ADHD & The Fountain of Youth

Posted by Peter on December 20th, 2010 | Comments off

A recent study published in the journal PLoS ONE reveals how we can all look younger and decrease cognitive deficits like ADHD. The secret: exercise! That’s probably not what you want to hear, but it makes sense.

Scientists at Tel Aviv University found that "endurance exercises," aerobic exercise like running or cardio kickboxing not only help burn fat, but can also make us look younger and decrease symptoms of cognitive decline.

The team at Tel Aviv University’s Sackler School of Medicine led by
Prof. Dafna Benayahu propose that their data reveal why older people who have exercised throughout their lives age more gracefully.

"When we age, we experience sarcopenia, a decline in mass and function of muscles, and osteopenia referrers to bone loss," says Dr. Benayahu. So without daily exercise, the muscular and skeletal systems weaken and are more susceptible to injury. This may also play a role in the increased likelihood of falling as we age.

The key to staying young seems to lie in stem cells that get activated during endurance exercise. To determine this, Benayahu and her team studied rats. Basically, making the rats exercise actually increased the number of muscle stem cells that typically decrease as we age.

The results were quite compelling when contrasting rats that exercised against sedentary rats:
* The number of youth producing stem cells increased after rats ran on a treadmill for 20 minutes a day for a 13-week period.
* The younger rats showed a 20% to 35% increase in the average number of stem cells per muscle fiber retained.
* Older rats attained a 33% to 47% increase in stem cells meaning they benefited even more significantly than the younger rats!
* Endurance exercise prompted the older rats to get up and go more often!

Aging while embracing a sedentary lifestyle significantly contributes to the development of disease. Furthermore, it contributes to a decline in cognitive abilities.

In other previous studies, researchers have also found that exercise in outdoor or ‘green’ settings reduces the symptoms of ADHD.

What’s the future? Well, it’s likely that scientists will try to discover the chemical process behind stem cell activation to produce more youthful bodies. It can then be sold as a pill. It seems the world would rather do that than just get up and dance! And no side-effects except sore muscles that are getting stronger, more youthful, and defined!

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So Is My ADHD Child Covered by Section 504?

Posted by Peter on October 26th, 2010 | Comments off

Your child may qualify to receive accommodations under Section 504 of the Rehabilitation Act. Section 504 states that:

“No otherwise qualified individual with a disability in the United States, as defined in section 706(8) of this title, shall, solely by reason of her or his disability, be excluded from the participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance….” [29 U.S.C. §794(a), 34 C.F.R. §104.4(a)].

Under Section 504, students qualify if they are between ages 3 and 22 and have a disability [34 C.F.R. §104.3(k)(2)].

So, the next question is, does ADHD qualify as a disability? The federal law states that:

“An individual with a disability means any person who:

i. has a mental or physical impairment which substantially limits one or more major life activity;

ii. has a record of such an impairment; or

iii. is regarded as having such an impairment” [34 C.F.R. §104.3(j)(1)].

Does ADHD qualify as an “impairment?” This is the gray area in which ADHD seems to fit well but allows wriggle room for schools. Under Section 504, impairment may include any disorder or disability that “substantially” reduces a student’s ability to access learning in the educational environment because of a learning or behavior related condition.

The wriggle room for schools is that the law is always subject to interpretation. So, every school interprets and implements Section 504 differently. Since ADHD has no physical manifestation like epilepsy or cerebral palsy, it is a hidden problem. Compounding this is the fact that many educators still believe the myth that poor parenting causes the problem or that by giving the child medication, all will be solved without need for accommodation at school. Therefore, under these circumstances, the onus is not on the school, they believe, it is on the parent.

Unfortunately, Section 504 does not define a list of specific disorders (again wriggle room). Obviously, that list would have to be highly comprehensive and definitive.

Also, ADHD would have to affect “major life activities” Major life activities do include, among a variety of other things, concentrating (ADHD), learning, sitting, working, thinking, and interacting/cooperating with others. Many of these major life activities are often affected by ADHD. So, your ADHD child may be included, but the school must agree that some of these “major life activities” substantially limit your child’s education.

