ADHD — It’s all in the hands

Posted by on April 5th, 2011 | Comments off

Can certain hand movements reveal ADHD?

Two studies, both funded by the U.S. National Institutes of Health and published in the Feb. 15 issue of the journal Neurology, reveal that ADHD children have a greater amount of unintentional hand movement than children not labeled ADHD.

Researchers from Cincinnati Children’s Hospital Medical Center and the Kennedy Krieger Institute in Baltimore performed joint research using sequential finger-tapping experiments on children with ADHD. The researchers found that ADHD children exhibited more than twice the amount of unintentional movements than typical children on one of the two tests used.

Additionally, the researchers measured cortical inhibition with magnetic pulses (transcranial magnetic stimulation or TMS) and compared the results to children without ADHD.

Let’s do a little brain anatomy here to make things clearer. The cortex is a layer or sheet of neural tissue that is outermost to the cerebrum. The cortex is responsible for attention, memory, consciousness, thinking, perceptual awareness, and language. The motor cortex is a term that describes regions of the cerebral cortex. The motor cortex plays a key role in the planning, control, and execution of voluntary motor functions (like hand movement).

Cortical inhibition is a term used to describe the cortex’s ability to control these functions.  By using magnetic pulses directed across the cortex, the researchers discovered that children with ADHD were less able to inhibit their hand movements than children without ADHD. ADHD children presented unintentional hand movements about 40 percent more of the time than children without ADHD.

“We now have a real, quantifiable measure of a problem with controlling behavior in these children,” said Dr. Stewart Mostofsky, primary author of the study performed at the Kennedy Krieger Institute.

“From a clinical standpoint, the critical issue is … they do have differences with these aspects of normal motor control,” Mostofsky said. “We have to recognize that and account for that in considering how to work with children with ADHD.”

Notably, ADHD children that presented the greatest inability to inhibit their hand movement usually received more severe parental reports of hyperactivity and impulsivity.

The question obviously missing is, “What is the significance of these two studies?” They do not provide any direct applications for either diagnosis or treatment of ADHD. Could any parent with an ADHD child tell the researchers that their ADHD child could not control himself like other children his age? The answer is likely a resounding, YES!

The studies do identify patterns of inhibition control. This has been documented in previous studies and is a known factor in ADHD. Could the researchers develop a diagnostic tool based on inhibition control? Yes. As a matter of fact, this type of measurement is commonly obtained in a Computerized Performance Test or “CPT.”

The CPT typically flashes a letter, number, or symbol on a computer screen. The student is tasked to press the space bar or mouse when a preselected number, letter, or symbol appears on the screen. The computer will measure how many times the student clicks correctly, incorrectly, unnecessarily, or impulsively. A wide variety of data are obtained from a CPT. Yet they can only be part of a comprehensive evaluation for evidence of ADHD as so many variables are involved that may mimic ADHD.

So, while studies like the finger tapping study are interesting, they do not provide significant insight into the field nor do they provide basis for a single method of diagnosis. One may wonder why we fund such studies given what is already known in the field.

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Diet and ADHD Symptoms

Posted by on February 5th, 2011 | Comments off

The February 5, 2011 issue of The Lancet reports that researchers in the Netherlands and Belgium were able to significantly reduce ADHD symptoms through restrictive dietary measures.

This theory has long been advocated by such notable groups as The Feingold Association (http://www.feingold.org/). However, their studies have been limited to smaller groups and anecdotal evidence. While their findings have been compelling, medical doctors and adversarial attacks by the processed food industry quashed overall acceptance of dietary restriction. The NIMH give only limited credence to the theory.

Feingold and other advocates of the restrictive diet have suggested that the introduction of food additives can affect the human immune system sometimes causing reactions like hyperactivity, inattention, and even eczema, asthma and gastrointestinal problems. In light of research about food colorings and hyperactivity, the British have taken steps to eliminate certain preservatives and food dyes from their food supply.

The study published in the Lancet was funded by Foundation of Child and Behaviour, Foundation Nuts Ohra, Foundation for Children’s Welfare Stamps Netherlands, and the KF Hein Foundation.  The researchers placed  100 children from Belgium and the Netherlands into two groups: one that received the restrictive diet and the other that only received advice on healthy eating habits. The group that received only advice on healthy eating was the control group. All of the children had been diagnosed with ADHD and were between the ages of 4 and 8.

