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.

For a recent review and meta-analysis on use of Omega-3s for ADHD, go 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.  I bet your brain will thank you.

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.)

Medication Metaphor: Tunnels

Imagine yourself inside a room full of tunnels.

You can look down any of them.  Maybe you like this sense of freedom.  Maybe you also find it distracting.led-lighting-1846929_1920

But now you have your ADHD medication.

Walls go up over all the tunnels except the one you’re facing.

When you turn your head, the wall for the last tunnel you faced slides up.  The wall for the tunnel you now face slides down.

You can switch which tunnel you look down, but you can see only one tunnel at a time.

You can also see the tunnels with obstacles.

On medication, you find it’s easier to enter these previously-avoided tunnels (maybe because the more appealing tunnels have their walls up, keeping their temptations out of sight).

And once you enter one of these “harder” tunnels, the medication helps you stay there.

This is part of the experience of ADHD medication for many of those with ADHD, on the one that’s working for them.

It’s nothing personal.

This is for the loved ones of those with ADHD.

Yesterday, I sat with my husband and tried to just talk.  We are so busy doing things, we hardly ever just talk.  Ten minutes into it, I could tell his mind was elsewhere.  I let him know it looked like he was somewhere else mentally.  He said he was.  I asked what was going on, and he said he was “bored.”  “Ouch,” I said.

Then I remembered something.  It’s nothing personal.  I know hong-kong-1990268_1920what I tried to share with him would be quite fascinating to another psychology-lover.  But my husband has ADHD and becomes easily bored with things less exciting than a book such as The Martian.

He also prefers action to talk.  It’s hard to keep his attention.

As Thom Hartmann, author of The Edison Gene, points out those with ADHD constantly monitor the environment for what’s of high stimulation, with a swift ability to turn to these things.  If this high stimulation or need to act is lacking, they may shut down on you.  Kind of like your computer going into sleep mode.  When this happens, breathe and begin breakdancing (attention-getter!) or relax and remind yourself it’s nothing personal.  Really.

Their brains may be tuned to a different frequency.

 

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.

To get things started, add sugar…a spoonful or more

Just the other day, my husband played this song to our daughter, and I said, “Hey, Mary Poppins had it right.”  As a mental health therapist running groups for adults diagnosed with ADHD, I encourage members to have fun with their tasks as much as possirestaurant-coffee-cup-cappuccinoble.  Turn up the pleasure, excitement, interest.  Some will work outside or somewhere they find pleasant, some pair a reward with tasks and some work with others, even just as company.  Some do all of these.

If you struggle to start something, remember Mary Poppins.  And that some of us need a little more sugar than a spoonful.

 

“It’s like a room full of puppies and candies.”

ADHD infoChildren often say it best.

My child said this as he heard me speaking about ADHD.

I asked him what he meant, and he said it’s what a room seems like to him.  I asked him what an empty room seems like, and he described how he will notice the shapes, curves, and corners of the walls; bumps on the ceiling; light seeping under the door; and the texture of the floor, adding that carpet’s like a maze of threads.  He concluded, “Even an empty room is filled with so much.  It’s insane.”

 

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