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.

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.

 

Fidgeting: Spin vs. Science

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.  ball-1023984_1920

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.  (Real added for my teenage son, who wanted me to buy a fidget spinner at the carnival.)

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.

For my fellow writers

background-1986075_1920Kristen Lamb’s posts offer clear guidance to writers trying to figure out how to use social media effectively.  Plus she offers opportunities for free critiques.

Here.

 

Medicating Children

As the mother of a teenager with ADHD soon entering high school, I want to know the pros and cons of medication.  If you are a parenpill-1254786t reading this, you likely do, too.  And I will admit, I’m torn.

The research seems too unfinished for me to rely on it as much as I might like.

Consider that over 40 scholars from the UK, USA, Denmark, Italy, Germany, Switzerland and Australia will be reviewing  various “pharmacological interventions” to rank how well they work and their “tolerability profiles,” looking at these things for children, teens and adults.  The scholars note that “there is a lack of up-to-date and comprehensive evidence on how available ADHD drugs compare and rank” with regard to their ability to deliver desired results and to do so with tolerable side effects.  See more here.

But do we keep waiting for what seem to be more definitive answers? At what cost?

Consider this…recent research suggests that school could be a more rewarding experience for children and teens with ADHD who use medication for their symptoms.

Examining about 10, 0000 12-year-old twins, some who’d been followed since 7 years of age, researchers found that medication-free children with ADHD showed lower educational achievement than children with ADHD using methylphenidate (Ritalin, Concerta).  And the medicated children showed lower educational achievement than children without ADHD.  That is, ADHD appeared to lead to lower educational achievement but especially when unmedicated.  Plus ADHD symptoms predicted a negative educational trajectory from 14 to 16 years of age.  See study here.

Where does this leave us parents wanting our children to have the best chance at achieving what deep down really matters to them?

It leaves me leaning toward the test of experience.  I am willing to let my teen, when wishing to do so, swallow a pill as I (figuratively) swallow mine.

Meanwhile, I will keep combing the research….

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.

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