The children were placed on the restrictive diet for a period of five weeks. They were allowed to eat only rice, meat, vegetables, pears and water. Later, the children were allowed to additionally consume potatoes, fruits and wheat. The researchers assessed ADHD symptoms during this period.

Over the course of the next four weeks, researchers reintroduced processed foods into the restricted diet group. The researchers selected foods that were previously considered to negatively affect body or immune responses.

Nine children withdrew from the restrictive diet group. Attrition in all studies is common. Of the forty-one children who completed the restrictive diet program, 78 percent had a reduction in their ADHD symptoms, compared with no improvement in the controls. Assessment was performed using an ADHD symptom scale that ranges from 0 to 72 points. Higher scores in the scale indicate more severe symptoms. The average reduction was 24 points, a significant reduction.

Thirty children who demonstrated decreased ADHD symptoms resulting from the restrictive diet were selected for reintroduction of foods outside the restrictive diet. This was deemed the ‘challenge test.’ Nineteen of the thirty children had a relapse in symptoms on the challenge test. Sensitivity to foods thought to produce high immune response didn’t seem to produce any greater negative effects than foods thought to produce lower immune response.

Limitations of the study include restriction to ADHD; it cannot be discerned whether it would apply to ADD. Secondly, not all children responded to the restrictive diet. Of those who did respond, responses to foods seemed to be equal no matter what processed food was introduced back into the diet. Additionally, under this research design, it was not possible to have a blind control; parents knew what group their child was in. If they also knew the expected outcome of the study, it might have influenced the outcome.

On the practical side, the restrictive diet is very difficult to follow consistently. However, if your child seems to respond well when you remove certain processed foods, this research seems to support your observation although the certainty about diet and ADHD symptoms has not been clearly established by this study.

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Texting and ADHD

Posted by on December 3rd, 2010 | Comments off

How much has information and communication technology (ICT) affected our lives? Researchers say that the average teenager sends a total of over 3,400 electronic [text] messages every month or surfs the Internet at bedtime. Could texting and bedtime web time influence the severity of your child’s ADHD symptoms?

In a study by the JFK Medical Center in Edison, New Jersey, and presented at the 76th annual meeting of the American College of Chest Physicians (ACCP), lead author Dr Peter G. Polos and his team found that more than half of these bedtime kiddy texters or web surfers are not only prone to have problems falling asleep, but experience mood, behavior and cognitive problems during the day.

"It is significant that these children are engaging in stimulating activity when they should be in an environment to promote sleep," says Polos.

Polos’ team analyzed questionnaire responses from 40 children and young adults aged between 8 and 22. This is a small group and the results must be considered preliminary. However, the researchers found that those who used electronic technology at bedtime (texting, game playing, email, surfing, etc.) also experienced sleep-related problems such as excessive movements, leg pain and insomnia, and also had a "high rate of daytime problems, which can include attention deficit hyperactivity disorder [ADHD], anxiety, depression, and learning difficulties," said Polos.

According to Medical News Today (www.medicalnewstoday.com), the analysis of the questionnaire data showed that:

    * 77.5 per cent of the participants had persistent problems falling asleep.

    * On average, participants were woken once per night by an ICT device.

    * On average, a participant sent 33.5 emails or texts per night when they were supposed to be asleep; and the average number of people texted each night was 3.7.

    * The average number of messages sent via ICT per person per month at sleep time was 3,404 and occurred over periods ranging from 10 minutes to 4 hours after bedtime.

    * Among the adolescent participants, the older they were, the later they went to bed, and the more time they spent with their ICT devices at bedtime.

    * Boys were more likely to use ICT to surf the net and play online games, while girls were more likely to text and make cell phone calls.

    * High rates of cognitive and mood problems during the day were linked with sleep time related use of ICT, including ADHD, anxiety, depression, and learning difficulties.

    * There were also higher rates of nighttime problems such as excessive movements, leg pain and insomnia.

Polos and colleagues concluded that use of ICT at bedtime may have "an adverse impact on sleep hygiene and daytime function which may be significant", and that questions about this should be included in routine evaluations of patients reporting problems sleeping.

"These data suggest that further studies are needed to evaluate the short and long term consequences of STRICT on sleep," they wrote.

Polos explained that "sleep is largely habitual in nature", and if "children begin this type of behavior, they may set themselves up for the need for external stimulation before sleep later in life".

