Understanding ADHD and Learning Disability Part VI: How is ADHD treated?

This is the sixth in a series on understanding Attention Deficit/Hyperactivity Disorder (ADHD).

Treatment

ADHD is commonly treated with parent education, school-based interventions, and medications such as stimulants (e.g., methylphenidate) and newer, nonstimulant drugs such as atomoxetine. Adults benefit from the same medications as children and may find some behavioural therapies helpful. On the behavioral side, children can be taught strategies for staying focused on a task such as following a detailed schedule, or for organizing materials. Adult ADHD can be a family problem as well as an individual problem. Because the symptoms of the disorder often wreak havoc on every member of the family, not just the individual with adult ADHD, it’s important for the entire group to undergo family therapy, even if the ADHD parent is already getting individual counselling. It is best to begin family therapy as soon as it becomes clear that the symptoms of adult ADHD are interfering with normal family functioning and thus avoid crises and emergencies that may take months or years to resolve. Family therapy may include teaching family members new skills and coping strategies, and therapy in which family members support and encourage each other and learn to communicate more effectively.

Drug treatment of ADHD

Many children with ADHD may also need medication. The use of stimulants to treat ADHD was first described in 1937.Since the late 1960s, stimulants such as Ritalin® or Adderall® have been prescribed to treat children with ADHD.

2011-12 shortage in U.S. market

In 2011 and 2012, there was a shortage of Ritalin® and Adderall® in U.S. pharmacies. Some say the shortage was caused by the US Drug Enforcement Administration’s (DEA) annual limits on the manufacture of controlled substances. The DEA argues that drug manufacturers had caused the shortage by applying their quotas toward more lucrative kinds of amphetamine-based medications. The shortage was resolved by November 2012. Currently, between 4 and 6 million children in the United States take one of these medications, which reduce hyperactivity and impulsivity, help improve the ability to focus, and even improve physical coordination. In fact, medications are so effective in helping people with ADHD that a recent shortage wreaked havoc for many families

Drug action

Nonetheless, there is concern about giving children a drug that is potentially addictive. Methylphenidate, the active ingredients in Ritalin®, acts like a weak form of cocaine to increase dopamine and noradrenaline levels but tend to do it all over the brain sometimes resulting in unwanted side-effects such as nervousness, drowsiness, insomnia, suspicion and paranoia. Concerta®is a slow release of methylphenidate while Daytranta® delivers the drug via a skin patch, similar to those used for nicotine replacement therapy.Adderall® is a mixture of amphetamine salts which also increase dopamine and noradrenaline levels but has a higher potential for abuse than Ritalin®.

Controversy

In addition, there is a worry that ADHD may be over-diagnosed, leading to the diagnosis and treatment of high-energy children who have difficulty in the classroom, but are medically normal. For this reason the effectiveness of treatments should be re-evaluated in each person on a regular basis to determine if the current treatment continues to be optimal. There are some reports that daily intake of fish oil can be helpful.

Related Reading

Part 1: Understanding ADHD and Learning Disability

Part 2: Understanding ADHD and Learning Disability

Part 3: Understanding ADHD and Learning Disability

Part 4: Understanding ADHD and Learning Disability

Part 5: Understanding ADHD and Learning Disability

 

 

Could there an evolutionary advantage in having ADHD?

Ariaal Elder

Ariaal Elder. The Ariaal are northern Kenyan pastoralists.

This is the fourth in a series on understanding Attention Deficit/Hyperactivity Disorder (ADHD). Today I want to examine if there is in fact an evolutionary advantage in having ADHD.

ADHD is strongly genetic and the genes involved regulate the levels of two neurotransmitters called dopamine and noradrenaline (noradrenaline is called norepinephrine in North America) – chemicals which act as messengers between nerve cells.

Hyperactivity has long been part of the human condition and some ADHD – linked genes are more common in nomadic populations and those with more of a history of migration. In fact,the health status of nomadic men such as those from the Ariaal people in northern Kenya was higher if they had an ADHD – linked gene. However, recently settled Ariaal men seemed to have slightly worse health.

