Research Review: Past, Present, and Future of ADHD

Below are highlights of an Oct. 2022 review: https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13696.

ADHD Over Time

For most individuals diagnosed with ADHD, symptoms first appear during childhood even if the diagnosis comes later.

For most, disappearance of symptoms for good is rare. It seems to persist though it may at various times appear to fade (i.e., you may no longer meet criteria for the diagnosis at various times over the course of your life).

What factors determine persistence are still unclear.

Current debate includes whether ADHD includes a late-onset variant. Estimates vary widely regarding how many people first present with ADHD as adults: from 30% to 87% (see how widely they vary?).

Still, it’s become clear that fluctuating symptoms and impairment are common. Moreover, there’s a lot of heterogeneity when it comes to ADHD (think of variants having overlap but also differences when it comes to how they present, their particular combination of causal factors, their courses/trajectories, and their outcomes).

Finally, we still know relatively little about later-life ADHD.

Co-travelers

Emotion Regulation Difficulties (ERD), as the researchers call them, are estimated to affect 40-50% of children with ADHD, presenting as being susceptible to anger/irritability/low frustration tolerance. One question then is whether it’s part of a particular ADHD variant/profile of ADHD.

Sleep Difficulties commonly travel with ADHD at ALL AGES. Kids, teens, and adults with ADHD have higher odds of getting too little or poorer quality of sleep compared to their peers. Some researchers are exploring the causal role that inadequate/poor sleep may play.

Now this may be surprising but the authors note that for females there are no increased odds of anxiety or depression, as females already have higher rates of anxiety and depression than males even without ADHD being added to the mix.

Living with ADHD

To be continued . . .

For an ADHD Group, from self-regulation to procrastination

The Nature of Willpower (aka Self-Regulation aka being the Captain of your Ship)

(I hate the title but appreciate the content):

If you want to get it straight from the source:

If you want a condensed version:

Episodic Future Thinking (to remember intentions and follow through with them):

Research Study on Mechs & Fxns: https://pubmed.ncbi.nlm.nih.gov/29130061/

Scholarly Explanation: http://www.its.caltech.edu/~squartz/files/atance.pdf

A quick, accurate explanation: https://twitter.com/ParnianRafei/status/1530224357087539202

Understanding, and Responding to, Procrastination

Additional Resources (for all three posts on an ADHD group)

https://www.focusmate.com/ (for dopaminizing/reducing friction)

https://askjan.org/index.cfm (for accommodations, free consults)

https://selfcontrolapp.com/ (for sinking your ships/designing a “no-temptation button”)

https://freedom.to/ (ditto)

https://students.dartmouth.edu/wellness-center/wellness-mindfulness/mindfulness-meditation/mindfulness-sessions-drop-ins-and-classes

https://www.uclahealth.org/marc/audio

For an ADHD Group, from environment to self

Changing Self by Changing the Environment (for Fuel & Friction)

Extreme Friction/Designing an (Effective) No-Temptation Button (second part)

Self-Compassion

Research Study on ADHD and Self-Compassion

Ted Talk on Mindfulness, Shame, Self-Compassion:

Video: https://greatergood.berkeley.edu/video/item/how_to_be_kinder_to_yourself

Urge Surfing (useful for procrastination and impulsiveness)

Article: https://www.dartmouth-hitchcock.org/sites/default/files/2021-03/urge-surfing.pdf

Video: Kelly McGonigal’s Google Talk (see last intervention, where people hold their breath)

https://www.youtube.com/watch?v=V5BXuZL1HAg

For an ADHD group, from overview to optimization

Understanding ADHD

Video: What is ADHD? https://www.understood.org/en/articles/what-is-adhd

Videos: https://howtoadhd.com/

Cutting-Edge Research Sites on ADHD:

https://www.ohsu.edu/school-of-medicine/center-adhd-research

https://mcgovern.mit.edu/research-areas/adhd/

Cool Comics: https://www.adhddd.com/comics/

Multitasking


Research Study on Media-multitasking and cognitive control across the lifespan: https://www.nature.com/articles/s41598-022-07777-1

From the study’s conclusion section:

“Collectively, the findings suggest that higher levels of media-multitasking are associated with better multitasking performance (as assessed in cognitive tests), but only for individuals aged ~ 7 to 29 years.”