So, does your ADHD child qualify for section 504? The answer is, yes – most likely. It should be apparent to you that the law has left a large gray area for interpretation in some cases.

Remember this: The squeaky wheel gets the grease. Squeak loud, know your rights, and document everything. You should be able to make good headway with this approach.

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Training the ADHD Brain

Posted by Peter on September 27th, 2010 | Comments off

For years, we at Play Attention, have trained thousands and thousands of people to better pay attention, learn the cognitive skills they need to succeed, and change their behavior. Our results have spoken clearly for us since 1994. Now science is catching up.

Two recent distinct studies validate the brain’s ability to change. While a vast plethora of research confirms these studies’ findings, they are noteworthy. The first study demonstrates the efficacy of skill training, and the second demonstrates how teaching skills rewires the living brain.

The first study, published in the August 25 Journal of the American Medical Association, was performed by researchers from Massachusetts General Hospital (MGH). They utilized cognitive behavioral therapy as a direct intervention for ADHD adults. Cognitive therapy teaches skills for managing life challenges.

The researchers at MGH found that while medications were the first line of treatment, many patients still persist with underlying symptoms. While previous studies on cognitive behavioral therapy for ADHD were small and short term, the researchers at MGH claim their study to be the first to conduct full-scale randomized, controlled trial of the efficiency of an individually-delivered, non-medication treatment of ADHD among adults.

“Medications are very effective in ‘turning down the volume’ on ADHD symptoms, but they do not teach people skills,” commented Steven Safren, PhD, ABPP, director of Behavioral Medicine in the MGH Department of Psychiatry, who led the study. “This study shows that a skills-based approach can help patients learn how to cope with their attention problems and better manage this significant and impairing disorder.”

“Sessions were designed specifically to meet the needs of ADHD patients and included things like starting and maintaining calendar and task list systems, breaking large tasks into manageable steps, and shaping tasks to be as long as your attention span will permit,” commented Safren, an associate professor of Psychology in the Harvard Medical School Department of Psychiatry. “The treatment is half like taking a course and half like being in traditional psychotherapy.”

Like Play Attention has been doing since 1994, the researchers provided training sessions mainly that included skills training in filtering of distractions, organization, problem solving, and planning.

Safren’s group receiving cognitive and behavioral training demonstrated advanced control of their symptoms over their control group. This benefit had persisted when measured three and nine months after the training.

The second study, published in The Journal of Neuroscience (August 25, 2010, 30 34 11493-11500 doi 10.1523 JNEUROSCI.1550-10.2010), examined the brains of rats when they learned to control their impulses. The researchers documented synaptic changes in the medial prefrontal cortex. They concluded that the rat’s brains rewired themselves to produce the impulse controls necessary to be successful in the tasks the scientists had established for them.

Other past studies have confirmed that the brain will rewire to make changes for skills, impulse control, organization, etc. We’re glad that science is catching up to an learning process that we’ve done at Play Attention for sixteen years now. That’s beyond cutting edge; it’s leading the way for others.

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Misdiagnosing ADHD

Posted by Peter on September 13th, 2010 | Comments off

According to a study released by the University of Michigan, nearly 1 million children in the United States are potentially misdiagnosed with ADHD.

The research was conducted, not by a medical group, but by economist Todd Elder in the Journal of Health Economics (Elder et al. The importance of relative standards in ADHD diagnoses: Evidence based on exact birth dates. Journal of Health Economics, 2010; DOI: 10.1016/j.jhealeco.2010.06.003).

Elder found that the youngest or often the most immature children are misdiagnosed with the ADHD label simply because of their age and exhibited maturity. Elder also found that these children are significantly more likely than their older classmates to be prescribed medications like Ritalin to control their behavior. Using a sample of 12,000 children, Elder examined the difference in ADHD diagnosis and medication rates between the youngest and oldest children in a grade. He found that the youngest kindergartners were 60 percent more likely to be diagnosed with ADHD than the oldest kindergarten children. Elder followed that group of children and found that they were more than twice as likely to be prescribed stimulant medication by the time they reached the fifth and eighth grades.

