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.

 

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.  Combine them and you have more extreme ADHD.  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.  See the latest review and meta-analysis on use of Omega-3s for ADHD 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.  Your brain will thank you.

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).

Here’s a translation.  Let’s 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).

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.

Go, Go, Go and Slow, Slow, Slow?

A few years ago, researchers at MIT showed that adults with ADHD have two brain networks that compete for their attention instead of “playing nice,” as they do for adults without ADHD.  These networks are essentially a go, go, go one that lights up when we have a task to do (“task-positive network”) and a slow, slow, slow one that activates when we have nothing to do and can daydream or let our minds wander (“defccv-jp-ngault mode network”).  Without ADHD, when one network has its turn to be active, the other one turns down…they cooperate.  With ADHD, they appear to often be active at the same time.  Imagine what that’s like.  If you have ADHD, you already know.  If only others could experience your brain to know what it’s like….

See for yourself.