This could lead to problems like difficulty falling asleep, not having enough sleep, and feeling sleepy during the day, he said adding that:

"More research is needed to determine all of the short- and long-term consequences."

Many parents know that healthy sleep habits are especially important to ensure progress at school and healthy development, and are concerned about how best to handle the growing problem of ICT devices in the bedroom.

Polos said that using cell phones or computers, to talk, text, surf the net, or play games, is "more addictive, seductive, and interactive than passively watching television," because of the graphics, rapid responses and interactivity.

"The sooner parents establish appropriate times for children to use this technology, the better," he urged, adding that perhaps they should also "move key items, such as computers, from a child’s bedroom into a common area".

Dr David Gutterman, President of the American College of Chest Physicians said concern about insomnia and other sleep disorders in children is growing and that "research shows that the problem is increasing, so it is more important than ever for physicians to ask questions about technology use when evaluating children for sleep issues".

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ADHD’s Genetic Link

Posted by on October 11th, 2010 | Comments off

What causes attention-deficit hyperactivity disorder – ADHD? Research in the English medical journal, The Lancet, says it’s not too much sugar, bad diet, or poor parenting. Professor Anita Thapar, lead author of the study, says it’s likely genetic.

Thapar and her group of scientists at Cardiff University in Wales compared 366 children with ADHD to 1,047 kids without ADHD. In particular, the researchers examined differences in the children’s DNA. They found that kids with ADHD were more likely to have small segments of DNA that were duplicates or missing (copy number variants or CNVs — either a deletion or duplication of genetic material).

"We hope that these findings will help overcome the stigma associated with ADHD," Professor Anita Thapar, the study’s lead author, said in a written statement. "Too often, people dismiss ADHD as being down to bad parenting or poor diet. As a clinician, it was clear to me that this was unlikely to be the case. Now we can say with confidence that ADHD is a genetic disease and that the brains of children with this condition develop differently to those of other children."

While being media friendly, Thapar’s last statement is a stretch in relation to her research. People and the media love statements that provide seemingly conclusive answers.

Let’s go beyond the media hype that says this research concludes there is a definite genetic link. The researchers really only say there seems to be a possible “genetic link.”  However, their research did not conclude that it is purely or even primarily genetic. What they truly are saying is that this study is evidence that ADHD is not purely social.

The authors conclude:

    “Our findings provide genetic evidence of an increased rate of large CNVs in individuals with ADHD and suggest that ADHD is not purely a social construct.”

This is logical because only 15% of the research subjects with ADHD demonstrated increased CNVs. So is it safe to conclude that genetic makeup may contribute, at least in some particular cases, to ADHD? Yes, but to be clear,  this research did not conclude that it is entirely genetically based and was only partially genetically based in a small segment of their study population. This is very similar to other genetic research.

Why is it, if ADHD is genetically based, at least in part, that 30% don’t have it as adults when diagnosed as a child? What happened? Where did it go? This is what is most  important to parents and professionals.

Epigenetic theory, now being widely embraced by the scientific community, maintains that human development  includes both genetic origins of behavior and the direct influence that environmental forces have on the expression of those genes (nature/nurture). Epigenetic theory regards human development as a dynamic interaction between these two influences.

Simply put, how our genes express themselves is greatly impacted by environment. This is likely why, over time, 30% of children don’t display symptoms as adults. The brain changes, rewires, or (a radical version of epigenetic theory) their genes change.

Do tools exist to do this? Yes. See www.playattention.com.

If I may quote Dr. Theodore Dalrymple, “What seems to have happened is that parents have lost the awareness that they had for decades – if not for centuries – that concentration and self-discipline do not come naturally to children, and have to be taught (as well, sometimes, as enforced).”

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Training the ADHD Brain

Posted by 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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ADHD and the Western diet

Posted by on August 23rd, 2010 | Comments off

A study published online in the international Journal of Attention Disorders examines the possible link between ADHD and a ‘Western-style’ diet in children.

The study was conducted by Perth’s Telethon Institute for Child Health Research in Australia. The researchers found that a diet typically consumed in the Western world consisting of ‘fast foods,’ sugar/corn syrup, processed meats and flour, fried, and refined foods nearly doubled the risk of an ADHD diagnosis. This Western diet is rich in total fat, saturated fat, refined sugar and sodium.

