Does a relationship really exist?

A study released this week by the journal Pediatrics reviewed research data from 1976 to date. Be advised, the conclusions from this study were not obtained from actual research done by the researchers, but were obtained from their critical review of previous published data regarding diet and ADHD.

The study’s authors, J. Gordon Millichap, a neurologist, and Michelle M. Yee, a nurse-practitioner are ADHD specialists at Children’s Memorial Hospital in Chicago. They reviewed articles from scientific journals relating to the use of diet and dietary supplements in treating ADHD. Their findings really aren’t new, but rather recap data known. They found:

• Sugar and aspartame really don’t show any relationship to ADHD symptoms.
• Fish oil might help with the cognitive and behavioral impairments associated with the disorder, but more research is needed as the data are not conclusive.
• Zinc and other mineral supplements like iron have shown to be helpful but still need more research.
• Some small subgroups show sensitivity to food preservatives and eliminating them may be helpful.
• Children who have food allergies should have the allergens removed.

As I wrote in a blog a while ago, scientists have shown a distinct relationship between ADHD and children who ate a Western diet high in saturated fat, refined sugars and sodium. Additionally, this diet commonly lacks omega-3 fatty acids, fiber and folate. It is unknown what relationship this has to poor attention and academic performance, but they commonly occur together.

The only certainty associated with this research is that we are uncertain about the relationship between diet and ADHD. Researching a relationship is difficult because of a placebo effect associated with dietary change.

However, this doesn’t mean that dietary change, regulating sugar intake, limiting fat and sodium intake, and restricting preservatives should be immediately tossed aside. It means that each child or adult must be reviewed individually and find what works for them personally.

Dietary changes are not costly. Personal dietary research just takes time and consistency. In other words, if it works for you after personally researching and testing it, then it works — use it.

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The good, the bad, and the ugly

New treatment guidelines were released this month by the American Academy of Pediatrics. These guidelines are issued to provide instructions for pediatricians on diagnosing and managing ADHD.

The good news is that the academy advises behavioral management techniques should be the first treatment approach for preschool-age children. The academy also recommends that pediatricians should evaluate childhood ADHD over four to six months in both the home and another environment, like school.

The British have adopted this approach, but have also taken it a step further to include cognitive training and parent training. Of course, Play Attention has been the leader in this type of training for over 16 years. Always way ahead of our time!

The bad is that the academy advises that ADHD can be diagnosed in children as young as age 4. This opens the gateway to giving Schedule II substances (class includes cocaine, amphetamines, etc.) like Ritalin to very young children.

The lead author of the academy’s new clinical practice guidelines is Dr. Mark Wolraich. Dr. Wolraich is professor of pediatrics at the University of Oklahoma Health Sciences Center. He noted that ADHD in a preschool-age child was very different from the typically active behavior seen in most young children. Most ADHD children have poor social skills which makes it difficult to play with other children or to make friends. A child with ADHD is often prone to accidents (new research bears this out — see previous blogs) and is overactive much of the time.

“It’s not the environmental things like parties triggering it,” Dr. Wolraich said.

The ugly and controversial side of the new guidelines is that they suggest pediatricians consider prescribing Ritalin in preschool-age children with moderate to severe symptoms and when behavior interventions don’t provide significant improvement.

Ritalin and similar medicines aren’t approved by the Food and Drug Administration for use within the preschool-age years. Once drugs are FDA approved however, they are not typically regulated regarding how doctors prescribe them. Doctors often prescribe drugs for use ‘off label’.

While the academy advises that medication should be considered for preschool-age children only if they exhibit symptoms of ADHD for at least nine months and only after behavior management techniques have been tried, prescribing medication ‘off label’ is controversial; these drugs haven’t been tested on this age group and the risks are unknown.

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Are there really benefits?

Brain training seems to be all the rage. Proponents claim many benefits ranging from simple improved memory to fewer car accidents.

