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’s 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 study.

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. : )   

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.

ADHD and Attentional Interference from Competing Brain Networks

As prior research out of MIT (Go, Go, Go and Slow, Slow, Slow?), research out of Oregon Health Sciences University (OHSU) recently examined the coordination between two brain networks:  the task positive network(s) and the default mode network. These networks have largely opposite functions. In the first–task positive network(s)–there’s increased activity when we have a particular task that demands focus, letting us start and sustain attention on the task. In the second–the default mode network–there’s increased activity when we have no particular task to do. In adults without ADHD, per the MIT research, these two networks cooperate:  When it’s time for one to get on stage, the other fades into the background. In adults with ADHD, these networks are uncooperative and can compete for attention at the same time.

vibrations-545138_1920In kids with ADHD, according to the results of the OHSU study (here), we see the same lack of coordination/cooperation between the networks as compared to children without ADHD, with this lack of coordination between networks increasing with age.

The result? Mixed signals. Attentional interference. Or, as the researchers put it, decreased attentional control. A reminder that behavior reflects brain activity, coordinated or otherwise.

Of interest, the OHSU researchers found that the brains of female children overall, with or without ADHD, showed more coordination between the opposing networks than the brains of male children.

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”).

 

 

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