ADHD – ‘the don’t fence me in’ gene

In nomadic Ariaal society,  those with ADHD may be better in tasks involving risk, competition, and/or unpredictable behavior (i.e. exploring new areas, finding new food sources, etc.). For instance, an Ariaal person killing a lion is highly respected and in these situations, ADHD would have been beneficial to the society as a whole even while severely detrimental to the individual.In addition, women in general are more attracted to males who are risk takers, thereby promoting ADHD in the gene pool. This might help explain why ADHD-linked genes have survived to the present day but are more suited to a previous nomadic, risk-taking lifestyle.

Like mother – like son

More recent research suggests that because ADHD is more common in mothers who are anxious or stressed that ADHD is a mechanism of priming the child with the necessary traits for a stressful or dangerous environment, such as increased impulsivity and explorative behaviour etc.

Journal reference: BMC Evolutionary Biology (DOI: 10.1186/1471-2148-8-173)

Part 1: Understanding ADHD and Learning Disability

Part 2: Understanding ADHD and Learning Disability

Part 3: Understanding ADHD and Learning Disability

 

 

 

Weekly Neuroscience Update

mgr_correl_all_wparavol

Composite of the scans of 20 individuals. Regions in yellow and red are linked to the parietal lobe of the brain’s right hemisphere.

Scientists say they have published the most detailed brain scans “the world has ever seen” as part of a project to understand how the organ works.

Psychologists at the University of Amsterdam (UvA) have discovered that changes in patterns of brain activity during fearful experiences predict whether a long-term fear memory is formed.

New findings about how the brain functions to suppress pain have been published in the leading journal in the field Pain, by National University of Ireland Galway (NUI Galway) researchers. For the first time, it has been shown that suppression of pain during times of fear involves complex interplay between marijuana-like chemicals and other neurotransmitters in a brain region called the amygdala.

Some of the dramatic differences seen among patients with schizophrenia may be explained by a single gene that regulates a group of other schizophrenia risk genes. These findings appear in a new imaging-genetics study from the Centre for Addiction and Mental Health (CAMH).

Research published in the March 2013 journal GENETICS explains a novel interaction between aging and how neurons dispose of unwanted proteins and why this impacts the rising prevalence of dementia with advancing age.

The brain adds new cells during puberty to help navigate the complex social world of adulthood, two Michigan State University neuroscientists report in the current issue of the Proceedings of the National Academy of Sciences.

The first large, population-based study to follow children with attention-deficit hyperactivity disorder into adulthood shows that ADHD often doesn’t go away and that children with ADHD are more likely to have other psychiatric disorders as adults. They also appear more likely to commit suicide and to be incarcerated as adults.

The infant brain does not control its blood flow in the same way as the adult brain, researchers have discovered.

Hypnosis has begun to attract renewed interest from neuroscientists interested in using hypnotic suggestion to test predictions about normal cognitive functioning. To demonstrate the future potential of this growing field, guest editors Professor Peter Halligan from the School of Psychology at Cardiff University and David A. Oakley of University College London, brought together leading researchers from cognitive neuroscience and hypnosis to contribute to this month’s special issue of the international journal, Cortex.

What is ‘attention’ and where is it in the brain?

This is the third in a series on Understanding Attention Deficit/Hyperactivity Disorder (ADHD). Today we look closer at the nature of attentiveness and its location in the brain.

english_brainAttention is the ability of the brain to selectively concentrate on one aspect of the environment while ignoring other things. There are two types of attention in two separate regions of the brain. The prefrontal cortex (directly behind the forehead) is in charge of willful concentration; if you are studying for a test or writing a novel, the impetus and the orders come from there. But if there is a sudden, riveting event – the attack of a tiger or the scream of a child – it is the parietal cortex (behind the ear) that is activated. Scientists have learned that these two brain regions sustain concentration when the neurons emit pulses of electricity at specific rates – faster frequencies for the automatic processing of the parietal region, slower frequencies for the deliberate, intentional work of the prefrontal region.

ADHD medications increase activity in the prefrontal cortex and attention-related areas of the parietal cortex during challenging mental tasks; these are the same areas that the study I cited yesterday demonstrated to be underactive in ADHD brains. However, there may be different forms of ADHD and there is an urgent need to develop more effective drugs to regulate these two different frequencies in order to improve attention for specific forms of the disorder.

Part 1: Understanding ADHD and Learning Disability

Part 2: Understanding ADHD and Learning Disability

Understanding Attention Deficit/Hyperactivity Disorder (ADHD) Part 2

In part two of my latest series on attention deficit/hyperactivity disorder (ADHD) we take a closer look at the nature of the disorder.