We know that the brain constantly changes. It rewires itself daily in response to our environments. That monumental task is called neuroplasticity. It’s a unique feature of the human brain that allows us to adapt and change permitting greater survival among our species.

The brain’s ability to change remains throughout our lifetimes. However, the brain is much like a muscle; it’s a use it or lose it proposition. This is especially true as we age.

The Journal of the American Geriatrics Society (November 2010) reports of a study involving more than 900 active drivers with an average age of 73. Several universities were involved in the study. The researchers divided the drivers into four groups. Group 1 used a computer program designed to decrease their reaction times. Group 2 were taught strategies to improve reasoning and problem-solving. Group 3 got classroom training designed to improve memory, and Group 4, which served as the control group, received no training at all.

The researchers collected data on the drivers (state driving records) over the following six years. They found that drivers who received the computer or problem-solving training caused 50 percent fewer accidents during the six years compared with the control group. Those who went through memory training, however, showed no significant change.

This indicates that if one’s goal is to improve driving skills, then they must practice a task that is closely associated with the driving. It is safe to generalize this maxim to virtually any skill set.

Another study published in the December 2010 Archives of Internal Medicine is a one-year follow-up of 155 women ages 65 to 75 who participated in an earlier strength-training exercise program in 2007-2008. Those researchers found that strength training not only increased strength and bone density, but also improved focus.

The researchers randomly divided the female participants into once-weekly and twice-weekly workouts that used dumbbells, weight machines and free-form exercises to build muscle strength. The control group performed twice-weekly balancing and toning exercises, but performed no weight lifting exercises. At the end of the 12-month program, both the weight-training groups showed sharply improved mental focus. In the control group, mental function slightly declined.

Many other studies confirm what these researchers tell us: brain exercises can improve cognitive function and exercise helps maintain a healthy focused brain. We’ve been saying this for close to twenty years. Play Attention can be used to maintain a healthy brain throughout one’s life. It addresses a variety of cognitive skill sets which will keep growing as new games are created. This is well past cutting edge; it’s leading edge.

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Do they suffer injury more often?

Research reported in the September/October issue of Academic Pediatrics reveals that young ADHD adolescents face unintended injury at nearly twice the rate of their peers.

“Preventing injuries is probably not the primary reason to treat ADHD, but it is one of many positive consequences that should emerge if ADHD is properly treated,” first author David C. Schwebel, PhD, professor and vice chair, Department of Psychology, University of Alabama at Birmingham, told Medscape Medical News (http://www.medscape.com/viewarticle/750259). “Both psychotherapy and pharmacotherapy have evidence of efficacy,” he added.

Dr. Schwebel and colleagues found a significant association between ADHD symptoms and an increased risk for injury. In an ethnically diverse group of children with a median age of 11 years, Schwebel and his colleagues found that fourteen percent of study participants suffered 1 or more injuries requiring medical attention in the previous year. The most common injuries were broken bones (52%), joint injuries/sprains/strains (15%), and cuts/bruises (15%). The risk of injury increased with the increase of ADHD symptoms. Boys also presented higher risk of injury than girls.

Dr. Schwebel’s results resonate and make sense to parents of ADHD children. These children often have impulse control problems. Inattention to their environment is common which can result in greater chance of injury as well.

Dr. Schwebel said in addition to treatment of ADHD, “if clinicians have time and resources to focus especially on injury prevention in children with ADHD, considering ways to help children recognize potentially dangerous situations, perhaps through cognitive techniques, might be helpful to reduce injury risk.”

“Recognition of danger and invocation of executive function/self-inhibition skills might be helpful to children with ADHD if clinicians can successfully train or hone such skills,” Dr. Schwebel added.

Using Play Attention to help decrease inattention and control impulsivity is a great start. Our Motor Skills module teaches mind/body coordination to help reduce injury. We’re in development of a specific Play Attention game that will help teach valuable skills to identify dangerous situations. It will be available in the near future.

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Is there a connection?

Teachers, parents, and ADHD exeprts almost expect to have a compounding issue along with an ADHD diagnosis. Reading disabilities, behavioral difficulties, dyslexia, etc. are very common among ADHD children.

