Mindfulness & Psychoeducation: “Everybody has won, and all must have prizes”?

The Dodo bird quote from Alice’s Adventures in Wonderland came to mind as I read the results of a recent study.  A randomised, controlled fMRI study of the effects of mindfulness and psychoeducation on the working memory of adults with ADHD found they both worked (for more on working memory, see What predicts ADHD symptom reduction over time?).  art-creative-flying-17679.jpg

After 8 wks, both interventions were found to increase working memory performance and to increase task-related right parietal lobe brain activity to a similar degree (study here).  Although I’d like to see the results for a third group who received neither intervention (to rule out any placebo effect), the good news is that, under both conditions, working memory increased.  What would be interesting to see next is what happens when we combine mindfulness and psychoeducation.

ADHD Effect on Divorce

In my last post about ADHD and Relationships, I mentioned The ADHD Effect on Marriage.  The author, Melissa Orlov, wrote the book after her husband with ADHD was unfaithful to her, and she began to examine the dynamics of their relationship.  Their relationship survived.  But, as Ms. Orlov points out, many others die.  She writes, “Research suggests that rates of marital dysfunction and divorce are about twice as high for people with ADHD as they are for people without it” (here).

And there are no books or research (that I can find) on the ADHD effect on divorce.  So how might ADHD come into play during a divorce? I hope there will be more research on this, but what I can say is that it makes sense to expect that the ADHD will show up.  The impulsivity, procrastination/lack of follow-through, aversion to low-interest/boring/tedious tasks, disorganization, etc. that the ADHD label describes will be present through a divorce just as through a marriage.

This likely will look different ways.  Impulsivity may show up as an unexpected announcement by the spouse with ADHD that s/he is leaving and wants a divorce (as one with ADHD might at work say, “I quit!” without having thought it all through).  Aversion to tedious tasks along with procrastination may show up as unfinished divorce paperwork and missed deadlines.  Disorganization may appear through lost paperwork or reliance on the spouse or others for reminders of events, etc.  I hope you get the idea.

Just as ADHD affects marriage (see ADHD and Relationships link at the top), it affects the end of a marriage, too.  Maybe, one day, we’ll know more about how, so that both parties involved know what to expect.

 

ADHD Elimination Diet

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).ADHD Elimination Diet

ADHD and Relationships

We know intimate relationships are hard.

When you have ADHD, they’re even harder.

How so?

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.

MIT & NYU Study: Your Input Gatekeeper may be to Blame for your “Distractibility”

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).

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Why?

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.

Social Skills Training and ADHD: What Gives it the Best Shot at Working?

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.

The Multiple Faces of ADHD

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.    grid-2111788_1920

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”).

 

 

What predicts ADHD symptom reduction over time?

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.

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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.

 

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