Category: Latest and Greatest

The latest and greatest research and news about ADHD

What gets us to change?

A 2018 review out of the Annals of the New York Academy of Sciences asks how we can use what we know about the brain to influence our behavior (copy and paste the link to get to the study). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6175225/

Three essential factors surfaced.

  1. Reward valuation. Where does your brain land on the pros and cons of a behavior (e.g., eating a donut)? Sometimes where our brains land gets us into trouble (eat it! eat two!). Research suggests that for less immediate rewards, our brains need to see the personal relevance of behaviors. So what if it’s “good” to exercise, what’s it matter to me and mine? Messages about such things as exercise and healthy eating carry more weight with us when we connect them to our values. Research shows that when people reflect on core values–what deep down really matters to them–and then get messages about healthy behaviors, they will more often practice them than people who receive the same messages without reflecting on their values.
  2. Delay discounting. Delay discounting refers to our tendency to discount the value of a reward the longer we have to wait for it. So we often choose smaller rewards with immediate gratification over bigger ones with delayed gratification. Eclairs over exercise. Research suggests a solution (if you want one): episodic future thinking (EFT). EFT is the capacity to imagine or simulate your future experiences. It works like this: You have a talk coming up tomorrow morning, and you intended to be well-rested for it. But you are tempted to watch another episode on Netflix tonight. You give EFT a try: You imagine you skip the show for sleep. And then imagine how the next morning plays out. You imagine it as vividly as possible, how you’re feeling, what you see from your audience. You can also imagine sacrificing sleep for the show and imagine how your morning plays out, as vividly as possible. EFT increases the chances we will remember our intentions and then act on them.
  3. Self-regulation, the capacity to direct different parts of ourselves (thoughts, urges, cravings, emotions, actions) toward achieving future-oriented goals. In the article, one means of increasing self-regulation that the authors discuss is physical exercise. In https://tonyalippert.blog/2017/08/01/understanding-adhd/, you can find several ways to increase self-regulation, with or without ADHD.

There you have it. Want to change a behavior? Play with reward valuation, delay discounting, and self-regulation. See what you notice. Is the review out of the Annals of the New York Academy of Sciences right?

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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.

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Two Awesome ADHD Resources

One resource focuses on children and teens; the other is for adults. Both can be remarkably useful for those with ADHD.

The first is understood.org (here) for “learning and attention issues.”  What it offers is vast and, though, it’s targeted to parents of children and teens with ADHD, many adults with ADHD can find it of use. Much of what’s suggested for teens applies to adults, except for the context (e.g., work vs. school).  Also, given that 25-35% of parents of youth with ADHD are likely to have ADHD (source), parents using the site may want to use the recommendations for themselves as well as their children.

The second resource is JAN, Job Accommodation Network (here), which is all about workplace accommodations for employers and employees needing or wanting to know what the American with Disabilities Act (ADA) encompasses, including job coaches…even the possibility of free ones.  Who knew? From what I can tell, fewer than would have liked to have known.

I hope something here is of use to you.

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ADHD Confusions

In the realm of ADHD research, OHSU professor Joel Nigg, Ph.D. is a major player.  He recently outlined the latest understanding of ADHD and three major confusions that have hurt this understanding (here).

Confusion #1:  It’s easy to fix.

Reality:  Long-term follow-up studies show that even the best “fixes” for ADHD barely change its long-term life outcomes.

Confusion #2:  It’s no big deal, anyway.

Reality:  Childhood ADHD has a strong association with future antisocial behavior, school and work failure, incarceration, and more, including serious injuries, shortening life spans.

Confusion #3:  It’s just inherited or it’s just a result of the environment.bees copy

Reality:  Its development appears to be a combination of uncommon gene mutations AND genetic factors common across psychiatric disorders, WITH the expression of these mutations and factors dependent on experience/environment (e.g., exposure to toxins/pollutants/contaminants).

The truth about us humans appears to be that we are just more complex and complicated than we’d like to believe sometimes.  This includes the reality that you, if you have ADHD, are more complex and complicated than it is.  It is a complex part of a complex you.

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Mindfulness & Psychoeducation: “Everybody has won, and all must have prizes”?

The Dodo bird quote from Alice’s Adventures in Wonderland came to mind as I read the results of a recent study.  A randomised, controlled fMRI study of the effects of mindfulness and psychoeducation on the working memory of adults with ADHD found they both worked (for more on working memory, see What predicts ADHD symptom reduction over time?).  art-creative-flying-17679.jpg

After 8 wks, both interventions were found to increase working memory performance and to increase task-related right parietal lobe brain activity to a similar degree (study here).  Although I’d like to see the results for a third group who received neither intervention (to rule out any placebo effect), the good news is that, under both conditions, working memory increased.  What would be interesting to see next is what happens when we combine mindfulness and psychoeducation.

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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.

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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.

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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.

 

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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

Book author: Greg Crosby, MA, LPC and Tonya K. Lippert, PhD
Reviewed by: Claire Nana
Last updated: 30 Apr 2017

~ 3 MIN READ

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.

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