A study in the September, 2011 issue of Pediatrics confirms this; ADHD children have a much higher risk of developing a written language disorder and especially a reading disability. Reading disabilites account for nearly 80% of all learning disabilities associated with an ADHD diagnosis.

To be specific, a written language disorder is an impaired ability to express oneself through the written word. Difficulties in organizing one’s thoughts, memory, distraction, and even poor motor skills contribute to written language disorders.

The study was performed by the Mayo Clinic’s department of health sciences research in Rochester, Minnesota. Co-author, Dr. Slavica K. Katusic, associate professor of epidemiology and pediatrics says,”So…the uniqueness of this study, [is] because this is population-based.And what we found is that, regardless of gender, there is a dramatic difference in the risk of written-language disorder. ADHD kids are at a five times greater risk for having writing problems compared to all others who do not have ADHD.”

To form their conclusions, the researchers performed meta-analysis of 5,718 children born between 1976 and 1982 in Rochester, Minnesota. The majority of the children were middle-class whites. All were tracked from birth until roughly the age of 19.

If the child had a reading diability, the risk of devloping a writing disorder vastly increased.

“When someone suspects that a child has ADHD, people are so impressed with concerns over dyslexia that they sometimes kind of forget about problems with writing. So, this should bring some needed attention to the need for equal testing and equal help for kids who also have writing problems,” warned Katusic.

Katusic’s research echoes previous research. ADHD is actually an impairment of a variety of skills. These skills are often fundamental to reading and writing. Remember that Play Attention teaches motor skills, auditory processing, memory and more.

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Is there a connection?

Two distinct studies examined the role of PFC (Perfluorinated chemicals) and their possible connection to ADHD and hyperactive/impulsive behavior in children. The studies were published online last month.

Perfluorinated chemicals (PFC) have been used since the 1950s. Commonly used in industry, they can be found in a wide variety of consumer products including, food containers, waterproof fabrics, paints, non-stick cookware, and stain-proof coatings. PFC are actually a class of chemicals that include perfluorooctane sulfonate (PFOS), perfluorononanoic acid (PFNA), perfluoroctanic acid (PFOA) and perfluorohexane sulfate (PFHxS).

In the first study, Brooks Gump of SUNY, Oswego, and colleagues assessed impulsive behavior using a computerized test. They compared the test results with PFC in the children’s blood samples. They used a sample of 83 children from Oswego County, N.Y. The children ranged in age from nine to 11 years old.

Gump found that higher concentrations of PFHxS were associated with increased odds of ADHD. Children with the highest exposure to PFHxS were 60 percent more likely to have ADHD and take ADHD medication. Gump could not find a strong correlation with the other PFC and ADHD.

Researchers Cheryl Stein from the Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, and David Savitz, Departments of Community Health and Obstetrics and Gynecology, Brown University, Providence, Rhode Island, are authors of a second study published online in Environmental Health Perspectives.

They reviewed data from the C8 Health Project survey conducted between 2005 and 2006. The project examined more than 10,000 parents and their children aged 5- to 18. These families lived in West Virginia and Ohio near a DuPont plant that manufactures PFOA. Commonly, PFC are transferred in food, but the plant seems to have exposed the families to PFOA through groundwater contamination and airborne plant emissions.

Stein and Savitz’s findings from the C8 Study echo results from a previous study done in 2010; higher levels of PFOA were highly associated with ADHD.

Neither of the studies can prove that PFC cause ADHD, only that there is a high degree of association between PFC levels and ADHD. It would be wise to limit exposure to PFC whenever possible. Further studies will have to be performed to determine if health outcomes are affected later in life.

Another environmental contributor to ADHD may be secondhand smoke. A recent study confirms a study done in 2007 by Richard D. Todd, M.D., Ph.D., the Blanche F. Ittleson Professor and director of the Division of Child Psychiatry at Washington University — secondhand smoke may be linked to a greater risk of ADHD and learning disabilities in children.

