Stepping over dollars to pick up pennies: What works for optimal cognitive functioning

Hot news out of Israel (Bar Ilan University) and Los Angeles (UCLA):  There is a way to increase cognitive functioning among children with ADHD that is FREE and leads to BIGGER change than other non-chemical interventions.

What is this magic they speak of? Exercise.

Researchers searched through studies published between 1980 and 2017 on various non-pharmacological interventions for cognitive functions among children with ADHD and narrowed these down to the most trustworthy studies. One of the requirements the researchers had was that the study included an objective measure of cognitive functions.

They examined the effects of several non-pharmacological interventions–neurofeedback, cognitive-behavioral therapy, cognitive training, and physical exercises (aerobic)–and found all the interventions associated with desired changes. Physical exercise, however, rose to the top with the largest average effect size. Granted 18 studies across four interventions is small; however, the results are consistent with tons of research on the association between exercise and optimal physical, emotional and cognitive functioning.

The link to the study is https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0022395619306168?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0022395619306168%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.ncbi.nlm.nih.gov%2Fpubmed%2F31629998

So this is what my title is about…we often step over the dollars of optimal functioning and well-being to pick up pennies. The dollars are regular physical exercise (aerobic), enough sleep, and healthy eating. The pennies are the skills, strategies, games we may play with ourselves (fun or otherwise) that we often seek instead. If we have the dollars, these pennies become dollars; however, without the dollars they lose value.

My two cents. Or dollars. : )   

Discovered blog post on my ADHD book

Recently found this 2017 blog post on the ADHD book I co-authored while searching for resources on ADHD-friendly environments. It’s like walking into an independent book store to pick up a book and having the bookstore owner suggest yours to you. Or so I imagine. Gratifying. : )

It’s at http://psyinfo3.blogspot.com/2017/05/have-adhd-designing-environment-that.html.

But to make it easy, it’s also here:

Monday, 22 May 2017

Have ADHD? Designing an Environment That Ignites Your Attention

When you have ADHD, it can feel like anything and everything hampers your focus. Everything is big and blinding. Everything is distracting. The TV. The slightest sound. The silence. Social media. Your coworkers. Your computer. Your dog.

It can feel like anything and everything is messing with your ability to get stuff done, whether you’re at work, at school or at home. And you need to get this stuff done. Which only adds to your already through-the-roof frustration.

In their book Transforming ADHD: Simple, Effective Attention and Action Regulation Skills to Help You Focus and Succeed, Greg Crosby, MA, LPC, and Tonya K. Lippert, Ph.D, share helpful tips for creating an attention-enhancing environment. They suggest thinking of yourself as an interior designer: You’re designing an optimal exterior environment that works with your interior. Which means that it’s very important to know yourself, to know your inner workings. It’s very important to know what distracts you and derails you. It’s very important to know what bores you and what excites you.

In order to enhance your attention, according to Crosby and Lippert, “your environment must contain cues, prompts, and reminders that guide your attention to where you need it and exclude distractions that tempt your attention away.” The authors suggest thinking of cues, prompts and reminders as guiding lights, “the reliable lights of lighthouses”; and thinking of distractions as flashing lights, “the blinking bright lights of a big city billboard.”

Crosby and Lippert share an excellent exercise for finding what works for you. It includes these steps:

  1. Pick an environment, such as work, school or home. Think about what you have a hard time doing there. For instance, you might struggle with writing at home. Next jot down the various flashing lights, the things that pull your attention away from that task. This might be anything from requests from your family to do chores to alerts on your phone to websites on your computer.
  2. For the same environment, list your guiding lights, the things that do or could guide your attention toward that task. This might be anything from posting a task list to using a white noise machine.
  3. Finally, identify how you can replace your flashing lights with guiding lights. For instance, you might work at a library, where you’re less available to your relatives. You might wear headphones while listening to classical music. You might tape a Post-It note on the side of your laptop with the three main steps you need to take to write your article. You might use an internet-blocking program. You might set an alarm to go off randomly, which prompts you to ask: “Am I on task?” (One example is the free Android app StayOnTask.) You might post visiting hours on your office door or a sign that says “crunch time.” You might use cues like checking your planner every morning while sipping coffee; and dedicating the same desk for solely studying and schoolwork. As the authors write, “our brains are association machines…Routines and rituals are brain reminders.”