“Interestingly, in our data the sign of the relationship between multitasking costs and multi-media use also changes with age from positive in young participants to negative in older participants, suggesting that the demographic composition of participant groups may have significantly influenced the pattern of results observed in previous studies.”

Dopaminizing

Book: THE WILLPOWER INSTINCT by Kelly McGonigal

Podcast:

Ted Talk (See First Part on Reward Substitution):

Optimal Brain Functioning, Setting Up for Effective Self-Regulation

Talks at Google (see first intervention)

Article: https://greatergood.berkeley.edu/article/item/what_is_the_best_diet_for_mental_health

Video (see the two on exercise): https://brainrules.net/video-tutorials/

ADHD & Romantic Relationships

Two well-circulated research studies came out relatively recently (2020, 2021) on ADHD & Romance.

First, 2020: Researchers looked at attachment styles & ADHD except, here, they looked at the non-ADHD partners of individuals with ADHD (74.2% with an official diagnosis). They wanted to know how the partner’s a) attachment style and b) ratings of their partner’s ADHD symptoms, together, influenced c) relationship quality.

What they found suggested that a partner’s high level of anxious attachment may make “the negative effect of ADHD symptoms on romantic relationship quality” worse. And, “Though insecure attachment styles are generally thought to have a negative impact on romantic relationships, avoidant attachment was generally associated with more positive outcomes….” Avoidant attachment refers to being an “Island” as couple therapist Stan Tatkin, Ph.D., describes it. Think of someone who likes you around sometimes but often at a distance. Dr. Tatkin describes anxious attachment as being a “Wave.” Think anxious about losing you but also doing things that might push you away.

As the researchers put it, “Individuals with an anxious attachment style experience heightened emotion during perceptions of abandonment (Dutton et al., 2014), frequently questioning the commitment of their partner (Bowlby, 1988).” On the other hand, “Individuals with an avoidant attachment style often seek to avoid conflict with their partner by withdrawing and becoming quiet and task-focused (Butzer & Campbell, 2008).” Why would avoidant partners possibly be a better match for individuals with ADHD than anxious ones? Consider that individuals with ADHD more often have such insecure attachment styles themselves. Good question. If you want to read how the researchers interpreted the results, you can get the study for free here https://scholarcommons.sc.edu/etd/4839/ (go to the conclusion section). Also remember this study looked at the ADHD partner’s perception of the relationship vs the perception of the person with ADHD. It’d be interesting to know much they line up.

Second, a 2021 study looked at the state of the literature on ADHD & romantic relationships to show what’s known and what remains unknown. The abstract is available here: https://pubmed.ncbi.nlm.nih.gov/33421168/. At this time, however, unless you have special access (as a student, for example), the article costs. A workaround is to look it up through the public library and see whether you can get a copy through ILL, for example. I will give you an overview of its content.

First, the researchers start with dating. There’s a gender difference that you may find interesting: “…young adult heterosexual men with ADHD appear to have more lifetime romantic partners than men without ADHD (Canu & Carlson, 2007), whereas young adult heterosexual women with ADHD reported having fewer lifetime romantic relationships than women without ADHD (Babinski, Pelham, Molina, Gnagy, et al., 2011).” They then delve into why this may be the case given other research findings.

Several studies suggest that as well as gender, one’s primary symptoms matter (inattentive, hyperactive/impulsive, or both). How they matter, though, depends on what you are looking at. So far, clinically significant inattentive symptoms, generally, stand out as the ones associated with lower levels of relationship satisfaction. So good news for those with other primary symptoms?

Well, it depends. Research coding how people actually behave within relationships overall suggests more conflict showing up for those with a combined presentation of ADHD (clinically significant levels of both inattentiveness and hyperactivity/impulsivity).

Next, the researchers turn to violence and sex. The research on violence is a bit complicated to describe briefly, and the researchers cite very few studies. So I’ll leave it out. Here’s what the researchers say about sexual activity after going through various studies: “Altogether, ADHD is a marker for adults prone to risky sexual behavior and unexpected consequences, but those with persistent symptoms and comorbid disruptive behavior problems are at greatest risk of both.”