The current study was funded by the Centers for Disease Control and Prevention (CDC) and the National Center for Health Statistics. The researchers found an amazing correlation between secondhand smoke and ADHD: children exposed to secondhand smoke in the home are twice as likely to develop either ADHD or a learning disability.

Data were collected from parents and guardians of over 50,000 children ages 11 and younger in the US. The researchers found that children exposed to secondhand smoke had a learning disability 8.2 percent of the time, ADHD nearly 6 percent of the time, or another conduct disorder 3.6 percent of the time.

Obviously, the cost of treatment via medical and educational interventions is in the billions of dollars. Environmental factors are something we can control, if we place emphasis on the need to control them. I’m quite certain that as we study the relationship between our environment and our health, greater causal relationships will be revealed.

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Are underlying problems like ADHD involved?

The July issue of Archives of General Psychiatry reports a study that finds teens who “cyberbully” others via the Internet or cell phones are more likely to suffer from both physical and psychiatric troubles. Additionally, their victims are at heightened risk from both physical and psychiatric troubles.

The research team was led by Dr. Andre Sourander, from Turku University, Finland, defines cyberbullying as aggressive, intentional, repeated acts using mobile phones, computers (including e-mails and Facebook) or other electronic media against victims who cannot easily defend themselves.

The study is relevant to current trends in the use of electronic media by teens. Researchers at the JFK Medical Center say that the average teenager sends a total of over 3,400 electronic [text] messages every month or surfs the Internet at bedtime. In January of 2011, national media focused on the death of 15-year-old Phoebe Prince. Prince, a Massachusetts teen, committed suicide after months of relentless cyberbullying.

The online Healthgrades.com site reports a recent U.S. survey of children aged 10 to 17 found that 12 percent were “aggressive” to someone else while online, 4 percent were victims of this type of online aggression, while 3 percent reported being both aggressors and targets.

The national spotlight on these trends has caused many parents to become increasingly concerned about both cyberbullying and their children’s Internet safety.

To evaluate cyberbullying, Sourander and team surveyed almost 2,500 teens. More than 7 percent of teens reported that they bullied other teens online. Almost 5 percent said they were targets of cyberbullies while 5.4 percent said they were both bullies and bullied.

The researchers’ data were quite compelling; teens who were victims of cyberbullying were more likely to come from broken homes and felt unsafe at school. Furthermore, they also had problems with concentration (ADHD), emotional problems, sleeping problems, and behavioral problems. The teens reported that they found it difficult to associate with their peers and were often prone to headaches and abdominal discomfort. It was quite apparent that psychological trauma was induced by cyberbullying.

Oddly, the cyberbullies had their own problems; they too were also more prone to suffer from problems with concentration (ADHD), emotional problems, sleeping problems, and behavioral problems. They too, found it difficult to associate with their peers. Cyberbullies also frequently smoked or got drunk, reported headaches, and were more prone to not feeling safe at school.

The researchers noted that cyberbullying was different than physical bullying. Physical bullying typically remains confined to school grounds or public places like the mall. Cyberbullies have an increased power and effect as they can bully 24 hours a day, seven days a week if so compelled. This relentless attack seems to affect both the cyberbully as well as the victim.

It is important to discuss this behavior with your child. That discussion should set stric

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Play Attention is delighted and excited to announce the introduction of Sheer Genius™ technology.

Play Attention has always been on the cutting edge of technology, but the most trusted name in educational attention training just got better. Sheer Genius™ is the virtual member of the Play Attention family. Essentially, we’ve built a virtual coach with over 30 years experience right into the Play Attention program. It’s like having a veteran professional right beside you all the time.

Play Attention also gives you access to live professionals with Master’s Degrees in education, psychology, or social work. But it’s nice to know that now a virtual coach is working beside you too!

Here’s what Sheer Genius™ does in Play Attention:

Play a game. Start at Beginner. When you’ve mastered that level, Play Attention’s Sheer Genius™ tells you when to advance to Intermediate, and finally to Advanced.

