Long-Term Use of ADHD Medications Changes Brain Function

What every parent and adult needs to know

Report By: Researchers at Brookhaven National Laboratory

For many years, dopamine, a neurotransmitter (a brain chemical that transmits a message from a brain cell to another brain cell), was thought to be primary culprit in ADHD. Dopamine plays a major function in the brain as it is responsible for reward-motivated behavior. A plethora of studies have shown rewards increase the level of dopamine in the brain. This is what makes us motivated to get rewarded. Many drugs, including cocaine, Ritalin, and methamphetamine, act by amplifying the effects of dopamine. Too little dopamine means greater distractability and riskier behavior as the brain constantly seeks ways to increase its dopamine levels.

Researchers at Brookhaven National Laboratory published a study in the journal PLOS One examining levels of dopamine in ADHD patients who had never taken stimulants. They reviewed dopamine transporter density. Transporters actually filter dopamine away from its receptors in the brain. More transporters means less dopamine (and therefore less bang for the reward). Transporter density was determined through PET brain scans.

Initial scans found no differences among their small population of 18 adults who suffered from ADHD but were never treated for it. This group was then treated with Ritalin. After a year, the researchers discovered that dopamine transporter density increased by 24 percent. What this study found was in fact what many parents have discovered during their child’s use of medication; taking ADHD medication may change the brain’s chemistry so that the effects of the medication are reduced over time. To accommodate this, one’s pediatrician or medical doctor will often increase the dosage due to drug tolerance.

More questions than answers arise due to this research. Here’s what’s now on the table:

* Medication is commonly taken over many years. The researchers are not sure whether the brains would return to their original state if they stopped taking the drug.

* Other studies have indicated that increased levels of dopamine transporters in the brain could be used as a diagnostic marker for ADHD — a way to screen for ADHD. This research tells us that long-term use of stimulant medications like Ritalin may actually cause these increased levels. So increase levels is not a good biomarker.

* Long-term effects are now questionable; will the medicated person constantly need more risk-associated behaviors including drug use as the effects of medication are reduced over time?

“In this study, we only proved that increased dopamine transporter levels cannot be used as a biomarker,” Wang said.

One of the patients in Wang’s study who had never received ADHD therapy was having difficulty in college and in her marriage, but she loved to paint. After taking medication she did better in school and with personal relationships, but she lost her creative drive, Wang said.

Michelangelo and the Sistine Chapel

Inattention Theatre Presents
Michelangelo and the Sistine Chapel
Most people don’t like Mondays, so here’s a little humor for you! It’s less than a minute and let’s us laugh at ourselves.
Enjoy!

Produced by the creative talents at Play Attention.

Creativity and ADHD

For many years, pundits have declared that although ADHD causes many hardships, it does have a side benefit: creativity.

Previous research has suggested that adults with ADHD may be more creative than adults without ADHD (White & Shah, 2006).

A current study by professors Holly White (University of Memphis, TN) and Priti Shah (University of Michigan, MI) replicated these previous findings. The study was published in the Journal of Personality and Individual Differences (January 2011).

To the skeptic, “creativity” is a nebulous term. Like art, what is creative to one person is not creative to another. Thus, standardized tests were developed that focus on qualitative and quantitative areas of creativity called “divergent” and “convergent” thinking. Divergent thinking is the brain’s ability to produce out of the box, spontaneous, and frequently, original ideas or solutions. Convergent thinking, as the name implies, is the antithesis of divergent thinking. Convergent thinking is the brain’s ability to dispense with non-essential data, move to the heart of the problem and quickly parse options to find one correct solution. Convergent thinking is the type of skill needed for most standardized testing. It would not be helpful if you were a marketing specialist thinking of new ideas for your client.

White and Shah recruited  30 university students with ADHD and 30 without. They used a standardized measure of creativity called the Abbreviated Torrance Test for Adults (Goff & Torrance, 2002). In addition to the Abbreviated Torrance Test, the students completed the Creative Achievement Questionnaire (“CAQ”). This questionnaire asks highly specific questions about achievements in 10 creative domains among which include science, drama, writing, and humor, etc. The questions in the CAQ are designed to remove or limit subjective responses. For example, a question on the CAQ: Whether the subject’s “work has won a prize at a juried art show.” Thus, the answer reveals information from a more objective outside source.

Doctors White and Shah also wished to investigate whether these standardized measures actually extrapolated to real-world creative achievement among adults with ADHD. This would answer whether ADHD really does have side benefit.

When the researchers examined the data from all 10 domains combined, they found that the students with ADHD had significantly higher scores than those without the diagnosis. According to White, a distinctive pattern also emerged: ADHD subjects were more likely to excel at certain creative domains than at others — especially the performing arts. While the data were not statistically significant, a clear trend could be seen: domains where inhibition is not necessary seem to be the areas where these students excel, especially theater and drama. This makes sense because scientists have known that inhibitory control is lacking in most ADHD individuals. They are chastised for speaking out of turn at the office or school. They have difficulty controlling impulsive behaviors. It would make sense that they would thrive in an environment that necessitates they behave without inhibition.

Interestingly, White noted that she could find no significant differences between ADHD students on medication and ADHD students who were not. She had no answers for this riddle.

“ADHD,” she says, “tends to just increase the amount of collisions between all of your ideas, so at any given time, you have more potential processes being activated and you’re less likely to rule out any options. It’s hard to know where this operates—like someone coming up with an idea and saying, ‘No, that’s not a good idea,’ and not even writing it down, versus, they don’t even think about it because they’re inhibiting it. But the key seems to be the inhibitory control—the same thing that allows somebody to not be distracted—which possibly could put a mental wall between what is right in front of them and other possibilities.”

There are limitations to a study like this. White and Shah specifically worked with students who had achieved or accomplished all requirements necessary to be admitted to university. Therefore, the trends she sees pertain specifically to them. ADHD students who flunked out of school, were incarcerated, etc. which prevented them from attending university were not included. That would make an interesting study because we’d know what affect family support, direction, and education play in success and creativity.

So, the bottom line here is: yes ADHD students can be more creative, but the research points only to a limited group of students. Is this an upside? For some yes. For others, we just don’t know yet.