Currently, about 4.5 million children are diagnosed with ADHD. Elder concludes that about 20 percent or about 900,000 children have likely been misdiagnosed.

In a press release from the University of Michigan, Elder said that such inappropriate treatment is particularly worrisome because of the unknown impacts of long-term stimulant use on children’s health. Elder is also concerned that misdiagnosis wastes an estimated $320 million-$500 million a year on unnecessary medication. He estimates that between $80 million-$90 million of it is paid by Medicaid.

"If a child is behaving poorly, if he’s inattentive, if he can’t sit still, it may simply be because he’s 5 and the other kids are 6," said Elder. "There’s a big difference between a 5-year-old and a 6-year-old, and teachers and medical practitioners need to take that into account when evaluating whether children have ADHD."

ADHD has no pathology, no biological marker in the brain that clearly demonstrates its existence. Thus, its diagnosis is always subjective. While teachers are not permitted to make this diagnosis, their perceptions and opinions serve as the initial step to a diagnosis made by a doctor.

"Many ADHD diagnoses may be driven by teachers’ perceptions of poor behavior among the youngest children in a kindergarten classroom," he said. "But these ‘symptoms’ may merely reflect emotional or intellectual immaturity among the youngest students."

According to Science Daily, Elder’s paper will be published in the Journal of Health Economics in conjunction with a related paper by researchers at North Carolina State University, Notre Dame and the University of Minnesota that arrives at similar conclusions as the result of a separate study.

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ADHD and dropout rates

Posted by Peter on August 2nd, 2010 | Comments off

The July issue of the Journal of Psychiatric Research reports a study by the University of California, Davis. The researchers examined whether ADHD could be predictive of failure to graduate high school on time.

When the UC Davis scientists reviewed different types of ADHD, they found all of the types of ADHD are associated with a high dropout rate.

"The study found almost a third (33%) of students with ADHD, don’t graduate with their peers. That’s high compared with the national high school drop out rate of 15 percent. High school dropout rate really is a national crisis. We know that a third of kids nationally who start in ninth grade don’t graduate in four years," says lead study author Dr. Joshua Breslau.

The researchers conducted structured diagnostic interviews with a US national sample of adults (18 and over). The interview process also correlated smoking and smokeless tobacco use. According to the National Institute of Health, nearly a 25% of high school students in the U.S. smoke cigarettes and another 8% use smokeless tobacco. The study found that students who use alcohol, smoke cigarettes and use other drugs are more at risk to drop out.

"There are really two main disorders, ADHD and conduct disorder, and there is an interlinking of smoking and drop out that is troubling…it really suggests that socioeconomic differences in health are already becoming established very early in life in adolescents…whether they smoke is probably the biggest indicator of their health in adulthood," said Breslau.

Intuitively, as parents and educators, we know this to be true. We have seen it in other families too. Intuitively we also know that we must do something as education and medicine alone fall far short.

Cognitive training, behavioral shaping, memory skills, and more must be instituted if we are to change the tide.

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Is ADHD all in your head?

Posted by Peter on July 19th, 2010 | Comments off

A study published in the June 14 edition of the Journal of Developmental and Behavioral Pediatrics has sparked controversy regarding ADHD medication and the brain’s power to regulate itself.

The study was funded by the National Institutes of Health and conducted by Dr. Adrian Sandler, a developmental-behavioral pediatrician and medical director of the Olson Huff Center for Child Development at Mission Children’s Hospital in Asheville, North Carolina. The research was performed over the course of eight years using 99 patients from Western North Carolina.

Sandler found that children with ADHD can do just as well on half their medication when the medication is combined with a placebo. They performed as well even when parents and children had full knowledge they were taking a placebo.

[Placebo -- A substance containing no medication and prescribed or given to reinforce a patient's expectation to get well. The placebo in this research was akin to a harmless inert pill].

Previous studies have shown that common stimulant medication causes side-effects like tics, weight loss, stunted growth, and even heart complications in some instances. This often causes trepidation in parents afraid of the possible side-effects on their children.

