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.

How to Make ADHD worse

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.

Book Review

TransformingADHD-MECH.inddI found two reviews of the book I co-authored. The first one is below, which I posted before. It’s so interesting to find reviews instead of having reviewers let you know of them. Never would have known except for a search for something related to ADHD that led to this review awhile back and the other a few weeks ago.

Book Review:

Transforming ADHD

ADHD is not as it sounds — an attention deficit disorder.

According to the authors of Transforming ADHD: Simple, Effective Attention & Action Regulation Skills To Help You Focus & Succeed, Greg Crosby, MA, LPC, and Tonya K. Lippert, PhD, ADHD is a difficulty regulating and adjusting attention to fit the situation you are in.

Guided by the interdisciplinary approach known as interpersonal neurobiology, Crosby and Lippert show that ADHD is about much more than simply learning to pay attention. It is about successfully navigating and recognizing the external and internal environments that influence attention.

“The biggest confusion about ADHD seems to stem from its reference to a ‘deficit.’ As ADHD scholar Hallowell and Ratey (2005) said to refer to an attention deficit when speaking of the experience of ADHD ‘completely misses the point’,” write Crosby and Lippert.

According to the authors, attention is biased — that is, it moves toward some things and away from others. For those with ADHD, it’s not that attention itself but the flexibility or control of attention that is lacking. The result of this low attention regulation, is not just over-focusing and under-focusing; it also effects how we sustain effort and manage emotions.

One biochemical reason people with ADHD may have difficulty paying attention to what is not exciting is because they have lower levels of dopamine. Low dopamine function in turn leads to behaviors that seek to compensate for dopamine deficiency.

Crosby and Lippert offer helpful tips for those with ADHD to learn to place their attention where they want. Learning what they call the four S’s of attention – starting, sustaining, stopping, and shifting – can be helpful. Next, by paying attention to what activities attract and detract attention, and pairing activities of low interest with those of high interest, those with ADHD can practice sustaining attention when it might otherwise wander.

A person’s environment can also have a significant impact on his or her ability to pay attention, according to the authors. They write that part of becoming successful with ADHD involves designing your environment for optimal attention and action regulation.

“When it comes to long-term goals, (designing your exterior environment to work with your interior environment) means introducing representations of your desired future into your present by, for example, taping pictures of your desired home on your computer screen if your impulsive purchases occur online,” write Crosby and Lippert.

They also offer some other examples of environmental design such as closing yourself into a room where you are less accessible to the dog, wearing headphones, working away from home or taping an assignment list to the side of your computer monitor.

Another practice, which Crosby and Lippert call Introduce Results of Tomorrow Today (IRTT) helps those with ADHD overcome urges that draw attention away from the long term results they want.

Crosby and Lippert tell the story of Zelda, who had tried and failed to quit cigarettes many times. It wasn’t until she made a pact with a close friend that if she smoked she’d have to give $5000 to the KKK that Zelda was able to quite for good. This practice is a powerful way to maintain personal accountability, and also to learn that with a little effort, it is possible to design an environment that improves attention and action regulation.

Those with ADHD can also adopt healthy behavior to change not just attention and action regulation, but the gene expression related to them – which is called epigenetics. Crosby and Lippert cite one study where exercise was shown to affect the gene expression within cells throughout the body – brain, heart, bone, muscle, mouth and fat – including directly altering fat formation. One helpful brain exercise the authors recommend: Replace multi-tasking with mindful-tasking.

Understanding relationships and the neurobiology between them is also important in managing ADHD. One important reason, the authors write, is that people with ADHD have higher rates of insecure attachment as children, which predisposes them to poor self-regulation.

While we can’t rewrite our childhoods, what we can do is better understand our attachment patterns (for which the authors offer a helpful quiz) and then shift to security through reflecting on our childhood and practicing mindfulness.

Learning to communicate more effectively is also fundamental for people with ADHD. The authors suggest practicing mindful listening, paraphrasing, and what they call “urge surfing” or learning to notice — but not respond to — urges within a conversation.

“When you surf an urge, including the urge to interrupt, you notice the urge without acting on it. It’s an action regulation skill — a way to stop an action,” they write.

