute mental and physical states, as well as by years of experience through which we filter our lives.  We’ll hear things quite differently when we’re relaxed than when we’re harried and walking in the door from work.

Mark Bertin, MD

 To be clear: A communication style where you accept everything you hear and never state your needs is not the point. Communicating mindfully doesn’t involve rolling over and giving up; it means keeping your own perspective while also empathetically noticing the viewpoint of another.

Somewhere in the middle is an opportunity to listen, to creatively problem solve, to engage your child (or your spouse, friend, coworker or anyone else) in the discussion without escalating their fear. As always, underneath their anger, withdrawn sullen silence, or seeming apathy, below all of it they want what you want:  They’d like to be happy and at ease, and that’s what you picture for them as well.
    
 
A communication checklist:

• Practice pausing and listening first. 
• Monitor your body language and tone.
• Monitor your expectations and any predictions of what will come next.
• When needed, take a few breaths – or a break.
• Pay full attention and create a situation where whomever you are talking to can do the same; stay away from other people, televisions, phones, computers, etc. while engaging in discussion. 

Adapted from The Family ADHD Solution:  A Scientific Approach to Maximizing Your Child’s Attention and Minimizing Parental Stress, by Mark Bertin, M.D. (2011), Palgrave Macmillan.  
    

Taking Away Recess Bad for ADHD Kids, Experts Say

Find this and more articles at http://www.myhealthnewsdaily.com 

Children with attention-deficit/hyperactivity disorder (ADHD) behave better when they exercise, recent research suggests. Over the last few years, studies in animals and people with ADHD have shown exercise may reduce impulsivity and improve attention. The findings suggest exercise could be used as an alternative ADHD treatment, or in combination with medications, experts say. Researchers emphasize that studies so far have been small, and much more work is needed to validate these results. And we don't yet know what types of exercise, or what amount, might bring a benefit, experts say. However, the findings raise concerns that taking away recess from kids with ADHD, which is a common form of punishment for acting out in class, might actually fuel more bad behavior, experts say.

"In general, kids who have ADHD need to have their gym class, need to have their recess," said Dr. Melvin Oatis, a child psychiatrist in New York City. Generally, if a teacher knows a child has ADHD, they should use other forms of discipline, such as encouraging good behavior, Oatis said.

Exercise benefits for ADHD

Currently, many of those who treat children with ADHD believe exercise is helpful, and some use exercise recommendations as an adjunct to, but not replacement for, medication, Oatis said. The idea is that children with ADHD feel less restless and more focused after they expend some energy, Oatis said. However, Oatis noted that this isn't the case for all children — some kids' energy levels are ramped up after exercise, and they can't settle back down, he said.

Exercise and ADHD medications act on the brain in very similar ways, said Thomas Lenz, an associate pharmacy professor at Creighton University in Omaha, Neb. Both are thought to increase levels of brain chemicals called dopamine and norepinephrine, which help people think, focus and control their actions, Lenz said. An imbalance of these chemicals is thought to contribute to ADHD symptoms, Lenz said.

Researchers have just begun to study exercise as a potential treatment for ADHD.

Recently, Betsy Hoza, a psychology professor at the University of Vermont, and colleagues studied 17 children with ADHD, ages 5 to 8. The kids participated in 30 minutes of moderate-to-vigorous exercise, such as playing tag, before school. After eight weeks, children showed improvements in impulsivity and aggression, and were less likely to interrupt others, Hoza said. In addition, about two-thirds of parents and teachers said the children had improved on the whole after the program.

And David Bucci, an associate professor at Dartmouth College in Hanover, N.H., has shown that rats with a condition similar to ADHD that are allowed to exercise improve in their ability to ignore distracting stimuli, compared with rats that don't exercise.

However, much remains unknown. Studies have not compared exercise with ADHD medications to see if one is more effective than the other, or if the two in combination have an additive benefit, Hoza said. In addition, there may be sex differences in children's responses, which researchers should explore, she said.

Take away recess?

It's a common scenario for children with ADHD to have recess taken away as punishment for acting out in class, said Ruth Hughes, clinical psychologist and CEO of Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD), who often hears from parents about the issue. (CHADD is an ADHD support and advocacy organization.)

"It's very frustrating for parents," Hughes said. "The need for that physical activity is important for these kids. They would behave better if they had a chance to be running around in recess," she said. Lenz likened taking away recess from kids with ADHD to taking away food from a person with low blood sugar who has become irritable. The food, just like the recess, is what is needed to improve symptoms."You're actually just pulling away the treatment they need to make that behavior become more in line," Lenz said.

However, Oatis, the child psychiatrist from New York, said, for some children, taking away recess might motivate kids to change their behavior. And because children with ADHD can have other mental health issues, including anxiety, bad behavior in class may not necessarily be a result of their ADHD. "[It's] not a one-size-fits-all," Oatis said. One of the best ways to help kids with ADHD behave better is to recognize and reward good behavior, Hughes said. "Find your kid doing something right, and make an example of it," she said.

Pass it on: Preliminary work suggests exercise improves symptoms of ADHD. In general, teachers should not take away recess from children with ADHD because the kids need it, experts say.

Follow MyHealthNewsDaily staff writer Rachael Rettner on Twitter @RachaelRettner. Find us on Facebook.