Sandler compared fully medicated children, children on reduced medication, and children on reduced medication with a known placebo. The results were quite intriguing. Both the fully medicated and reduced medication groups had increased side-effects while the reduced medication with placebo demonstrated decreased side-effects. Furthermore, the reduced medication group reported decreased control of their ADHD symptoms. However, the control of ADHD symptoms was no different in the reduced medication with placebo group than in the full dose group, i.e. the reduced medication with placebo performed as well as the fully medicated group with less side-effects as well.

“I’ve been getting a lot of calls and e-mails,” said Sandler,, who conducted the research with James Bodfish, a professor in the departments of psychiatry and pediatrics at UNC Chapel Hill School of Medicine, and study coordinator Corrine Glesne.

“Medications work,” Bodfish said in a statement. “The question is whether we always need to use them at the highest dose. Many parents are concerned about placing their child on medication. Some choose not to treat their child because of concerns about side effects.”

While the research doesn’t address it, the obvious question is, Why? Parents and children in this study knew they were taking a placebo. Why then did they perform as well as their peers without the side-effects — at essentially half the dose as their peers? While the placebo effect has been studied widely, the exact mechanisms are unknown. We do know that the mechanism is governed by the brain. This clearly tells us that having ADHD or not, our brain is still a powerful weapon in our arsenal.

We also cannot exclude the influence of the parents during this research. Did they expect their child to do better? The authors suggest that this was so. This dynamic cannot be overlooked in your family either.

The bottom line is that we likely have far more control over our behaviors and cognitive processes than we are given credit for. Modern medicine, as this research suggests, is just beginning to understand the brain’s role in shaping our lives. We’ve known this for years at Play Attention. Cognitive training. Memory training. Motor skills. Attention training. Behavioral shaping. It’s time to take control over our lives. We’ve all got the power to do it. It lies right behind our eyes.

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New research on attention and video games

Posted by Peter on July 6th, 2010 | Comments off

Research published in the July issue of Pediatrics reveals that too much time spent watching television and playing video games can cause attention problems.

A graduate student at Iowa State University, Edward Swing, found that excessive screen time, whether in front of a computer or TV, could double the risk of attention problems in children and young adults.

Swing’s research confirms previous findings from Dr. Dimitri Christakis, the George Adkins Professor of Pediatrics at the University of Washington in Seattle. Christakis’ research found that faster-paced shows increased the risk of attention problems. "You prime the mind to accept that pace. Real life doesn’t happen fast enough to keep your attention,” says Christakis.

The American Academy of Pediatrics (AAP) has long recommended that children over the age of 2 view less than two hours of TV or computer per day. Prior to that age, they suggest no TV viewing or computer.

Swing compared data of 1300 children in grades three, four, and five who watched TV or played video games less than two hours a day to children who watched more. He found that more video time could nearly double the risk of attention problems in children and young adults

"The children were reporting their TV and video game use and the parents were also reporting TV and video game use," Swing said. "The teachers were reporting attention problems," he said of the middle school students.

While both Swing’s and Christakis’ studies do merit attention, they are quite limited. For example, Swing used teacher rating reports to assess whether children had problems paying attention, if they interrupted classmate’s work, if they had trouble staying on task, or showed problems in other areas related to inattention. Teacher reports typically vary over time and from teacher to teacher. They are also highly subjective. To account for this, Swing had more than one teacher rate the children and that the ratings tended to be in agreement.

The greatest flaw in this research is that Swing did not account for content, i.e. what were the students watching or playing? Were the students watching educational TV or playing educational games? Were they playing race car games? Shooting games? Were they playing problem solving games? Were the games fast paced? Slow? Did they require reasoning skills? We’ll never know and that’s problematic because it leaves so many questions unanswered. As we are what we eat, we are what we stimulate ourselves with.

"These media aren’t going away," Christakis said. "We do have to find ways to manage them appropriately." On this I can agree. Limiting time to the AAP recommendations is prudent parenting.