These positron emission tomography (PET) scans show that patients with ADHD had lower levels of dopamine transporters in the nucleus accumbens, a part of the brain’s reward center, than control subjects.

What is attention deficit/hyperactivity disorder?

Do you remember a classmate who just could not sit still or another who just sat quietly in the corner, day dreaming and looking out the window but when called on by the teacher did not know what was going on? Today both of these children might be diagnosed with ADHD. Indeed some still argue that there is no such thing as ADHD – that it is an artificially conceived diagnosis to aid the selling of prescription drugs and that in previous times a child with ‘ADHD’ was no more than considered to be no more than ‘bored’,’ restless’ or ‘giddy’.

Prognosis

ADHD was first described more than 100 years ago and its symptoms include excessively inattentive, hyperactive, or impulsive behaviours. For instance, children with ADHD find it more difficult to focus and to complete their schoolwork. ADHD affects up to eight in one hundred children and in over half the cases, it continues to persist into adulthood.Although most individuals with ADHD do not outgrow the disorder, their symptoms often change as they grow older, with less hyperactivity as adults. Problems with attention tend to continue into adulthood. There is no cure for ADHD at this time.

Possible causes

Recent brain imaging studies have shown a reduction in the levels of the neurotransmitters dopamine and noradrenaline in at least some people with the disorder. Because the nerve circuits in the prefrontal brain regions, which are normally involved in attention, require high levels of dopamine and noradrenaline stimulation, reduced levels of these two neurotransmitters could potentially lead to the weakened regulation of attention and behavior observed in ADHD .Altered brain activity also has been observed in particular nerve circuits connecting the cortex (outer part), striatum (deeper parts), and cerebellum (back of the neck), particularly in the right brain hemisphere with a delay in cortical development seen in some children with ADHD.
In part three of this series,  I will explain more what neuroscientists mean by ‘attention’, where it is found in the brain and how it is affected in ADHD.

Other Sources:
http://www.webmd.com/add-adhd/guide/

Part 1: Understanding ADHD and Learning Disability

 

Weekly Neuroscience Update

New research from Weizmann Institute, published in Nature Neuroscience has discovered that people can actually learn during sleep, which can unconsciously modify their behavior while awake.

Studies have shown that listening to music can soothe hospital patients, improve stroke outcomes and promote the releaseof the neurotransmitter dopamine in the brain sending pleasure signals throughout the body. Now findings recently presented at the Association for the Scientific Study of Consciousness suggest that playing familiar music could enhance cognitive response among patients with brain damage.

In a major development  Bionic Vision Australia researchers have successfully performed the first implantation of an early prototype bionic eye with 24 electrodes.

Researchers have discovered two gene variants that raise the risk of the pediatric cancer neuroblastoma. Using automated technology to perform genome-wide association studies on DNA from thousands of subjects, the study broadens understanding of how gene changes may make a child susceptible to this early childhood cancer, as well as causing a tumor to progress.

In a study published in the Journal of Neurology, researchers claim that because Attention Deficit Hyperactivity Disorder (ADHD), Fetal Alcohol Spectrum Disorder (FASD) and Parkinson’s Disease (PD) each involve ocular control and attention dysfunctions, they can be easily identified through an evaluation of how patients move their eyes while they watch television.

A new study by researchers at NYU School of Medicine reveals for the first time that metabolic syndrome (MetS) is associated with cognitive and brain impairments in adolescents and calls for pediatricians to take this into account when considering the early treatment of childhood obesity.

People whose blood sugar is on the high end of the normal range may be at greater risk of brain shrinkage that occurs with aging and diseases such as dementia, according to new research published in the September 4, 2012, print issue of Neurology®, the medical journal of the American Academy of Neurology.

Weekly Neuroscience Update

A growing body of evidence suggests that learning to play an instrument and continuing to practice and play it may offer mental benefits throughout life. Hearing has also been shown to be positively affected by making music. The latest study, published in the July issue of Frontiers in Human Neuroscience, shows that musical instrument training may reduce the effects of mental decline associated with aging. The research found that older adults who learned music in childhood and continued to play an instrument for at least 10 years outperformed others in tests of memory and cognitive ability.

