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).
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.
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.
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).
There are three things to know about coaching.
First, if you read Russell Barkley, scholar and researcher on ADHD, the idea of coaching makes sense. Barkley argues that what you need with ADHD is something external to guide your behavior right at the moment that the behavior’s needed.
Imagine you need to study for a job interview you have the next day and you are about to surf online. Right at that moment, with your fingers poised to tap the keyboard, you need something external to stop you (or to guide you toward stopping). This something will then need to remind you of your interview and reinforce studying over surfing. This is ideally what a coach does…guides your behavior at the moment it most matters, which is when you play the game…of job-seeking or whatever it is.
A coach guides your action as it is happening.
Second thing to know is that the reality of ADHD coaching appears to approximate this at best.
You can get a coach working with you multiple times a week and the work can center around where you most struggle. But, at best, it’s like having a coach available by phone some of the times you play the game. It’s just unrealistic to have the ideal kind of coaching…unless you’re wealthy and want to pay someone to be with you, guiding your behavior at various points of the day, as needed. Perhaps one day, we’ll have robots do this for us, should we choose…hmm.
The third thing to know is that the research on what makes for an effective ADHD coach is sorely lacking. Only a few exploratory kind of studies, primarily focused on college students, seem to look at this, with the recommendation for future larger scale, more rigorous research. So while you can find folks credentialed to be an ADHD coach, there’s no real research showing coaching clearly works and under what circumstances.
This leaves us all figuring out for ourselves, if we pursue coaching, whether it’s working. Actually, even if research clearly said it’s likely to be effective for most, we’d still have to figure out whether it was effective for us.
My local Memorial weekend festival had fidget spinners for sale, ranging from $12 to over $20, advertised to help with ADHD, anxiety and more. It left me wondering what we know about their effectiveness. It turns out very little. On my go-to research source, pubmed, I could find no single study on fidget spinners or their kin (cubes, etc.). But NPR published two articles exactly two years apart, one on fidget spinners and one on fidgeting.
On May 14, 2017, NPR published an article on fidget spinners.
Essentially, the article quotes a Duke professor suggesting to stick with what’s known to work.
The professor points out that there’s no evidence that fidget spinners work. Though it’s said, what seems perhaps buried or likely to be easily overlooked is that the reason there’s no evidence is that there’s actually no trustworthy research on them. See here.
Meanwhile, two years earlier, on May 14, 2015, NPR published an article describing a small study that shows that children with ADHD performed better on tasks requiring concentration when they fidgeted. (The children worked while on a swivel chair that they, of course, spun and moved.)
Overall, more movement meant better performance for these kids (kids without ADHD, on the other hand, did worse with movement). The lead author, however, cautioned against both too little and too much movement. See here.
Perhaps fidget spinners would fall into too much movement or the wrong kind (attracting eyes as well as fingers), but it’d be interesting to see some real research on them.
Imagine yourself inside a room full of tunnels.
You can look down any of them. Maybe you like this sense of freedom. Maybe you also find it distracting.
But now you have your ADHD medication.
Walls go up over all the tunnels except the one you’re facing.
When you turn your head, the wall for the last tunnel you faced slides up. The wall for the tunnel you now face slides down.
You can switch which tunnel you look down, but you can see only one tunnel at a time.
You can also see the tunnels with obstacles.
On medication, you find it’s easier to enter these previously-avoided tunnels (maybe because the more appealing tunnels have their walls up, keeping their temptations out of sight).
And once you enter one of these “harder” tunnels, the medication helps you stay there.
This is part of the experience of ADHD medication for many of those with ADHD, on the one that’s working for them.