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The ADHD link to social dynamics

Posted by Peter on June 21st, 2010 | Comments off

If I told you that women who received only basic education were 130 % more likely to have a child on ADHD medication than women with university degrees, you’d see a link, wouldn’t you?

Well, that’s what a study published this month in Acta Paediatrica found. That implies that nearly half of the serious cases of ADHD in children are closely tied to social factors. The study reveals that factors like single parenting and poor maternal education were directly tied to ADHD medication use.

While we know that a genetic propensity likely exists, the human brain develops based on a complex interplay between nature and nurture; between genetic endowment (nature) and environment/social factors (nurture). Epigenetic theory tries to explain this relationship.

Curiously, few large-scale studies have tried to determine the impact of social and family influences on ADHD. Researchers at the Karolinska Institute in Stockholm, Sweden assessed data on 1.16 million school children and examined the health histories of nearly 8,000 Swedish-born kids, aged six to 19, who had taken ADHD medication.

"We tracked their record through other registers … to determine a number of other factors," said lead author Anders Hjern.

Here’s what the researchers found:

Living in a single parent family increased the chances of being on ADHD medication by more than 50 percent.
A family on welfare upped the odds of medication use by 135%.
Boys were three times more likely to be on medication than girls.
Social dynamics affected both sexes equally.

"Almost half of the cases could be explained by the socioeconomic factors included in our analysis, clearly demonstrating that these are potent predictors of ADHD-medication in Swedish school children," Hjern said.

It’s clear that this study found a link between socioeconomic factors and ADHD medication use/diagnosis. Other US studies have found that minority children and children of low socioeconomic status were more likely to receive ADHD medication.

Factors like low income and diminished quality time are more common in single-parent families. These typically lead to stressors like family conflict and a lack of social support, Hjern said.

While more research must be done, one has to ask, is medication the answer to social stressors like lack of time and money? Sounds too silly to ask, but it seems that our answer, ridiculously, is a resounding, YES!

We are the masters of our lives. We can make significant personal changes, but we must have the tools to do so. That’s why I began Play Attention (www.playattention.com) years ago.

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Immediate rewards and the ADHD brain

Posted by Peter on April 23rd, 2010 | Comments off

A Nottingham University research team in the United Kingdom found that the brains of children with ADHD appear to respond to immediate rewards in the same way as they do to medication. Their research was published in the journal Biological Psychiatry.

“Our study suggests that both types of intervention [medicine and immediate reward/reinforcement] may have much in common in terms of their effect on the brain,” said Professor Chris Hollis, the lead investigator of the study.

The research team used an EEG (electroencephalograph) to measure the brain activity of children as they played a computer game that provided extra points for less impulsive behavior.

The researchers devised a computer space game which rewarded the ADHD children when they caught aliens of specific colors while avoiding aliens of designated colors. The game design actually tested the children’s ability to resist the impulse to grab the wrong colored aliens.

To test whether immediate reward/reinforcement made a difference, one iteration of the game rewarded the children fivefold for catching the right alien and penalized them fivefold for catching the wrong one. All of this was done while activity in different parts of their brains was monitored with an EEG.

Hollis found that the immediate rewards helped the children perform better at the game. This was verified by the EEG which revealed that both medication and immediate reward/reinforcement were "normalizing" brain activity in the same regions.

Many parents of ADHD children are aware that giving a reward to an ADHD child a week after their good behavior is insignificant to that child. ADHD children respond better to immediate reward, not delayed reward.

"Although medication and behavior therapy appear to be two very different approaches of treating ADHD, our study suggests that both types of intervention may have much in common in terms of their effect on the brain. Both help normalize similar components of brain function and improve performance," said Hollis.

"We know that children with ADHD respond disproportionately less well to delayed rewards – this could mean that in the ‘real world’ of the classroom or home, the neural effects of behavioral approaches using reinforcement and rewards may be less effective."

It’s obvious that providing immediate rewards/reinforcement 24 hours a day and 7 days a week would be impractical and impossible. But what does this research tell us? It tells us that if we are to train an ADHD student, feedback, reward, and reinforcement need to be immediate if we are to get their brain to rewire.

