The U.S. has lagged behind Western Europe when it comes to examining the effects of diet on ADHD. Recently, however, U.S. researchers giving this another look agree that the evidence persistently indicates that some children with ADHD will benefit from dietary intervention. This list of such an intervention comes from Nigg and Holton (2014).
We know intimate relationships are hard.
When you have ADHD, they’re even harder.
Research suggests discontent and disloyalty among the reasons, but, hold off on nodding knowingly. The discontent and disloyalty may be on a different side than you imagine.
Research suggests that it’s the partner with ADHD who’s likely to be unhappy. Again, the one with ADHD (the opposite of what many might guess).
One study found that adults with ADHD had more negative perceptions of their relationships and families than their non-ADHD spouses did. These perceptions were also more negative than members of couples where neither had ADHD (see here).
Research also indicates that ADHD’s associated with a higher rate of infidelity. One study delved into this a little and found that “relational alternatives” were of “greater interest” when adults’ inattentive symptoms were high (see here). (This same study found that when either inattentive or hyperactive-impulsive symptoms were high, adults showed “less constructive responses” to a partner’s “bad behavior.”)
There’s more, but the picture painted is that relationships are harder. Namely, harder to sustain (versus start).
So does this mean couple therapy early on? Probably a good idea.
But choose carefully.
Some couple therapies depend on out-of-session assignments, and this could be a set up for failure.
Fights might become about who does the homework and how much of it.
Some couple therapies, however, focus on experiencing useful ways of relating during the session. When my group members ask me about couple therapy, this is the kind that I suggest. One of these is Psychobiological Approach to Couple Therapy (PACT).
There’s no research-tested ADHD-specific couple therapy of which I am aware. Instead, there are therapists who understand ADHD and offer couple therapy/counseling.
One of these is Melissa Orlov, the author of The ADHD Effect on Marriage. Her book describes common patterns of relating between partners when only one has ADHD, and she offers couple counseling through her website (here).
Whatever you choose, I wish you happiness.
Some people with ADHD have a Ptchd1 gene mutation (more often these are males). MIT and NYU scholars studied the Ptchd1 gene using mice and discovered that its loss may be the basis for symptoms of ADHD (as well as autism spectrum disorder and schizophrenia).
Because its loss most significantly affects the part of the brain responsible for keeping out sensory input that’s irrelevant. This part of the brain is the thalamic reticular nucleus (TRN).
According to one of the senior authors of the study, the TRN determines what input reaches the cortex, where thinking and planning occurs. “We receive all kinds of information from different sensory regions, and it all goes into the thalamus,” Feng says. “All this information has to be filtered. Not everything we sense goes through.”
Except when Ptchd1 mutations lead to TRN defects. Then, more of everything can go through, leading to, you guessed it, being distracted and overwhelmed.
Can you imagine no filter or one that loosely functions? For some, there’s no need to.
Last year, the prestigious science journal Nature published the study.
Find a summary of it here.
A short supply of self-restraint and other characteristics of ADHD can hurt relationships. Social skills training is one of the interventions used to prevent relationship damage and increase relationship repair. But does it work?
The results of a fresh-off-the-presses study on social skills training support Russell Barkley’s argument (Understanding ADHD) that skills presented and practiced away from real-life situations at the moment of trouble (e.g., as one is about to curse someone out) may be of little value.
Social skills training had “limited efficacy” according to Canadian researchers reviewing social skills training for kids and teens with ADHD (study here). Nonetheless, they identified “two promising” ways to increase its usefulness. First, offer “increased reinforcement and reminders of appropriate social behavior at the point of performance to youth with ADHD (e.g., in vivo, in real life peer situations as opposed to in the clinic).” Second, encourage “peers to be more socially accepting and inclusive of youth with ADHD.”
In other words, go to the youths’ environments to work on what’s happening there (looking at both their actions and the actions of others toward them).
Maybe some day, we’ll send kids to mental health clinics less often and start going to them, where the action is. And where science suggests we need to be.
When I run my ADHD group, I start off with an orientation that includes sharing how complex ADHD really is. And one of the things that surprises most group members is hearing that ADHD is actually seen as multiple conditions.
And I’m talking about something bigger than whether one’s diagnosed as having a “presentation” of ADHD as primarily inattentive, primarily hyperactive or a mix of both.
As Joel Nigg at OHSU puts it, ADHD appears to be an “umbrella diagnosis,” such as cancer once was (see here).
Cancer was thought to be a single disease, and we now know there are various types of cancer.
Researchers are currently trying to identify the various conditions found under the umbrella of “ADHD.” Each may have different genes, environmental causes, and clinical outcomes. They likely have different brain signatures (see Understanding ADHD for more on brain differences).
And they may have different optimal interventions.
This complicates research findings that include participants only because they share a diagnosis of ADHD. It might be like trying to understand cancer by averaging results across participants with skin cancer and liver cancer. Or perhaps it’s more analogous to averaging results across participants with different forms of skin cancer. It’s unclear.
Once the fog clears, I’m excited to know what we’ll learn about the different conditions all now diagnosed as simply ADHD (with three “presentations”).
In school-age children with ADHD, “visual spatial working memory maintenance” improvement predicts symptom improvement. See the Oregon Health and Science University (OHSU) study here.
Let’s unpack this.
“Visual spatial working memory maintenance” is about maintaining mental representations of the arrangement of what you’ve just seen as the next sights show up.
It’s what you have to do when you drive. You have to remember the positions of other cars and cyclists as you also attend to traffic lights and road signs. Imagine you come to a light where you want to turn right. To do this without an accident, you need to maintain the representation of the cyclist who was riding on your right side seconds before.