Neuroscientists are finding that, as we get older, our aging brains are proving surprisingly malleable, and in ways not previously anticipated. But there are limitations. There is growing evidence that, beyond what was previously believed, the adult human brain is remarkably malleable and capable of new feats — even in the last decades of life. And UCLA researchers found that older adults who regularly used a brain fitness program played on a computer demonstrated significantly improved memory and language skills.

From older to younger brains now…

Determining when a teenage brain becomes an adult brain is not an exact science but it’s getting closer, according to an expert in adolescent developmental psychology, speaking at the American Psychological Association’s 120th Annual Convention.

Researchers at Aalto University in Finland have developed the world’s first device designed for mapping the human brain that combines whole-head magnetoencephalography (MEG) and magnetic resonance imaging (MRI) technology. MEG measures the electrical function and MRI visualizes the structure of the brain. The merging of these two technologies will produce unprecedented accuracy in locating brain electrical activity non-invasively

According to a study conducted by the National Institutes of Health, children with attention-deficit/hyperactivity disorder (ADHD) experience a developmental delay in frontal regions of the brain.

The brain differences found in people with schizophrenia are mainly the result of the disease itself or its treatment, as opposed to being caused by genetic factors, according to a Dutch study

Bilingual children outperform children who speak only one language in problem-solving skills and creative thinking, according to research led at the University of Strathclyde.

When we focus intently on one task, we often fail to see other things in plain sight – a phenomenon known as ‘inattention blindness’. Scientists already know that performing a task involving high information load – a ‘high load’ task – reduces our visual cortex response to incoming stimuli. Now researchers from UCL have examined the brain mechanisms behind this, further explaining why our brain becomes ‘blind’ under high load.

Weekly Neuroscience Update

UC Santa Barbara scientists turned to the simple sponge to find clues about the evolution of the complex nervous system and found that, but for a mechanism that coordinates the expression of genes that lead to the formation of neural synapses, sponges and the rest of the animal world may not be so distant after all.

Scientists have discovered a mechanism which stops the process of forgetting anxiety after a stress event. In experiments they showed that feelings of anxiety don’t subside if too little dynorphin is released into the brain. The results can help open up new paths in the treatment of trauma patients. The study has been published in the current edition of the Journal of Neuroscience.

The biological role of a gene variant implicated in multiple sclerosis (MS) has been determined by researchers at Oxford University. The finding explains why MS patients do badly on a set of drugs used successfully in other autoimmune diseases, such as rheumatoid arthritis and inflammatory bowel disease – something that has been a puzzle for over 10 years.

A clinical trial of an Alzheimer’s disease treatment developed at MIT has found that the nutrient cocktail can improve memory in patients with early Alzheimer’s. The results confirm and expand the findings of an earlier trial of the nutritional supplement, which is designed to promote new connections between brain cells.

An international consortium, has taken cells from Huntington’s Disease patients and generated human brain cells that develop aspects of the disease in the laboratory. The cells and the new technology will speed up research into understanding the disease and also accelerate drug discovery programs aimed at treating this terminal, genetic disorder. 

Stem cells that come from a specific part of the developing brain help fuel the growth of brain tumors caused by an inherited condition, researchers at Washington University School of Medicine in St. Louis report.

Findings from the first study directly examining gamma-aminobutyric acid (GABA) concentrations in the brains of children with ADHD were published last week in the Archives of General Psychiatry. In this new article researchers report finding significantly lower concentrations of GABA in the cerebral cortexes of children diagnosed with ADHD, compared with typically developing children. GABA is the brain’s main inhibitory neurotransmitter. The differences were detected in the region of the brain that controls voluntary movement.

People who are born deaf process the sense of touch differently than people who are born with normal hearing, according to research funded by the National Institutes of Health. The finding reveals how the early loss of a sense— in this case hearing—affects brain development. It adds to a growing list of discoveries that confirm the impact of experiences and outside influences in molding the developing brain. The study is published in the July 11 online issue of The Journal of Neuroscience.

Neuronal abnormalities in the brains of children with obstructive sleep apnea are reversible with treatment, a prospective study has shown.