What about marriage and divorce? It sounds bleak. I wish more researchers asked about some of the positives that may be present, so let me say this: research looks at groups, averages, frequencies, and the like. Often these frequencies are low but higher than they are for the comparison group (here, those without ADHD). So usually what you are getting with “more likely” and similar research language is a higher chance of something; however, you may still have a higher chance of the other possibility (e.g., it may be that one group has a 30% chance of something and another a 40% chance so overall even the group with a 40% chance has a 60% chance of the desired result). This said, here’s the researchers’ summary on marriage and divorce: “In sum, marriages including adults with ADHD are more likely to be unsatisfying, a burden for partners, and to end in divorce.” You see “more likely” and this can be scary but the next question is HOW much more likely? Five percent? Ten?

Finally, the researchers delve into the complexities of ADHD and how so much is still unknown. They discuss the focus on heterosexual relationships, for example. They, nonetheless, develop recommendations for therapists doing couple therapy where at least one partner has ADHD.

I hope this is of use to you.

Recent Resources for ADHD

Understanding ADHD

Brief, fun video on what it is that accurately reflects the latest and greatest understanding.

Getting what you want when you have it

Effective interventions and therapies This gets you to the blog of the American Professional Society of ADHD and Related Disorders, which was partly formed to spread the word about evidence-based practices.

Practices Christine Carter, who’s connected to the Greater Good Science Center at UC Berkeley, offers a free ebook on ways to play the short game to win the long game. Go back and click on Practices to get to her site and the ebook link.

Coaches We still need good research on ADHD coaches, but what research we now have suggests high satisfaction from those who use them. Thing is, they can cost many quite a bit. A coach through Edge, for example, costs $400 for an initial session and then $125/week (if interested, go back and click on Coaches).

More Click on More for two resources that I previously posted. They remain awesome.

Ugh! False Rumors about Fidget Spinners

I start with “ugh!” because I paid for the Special Edition of TIME today on THE SCIENCE OF LEARNING and opened it up by chance to an article with a picture of a child holding a fidget spinner with the caption, “Fidget spinners can help children with ADHD focus.” WT*? I thought. Is the rest of the magazine going to present false claims? I scoured through the one-page article looking for a research citation, wondering whether the latest research shows something different than earlier studies (Fidgeting: Spin vs. Science).

Well, the article had no research cited. So I pulled up pubmed.gov to check on the latest. I found a 2020 study. As prior research, it shows that fidget spinners DECREASE kids’ ability to focus (https://pubmed.ncbi.nlm.nih.gov/29676193/).

The FIU researchers found, “Children’s use of fidget spinners was associated with poorer attention across both phases of treatment.” They concluded, “Fidget spinners negatively influence young children with ADHD’s attentional functioning, even in the context of an evidence-based classroom intervention.”

A glance at other recent research revealed that there are now battery-powered fidget spinners that some kids are swallowing.

So I ended up learning something at least.

The Frontier of ADHD Interventions

In my last post, Let the Games Begin?, I shared the recently approved video game prescription for ADHD and this got me thinking about other interventions on the frontier… 

Trigeminal Nerve Stimulation. In the spring of 2019, the FDA approved TNS as a “treatment” for childhood ADHD based on research out of UCLA:  here.

The device the researchers used is called Monarch eTNS. It sends gentle electrical pulses to the trigeminal nerve, which then leads to stimulation of various brain regions.

For a user-friendly description of the research, read this.

Neurofeedback. A 2020 review by scholars from several countries found it useful for children with ADHD: here.

Other research suggests its promising use with adults, too, including research out of MIT (here). Also see here.

 

Let the Games Begin?

The latest prescription for childhood ADHD is a game. EndeavorRx is its name. Want to see it? Go to https://www.cnbc.com/2020/06/17/video-endeavorrx-is-first-video-game-approved-by-fda-to-treat-adhd.html.

The FDA approved it for children ages 8-12…the first game it has EVER approved as a prescription.

Apparently, the research behind it, out of UCSF, was convincing… https://www.ucsf.edu/news/2020/06/417841/fda-approves-video-game-based-ucsf-brain-research-adhd-therapy-kids

To some….  See some criticisms here.

If you’re interested but outside the age window, you might like to know this: In 2013, Nature published the results of a study on a game called Neuroracer showing that six weeks of training with the game improved older adults’ attention. How old are we talking? 60-85 years of age. For more see https://www.ucsf.edu/news/2013/09/108616/training-older-brain-3-d-video-game-enhances-cognitive-control.

Under 60 and over 12? Well, UCSF’s working on games for various ages and abilities. Find them at https://neuroscape.ucsf.edu/technology/.

A spoonful of sugar helps the medicine go down I guess.

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