During each game, Sheer Genius™ sits in the background and watches how well you play. Then he sets and prioritizes achievable goals for your next session to increase your performance every step of the way.

The Sheer Genius™ virtual coach can help identify problem behaviors. Sheer Genius™ can then set behavioral goals to extinguish problem behaviors. This is done using a remarkable, non-punitive behavioral shaping system that empowers you to take control of your life. No punishment, no yelling, no tears.

Sheer Genius™ watches how much attention you can pay. He’ll challenge you to pay a little more attention each time. If the game gets too difficult, he’ll adjust to your last truly successful state of attention…and then the challenge is back on! You become part of his challenging program, but are never allowed to fail or become frustrated. This is done through the Sheer Genius™ auto-adjust algorithm so each session is custom tailored for you.

Rewards, both near term and long term are essential to the learning process. Sheer Genius™ encourages positive behavior with a banking system of immediately redeemable points for motivation. He also allows you to set long term goals to create an environment that teaches delayed gratification and personal goal setting.

Are you beginning to think that Sheer Genius™ can’t get any smarter? He even logs improvement and changes in self esteem as well as a collecting data and generating easy to read graphs.

Life is hectic enough. Sheer Genius™ makes using Play Attention easier and more efficient. If you’re struggling with attention challenges, Sheer Genius™ is you answer.

Even if you’re not struggling, but want the extra edge of peak performance, Sheer Genius™ awaits.

Call 800.788.6786 today to find out how you can reap the benefits of Play Attention’s newest little coach and your new best friend…Sheer Genius™! When you need to pay attention, there’s no better way than with Play Attention.

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The Center for Disease Control says yes!

In a study published online in the May 23 issue of Pediatrics,researchers found that one in six U.S. children now has a developmental disability such as autism, learning disorders or ADHD.

The U.S. Centers for Disease Control and Prevention researchers also found that the number of children with mental disorders or developmental disabilites seems to be on the rise. In 1997-1999, about 12.8 percent of kids were diagnosed with a developmental disability. In just ten years, that number increased to 15 percent. While 2.2 percent doesn’t seem like a big leap, it accounts for an additional 1.8 million U.S. children or a total of 10 million US school children.

“The most important message here is raising awareness of the importance of this as a health problem and one we need to address,” said lead study author Coleen Boyle, director of the U.S. National Center on Birth Defects and Developmental Disabilities. “Children are our future, and many of these children can grow up to be very productive citizens, so we need to invest in programs to help facilitate their development.”

To form their conclusions, researchers analyzed data from the 1997-2008 National Health Interview Surveys. This annual survey of US households asked parents of children aged 3 to 17 if their children had been diagnosed with ADHD, intellectual disability, cerebral palsy, autism, seizures, stuttering or stammering, moderate to profound hearing loss, blindness, learning disorders and/or other developmental delays.

According to Boyle, much of the increase can be attributed to ADHD and autism diagnoses. The figures are compelling to make that case: About 7.6 percent of children were diagnosed with ADHD in 2006-2008, up from 5.7 percent in 1997-1999. About 0.74 percent of kids had received in autism diagnosis in 2006-2008, up from 0.19 percent in 1997-1999.

Many questions arise from research like this. Is greater awareness driving diagnoses? Is there a greater number in the population that has developed ADHD? Is the fact that pharmaceutical companies can market their medications on TV a factor(the rates are higher in the US where it is only one of two countries in the world that allows prescription drugs to be marketed to the consumer)? Are biological or genetic factors involved? Are parenting factors involved?

In light of these questions, curiously, children with public insurance, mainly Medicaid, were more likely to have disabilities than those on private insurance plans. Medicaid supported children are lower income and commonly minority children. Does this mean they have greater rates of developmental disorders or is something else happening when diagnosing these children compared to children from better socioeconomic means?

In light of those questions, it’s interesting to note that although rates of ADHD and autism were up, other developmental conditions remained basically steady or in decline.