Although many areas of the human brain are devoted to social tasks like detecting another person nearby, a new study has found that one small region carries information only for decisions during social interactions. Specifically, the area is active when we encounter a worthy opponent and decide whether to deceive them. A brain imaging study conducted by researchers at the Duke Center for Interdisciplinary Decision Science (D-CIDES) put human subjects through a functional MRI brain scan while playing a simplified game of poker against a computer and human opponents. Using computer algorithms to sort out what amount of information each area of the brain was processing, the team found only one brain region — the temporal-parietal junction, or TPJ — carried information that was unique to decisions against the human opponent.

 

Neuroscience News

Is Angry Birds keeping your brain healthy?

A new study from the Archives of Neurology says playing brain stimulating games can improve your memory and delay or prevent the onset of Alzheimer’s disease.

A new study suggests hearing metaphors can activate brain regions involved in sensory experience.

Whether you are an athlete, a musician or a stroke patient learning to walk again, practice can make perfect, but more practice may make you more efficient, according to a surprising new University of Colorado Boulder study.

Researchers have found a way to study how our brains assess the behavior – and likely future actions – of others during competitive social interactions. Their study, described in a paper in the Proceedings of the National Academy of Sciences, is the first to use a computational approach to tease out differing patterns of brain activity during these interactions, the researchers report.

A molecular path from our body’s internal clock to cells controlling rest and activity have been revealed.

A new study looks at how our brain processes visual information to prevent collisions.

Can Brain Scans of Young Children Predict Reading Problems?  Brain scientists are studying whether they can predict which young children may struggle with reading, in order to provide early help.

Virtual therapists being developed to treat depression. Scientists at a U.S. university are developing new technologies to treat depression and other disorders — including a mood-detecting smart phone that will call to check up on you.

A new study shows how to boost the power of pain relief without drugs.

Neuroscience could change the face of warfare. Soldiers could have their minds plugged directly into weapons systems, undergo brain scans during recruitment and take courses of neural stimulation to boost their learning, if the armed forces embrace the latest developments in neuroscience to hone the performance of their troops

Brain activity differs when one plays against others. Researchers have found a way to study how our brains assess the behavior – and likely future actions – of others during competitive social interactions. Their study, described in a paper in the Proceedings of the National Academy of Sciences, is the first to use a computational approach to tease out differing patterns of brain activity during these interactions, the researchers report.

Reporting in PLoS Biology, researchers write that they were able to correlate words a person was hearing to specific electrical activity in the brain. Neuroscientist Robert Knight, a co-author of the study, discusses future applications of this research and concerns that it amounts to mental wiretapping.

Brains may be wired for addiction.  Abnormalities in the brain may make some people more likely to become drug addicts, according to scientists at the University of Cambridge.

Patients’ Brains May Adapt to ADHD Medication. New research reveals how the brain appears to adapt to compensate for the effects of long-term ADHD medication, suggesting why ADHD medication is more effective short-term than it is long-term.

A two-year study of high school football players suggests that concussions are likely caused by many hits over time and not from a single blow to the head, as commonly believed.

Weekly Round Up

Finnish researchers have developed a groundbreaking new method that allows them to study how the brain processes different aspects of music, such as rhythm, tonality and timbre (sound color) in a realistic listening situation. The study is pioneering in that it for the first time reveals how wide networks in the brain, including areas responsible for motor actions, emotions, and creativity, are activated during music listening. The new method helps us understand better the complex dynamics of brain networks and the way music affects us.

Dreaming may act like a type of overnight therapy, taking the edge off painful memories, a new study says.

Connectivity is a hot topic in neuroscience these days. Instead of trying to figure out what individual brain regions do, researchers are focusing more on how regions work together as a network to enable memory, language, and decision-making. Now, a study of more than 100 children finds that interconnected brain regions develop in concert through childhood and adolescence. The researchers say their work could have implications for understanding various puzzles in neuroscience, such as what goes wrong in autism or why adolescent boys are prone to risky behavior.

Using functional magnetic resonance imaging (fMRI), researchers have identified abnormalities in the brains of children with attention deficit/hyperactivity disorder (ADHD) that may serve as a biomarker for the disorder.

People who meditate seem to be able ‘switch off’ areas of the brain associated with daydreaming as well as psychiatric disorders such as autism and schizophrenia, according to a new brain imaging study published in the Proceedings of the National Academy of Sciences.

Sustained changes in the region of the brain associated with cognitive function and emotional control were found in young adult men after one week of playing violent video games, according to study results presented by Indiana University School of Medicine researchers at the annual meeting of the Radiological Society of North America.