Air traffic controllers and pilots require especially good visual spatial working memory maintenance (for a brief, clear description of visual working memory from the University of Michigan, go here).
Now, hold on to this idea as we look at the OHSU study.
What the OHSU researchers found is that the children of their study who showed some ADHD symptom “recovery” or “remission” were the ones whose visual working memory maintenance improved as they developed.
It raises interesting questions, including whether to focus attention on developing this cognitive ability to reduce ADHD symptoms and whether a third factor contributes to both visual working memory maintenance improvement and ADHD symptom reduction. Of note, the researchers examined how two other cognitive processes changed over time. These processes were response inhibition (self-restraint, essentially) and delayed reward discounting (depreciating the value of a non-immediate reward). Their changes were unrelated to symptom reduction.
When you have ADHD, here’s your recipe for disaster: Mix sleep deprivation with carnival food. Deep fry.
Hold the physical exercise and Omega-3s.
No one says, “I want to be my worse self.” Yet many of us are doing exactly what we need to get us there or keep us there.
When you have ADHD, sleep deprivation makes your symptoms worse, carnival-like food makes your symptoms (particularly forgetfulness) worse and lack of physical exercise and Omega-3s keeps them from getting better.
If you want to give yourself the best chance at optimal brain functioning, here’s the winning combination: sleep enough, eat healthy food (including Omega-3s), and exercise regularly. This is true for all us but is essential when you have ADHD.
Consider that chronic sleep deprivation looks like ADHD. Imagine what happens when you combine them. Check out recent research on ADHD and circadian rhythms here.
Omega-3s matter so much, there’s even an Omega-3 prescription for ADHD called Vayarin. See specifics on the Omega-3 and ADHD connection here: Something Fishy.
For a recent review and meta-analysis on use of Omega-3s for ADHD, go here.
As for exercise, namely cardio exercise, check out this recent review.
Try the winning combination for even just one week and see what you notice. I bet your brain will thank you.
I found a review of the book I co-authored here.
Per Russell Barkley (RB), ADHD guru (i.e., scholar and scientist):
ADHD is a disorder of self-regulation that can also be described as a “disorder of age-inappropriate behavior” that looks like inattention and lack of inhibition.
Though I want to clarify that the inattention depends on what you are doing; another guru of ADHD, Thomas Brown, says the “central mystery” of ADHD is that those with it can pay attention to some things and seem incapable of paying attention to other things.
But back to RB and ADHD as a disorder of self-regulation.
RB defines self-regulation as “self-directed action intended to alter subsequent behavior so as to change the probability of a future event or consequence” (to improve your longer-term welfare).
For example, say you have a problem with money and keep getting into debt by living off credit. You want to pay off your debt (self-directed action) to be able to cancel your credit card and limit spending (subsequent behavior) to reduce the chance you’ll get into debt again (change the probability of a future event).
Where does ADHD fit? With ADHD one has the intention to alter behavior (e.g, limit spending) to change the future (e.g., live debt-free) but struggles with the self-directed action (e.g., paying off debt) required for this.
Barkley says it’s a disorder where knowledge fails to guide performance. You know what to do but struggle to do it.
RB highlights that ADHD brains show prefrontal cortical network differences (these networks are responsible for Executive Functioning and self-regulation is the core of Executive Functioning). Here is where the differences exist and what comes into play:
- Frontal-striatal circuit, the “what” network (what we think influences what we do) Here lives…
- Freedom from distraction
- Working memory
- Organization and planning
- Frontal-cerebellar circuit, the “when” network (timing of thought, behavior)
- With ADHD, there’s “time blindness,” and
- A “myopia to the future”
- Frontal-limbic circuit, the “why” network. Here lives…
- The decision-maker of the brain (if you have multiple goals, which do you pursue? this circuit, as RB puts it, “makes the final call”)
- Emotional control or dyscontrol
These network differences show up as self-regulation differences that encompass
Self-directed action, Self-awareness, Self-motivation, Self-directed attention, Self-restraint, Self-directed sensing, Self-directed emotions, and Self-directed play.
WHAT TO DO?
Outsource these brain functions.
RB calls this externalizing the brain functions where there are deficits. For example, he says, use “artificial prosthetic cues to substitute for working memory deficits.”
Ideally, this is what ADHD coaches will help you do (for more on this, see Does ADHD Coaching Work?)
Here are some pointers for externalization:
- Per RB, the externalization of brain functions is needed at the point of performance and within your natural setting (e.g., if you struggle to write a report at work, you need external factors to guide your attention at work at the time you need to write); and
- To externalize, change your environment (think planners, alarms, points, signs).
Replenish your self-regulation (think self-control) resource pool. It’s depleted by simple use as well as stress, drug abuse, illness. Replenish through
- Rewards, positive emotions
- Positive self-talk
- 10 minute breaks between tasks requiring self-control
- 3 minutes of relaxation or meditation
- Glucose ingestion (Gatorade, lemonade, sugar water) while working on tasks requiring self-control
- Daily physical exercise
Also, break lengthy or complicated tasks down. One of my favorite reminders of this, though I really like elephants, is, “How do you eat an elephant?”
Answer: one bite at a time.
RB adds that accommodations or scaffolding and the compassion and willingness of others to make accommodations are “vital” to your self-regulation effectiveness.
Sources: Two talks by Russell Barkley on ADHD, one from 2013 entitled, “The Importance of Emotion in Understanding and Managing ADHD (here) and one from 2012 entitled, “ADHD, Self-Regulation, and Executive Functioning: Theory and Implications for Management” (the part of it I used is here).