Awareness is up, especially by teachers who are usually the first to spot developmental or intellectual problems. Where does this awareness come from? Typically from TV advertisements or an afternoon workshop. While they are not experts in diagnosis or treatment, they often tend to spot trends. Thus, it is essential to have a full diagnostic battery performed by an expert. While this may be costly and time consuming, it is essential that the problem be identified correctly. It may very likely be that we are overdiagnosing or diagnosing socioeconomic problems that won’t be resolved via medication.

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ADHD is a hot topic. You’re likely reading this because you’re interested in ADHD. It’s such a hot topic that many claim ADHD is a growing epidemic. It’s estimated that about 4 percent of the adult population has ADHD. That’s approximately 8 million people. However, a study published in the journal The Clinical Neuropsychologist finds that almost one in four adults who show up in doctors’ offices seeking treatment may be exaggerating or possibly faking their symptoms. That means that approximately 2 million adults may be faking ADHD symptoms.

Paul Marshall, a clinical neuropsychologist with Hennepin Faculty Associates, a medical group that provides services at Hennepin County Medical Center in Minneapolis, Minnesota found that twenty-two percent of adults in the study tried to skew test results to make their symptoms look worse. Dr. Marshall and his colleagues examined the medical records of 268 patients. They carefully scrutinized patient interviews and questionnaires. The questionnaires were cleverly designed with mini-tests embedded that would expose people who might exaggerate their symptoms. Marshall noted that people in the survey who exaggerated their symptoms also scored much more poorly on the embedded tests than people with actual ADHD symptoms.

“Some of those who exaggerated their symptoms actually had ADHD, but embellished their reports to ensure they got diagnosed”, said Dr. Marshall. “Others didn’t have the disorder at all, but were having a tough time dealing with their workloads and lives. A lot of people think they have it because they are struggling, but it’s not because of ADHD,” Marshall said. “Often times, it’s simply depression, anxiety or lack of sleep.”

As I’ve written many times before, there is no pathology to ADHD; there is no place that it exists in the brain like a tumor or scar tissue. There’s also no definitive test for it. Therefore, it’s a highly subjective diagnosis. Most people are prescribed medication after a simple 20 minute visit with their family practitioner. So, for adults, the practitioner must simply rely upon the patient’s word.

Other patients may have been faking symptoms to get access to stimulant medications, Marshall said. In some cases, college and graduate school students want to be diagnosed with ADHD in hopes of gaining access to medications that boost concentration and focus, as well as accommodations such as longer times for tests. And some just want the meds for an inexpensive high, he added.

Marshall’s observations echo many previous studies (Journal of American College Health. Issue: Volume 57, Number 3 / November – December 2008 Pages:315 – 324) that found 34% of university students reported the illegal use of ADHD stimulants. Most illegal users reported using ADHD stimulants primarily in periods of high academic stress and found them to reduce fatigue while increasing reading comprehension, interest, cognition, and memory.

What benefits do ADHD drugs produce for the non-ADHD person? They are considered Schedule II substances in the same class as cocaine and amphetamines.

It may surprise you that ADHD drugs work for everyone. Stimulant medications can temporarily increase brain function making it easier for a high-school or university student to study for a test. These students are well aware of this and often use the drugs for this purpose.

This fact also exposes a major flaw in our medical system: many doctors use a reverse logic or rationale for diagnosing ADHD. When a patient is seen and describes their symptoms, the doctor will often prescribe ADHD medication first and see if the symptoms improve. The rationale is: if the symptoms improve using ADHD medications, then the problem was ADHD. This is known as a false conclusion because the symptoms will improve for just about everyone — at least temporarily.

Medications do have their place. Must we have a true evaluation from a professional to obtain a correct diagnosis? Yes. Does this take longer than 20 minutes? Yes. Should we do more than just medicate? Yes. The NIH has concluded that a multi-modal approach is best. This includes behavior shaping and cognitive skills training. Sound familiar? Yes, that’s Play Attention.

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