“We found a diet high in the Western pattern of foods was associated with more than double the risk of having an ADHD diagnosis
compared with a diet low in the Western pattern, after adjusting for numerous other social and family influences. We looked at the dietary patterns amongst the adolescents and compared the diet information against whether or not the adolescent had received a diagnosis of ADHD by the age of 14 years. In our research, 115 adolescents had been diagnosed with ADHD, 91 boys and 24 girls,” says Associate Professor Wendy Oddy.

The Perth researchers analyzed the dietary patterns of 1800 youth and separated them as having  ‘Healthy’ or ‘Western’ patterns. A diet rich in fresh fruits and vegetables, whole grains and fish was designated as a healthy pattern.

Dr. Oddy added, “When we looked at specific foods, having an ADHD diagnosis was associated with a diet high in takeaway foods, processed meats, red meat, high fat dairy products and confectionary. We suggest that a Western dietary pattern may indicate the adolescent has a less optimal fatty acid profile, whereas a diet higher in omega-3 fatty acids is thought to hold benefits for mental health and optimal brain function. It also may be that the Western dietary pattern doesn’t provide enough essential micronutrients that are needed for brain function, particularly attention and concentration, or that a Western diet might contain more colors, flavors and additives that have been linked to an increase in ADHD symptoms. It may also be that impulsivity, which is a characteristic of ADHD, leads to poor dietary choices such as quick snacks when hungry.”

Of note, the scientists were unable to determine if poor diet causes ADHD or ADHD leads to poor dietary choices and cravings – a problem of antecedence.  Furthermore, the researchers had to determine and adjust for social and family influences. This, in itself could greatly skew final data. 

The British have performed similar studies examining the role of refined or processed foods and ADHD.  Certain food colorings were found to influence hyperactivity.  Knowing this, in addition to research that indicates better cognitive function through better diet, it would be wise to greatly reduce or totally extinguish consumption of fast food, refined and processed foods, etc. if one wishes to maximize one’s cognitive potential.

Diet alone will not solve the ADHD riddle. Cognitive training, memory training, behavioral shaping, and attention training are key ingredients to the solution.

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ADHD and dropout rates

Posted by 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 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 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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Summer ADHD brain drain

Posted by on May 10th, 2010 | Comments off

Research tells us that during the summer, the average student loses one to three month’s math and reading gains made over the prior year. Academic losses are so common among students that educators have given the phenomena a name: Summer Brain Drain.

Summer Brain Drain may even be worse for ADHD students already having trouble at school.

Going to school daily provides schedules and routines. The summer break means those routines aren’t there. Expectations are lowered or relaxed. Even sleep schedules are often totally abandoned.

Unfortunately, exercise is often replaced with computer time, watching movies, or playing video games with friends. That’s a bad idea. While there’s nothing wrong with playing video games or watching movies, sedentary activity must always be balanced with exercise. This is especially important for an ADHD student. 

I’ve included some specific articles that approach this topic from varying perspectives. Enjoy and gain the benefits this summer!

Children with ADHD benefit from time outdoors enjoying nature

(http://www.news.uiuc.edu/NEWS/04/0827adhd.html)

News Bureau at the University of Illinois at Urbana-Champaign from May 15 through June 8. — Kids with attention deficit hyperactive disorder (ADHD) should spend some quality after-school hours and weekend time outdoors enjoying nature, say researchers at the University of Illinois at Urbana-Champaign.

The payoff for this “treatment” of children 5 to 18 years old, who participated in a nationwide study, was a significant reduction of symptoms. The study appears in the September issue of the American Journal of Public Health.

“The advantage for green outdoor activities was observed among children living in different regions of the United States and among children living in a range of settings, from rural to large city environments,” wrote co-authors Frances E. Kuo and Andrea Faber Taylor. “Overall, our findings indicate that exposure to ordinary natural settings in the course of common after-school and weekend activities may be widely effective in reducing attention deficit symptoms in children.”

ADHD is a neurological disorder that affects some 2 million school-aged children, as well as up to 2 to 4 percent of adults, in the United States. Those with ADHD often face serious consequences, such as problems in school and relationships, depression, substance abuse and on-the-job difficulties.

“These findings are exciting,” said Kuo, a professor in the departments of natural resources and environmental sciences and of psychology at Illinois.