Here’s a real-life example: Lippert’s husband, Sergio, has ADHD and was attending an MBA program. Even though he started with high test scores, by the end of his second semester, he was close to academic probation. His entire environment seemed packed with flashing lights: During class, he’d read news websites and articles on his laptop. When he’d lose his internet connection, he’d focus on getting it back. When a class didn’t have internet access, he’d play games on his phone. He’d also do work for his part-time job or study for another class. Every time he’d get distracted, he told himself this would be the last time. But it wasn’t.

What worked for Sergio? When he attended his class lectures, he’d leave his computer, phone, work for his part-time job and other class materials at home or in a school locker. He also got honest with himself about his distractions and tomorrow being different. As Crosby and Lippert write, “He had to acknowledge that if he brought his distractions with him, each day would be like the previous 180 days he thought would be different.”

Sergio’s guiding light was a paper planner that he color-coded. Each class had its own color, so it was easy to see what classes he was attending in a given day and what materials he needed to bring. He also set alarms that signaled when to start homework and when to stop.

When it’s time for you to get to work, you might feel like you have a thousand bells going off in your brain. And you might feel like you’ll never get anything accomplished. However, you can use your environment to facilitate your focus, and support you. Experiment with different tools and techniques, and you’ll absolutely find what works well for you.

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The Future and Finances

The “golden years.”

With ADHD, you’re likely to give up a bigger reward for a smaller one if the smaller one comes NOW and the bigger one LATER. NOW wins time after time. Why? Partly because our future selves are strangers to most of us, and we feel little for them. What do we owe this stranger? For many of us it turns out, “Nothing.” We see this when it comes to money. Specifically, saving it.

I know this can be a bleak subject, but part of the remedy is facing reality. Let’s start with the state of the union on this. I, for one, was blown away.

In the U. S., post-retirement we live 17-20 years on average, and over 50% of us have less than $25,000 saved for these years. This means, apart from social security, over half of us have less than $123/month to live out our “golden years.” More like copper years, right? See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764505/.

Sure, for some, this is a continuation of pre-retirement poverty (it’s hard to save living hand to mouth), but for many this goes back to the present winning over the future. At a great cost.

With ADHD, the cost is likely to be higher. Recent research examining the financial status of adults with and without ADHD (https://www.ncbi.nlm.nih.gov/pubmed/31343233) went beyond confirming prior research noting bad financial news, on average, for those with ADHD. The researchers looked at some of the reasons why this is the case. That is, why less income, less savings, and more debt?

Here’s what they found. Compared to adults without ADHD, adults with it reported more often buying on impulse and more often using “an avoidant or spontaneous decision-making style” (e.g., I will avoid looking at my bank account before buying). On top of this, adults with ADHD scored lower when given measures of financial competence and capacity (e.g., being able to evaluate financial problems and to understand bank statements) . Yikes!

But there is good news is. If you struggle with money, things can be better.

Here are some antidotes to an impoverished future (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764505/):

1) Episodic Future Thinking, or EFT (https://tonyalippert.blog/2019/03/19/what-gets-us-to-change/),

2) Focus on the “cool” versus the “hot” aspects of what you want NOW (e.g., on the color and shape of a cinnamon roll versus the anticipated taste),

3) Sinking your ships by giving yourself no way out (or in) by, for example, leaving money at home when you are out and about apart from what’s needed–no credit cards, Apple Pay, etc.–on hand)–see https://www.youtube.com/watch?v=PPQhj6ktYSo starting where Dan Ariely talks about self-control contracts for more–, and

4) Connect to your future self (https://ggia.berkeley.edu/practice/best_possible_self).

For more examples on the above antidotes, go to https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764505/.

Here’s a toast to your future self! And to your present one who cares.

Adults with ADHD: You are less and less alone.

Hot off the press: Adult ADHD appears to be on the rise. At least the diagnosis of it.

Scholars at Syracuse University compared the prevalence of ADHD among adults from the 2007 and 2012 U.S. National Health Interview Survey and found it jumped. From 3.41% to 4.25%, with the gap between women and men closing by almost a third (31.1%), given the increased prevalence among women of all ages.

I know, I said hot off the press, and we are talking about numbers from 2012. But the study just came out days ago, so it’s hot off the press.

To see the study, or at least the summary of it, here’s the link: https://www.ncbi.nlm.nih.gov/pubmed/31189421.

ABCs and 123s of ADHD

This is an overview of ADHD (Attention Deficit and Hyperactivity Disorder), primarily numbers and names.