Packed with useful and effective exercises, Transforming ADHD offers a fresh and insightful look at ADHD – and one that might just change your life.

Understanding ADHD

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.white-matter-fibers-hcp-dataset-red-corpus-callosum

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.

WHY?

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”)
    • Motivation
    • 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:

  1. 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
  2. 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).

Does ADHD Coaching Work?

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.

baseball-1536097_1920Second 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.

Medication Metaphor: Tunnels

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.led-lighting-1846929_1920

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.

Something Fishy

ADHD comes with omega-3 and omega-6 fatty acid deficiencies.

But upping your omega-3 and omega-6 fatty acids may have little effect on your ADHD symptoms.  What gives? Recent research reveals that it’s all about the ratio.

ADHD means low levels of both but overall higher levels of omega-6 to omega-3.

So now you may say, well, I just need to increase my omega-3 levels, right? Oh, how I wish it were so simple.  Researchers have tried this with only some succesfish-2207845_1920s.  A supplement heavier on the omega-3 than omega-6 side may be better, as indicated by a study that found benefit from giving participants an omega-3/6 supplement containing mostly EPA and DHA (omega-3), with only 60mg of LA (omega-6).

Still, it seems you’re best off knowing your ratio.  And then knowing how much omega-3 (EPA and DHA, specifically) and omega-6 (LA or AA, specifically) you need to optimize it.

See here.

Marijuana + ADHD = ?

My husband read my post below and, essentially, said, “Huh?” He suggested I keep it simple and get right to the answer to the question posed above.  Here it is:  A big-deal study showed that, contrary to expectations, marijuana (mj) had no effect on ADHD-related brain differences.  It had effects on the brain, of course, but these effects were separate from the effects of ADHD.  Details and other results, which are the ones of more interest to me, below.

An impressive group of scholars got together to examine the mj + ADHD question using 21- to 25-year-olds followed since elementary school as part of a large multi-site longitudinal study of ADHD known as MTA.  Comparing mj users (who used at least once/week) & non-users with & without ADHD, the group expected to find that mj intensifies ADHD-related brain alterations.  They, essentially, thought mj would add insult to injury (the injury being the decreased “integrity of functional networks” seen with ADHD).

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But they found no one-two punch.

ADHD was associated with decreased integrity of functional networks responsible for executive function and somatomotor control, but mj affected different functional networks.

Interesting to me is that one of the mj-affected networks was the default mode network, which, when you have ADHD, fails to cooperate with the task-positive network (for more on this).  It raises the question of whether mj has an indirect effect on ADHD symptoms, even if no direct one.  (The other mj-affected network was the lateral visual one.)

Also interesting to me is that ADHD was associated with INCREASED functional network integrity for two networks:  1) “stronger integration of right posterior parietal cortex” within the dorsal attention network & 2) “stronger integration of left inferior premotor region within the cingulo-opercular network.”  For 1, think spatial orientation toward what’s relevant and, for 2, think maintaining alertness.

The researchers described the first strengthening (1 above) as “maladaptive” because of its association with slower processing speed for those without ADHD.

But they saw the second (2 above) as helpful and suggest it “may reflect a compensatory adaptation – the strengthening of connections or recruitment of additional brain regions” for the sake of “maintaining normal cognitive performance.”

In almost a side-note kind of way, they note that their data support that ADHD-related differences seen within the somatomotor network “are a good candidate for imaging-based prediction of ADHD diagnosis,” as suggested by earlier research.  Wow.

Actual study here.

Show & Tell or Hide & Seek?

When one has a psychiatric diagnosis, questions about revelation come up.  A search for answers around revealing ADHD brings up onhide-seeke:  It depends.

What’s the context (work, school, home)? What’s the situation? Who are the parties involved (believers, non-believers, agnostics)? What are the stakes? Ultimately, what are the real pros and cons, short- and long-term? For ADHD, the only time I’ve seen the answer clearly lean toward “yes, tell” is at school for the purpose of working out accommodations.

At work, the answer may largely depend on the work culture.  How much and what kind of diversity surrounds you?

How I wish we had more research examining the reality of telling vs. staying quiet.

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