“I think we’re on the track of something really important, something that could affect a lot of lives in a substantial way,” she said. “We’re on the trail of a potential treatment for a disorder that afflicts one of every 14 children – that’s one or two kids in every classroom.”

If clinical trials and additional research confirm the value of exposure to nature for ameliorating ADHD, daily doses of “green time” might supplement medications and behavioral approaches to ADHD, the authors suggest in their conclusion.

Kuo and Faber Taylor, a postdoctoral researcher who specializes in children’s environments and behavior, recruited the parents of 322 boys and 84 girls, all diagnosed with ADHD, through ads in major newspapers and the Web site of Children and Adults with Attention Deficit/Hyperactivity Disorder. Parents were interviewed by means of the Web and asked to report how their children performed after participating in a wide range of activities. Some activities were conducted inside, others in outdoor places without much greenery, such as parking lots and downtown areas, and others in relatively natural outdoor settings such as a tree-lined street, back yard or park.

The researchers found that symptoms were reduced most in green outdoor settings, even when the same activities were compared across different settings.

“In each of 56 different comparisons, green outdoor activities received more positive ratings than did activities taking place in other settings, and this difference was significant or marginally significant in 54 of the 56 analyses,” Kuo said. “The findings are very consistent.”

The two researchers have been pursuing the ADHD issue as an extension of a long line of previous research they’ve conducted on the nature-attention connection among the general population in mostly urban settings.

“The medications for ADHD that are currently available work for most kids, but not all,” Kuo said. “They often have serious side effects. Who wants to give their growing child a drug that kills their appetite day after day and, night after night, makes it hard for them to get a decent night’s rest? Not to mention the stigma and expense of medication.”

Simply using nature, Kuo said, “may offer a way to help manage ADHD symptoms that is readily available, doesn’t have any stigma associated with it, doesn’t cost anything, and doesn’t have any side effects – except maybe splinters!”

There are a number of exciting possible ways in which “nature treatments” could supplement current treatments, she said.

Spending time in ordinary “urban nature” – a tree-lined street, a green yard or neighborhood park – may offer additional relief from ADHD symptoms when medications aren’t quite enough. Some kids might be able to substitute a “green dose” for their afternoon medication, allowing them to get a good night’s sleep.

“A green dose could be a lifesaver for the 10 percent of children whose symptoms don’t respond to medication, who are just stuck with the symptoms,” Kuo said. As Kuo and Faber Taylor wrote, a dose could be as simple as “a greener route for the walk to school, doing classwork or homework at a window with a relatively green view, or playing in a green yard or ball field at recess and after school.”

The National Urban and Community Forestry Advisory Council, U.S. Forest Service, and the U.S. Department of Agriculture’s Cooperative State Research, Education, and Extension Service supported the project.

Exercise Improves Learning and Memory
Chalk up another benefit for regular exercise. Investigators from the Howard Hughes Medical Institute (HHMI) have found that voluntary running boosts the growth of new nerve cells and improves learning and memory in adult mice.
"Until recently it was thought that the growth of new neurons, or neurogenesis, did not occur in the adult mammalian brain," said Terrence Sejnowski, an HHMI investigator at The Salk Institute for Biological Studies. "But we now have evidence for it, and it appears that exercise helps this happen."
USA Today (http://www.usatoday.com/news/health/2006-03-26-adhd-treatment_x.htm)

ADHD treatment is getting a workout

http://www.usatoday.com/news/health/2006-03-26-adhd-treatment_x.htm
Doctors haven’t done many definitive studies about exercise and ADHD, says David Goodman, an assistant professor of psychiatry at the Johns Hopkins University School of Medicine. But Goodman says it makes sense that working out would help people cope with the condition. Studies show that exercise increases levels of two key brain chemicals — dopamine and norepinephrine — that help people focus.

"Your cognitive function is probably better for one to three hours after exercise," Goodman says. "The difficulty is that by the next day, the effect has worn off."

If kids could exercise strenuously three to five times a day, they might not need medications at all, says John Ratey, an associate clinical professor of psychiatry at Harvard Medical School. Ratey is so intrigued by the question that he’s writing a book about how exercise can reduce symptoms of ADHD or at least help patients cope.

Team sports might help children with ADHD in several ways, says James Perrin, a professor of pediatrics at Boston’s MassGeneral Hospital for Children. Children with the condition benefit from following a regular schedule. Coaches who lead kids through structured exercises also might help build concentration and organizational skills.

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