123s…

What’s the prevalence? It’s estimated to be about 5-6% of the world population of children and 3-4% of the world population of adults (using DSM-IV criteria, DSM-5 criteria increase the estimates slightly). It’s estimated that about 1-2% of children without childhood ADHD may meet criteria for ADHD after 12 years of age. This suggests that about half of the population of adults with ADHD develop it “late.”

123s and ABCs…

When did the first formal description of ADHD appear, albeit under a different name? One best guess is 1798 by Alexander Crichton. Dr. Faraone at SUNY Upstate Medical University suggests it goes back even farther…to Weikard and a 1775 German medical textbook. See https://adhdinadults.com/a-brief-history-of-adhd/

Fast forward to 1968, when it became an official diagnosis here (the U.S.), being added to the DSM-II, clinicians’ reference for diagnoses of mental disorders. It was called Hyperkinetic Disorder of Childhood. The name changed over the years but the essence of the disorder as one of childhood hyperactivity, impulsivity and wayward attention remained.

In 1980, the DSM-III came out and added specifics to the diagnosis, such as indicating that symptoms had to appear before 7 years of age. There was no research showing that 7 was a magic number; only enough clinicians believing this made sense.

In 1994, the DSM-IV softened the age of onset “rules” requiring only some of the symptoms to appear before age 7. Subtypes were also added. It is during the 1990s that Adult ADHD becomes recognized as a valid disorder.

In 2013, the DSM-5 changed the requirement that symptoms be present before age 7 to before age 12.

WHAT IS IT? ADHD is a self-regulation disorder. Regulation is, essentially, flexible self-control described by 4 Ss: starting, sustaining, stopping and switching attention, action, motivation, and more. It is understood as a neurodevelopmental disorder, which is to say it is a way that the brain (“neuro”) develops that affects, more than anything, self-regulation, essentially, decreasing it compared to what’s seen for those without ADHD. And here’s the disorder part: It is associated with distress and/or dysfunction, including poorer results at school and work, higher levels of health-risking behaviors, and being less satisfied with oneself.

What Causes It? It’s believed to result from certain combinations of genes and environmental factors. Genes are believed to be necessary and… insufficient. So are environmental factors.

Sources:

https://www.ncbi.nlm.nih.gov/pubmed/?term=annual+research+review+does+late-onset+attention-deficit

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000907/

What gets us to change?

A 2018 review out of the Annals of the New York Academy of Sciences asks how we can use what we know about the brain to influence our behavior (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175225/).

Three essential factors surfaced.

  1. Reward valuation. Where does your brain land on the pros and cons of a behavior (e.g., eating a donut)? Sometimes where our brains land gets us into trouble (eat it! eat two!). Research suggests that for less immediate rewards, our brains need to see the personal relevance of behaviors. So what if it’s “good” to exercise, what’s it matter to me and mine? Messages about such things as exercise and healthy eating carry more weight with us when we connect them to our values. Research shows that when people reflect on core values–what deep down really matters to them–and then get messages about healthy behaviors, they will more often practice them than people who receive the same messages without reflecting on their values.
  2. Delay discounting. Delay discounting refers to our tendency to discount the value of a reward the longer we have to wait for it. So we often choose smaller rewards with immediate gratification over bigger ones with delayed gratification. Eclairs over exercise. Research suggests a solution (if you want one): episodic future thinking (EFT). EFT is the capacity to imagine or simulate your future experiences. It works like this: You have a talk coming up tomorrow morning, and you intended to be well-rested for it. But you are tempted to watch another episode on Netflix tonight. You give EFT a try: You imagine you skip the show for sleep. And then imagine how the next morning plays out. You imagine it as vividly as possible, how you’re feeling, what you see from your audience. You can also imagine sacrificing sleep for the show and imagine how your morning plays out, as vividly as possible. EFT increases the chances we will remember our intentions and then act on them.
  3. Self-regulation, the capacity to direct different parts of ourselves (thoughts, urges, cravings, emotions, actions) toward achieving future-oriented goals. In the article, one means of increasing self-regulation that the authors discuss is physical exercise. In https://tonyalippert.blog/2017/08/01/understanding-adhd/, you can find several ways to increase self-regulation, with or without ADHD.

There you have it. Want to change a behavior? Play with reward valuation, delay discounting, and self-regulation. See what you notice. Is the review out of the Annals of the New York Academy of Sciences right?

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