We at Play Attention have known this for many years. This is why we integrated immediate feedback/reinforcement for attention training, cognitive training, memory training, and behavioral shaping by using feedback technology. We patented this method years ago because of its inherent strength. While we knew this was the best way to achieve success, we feel research like this rather reinforces our approach. It’s about time the world caught up!

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Should I play or should I grow?

Posted by Peter on March 1st, 2010 | Comments off

PART TWO OF THREE

Entertainment vs. learning
Entertainment is usually a passive act that includes an activity which provides a distraction to everyday events or provides amusement. A good example of entertainment is watching a movie or concert. However, one may also actively participate in recreational entertainment such as playing video games or sports. One does not participate in an entertaining activity to be educated. That is far from the goal of entertainment. In fact, we participate in entertainment to be relieved of having to work, having to learn, or having to be actively engaged for those purposes. We seek entertainment for fun and pleasure.

Entertainment is a vast industry. The modern American video game industry made about $18.85 billion on video-game hardware, software, and accessories in 2007. That’s nearly twice what movie theaters made and triple what the video game industry made in 2000. Most authorities on video games estimate that 70 to 80 percent of boys and approximately 20 percent of girls play video games daily.

Learning is on the other end of the spectrum from entertainment. In order to learn, we need attention, challenge, and deliberate practice. We need to be actively engaged. To apply the mind with the intent of long-term retention, assimilation, and application of new information. This implies both effort and commitment. While we may employ some of these elements, the purpose is far different in a learning environment. The purpose of learning in Star Trek: Bridge Commander is to keep the ship from exploding by using the controls correctly. Learning is there to benefit your game play. While this takes some reasoning and trial and error, is this useful in the classroom or at the office? Not likely. It’s not likely transferrable or to generalize either unless your child’s job is commanding Star Fleet.

If I may paraphrase the late martial artist and film legend Bruce Lee, you cannot learn to swim by kicking your legs and stroking with your arms on land. You have to jump in the water. You cannot learn to run a marathon by jogging around the track.

In other words, if we want to learn something, it has to be taught with a purpose or aim, and we have to practice it deliberately to improve. If we closely examine what video games our spouse, child, or clients are playing, then we might just be alarmed at the violence, the lack of humanity, and gratuitous sex involved.

The most popular video games are those that are visually intense and graphically frenetic. It’s important to mention here that paying attention to visually stimulating and frenetic activity is another hallmark of an ADHD individual. Offer a 3-ring circus and their brain is quite capable of attending to it. Ask them to clean their room, a much less stimulating activity, and it’s very difficult. This predisposition towards highly stimulating activities seems to involve the brain’s reward and gratification systems as well as its processing and other regulatory systems.

Thus, a high stimulation Xbox or Play Station game is quite satisfying; ADHD individuals can hyperfocus on these games for hours on end. What does that teach? Research tells us that people who play these games do learn visual recognition skills, i.e. they can rapidly determine the number of opposing characters on screen far faster than the average human being. So, if the only thing they’re going to be is a fighter pilot, then these games might be suitable.

Other research tells us that if one chronically plays these games (chronically would be classified as one hour or more per day), one is more likely to report lower grades at school, diminished attention at school, and a greater probability of being addicted to these games or the Internet itself. Good Japanese research also noted that entertaining, highly stimulating video games that involve little else than pointing and shooting can lower both the metabolic rate and EEG in the frontal lobes of the brain. The frontal lobes, among other capacities, govern attention, aggression, and impulsivity. This is important to know especially if you have an ADHD person in your household using these games.

It seems that most ADHD children and adults are prewired to pay attention to overly stimulation things. That seems to be a hallmark of the trait. They frequently become hyperfocused on them for hours at a time. Taking these games away is probably not practical. However, limiting play time is quite sensible.

If one is to learn skills, techniques, or methods that will strengthen the brain, then the video game must be quite different than the Xbox or Play Station most popular list.

Upcoming, part 3, Play Attention vs. off the shelf video games.

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